Foot & Ankle
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Common causes of Foot and Ankle pain are detailed below
The Achilles is a large tendon which connects the two major muscles of the calf (gastrocnemius and soleus) to the back of the heel bone. Typically Achilles tendinitis is not associated with a singular specific injury, more frequently it results from overuse and repetitive stress to the area. The pain associated with Achilles tendinitis usually begins as a mild ache at the back of the leg or above the heel after running or other sporting activity. Patients may also experience tenderness, stiffness and thickening of the tendon which is worse in the morning and the following day after exercise.
Causes of Achilles tendinitis are due to activities that include running and jumping. A poor running technique, inadequate footwear, uphill running or a recent increase in intensity of activity may trigger symptoms to develop.
Inversion ankle sprain
An inversion sprain of the ankle is one of the most common injuries to occur in sport participation, in particular those which require running and jumping, or a sudden rapid change in direction especially on uneven surfaces i.e. rugby and football. It refers to an injury where the ankle is ‘rolled’ in an inwards direction causing damage to the soft tissues structures around the outside of ankle. The most frequently damaged is the anterior talo-fibular ligament. The severity of damage can be classified grade 1 -3. This can range from mild damage to a complete rupture. In milder cases the patient may experience a small degree swelling, tenderness and stiffness, however continuing with day to day activity should be manageable. When severe, an immediate onset of swelling may occur with stiffness, intense pain and bruising developing and intensifying over the following days.
Contrary to the popular belief that shin splints are small fractures which occur along the shin bone (tibia), the condition is in fact, characterised by the inflammation of the connective tissues which joins the muscles to the inside of the tibia. The medical term used to describe shin splints is ‘medial tibial stress syndrome’.
The cause is simple – exercise induced and too much too soon. Running on hard surfaces, on an incline and with poorly fitted footwear may all contribute the development of symptoms.
Patients usually present with pain in the middle, lower and inner aspect of the shin. Originally pain is experienced post exercise however as it develops, it may come on during activity such as running, walking, ascending/descending stairs.
Stress fractures are very small cracks in the bone which occur due to repetitive stress and overuse of a weight bearing structure. Most commonly stress fractures occur in the small bones in the foot, lower leg and hip. Stress fractures may go undetected on x-ray imaging up to weeks after the pain was initially noted.
The initial symptoms of a stress fracture can be minimal; typically they develop over time, with a small degree of swelling and pain that is aggravated by the provocative activity i.e. jogging. Pain will typically subside during periods of inactivity or rest.
Stress fractures can also occur in those who are osteoporotic or suffer from reduced bone mineral density level.
On the underside of the foot we have a thick, strong band of connective tissue which runs from the heel of the foot to the middle of the toe bones. This structure supports the medial foot arch and acts as a shock absorber during gait. ‘Plantar fasciitis’ is characterised by damage to the plantar fascia with subsequent inflammation, thickening and degeneration. It typically occurs when tension placed on the underside of the foot are too excessive or forceful. A rise in the demand of this structure may be due to weight gain or obesity, change in footwear (flat shoes), increased activity levels or altered lower limb biomechanics.
Pain is usually localised to the underside of the heel and inner sole of the foot. Characteristically, the pain is worse in the morning (first steps) and when standing from a prolonged period of rest.
Hallux valgus (bunion)
A bunion is a bony lump that develops side of your foot making walking and weight bearing activity painful. The term hallux-valgus refers to the orientation of the big toe. When a hallux valgus is present, the base of the big toe moves in an outwards direction to the side. The big toe then angles itself towards the other toes.
There are a number of reasons bunions can develop. Firstly, if you’re woman you have far higher chance of developing the condition, however it is more than likely that this is due to choice of footwear, such as high heels. Secondly, there seems to be genetic predisposition, meaning that it tends to run in families and finally, the biomechanical orientation of you lower extremity, in other words, the way you walk; if you tend to roll inwards over your foot this can assert pressure on the big toe and over time, alter the position.
Symptoms may be pain, redness and swelling in the joint of the big toe, the formation of blisters and callus’ and difficulty finding comfortable footwear.