Leg

Achilles Tendinitis

achilles-tendinitis

Definition: The Achilles tendon, the largest tendon in the body, connects the calf muscle to the calacaneus (heel bone). It is essential to the process of walking, running and jumping. So it is not surprising that Achilles Tendinitis is a common complaint of sports men and women. Excess strain can be placed on the tendon through poor foot function/alignments and calf muscle tightness leading to damage within the tendon and sometimes to the outer parts – paratendinitis. Most commonly the midportion of the tendon is affected but sometimes the insertion – where the tendon meets the bone can be affected.

Treatment: Depending on the severity, we can apply cold therapy, dispense anti-inflammatory drugs, create an orthosis to correct poor foot function and alignment, recommend exercises, dry needling and mobilisations and laser therapy. We can also help you find the right type of footwear.

Calf soreness and cramp

Definition: Persistent calf soreness can be the result of several causes: injury, previous unhealed injury (scar tissue) poor foot or leg function, inappropriate training routine, circulation,  exposure to cold, any of several thrombotic conditions including deep vein thrombosis, restless legs syndrome, intermittent claudication and many more…

Treatment: Depending on the severity, we can apply and suggest cold therapy, dispense anti-inflammatory drugs, create an orthosis to correct poor foot function and alignment, recommend exercises, dry needling and mobilisations and laser therapy. We will also advise you on the right type of footwear for your mechanics and activity.

Iliotibial Band Syndrome

Description: The Ilio-tibial band is a fibrous tract that is joins the hip to the knee. Friction through over-use causes it to become inflamed causing acute pain at the hip or the knees. It is common in pregnant women, runners, cyclists, weightlifters, squash and tennis players. This condition may result from poor foot posture, or poor/weak hip function during walking and running.

Treatment: We will assess your gait pattern as well as your lower limb strength and alignment. If necessary, we may: prescribe orthoses, apply dry needling, assess the suitability of your sports shoes and/or recommend a physiotherapist, chiropractor or osteopath.

Knee Pain

Definition: The knees play a vital role in human movement but anatomically they are very vulnerable to injury and pain. Poor posture caused by excessive pronation (flat feet) or supination of the feet can result in excessive knee rotation. Running will cause excess wear and tear of the cartilage leading to osteo-arthritis and other conditions like patello-femoral syndrome  (Runners Knee) where the patella gets pulled away from its normal tracking position and surface of the cartilage behind the knee-cap gets worn.

Treatment: Orthoses to re-align the feet and legs, exercises, dry needling, often together with physiotherapy or chiropractic.

Osteo-arthritis

Info coming soon.

Patellofemoral Syndrome

Definition: When walking or running, the knee cap (patella) glides over the thigh bone (femur) in the patellofemoral groove. If it tracks out of this groove the result is excessive wear behind the patella. Pain is usually felt while running and especially when climbing or descending stairs. This condition may result from poor foot posture, which in turn will cause misalignments of the leg and knee.

Treatment: We will assess your gait pattern as well as your lower limb strength and alignment. If necessary, we may: prescribe orthoses, apply dry needling, give exercises and assess the suitability of your sports shoes and/or recommend a physiotherapist, chiropractor or osteopath.

Restless Leg syndrome - Wittmaack-Ekbom's syndrome

Definition: This condition is an irritating compulsion to twitch the affected leg which sometimes brings temporary relief. It often occurs in periods of inactivity like watching TV or on a long flight and usually at the end of the day. One in five women suffer from it in late pregnancy. It may be caused by iron deficiency or as a side effect of some drugs. It is also a side effect of kidney failure, Parkinson’s disease, diabetes or an underactive thyroid.

Treatment: 

  • Check with your doctor about any medication that you are taking
  • Dry needling (acupuncture).
  • Exercise in the day but not in the evening;
  • Go to bed and rise as a regular routine; avoid a  nap in the evening;
  • Avoid caffeine before bedtime.
  • Take a relaxing warm bath before going to bed.

Shin Splints - medial tibial stress syndrome

Definition: Most often caused by overuse, misalignment or muscle imbalance of the feet or legs especially during running activities. Overuse of the posterior tibial tendon or the medial part of the soleus attachment to the tibia can cause inflammation where the muscle and bone are attached.

Treatment: Rest and re-evaluation of your training regime. Treatments can also include: strapping, orthoses, anti-inflammatory drugs or dry needling/acupuncture. Active Life Podiatry will also examine your training shoes and check their suitability to you.

Stress Fractures

stress fractures

Description: Stress fractures are hairline fractures usually in the weight-bearing bones such as the tibia in the lower leg and the metatarsals in the foot. They occur when repeated stresses are placed through the bone caused by poor biomechanics and footwear. Pain occurs in the general area of the fracture and increases with exercise, and is progressive.  The fracture itself is often invisible to X-rays for 2 to 3 weeks after the injury. Confirmation of diagnosis may require an MRI scan.

Treatment: Complete rest is essential for several weeks. Sometimes an Airboot or CAM Walker boot is worn to immobilise the foot. Laser therapy can help manage the pain and speed up the healing process. Full recovery can take up to 2 months. After this time, gait analysis   can be used to see what caused the fracture and foot orthoses may be prescribed to avoid repetition. Exercises devised at ALP to improve foot intrinsic muscle strength are important ways to reduce future fractures.

For women we recommend seeing your GP and having bone density tests.

Ankle

Accessory Navicular Syndrome

Description: The accessory navicular is an extra bone or piece of cartilage located on the inner side of the foot just above the arch and is a congenital condition. Sometimes its has no consequences but problems can arise with a foot or ankle sprain, poorly fitting footwear or certain types of activity where the foot is forced to excessive pronation. This is when the navicular bone and/or the posterior tibial tendon become aggravated, inflammed and damaged. The condition is often found in children with flat/pronating feet and usually occurs in adolescence.

Treatment: Ice packs and rest through immobilisation reduces the inflammation. We may prescribe anti-inflammatory drugs or orthoses to support the arch. Physiotherapy and a regime of exercises are helpful in preventing re-occurrence. In persistent cases, surgery may be advised to remove the  bone altogether.

Kohlers Disease

kohlers disease

Description: This is a rare disease that happens when there is a temporary or permanent loss of the blood supply to the Navicular (a bone above the inner arch of the foot). Without the blood supply the bone gradually dies (necrosis). It is noticeable when the child walks with a limp using the outside edge of the foot to prevent pain. Other symptoms are swellings and redness in the inner side of the ankle area.

Treatment: Orthoses can help alleviate pain while walking. If the disease has progressed, the foot must be immobilised in a plaster cast for some six weeks. Prognosis is very good.

Heel

Heel Pain - Plantar Fasciitis

heel pain - plantar fasciitisDefinition: Often referred to as plantar fasciitis; where the  insertion of the thick band of fascia becomes aggravated and inflammed.  It is often associated with poor foot or leg function and may be aggravated by people who are overweight, or have undertaken sudden excessive over activity.

Treatment:  There are many forms of treatment. At ALP we have the experience and knowledge to  utilise the all the major palliative treatment modalities:

  • anti-inflammatory drugs
  •  stretching, manipulation and taping
  •  dry needling (acupuncture)
  •  steroid injections, in conjunction with local anaesthetic.
  • orthoses and night splints.
  • changes to walking and running technique

Sever’s Disease - Calcaneal Apophysitis

Sever’s Disease - Calcaneal Apophysitis

Description: Sever’s Disease sometimes affects children between 8 and 14 years old. It occurs when there is repetitive stress on the heel bone (calcaneus) before it is fully developed. Inflammation develops on the heel’s growth plate (epiphysis) causing pain. The condition is self-limiting and will resolve with time.

Treatment: Limit sporting activities and insert a heel-lift (orthosis) to reduce the trauma. Ice packs in the inflamed area physiotherapy may help.

Haglund’s Deformity

Haglund’s DeformityDescription: A bump on the back of the heel accompanied by redness and swelling where the Achilles tendon attaches to the heel. This is caused by the formation of a bony spur (see diagram) caused by friction  rigid back of a shoe or boot. This condition may be heredity as can the rearfoot mechanics in which excess strain through the calf and Achilles tendon can irritate the lateral insertion of the tendon.

Treatment: The first thing is to wear a shoe that puts no pressure on this part of the foot. Heel pads and orthoses will reduce the pressure. Anti inflammatory drugs and ice packs may reduce the pain and the swelling. Active Life Podiatry will advise on  exercises to relieve the tension from the Achilles tendon. Laser and dry needling are very helpful in pain reduction. Ultimately surgery may be required.

Underfoot

Corns & Calluses

Definition: a horny induration and thickening of the outer parts of the epidermis,(stratum corneum) caused by excessive friction and pressure  forming a conical mass pointing down into the dermis, which can be painful. 

Calluses are also hard rough skin caused by pressure and friction and formed to protect the softer tissue beneath. Both can be the result of tight fitting shoes or poor foot function.

Treatment: A painless removal of the hard tissue with a scalpel. Once the pressure has been removed, pads, splints or insoles may be used for longer term relief or to prevent re-occurrence.

Verrucas & Warts

Definition: Verrucas and warts and basically the same thing: skin that has been invaded by a virus causing a round hard patch. When warts/verrucas occur on the soles of the feet, the body’s weight flattens them and pushes the wart in the thick dermis of the skin.  They are usually painless but can be painful in some cases. Warts and verrucas are infectious and the greatest risk of infection is in warm damp places such as communal changing rooms.

Treatment: 

  • A course of treatment is usually required.
  • Applications of caustics
  • Cryotherapy (liquid nitrogen)
  • Dry needling under local anaesthetic
  • Laser therapy
  • Electro-surgical excision under a local anaesthetic.

Plantar neuromas, Morton's neuromas or Interdigital neuritis

plantar neuromas

Definition: Plantar Neuromas are benign growths of the nerve tissue between the metatarsal heads. The cause is not always clear but hypermobility of the metatarsals during walking or running are thought to be a major causative factor. Wearing high heels compresses the nerves that run between them. Symptoms include: a sharp pain in the foot, shooting leg pains, tingling, a burning sensation or numbness. Very often the shooting pan is enough to stop walking and removing the shoe alleviates the pain.

Treatment: Correction of any misalignment using insoles or orthoses. In addition, steroid injection or acupuncture can help. If these fail to alleviate the problem, surgery is indicated.

Peroneal Tendon Injuries

Peroneal Tendon Injuries

Definition: Peroneal tendon injuries are caused by repetitive ankle movements usually in a sporting context or poor posture such a excess supination. The symptoms are pain, swelling, warmth or a combination of these at the outside edge of the foot, ankle or under the foot where the peroneal tendons are attached. Tension and tender points will often be found within the peroneal muscles in the outer part of the leg.

Treatment:  use anti-inflammatory drugs and to ease the pain or, We also use dry needling (acupuncture) depending on the patient. A biomechanical examination and gait analysis will be required to make a correctly prescribed orthosis will form the main part of the treatment in conjunction with the recommendation of the correct training / running shoe. As a last resort, inject a cortico-steroid into the affected area may be used.

Sesamoiditis

sesamoiditisDefinition: Sesamoiditis is an inflammation of one or both the sesamoid bones under the first metatarsal head. These bones take the weight of the body and are act to allow proper function /movement of the long big toe (hallux) flexor tendon. They can become damaged form direct trauma form wearing high heeled shoes or from the pressure from  a stud positioned under the metatarsal head when wearing studded boots for sports such a rugby or football.

Treatment: 

  • Rest
  • Anti-inflammatory drugs
  • Padding and strapping is used around the big toe
  • Custom-made orthosis to re-distribute pressure away from the 1st metatarsal head area
  • Steroid injection therapy.

Capsulitis

CapsulitisDefinition: Capsulitis is a inflammation of the ligaments and joint capsule connecting the metatarsal to the toe bone (phalanx). The second toe is most commonly affected. It is a progressive disorder that, left untreated can lead the dislocation of the toe and arthritis.

Treatment: Dry needling (Western acupuncture), laser therapy and orthoses usually solve the problem. In more advanced cases a high volume steroid injection may be used as part of the treatment plan. We can advise on the best footwear during recovery and beyond.

Toes

Athletes Foot

Definition: Athletes foot affects the skin anywhere on the foot but it is most commonly found between the toes. It is caused by a variety of fungi that thrive in warm damp conditions. Symptoms include cracked and itchy patches of soft, flaky skin. It is infectious and can be picked up by walking barefoot in changing rooms and other communal areas.

Treatment: Wash your feet twice a day taking care to dry thoroughly between the toes. There are over-the-counter remedies which can help but remember to continue the treatment for  a month or more after the symptoms disappear. If the symptoms persist, make an appointment to see Active Life Podiatry for an alternative anti-fungal medications and further advice.

Bunions

Definition: A bunion is a swelling at the base of the big toe formed by an increase in angle between the metatarsal and phalanx. The reasons are many: family history, injury, foot  hypermobility, anatomy of the joint – such as  rounded surfaces if the metatarsal and phalanx, poorly fitting shoes or, most common of all, poor foot mechanics. Sometimes there is no obvious cause at all. Untreated, bunions can lead to osteoarthritis in the joint of the big toe and can be unsightly, difficult to fit into shoes and can be very painful.

Treatment:  Deterioration may be stopped through manipulation, exercises and  orthoses. For painful, bunions we offer injection therapy,

Hammertoes

hammertoesDefinition: A hammertoe happens when the first joint of a toe is constricted into a fixed downward angle and usually affects the smaller digits (the second to the fifth toe). There are two types: flexible and rigid. Flexible hammertoes are still moveable at the joint and can be more easily treated conservatively. Rigid hammertoes occur when the flexible hammertoe has been left untreated and becomes immovable. It is common amongst those with severe arthritis.

Treatment: Shoes with a deep toe box and pads may ease any painful pressure but not necessarily solve the problem. Active Life Podiatry will apply tape and orthoses in the first instance with anti-inflammatory drugs and mobilisation to straighten the toe/s. A cortisone injection will ease joint pain, and possibly encourage more motion.  Surgery is the ultimate course of action; ALP can recommend a competent expert for this.

Ingrown Toenails

Definition: A nail that grows and penetrates  into the surrounding tissue of the toe and usually occurs:

 

  • When a tight-fitting shoe puts pressure on the big toe
  • As a result of injury
  • If the nail has been cut badly

 

Ingrown toenails can be quite painful especially if tight-fitting shoes are worn.

Treatment: The toenail is cut back to the point where the curling starts. In severely painful cases a local anaesthetic is offered. Usually the treatment is quick and lasting but in recurrent cases, minor surgery performed routinely at ALP is required.

Nail Thickening

Definition: The nail thickens and becomes discoloured. The texture of the nail changes so that it becomes chalk-like and crumbly. This condition is caused damage and trauma and is not infectious.

Treatment: On going, periodic treatment using special drills and burrs can painlessly hone the nail to its natural thickness. In the most serious cases, the nail can be temporarily or permanently removed surgically under local anaesthetic here at ALP.

Paronychia

Definition: Infection of the skin around the surface of the nail causes swelling and pain. Paronychia is caused by a bacterial infection usually caused by a cut or break in the skin. It can occur suddenly (acute paronychia) or over time (chronic paronychia).

Treatment: Acute paronychia can be successfully treated by over-the-counter preparations. For chronic paronychia, we can supply oral antibiotics to resolve the problem.