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Foot and Ankle

Common Foot and Ankle Injuries

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Achilles tendinopathy
Plantarfascitis
Metatarsalgia
Definition

Inflammation/degeneration of the Achilles tendon

Structure and Function

The Achilles tendon spans from the calcaneus (heel bone) and ascends into the back of the leg providing attachment to the calf muscles.

Why does it occur?

Excessive stretch and overuse are the most common causes, direct trauma is rare. Being overweight and/or pregnant is also known to increase the risk of development. Common occurrence in runners.

Symptoms

-Pain felt above the heel increasing with activity/stretching (less common in chronic cases)
-Increased pain in the morning or starting activity, particularly in chronic cases
-Touching/squeezing the Achilles elicits pain.

Treatment

Orthotics such as heel lifts or Achilles padding can help reduce symptoms. Stretching exercises are usually prescribed to address calf tightness to reduce tension placed on the Achilles. Eccentric exercise can be instructed to help rehabilitate the tendon.

What to avoid

-Increased activity
-Tight/poorly fitted shoes
-Calf raises/jumping activity during acute recovery

Definition

Inflammation and pain of the plantar fascia.

Structure and Function

The plantar fascia is a thick band of connective tissue spanning the sole of the foot connecting the calcaneus (heel bones) to your toes. It plays an important role in supporting the arches of the foot.

Why does it occur?

Plantarfascitis is one of the most common over-use injuries in runners. It can be caused by numerous factors such as: prolonged standing, improper footwear, or biomechanical issues such as over pronation or weak dorsiflexion (muscle responsible for pulling foot upward)

Symptoms

-Morning pain, especially on initial standing
-Tired, aching feet toward end of the day
-Pain on touching underneath the inner side of the heel

Treatment

Massage and manual therapy techniques to address calf muscle tightness and associative tension to the plantar fascia is often advised. Night splits or taping might be suggested to help keep the foot in a position of dorsiflexion to prevent further irritation of the plantar fascia. Stretches for the calf muscles and foot and ankle mobilisation can also be prescribed.

What to avoid

– Running down hill (increases rate of plantar to dorsiflexion)
– Calf raises / activity placing isolated resistance to calf muscles.
– Wearing high heels or improper fitting shoes

Definition

Pain located at the 2nd-4th metatarsal heads on the plantar surface of the foot (ball of the foot) associated with collapse of the transverse arch

Structure and Function

The metatarsals are the bones in the feet connecting to the phalanges (toes). The transverse arch spans the width of the foot and is made up of the cuboid, 3 cuneiform bones and the base of the metatarsals.

Why does it occur?

Increased weight bearing to the metatarsals causes excessive wear & tear. Gait and underlying mechanical issues are therefore often causative. History of ligamentous laxity can cause structural weakness and lead to this condition. As with many conditions of the foot improper footwear and poor shock absorption are key factors. Metatarsalgia can be a symptom of other forefoot conditions such as arthrosis, Morton’s neuroma or a stress fracture.

Symptoms

-Pain tends to be insidious, becoming apparent and then disappearing again over several months/years
-Patient often describes a feeling like a “pebble in the shoe”
-Pressing into the metatarsal heads causes pain

Treatment

Massage to the intrinsic foot muscles and padding placed correctly in the shoe over the metatarsal head and phalanges (toes) can reduce pain and prevent the condition from worsening.

What to avoid

-Walking bare foot, shoes with poor shock absorption or footwear placing increased pressure to the metatarsal heads (e.g. high heels)
-The intrinsic foot muscles should be strengthened to help support the foot