Cruciate Ligament Injury

There are 2 Cruciate ligaments in the knee. These are the Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). The role of the cruciate ligaments is to provide stability by limiting the amount of bending, strengthening, and rotation within the knee. Therefore an injury to this structure can be very debilitating.

The cruciate ligaments are found within the knee joint and cross each other like an X. The ACL is lateral (outside) and PCL is medial (inside). The ACL keeps the tibia from slipping forward and PCL from the tibia slipping backwards.

Causes:

ACL injury:

👣 Mostly occur during sports, especially collision or contact sports e.g football, or basketball

👣 Landing awkwardly from a jump

👣 Abnormal twisting

👣 Direct blow when foot is firmly planted in the ground

👣 Awkward fall

👣 Stopping suddenly when running

PCL injury:

👣 Less common injury

👣 PCL can tear if shinbone is hit hard just below the knee or if you fall on a bent knee

👣 Motor vehicle accident- Dashboard injury when knee hits the dashboard

👣 Contact sport. Falling on a bent knee or contact on a bent knee

Symptoms:

ACL:

👣  May feel popping sound

👣 Pain

👣 Knee instability

👣 Unable to weightbear

👣 Swelling

👣 Reduced range of movement

PCL:

👣 Severe knee pain

👣 Swelling

👣 Pain on weightbearing

👣 Unable to straighten knee

👣 May feel/ hear grating, cracking, popping noises

Treatment:

👣 Follow the POLICE protocol:

Protection- Rest for the first few days following injury , however, you should then begin gentle motions to maintain movement and avoid a decreased muscle strength and flexibility. You may require assistive devices at this time, for example crutches.

Optimal Loading- Whilst protecting the effected area, gentle movement should be started to help promote optimal healing of the injury and prevent delay in returning to normal activities.

Ice- Apply ice to help manage swelling. Ice can also help decrease some acute pain.

Compression- Compression bandaging will help reduce swelling as a result of the inflammatory process.

Elevation- Elevating the foot above heart level will help reduce swelling by allowing fluid to drain from the area.

👣 Avoid the HARM factors for 2-3 days post injury

Heat- Increases swelling and bleeding. Avoid hot baths, heat packs and saunas

Alcohol- Can delay healing by increasing swelling and bleeding

Running or exercise- This can aggravate the injury and therefore increase pain, swelling and bleeding.

Massage- Massage on the injured area can aggravate the damaged tissues. Massage away from the injury site may be helpful. Seek medical advice before proceeding.

👣 Immobilise knee

👣 Seek Medical attention

👣 Rehab program to strengthen the knee 

Patella Bursitis

Bursae are small fluid filled sacs that are found within joints and soft tissue to cushion and help reduce friction.

Patella bursitis is inflammation of the bursa in front of the knee. This usually occurs because of irritation, causing the bursa to produce too much fluid, and therefore becomes swollen and painful.

Causes:

👣 Patella bursitis is very common in individuals who spend a lot of time kneeling, e.g gardeners, carper fitters, or plumbers

👣 Can also be referred to as “Housemaids knee” due to historically housemaids who spent long periods kneeling when cleaning

👣 A direct blow to the knee or fall onto the knee

👣 Patellar bursitis is also linked with friction and overuse

👣 Those with Rheumatoid Arthritis or Gout are more susceptible to patella bursitis

👣 Infection

Symptoms:

👣 Knee pain

👣 Pain, swelling, tenderness in the kneecap

👣 Difficulty walking

👣 Painful to kneel

Treatment:

👣 Follow the POLICE protocol:

Protection- Rest for the first few days following injury, however, you should then begin gentle motions to maintain movement and avoid a decreased muscle strength and flexibility. You may require assistive devices at this time, for example crutches.

Optimal Loading- Whilst protecting the effected area, gentle movement should be started to help promote optimal healing of the injury and prevent delay in returning to normal activities.

Ice- Apply ice to help manage swelling. Ice can also help decrease some acute pain.

Compression- Compression bandaging will help reduce swelling as a result of the inflammatory process.

Elevation- Elevating the foot above heart level will help reduce swelling by allowing fluid to drain from the area.

👣 Pain relief medication

👣 Antibiotics maybe required

👣 If these do not help:

                - Drainage of bursa

                - Steroid injection into bursa

                - Rare cases surgery is required

How can a Podiatrist help:

👣 Biomechanical assessment to determine cause

👣 Orthotic prescription

👣 Strengthening exercises for the knee

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is an extremely common knee condition. It is a broad term used for pain in the front of the knee and kneecap. Also known as runners knee, or jumpers knee.

Causes:

👣 Poor biomechanics e.g abnormal tracking of the kneecap

👣 Usually related to muscle imbalance or weakness

                                - Tight hamstrings

                                - Shortened ligaments around the knee

                                - Weakness or imbalance of muscles in thigh and buttocks

👣 Overuse- Repeated stress on the knee joint e.g running, squatting, or climbing

👣 Incorrect footwear

 Symptoms:

👣 Dull ache in the front of the knee

👣 Pain usually triggered after activity placing pressure on the knee

👣 May have swelling in the knee

 Treatment:

👣 Follow the POLICE protocol:

Protection- Rest for the first few days following injury , however, you should then begin gentle motions to maintain movement and avoid a decreased muscle strength and flexibility. You may require assistive devices at this time, for example crutches.

Optimal Loading- Whilst protecting the effected area, gentle movement should be started to help promote optimal healing of the injury and prevent delay in returning to normal activities.

Ice- Apply ice to help manage swelling. Ice can also help decrease some acute pain.

Compression- Compression bandaging will help reduce swelling as a result of the inflammatory process.

Elevation- Elevating the foot above heart level will help reduce swelling by allowing fluid to drain from the area.

👣 Stop activity that makes it worse until pain resolved.

👣 Changing activity e.g from running to cycling

👣 Lose weight if overweight

👣 Pain relief medication

👣 In rare cases surgical intervention maybe required if other treatments don’t work.

Podiatrists role:

👣 Biomechanical assessment

👣 Strengthening exercises- working with Physio

👣 Soft tissue work

👣 Orthotic prescription

Knee Pain

Knee pain is very common and can occur due to a number of reasons. 1 in 4 adults are affected by knee pain at some point in their lives.

The knee is a complex structure of 3 bones, 4 ligaments, and 2 muscle groups (the hamstrings and quadriceps). Any of these components can be affected causing knee pain.

Causes:

👣 Anterior Collateral Ligament (ACL) Sprain

Common in contact sports. Immediate pain in knee joint with rapid swelling.

👣 Medial Collateral Ligament (MCL) Sprain

Tear of ligament on inside of knee from direct impact or twisting motion.

👣 Posterior Cruciate Ligament is important for stabilizing the knee and preventing it from bending back the wrong way. Sprain causes instability of knee joint with a feeling of the knee giving way. Pain occurs when bending the knee the wrong way.

👣 Patella Tendon Rupture

This injury is extremely painful. Common in individuals with a history of patella tendon injury e.g jumpers knee or degeneration.

Symptoms are swelling of the knee- particularly at the bottom of the knee. There may also be an inability to weightbear or hold the knee straight.

👣 Patellofemoral Pain (AKA runners knee, Chondromalacia Patella, Anterior knee pain)

Pain is in the front of the knee. Occurs when the patella rubs on the femur bone.  Symptoms include aching at the front of the knee and under the patella, tenderness inside border of kneecap, swelling of knee after exercise. Pain is worse when walking up and down hills or sitting for long periods.

👣 Jumpers Knee (Patella tendonitis)

This is an overuse injury causing pain in front of the knee. Symptoms include tenderness when pressing and may appear larger or thicker than the other side. The knee will ache or stiffen after exercise. Jumping activities may cause pain.

👣 Osgood Schlatter disease

This is a common cause of knee pain in children between 10-15 years of age. It is primarily an overuse injury. pain is worse during and after exercise and usually improves with rest. Early diagnosis and treatment is important to prevent further problems.

👣 Meniscal tear

Pain is present on inside or outside of the knee. These can result from injury, twisting, or direct impact. Symptoms are graded I, II, III depending on severity.

👣 Osteoarthritis

Wear and tear of the knee joint is a common cause of knee pain. Symptoms include aching pain in the knee, pain is worse after exercise, swelling may be present with some joint stiffness. You may hear a clicking or cracking noise in your knee.

👣 Illiotibial Band Syndrome (Runners Knee)

This is a gradual onset injury causing pain on the outside of the knee. Pain gets progressively worse. Symptoms are eased with stretching, foam rolling and strengthening.

Risk Factors:

👣 Poor biomechanics

👣 Being Overweight

👣 Overuse

👣 Previous Injury

Treatment:

👣 It is essential that knee injuries are properly assessed so that the correct diagnosis can be made and right treatment provided.

Treatment Options:

👣 Strengthening and Stretching

👣 Orthotic prescription

👣 Steroid Injection

👣 Pain relief medication

👣 Surgery

Sinus Tarsi Syndrome

Sinus Tarsi Syndrome is a painful condition where the fluid and tissue inside the sinus tarsi become inflamed. Usually caused by overuse and often associated with ankle sprains.

The sinus tarsi is a small bony canal which runs into the ankle under the talus ankle bone.

 Causes:

👣 Common in runners

👣 Poor biomechanics

👣 Previous ankle sprain

 Symptoms:

👣 Pain can be difficult to locate, but is somewhere just in front of the bony bit on the outside of the ankle (lateral malleoli)

👣 Pain may occur when running on curves

👣 Inverting the ankle (turning ankle inwards)

 Treatment:

👣 Follow the POLICE protocol:

 Protection- Rest for the first few days following injury, however, you should then begin gentle motions to maintain movement and avoid a decreased muscle strength and flexibility. You may require assistive devices at this time, for example crutches.

Optimal Loading- Whilst protecting the effected area, gentle movement should be started to help promote optimal healing of the injury and prevent delay in returning to normal activities.

Ice- Apply ice to help manage swelling. Ice can also help decrease some acute pain.

Compression- Compression bandaging will help reduce swelling as a result of the inflammatory process.

Elevation- Elevating the foot above heart level will help reduce swelling by allowing fluid to drain from the area.

👣 Non-Steroidal anti-inflammatory drugs

👣 Mobilisation of the ankle joint

👣 Orthotic prescription

👣 Strengthening exercises

Ankle Impingement

Ankle Impingement is a condition causing pain in the front of the ankle, due to compression of the bone or soft tissue structures during activities that involve maximum ankle motion.

Causes:

👣 Ankle Sprain

👣 Recurrent ankle sprain

👣 Activities requiring repeated dorsiflexion of the ankle e.g squatting

👣 Inadequate rehab

👣 Joint stiffness

👣 Muscle tightness

👣 Poor biomechanics

👣 Inappropriate training

👣 Inadequate warm up

👣 Poor core stability

👣 Poor proprioception or balance

Symptoms:

👣 Dull ache in front of the ankle

👣 Pain following: Deep squat, Excessive running/walking, landing from jump, Heavy lifting, twisting activities

Treatment:

👣 Follow the POLICE protocol:

Protection- Rest for the first few days following injury , however, you should then begin gentle motions to maintain movement and avoid a decreased muscle strength and flexibility. You may require assistive devices at this time, for example crutches.

Optimal Loading- Whilst protecting the effected area, gentle movement should be started to help promote optimal healing of the injury and prevent delay in returning to normal activities.

Ice- Apply ice to help manage swelling. Ice can also help decrease some acute pain.

Compression- Compression bandaging will help reduce swelling as a result of the inflammatory process.

Elevation- Elevating the foot above heart level will help reduce swelling by allowing fluid to drain from the area.

👣 When comfortable begin a rehab program of the ankle

👣 See a Physio for treatment program

What can a Podiatrist do:

👣 Biomechanical assessment

👣 Orthotic prescription

👣 Taping

👣 Joint mobilisation techniques

👣 Exercises

Shin Splints

The term “Shin Splints” refers to pain felt in the front of the lower leg.

Medically, shin splints are known as medial tibial stress syndrome.

Common causes of shin splints include:

👣 Failure to warm up properly

👣 Recent increase in training intensity

👣 Running on hard or inclined surfaces

👣 Poor technique

👣 Foot abnormalities

👣 Compartment syndrome

👣 Biomechanical factors

👣 Muscle weakness

Symptoms:

👣 Usually come on gradually

👣 Pain starts as a dull ache on the side of the shin that intensifies with exercise

👣 There may also be swelling present

Differential diagnosis:

👣 Stress fracture

👣 Chronic compartment syndrome

Treatment:

👣 Avoid overdoing it- too much to too high intensity

👣 Wear correct footwear

👣 Consider orthotics to offload affected structures

👣 Add strengthening to training program

👣 Gait re-training

What can Podiatrists do:

👣 Gait analysis- to analyse movement patterns

👣 Prescribe orthotics

👣 Exercise program