Friday, 1 March 2019

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:

πŸ‘£ Mostly occur during sports, especially collision or contact sports e.g football, or basketball

πŸ‘£ Landing awkwardly from a jump

πŸ‘£ Abnormal twisting

πŸ‘£ Direct blow when foot is firmly planted in the ground

πŸ‘£ Awkward fall

πŸ‘£ Stopping suddenly when running

PCL injury:

πŸ‘£ Less common injury

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

πŸ‘£ Motor vehicle accident- Dashboard injury when knee hits the dashboard

πŸ‘£ Contact sport. Falling on a bent knee or contact on a bent knee

Symptoms:

ACL:

πŸ‘£  May feel popping sound

πŸ‘£ Pain

πŸ‘£ Knee instability

πŸ‘£ Unable to weightbear

πŸ‘£ Swelling

πŸ‘£ Reduced range of movement

PCL:

πŸ‘£ Severe knee pain

πŸ‘£ Swelling

πŸ‘£ Pain on weightbearing

πŸ‘£ Unable to straighten knee

πŸ‘£ May feel/ hear grating, cracking, popping noises

Treatment:

πŸ‘£ 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.

πŸ‘£ 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.

πŸ‘£ Immobilise knee

πŸ‘£ Seek Medical attention

πŸ‘£ 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:

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

πŸ‘£ Can also be referred to as β€œHousemaids knee” due to historically housemaids who spent long periods kneeling when cleaning

πŸ‘£ A direct blow to the knee or fall onto the knee

πŸ‘£ Patellar bursitis is also linked with friction and overuse

πŸ‘£ Those with Rheumatoid Arthritis or Gout are more susceptible to patella bursitis

πŸ‘£ Infection

Symptoms:

πŸ‘£ Knee pain

πŸ‘£ Pain, swelling, tenderness in the kneecap

πŸ‘£ Difficulty walking

πŸ‘£ Painful to kneel

Treatment:

πŸ‘£ 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.

πŸ‘£ Pain relief medication

πŸ‘£ Antibiotics maybe required

πŸ‘£ If these do not help:

                - Drainage of bursa

                - Steroid injection into bursa

                - Rare cases surgery is required



How can a Podiatrist help:

πŸ‘£ Biomechanical assessment to determine cause

πŸ‘£ Orthotic prescription

πŸ‘£ 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:

πŸ‘£ Poor biomechanics e.g abnormal tracking of the kneecap

πŸ‘£ Usually related to muscle imbalance or weakness

                                - Tight hamstrings

                                - Shortened ligaments around the knee

                                - Weakness or imbalance of muscles in thigh and buttocks



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

πŸ‘£ Incorrect footwear

 Symptoms:

πŸ‘£ Dull ache in the front of the knee

πŸ‘£ Pain usually triggered after activity placing pressure on the knee

πŸ‘£ May have swelling in the knee

 Treatment:

πŸ‘£ 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.



πŸ‘£ Stop activity that makes it worse until pain resolved.

πŸ‘£ Changing activity e.g from running to cycling

πŸ‘£ Lose weight if overweight

πŸ‘£ Pain relief medication

πŸ‘£ In rare cases surgical intervention maybe required if other treatments don’t work.

Podiatrists role:

πŸ‘£ Biomechanical assessment

πŸ‘£ Strengthening exercises- working with Physio

πŸ‘£ Soft tissue work

πŸ‘£ 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:
πŸ‘£ Anterior Collateral Ligament (ACL) Sprain
Common in contact sports. Immediate pain in knee joint with rapid swelling.
πŸ‘£ Medial Collateral Ligament (MCL) Sprain
Tear of ligament on inside of knee from direct impact or twisting motion.
πŸ‘£ 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.
πŸ‘£ 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.
πŸ‘£ 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.
πŸ‘£ 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.
πŸ‘£ 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.
πŸ‘£ 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.
πŸ‘£ 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.
πŸ‘£ 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:
πŸ‘£ Poor biomechanics
πŸ‘£ Being Overweight
πŸ‘£ Overuse
πŸ‘£ Previous Injury

Treatment:
πŸ‘£ It is essential that knee injuries are properly assessed so that the correct diagnosis can be made and right treatment provided.

Treatment Options:
πŸ‘£ Strengthening and Stretching
πŸ‘£ Orthotic prescription
πŸ‘£ Steroid Injection
πŸ‘£ Pain relief medication
πŸ‘£ 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:

πŸ‘£ Common in runners

πŸ‘£ Poor biomechanics

πŸ‘£ Previous ankle sprain

 Symptoms:

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

πŸ‘£ Pain may occur when running on curves

πŸ‘£ Inverting the ankle (turning ankle inwards)

 Treatment:

πŸ‘£ 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.

πŸ‘£ Non-Steroidal anti-inflammatory drugs

πŸ‘£ Mobilisation of the ankle joint

πŸ‘£ Orthotic prescription

πŸ‘£ 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:



πŸ‘£ Ankle Sprain

πŸ‘£ Recurrent ankle sprain

πŸ‘£ Activities requiring repeated dorsiflexion of the ankle e.g squatting

πŸ‘£ Inadequate rehab

πŸ‘£ Joint stiffness

πŸ‘£ Muscle tightness

πŸ‘£ Poor biomechanics

πŸ‘£ Inappropriate training

πŸ‘£ Inadequate warm up

πŸ‘£ Poor core stability

πŸ‘£ Poor proprioception or balance



Symptoms:



πŸ‘£ Dull ache in front of the ankle

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



Treatment:



πŸ‘£ 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.



πŸ‘£ When comfortable begin a rehab program of the ankle

πŸ‘£ See a Physio for treatment program



What can a Podiatrist do:



πŸ‘£ Biomechanical assessment

πŸ‘£ Orthotic prescription

πŸ‘£ Taping

πŸ‘£ Joint mobilisation techniques

πŸ‘£ Exercises

Shin Splints




The term β€œShin 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:



πŸ‘£ Failure to warm up properly

πŸ‘£ Recent increase in training intensity

πŸ‘£ Running on hard or inclined surfaces

πŸ‘£ Poor technique

πŸ‘£ Foot abnormalities

πŸ‘£ Compartment syndrome

πŸ‘£ Biomechanical factors

πŸ‘£ Muscle weakness



Symptoms:



πŸ‘£ Usually come on gradually

πŸ‘£ Pain starts as a dull ache on the side of the shin that intensifies with exercise

πŸ‘£ There may also be swelling present



Differential diagnosis:



πŸ‘£ Stress fracture

πŸ‘£ Chronic compartment syndrome



Treatment:



πŸ‘£ Avoid overdoing it- too much to too high intensity

πŸ‘£ Wear correct footwear

πŸ‘£ Consider orthotics to offload affected structures

πŸ‘£ Add strengthening to training program

πŸ‘£ Gait re-training



What can Podiatrists do:



πŸ‘£ Gait analysis- to analyse movement patterns

πŸ‘£ Prescribe orthotics

πŸ‘£ Exercise program

Achilles Tendonitis






Achilles tendonitis is an overuse injury causing pain, inflammation, and or degeneration of the Achilles’ tendon at the back of the ankle.

The Achilles’ tendon attaches the calf muscles to the heel bone (or calcaneus). This tendon is used when walking, running, or jumping. Excessive walking or exercise can commonly cause Achilles tendonitis.



Causes:

πŸ‘£ Exercising without a proper warm up

πŸ‘£ Sudden increase in activity without an adjusted increased training program

πŸ‘£ Playing sports that require sudden changes of direction and quick stops

πŸ‘£ Strained calf muscles from repeated exercise

πŸ‘£ Wearing poor fitting footwear

πŸ‘£ Wearing high heels daily for long durations

πŸ‘£ Poor biomechanics

πŸ‘£ Training uphill or treadmill running



Symptoms:

πŸ‘£ Pain and stiffness of Achilles tendon at the back of the ankle

πŸ‘£ May have some swelling and thickening around the tendon

πŸ‘£ Tight calf muscles



Treatment:

πŸ‘£ 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 decrsed 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 inury 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.



πŸ‘£ Gentle exercise

πŸ‘£ Switch activities to less strenuous sport

πŸ‘£ Add heel raises to shoes



What can Podiatrists do:

πŸ‘£ Gait analysis

πŸ‘£ Orthotic prescription

πŸ‘£ Exercise program