From knee pain to shin pain to ankle pain to heel pain to toe pain, our performance podiatry experts have it covered.
Achilles tendonitis is a common injury in runners and other athletes who run often during sports. The Achilles tendon is the largest and most vulnerable tendon in the body. It joins the gastrocnemius (calf) and the soleus muscles of the lower leg to heel of the foot. The gastrocnemius muscle crosses the knee, the ankle, and the subtalar joints and can create stress and tension in the Achilles tendon. Tendons are strong, but not very flexible so they can only so far before they get inflammed and tear or rupture.
Achilles Tendonitis Symptoms
Achilles tendonitis can come on gradually or suddenly. Acute symptoms are hard to ignore and includes pain in the back of the ankle and just above the heel that comes on quickly over a few days. It increases during exercise (particularly running). It often has a very specific pinpoint tenderness or soreness that increases when palpated.Chronic Achilles tendonitis often results from a bout of acute tendonitis that fails to heal properly. In some cases, tendonitis comes on slowly and gradually gets worse over weeks or months. This type of pain is often worse in the morning upon waking and eases as you warm up and stretch the tendon. A chronic condition may actually cause small scar-like bumps to develop in the tendon. If you run your hand over the Achilles you may feel small lumps and bumps.
Achilles tendonitis is a chronic injury that occurs primarily from overuse. It tends to come on gradually over time until pain is constant and exercise or activity too painful to continue. The biggest cause of chronic Achilles tendonitis is ignoring early warning signs and pushing through pain. If the Achilles tendon is sore, or aches, you need to pay attention and rest it immediately.
Another major contributor in the development of Achilles tendonitis is lack of flexibility in the calf muscles, which cause the muscle to shorten which creates more tension in the tendon. Overuse can also contribute to Achilles tendonitis as can a sudden increase in training mileage, hill running or a lot of speed work. The Achilles tendon has a limited blood supply, which makes this injury slow to heal. Early recognition of any tension, aches or tenderness is the most important aspect of treating tendon injuries.
Achilles Tendonitis Treatment
At the first sign of Achilles tendon pain, cut back and reduce your training. Stop speed training and hill running, and begin gentle calf stretching after exercise when the muscle and tendon is still warm and flexible. Post-exercise ice may also help. Be careful to avoid excessive stretching that could aggravate the problem. Strengthening the calf muscle can help reduce the stress on the Achilles tendon. Toe raises, and balancing on your toes, and wall stretching are useful exercises.
It is not necessary to stop activity completely (you may consider cross training) as long as you pay attention to muscle soreness and reduce activity accordingly.
Radial shockwave therapy
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Achilles Tendonitis Stretches
Achilles Tendonitis Strengthening
Most experts agree now that eccentric strengthening of the Achilles, gastrocnemius, and soleus muscles reduces the risk of Achilles tendonitis and calf strain.
When to seek podiatry treatment.
If you have not been able to resolve the pain of your Achilles with rest and self-care, then see the podiatrist for a comprehensive assessment. The podiatrist will be able to discuss the exact causes of your pain and how to treat them and prevent future occurrences.
About ankle sprains.
A sprained ankle occurs following a sudden sideways or twisting movement of the foot. An ankle sprain can occur during athletic events or during everyday activities. All it takes is an awkward step or an uneven surface to cause an ankle sprain.
A sprained ankle usually occurs when a person lands from jumping or running on to an uneven surface. For example, sprained ankles are often seen when basketball players come down from a jump and land on another player’s foot. Ankle sprains also occur with more routine daily activities such as stepping off a curb or slipping on ice.
An ankle sprain is an injury to the ligaments that support the ankle. The ligaments are structures that control excessive movement of the joint. When an ankle sprain happens, the ligament is stretched too far, and is either partially or completely torn.
Ankle Sprain Symptoms
Common symptoms associated with an ankle sprain are pain with swelling and bruising. The degree of symptoms tends to correlate well with the extent of the damage to the ligaments.
- Grade I Ankle Sprain:Grade I ankle sprains cause stretching of the ligament. The symptoms tend to be limited to pain and swelling. Most patients can walk without crutches, but may not be able to jog or jump.
- Grade II Ankle Sprain:A grade II ankle sprain is more severe partial tearing of the ligament. There is usually more significant swelling and bruising caused by bleeding under the skin. Patients usually have pain with walking, but can take a few steps.
- Grade III Ankle Sprain:Grade III ankle sprains are complete tears of the ligaments. The ankle is usually quite painful, and walking can be difficult. Patients may complain of instability, or a giving-way sensation in the ankle joint.
As said before, pain and swelling are the most common symptoms of an ankle sprain. Patients often notice bruising over the area of injury. This bruising will move down the foot towards the toes in the days after the ankle sprain–the reason for this is gravity pulling the blood downwards in the foot.
When to see a Podiatrist
If you do have significant symptoms following a sprained ankle, you should seek medical attention. Signs that should raise concern include:
- Inability to walk on the ankle
- Significant swelling
- Symptoms that do not improve quickly or persist beyond a few days
- Pain in the foot or above the ankle
Differentiating between a sprained ankle and an ankle fracture can be difficult, and sometimes an x-ray is needed. While moderate pain and swelling are common symptoms following a simple sprained ankle, symptoms such as inability to place weight on the leg or pain directly on the bone should raise concern. If you think you may have done more than sustained a sprained ankle, you should see the podiatrist.
Ankle Sprain Treatment
Treatment of sprained ankles is important because returning to normal activities in a timely manner is important for most patients. Treatment begins with standard R.I.C.E. (Rest, Ice, Compression, and Elevation) treatments, but should quickly progress to rehabilitation and strengthening.
The podiatrist will be able to supervise and provide a tailored ankle rehabilitation program so you are able to return to your daily functions and playing sports. Also, ankle rehabilitation is important in preventing another ankle sprain.
The region of the body commonly referred to as the calf is in the back of the leg, just below the knee. The calf is made of three major muscles. These muscles are the two gastrocnemius muscles (medial and lateral), and the soleus muscle. Another smaller muscle, called the plantaris muscle, is also in the calf.
While muscle injuries are the most common cause of calf pain, there are other causes of calf pain due to circulation problems, knee joint problems, and other conditions. Determining the cause of your calf pain can help guide appropriate treatment.
Some common causes of calf pain include:
Calf Muscle Strain
A calf muscle strain is the most common cause of acute onset calf pain. Usually this injury occurs during a sports or exercise activity. Common symptoms of a calf strain include pain, swelling, and bruising.
Plantaris Muscle Rupture
The plantaris muscle is a thin, small muscle that is not even present in about 10% to 20% of the population. The muscle runs along the gastrocnemius muscle, but is a tiny fraction of the size. The plantaris muscle can rupture, causing a sudden, snapping pain in the back of the leg. Because the muscle is of no functional importance, treatment is non-operative.
The Achilles tendon is the connection of the calf muscles to the heel. Calf pain is usually considered pain in the softer, muscular portion of the lower leg, whereas an Achilles tendon rupture typically causes pain in the back of the heel. Achilles ruptures that occur higher up on the tendon should be considered in the evaluation of calf pain.
A Baker’s cyst is not a true cyst, rather it is a collection of knee joint fluid that has pooled in the back of the knee. When excessive amounts of fluid accumulate, it can cause pain in the back of the leg. Occasionally, the Baker’s cyst will rupture causing the fluid to enter the calf region.
A blood clot needs to be considered as a cause of calf pain, especially when the calf pain is not the immediate result of an injury. Blood clots can form is the deep veins of the leg, causing a blockage in circulation. This may cause swelling and pain in the calf. Blood clots are more common in the days and weeks after injuries and surgical procedures.
Cramps in the leg muscles are a common cause of calf pain. Usually the symptoms are intermittent (not constant pain), and relieved by stretching and heat application.
When should I see a podiatrist ?
If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should see the podiatrist. Treatment of calf pain must be directed at the specific cause of your problem.
Treatment of calf pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program.
Some common treatments for calf pain are listed here. Not all of these treatments are appropriate for every condition, but they may be helpful in your situation.
Rest: The first treatment for most common conditions that cause calf pain is to rest the muscles, and allow the acute inflammation to subside. Often this is the only step needed to relieve calf pain. If the symptoms are severe, crutches may be helpful as well.
Ice and Heat Application: Ice packs and heat pads are among the most commonly used treatments for calf pain if there is inflammation. But if its cramping that causing the pain, then heat packs would be better.
Stretching: Stretching the muscles and tendons of the calf can help with some causes of calf pain. A good routine should be established, and following some specific suggestions will help you on your way.
Most bones in the human body are connected to each other at joints. But there are a few bones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the big toe joint.
Sesamoids act like pulleys. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the great toe. Like other bones, sesamoids can break (fracture). Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis. It is common among ballet dancers, runners and baseball catchers.
Pain is focused under the great toe on the ball of the foot. With sesamoiditis, pain may develop gradually; with a fracture, pain will be immediate.
Swelling and bruising may or may not be present.
You may experience difficulty and pain in bending and straightening the great toe.
During the examination, the podiatrist will look for tenderness at the sesamoid bones and may request X-rays of the foot to ensure a proper diagnosis. The sesamoid bone may also be in two parts, called a bipartite sesamoid. Because the edges of a bipartite sesamoid are generally smooth, and the edges of a fractured sesamoid are generally jagged, an X-ray is useful in making an appropriate diagnosis. If the X-rays are not definite, then CT scan may be needed.
Treatment is generally non-operative and takes upto 6-8 weeks to heal completely.
Stop the activity causing the pain.
Rest and apply an ice pack on the area.
Wear soft-soled, low-heeled shoes.
Use a felt cushioning pad to relieve stress.
Avoid activities that put your weight on the balls of the feet.
When to see a podiatrist
If pain persists, or is moderate to severe, you should see the podiatrist as soon as possible to prevent the problem from becoming worse. The podiatrist will find out the cause of your pain and address it. The podiatrist may do one or more of the following:
Tape the toe and foot
Dispense a surgical boot,
Analyse your existing footwear
Applying deflective padding on the foot.
Analyse your foot mechanics to see if its causing pressure on your sesamoids.
Shin splints is the name often given to exercise-induced pain in the lower leg, specifically along the front of the leg between the knee and the ankle – the area known as the shin. The exact cause of shin splints is not certain but they tend to be as a result of overuse and typically occur in runners.
Shin splints are really a symptom rather than a specific diagnosis because they are probably caused by a number of different problems. Shin splints are one of the most common problems in the lower leg in people who exercise or play sports.
In typical shin splints, pain is felt more over the medial (inner) part of your shin. Pain felt over the lateral (outer) part of your shin may not be due to shin splints and may be due to a compartment syndrome in your leg.
Shin splints are sometimes called medial tibial stress syndrome.
What causes shin splints?
Experts do not all agree on the cause of shin splints and the exact cause is not known. They are thought to be caused by overuse or overactivity and typically occur in runners. There are certain things that have been suggested that may make shin splints more likely. These include:
A sudden increase in training frequency or intensity.
A lack of calcium.
Hard running surfaces.
Running up an incline
Previous leg injury.
Poorly fitted or inadequate running shoes that do not support the foot and ankle.
Various problems with muscles in the lower leg and foot position, including over-pronation of the foot.
(The foot (and ankle) normally roll slightly inward when we move. Over-pronation is where the foot rolls inward more than normal.)
Some experts suggest that shin splints are caused by small tears in the structure of the membrane between the two bones of the leg below the knee (the tibia and fibula). This structure is called the interosseous membrane. Others suggest that they may also be caused by inflammation of tendons (tendonitis), muscle sprains, or inflammation of the membrane surrounding the tibia and fibula bones (periostitis). Tiny fractures (microfractures) in the surface of the tibia have also been suggested as a cause.
What are the symptoms of shin splints?
The main symptom is pain in the shin area. The pain tends to be in the middle and lower shin and on the medial (inner) half. Pain first comes on after running or exercising. However, over time, the pain can come on during running or exercising. If severe, it may also come on when climbing stairs.
What else could the pain be?
Stress fractures of the tibia (one of the two bones in the leg below the knee) can also cause shin splint-type pain. A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as overuse injuries.
Do I need any tests?
X-rays are usually normal in people with shin splints. The main reason that your podiatrist may suggest an X-ray of your leg below the knee is to rule out a stress fracture in one of the bones. However, not all stress fractures show up on X-rays.
In some cases, the podiatrist may refer you for a bone scan of your lower leg. This can help to differentiate between shin splints and a stress fracture. An MRI scan is also sometimes used to help to tell the difference between shin splints and stress fractures.
What is the treatment?
Rest. This is the main treatment for shin splints. This means avoiding any activity, such as running, that may have led to the shin splints.
Ice. Applying ice to your shin and raising your leg may also help to relieve pain from shin splints.
Elevation of the leg aims to limit and reduce any swelling
Painkillers such as paracetamol are useful to ease pain. It is best to take these regularly initially. Anti-inflammatory painkillers are an alternative. There are many types and brands. Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatory painkillers.
What is the prognosis (outlook)?
With rest and treatment, you can fully recover from shin splints. However, they may recur if you do not look at the underlying cause of your shin splints.
You may benefit from seeing a podiatrist. They may be able to help you to modify your exercise programme and may also be able to assess your legs, feet and shoes. This may show up some problems that may have caused your shin splints, such as over-pronation of your foot or poorly fitting training shoes. They may suggest the insertion of an insole inside your shoes.
Can shin splints be prevented?
Studies and trials have been done to look at preventing shin splints. No single prevention method has been found to be consistently effective and further trials are needed. However, one of the things that does show some promise is the use of shock-absorbent insoles inside shoes while you are exercising. Special insoles to correct over-pronation of your foot (if you have this) may also be helpful. You should also regularly replace your running shoes. Graduated running programmes that build in rest days may also help.
One of the most common injuries in sports is a stress fracture. Overcoming an injury like a stress fracture can be difficult, but it can be done. A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.
What causes a stress fracture?
Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).
Where do stress fractures occur?
Most stress fractures occur in the weightbearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.
What activities make athletes most susceptible to stress fractures?
Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete is at risk for developing a stress fracture.
What are the symptoms of a stress fracture?
Pain with activity is the most common complaint with a stress fracture. This pain subsides with rest.
How are stress fractures diagnosed?
It is very important that during the medical examination the podiatrist evaluates the patient’s risk factors for stress fracture.
X-rays are commonly used to determine stress fracture. Sometimes, the stress fracture cannot be seen on regular x-rays or will not show up for several weeks after the pain starts. Occasionally, a computed topography (CT) scan or magnetic resonance imaging (MRI) will be necessary.
How are stress fractures treated?
The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.
If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly.
In addition to rest, orthotics or braces may be used to help these injuries heal.
When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.
Cross-training — alternating activities that accomplish the same fitness goals — can help to prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility exercises to the mix for the most benefit.
Maintain a healthy diet. Make sure you incorporate calcium- and Vitamin D-rich foods in your meals.
Use the proper equipment. Do not wear old or worn running shoes.
If pain or swelling occurs, immediately stop the activity and rest for a few days. If continued pain persists, see the podiatrist.
It is important to remember that if you recognise the symptoms early and treat them appropriately, you can return to sports at your normal playing level.