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

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:

👣 Exercising without a proper warm up

👣 Sudden increase in activity without an adjusted increased training program

👣 Playing sports that require sudden changes of direction and quick stops

👣 Strained calf muscles from repeated exercise

👣 Wearing poor fitting footwear

👣 Wearing high heels daily for long durations

👣 Poor biomechanics

👣 Training uphill or treadmill running

Symptoms:

👣 Pain and stiffness of Achilles tendon at the back of the ankle

👣 May have some swelling and thickening around the tendon

👣 Tight calf muscles

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 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.

👣 Gentle exercise

👣 Switch activities to less strenuous sport

👣 Add heel raises to shoes

What can Podiatrists do:

👣 Gait analysis

👣 Orthotic prescription

👣 Exercise program

Calf Pain

What is calf pain? Here I discuss the condition, symptoms and potential causes of why you may get pain in the calf.....

The calf is the area on the back of the leg between the knee and ankle. Pain in this area can cause problems when walking, running and jumping. It is important that a full assessment is undertaken to ensure correct diagnosis and treatment.

There are a number of potential causes of calf pain, from injury, to underlying medical conditions, or problems with nerves or arteries in the lower leg.

Symptoms:

Pain can vary from person to person. It usually feels like a dull ache, or sharp pain.

Symptoms can also include:

·         Swelling

·         Tingling or numbness in the calf and/or leg

·         Weakness of the leg

·         Fluid retention

·         Abnormal cool or pale colour in the calf

·         Redness, warm and tenderness in the calf

Causes:

1.       Muscle cramp

Cramp is an involuntary, sudden and painful contraction of muscle. They can be brief or can last several minutes.

Cramp is very common and usually caused by over exercising or doing new exercises. Other causes include dehydration, low salt levels, or muscle injuries.

There can be more serious causes of muscle cramps which include:

·         Kidney failure

·         Hypothyroidism

·         Alcoholism

·         Diabetes

·         Peripheral Vascular Disease (PVD)

Treatment for muscle cramps:

·         Stretches

·         Massage

·         Good diet

·         Supportive footwear

2.       Muscle Strain

Usually caused from overuse, fatigue or improper use of a muscle. It will usually be felt as it occurs with sudden onset pain and soreness in calf. Mild to moderate strains can be treated with ice, heat and anti-inflammatories. More severe strains or tears require medical attention.

3.       Achilles Tendonitis

This condition is characterised by pain and swelling in and around the achilles tendon at the back of the lower leg.

It is usually caused by overuse due to repetitive strain and excessive stress to the area.

Symptoms include pain, swelling, and reduced range of motion in the ankle joint.

Treatment should initially be PRICE:

P- Protection

R- Rest

I- Ice

C- Compression

E-Elevation

If PRICE doesn’t work or pain increases then seek medical attention.

4.       Sciatica

This is a condition when the sciatic nerve (which runs from your hips to your feet) is irritated.

This can cause pain, numbness, and tingling in the lower back that can stretch down the leg and into the calf.

Sciatica usually resolves in 4-6 weeks but can sometimes take longer.

Self treatment includes:

·         Carry on with normal activities as much as possible

·         Do regular back stretches

·         Do gentle exercises to keep moving

·         Apply heat packs to painful areas

·         Speak to pharmacy regarding pain relief

5.       Contusion of lower leg

This is a bruise from a direct blow or impact. The bruises maybe visible to the surface of the skin or maybe within the muscle strength. These bruises usually heal on their own.

6.       Deep Vein Thrombosis (DVT)

A DVT is a blood clot that forms in the deep veins of the calf.

Symptoms include:

·         Pain and tenderness along the line of the vein.

·         Swelling

·         Warm skin that looks red

·         Leg tenderness

Risk factors:

·         Family history

·         Male gender

·         Smoking

·         Age over 60

·         Being overweight

·         Having varicose veins

·         Dehydration

·         Heart failure

·         Combined oral contraceptive pill

·         Immobilisation- sitting long periods (e.g long haul flight)

                           - Following injury/ surgery (e.g in a cast)

A DVT is a serious cause of calf pain and requires immediate medical attention.

7.       Peripheral Vascular Disease (PVD)

PVD is a blood circulation disorder that causes a narrowing of the blood vessels and reduces blood flow. Many people with PVD have no symptoms, but some symptoms include:

·         Intermittent claudication- Painful ache in the back of the legs when walking which disappears after a few minutes rest.

·         Both legs are usually affected at the same time, although pain maybe worse in one leg.

·         Hair loss on feet and legs

·         Numbness or weakness in legs

·         Brittle, slow growing nails

·         Shiny skin

·         Skin turning pale or blue

·         Muscle sin legs shrinking

·         Ulcers (open sores) which don’t heal

Causes:

·         Smoking

·         Diabetes

·         Increased blood pressure

·         Increased cholesterol

·         Increased risk with age

·         Male more at risk than female

Treatment:

·         See GP for medication review

·         Healthy diet

·         Healthy lifestyle- Exercise, Weight loss, and reduced alcohol intake

This blog post is for information only and should not be used for diagnosis purposes. If you do have concerns regarding calf pain, it is always recommended to seek professional medical attention for correct diagnosis and appropriate treatment plan.

Dry Skin and Fissures

A fissure is a crack or split in the skin and can be commonly found on the heel of the foot. These cracks can be a chronic problem and be very painful. They can also cause further problems for people with underlying medical conditions, for example, Diabetes or poor circulation.

Causes:

• Dry Skin- Rough, flaky skin on the sole of the feet.

• Moist Skin- Through excessive sweat, not drying feet properly, or wearing shoes without socks that don’t breathe well will all contribute to moist skin. This can cause breaks in the skin, leading the foot to become at risk of bacterial or fungal infections.

• Walking barefoot- This leads to a reduction in the natural oils within the foot, therefore drying out the skin.

• Long periods in the sun.

• Cold Weather

• Ageing- We lose the natural moisture within our skin as we get older.

• Genetics

• Diuretics- Taking water tablets

• Decreased sweat

• Backless shoes

• Athletes foot

• Various medical conditions- Venous Statis, Eczema, Diabetes, hypothyroidism, Downs, Kidney, Lymphoma, Malnutrition can all lead to dry skin and fissures.

Symptoms:

·         Cracked skin on heels

Treatment:

Heel fissures may go on their own if properly treated and moisturised. Cracks in the skin are at risk of infection so need to be properly looked at.

Self Care:

Check feet daily for signs of redness, swelling, or heat as these are common signs of infection.

Dry Skin:

·         Moisturise

·         Never walk barefoot

·         Avoid open shoes

·         Use a Foot file for callus

Moist Skin:

·         Ensure feet are dried properly

·         Do not apply cream between the toes

·         Wear cotton socks not nylon as cotton will help

          absorb any moisture

·         Use antifungal powders as appropriate

When to see a Podiatrist:

·         If the cracks become painful, or unmanageable

What can a Podiatrist do?:

·         Reduce hard skin

·         Dress affected areas

·         Suggest/ prescribe antifungals or antibiotics if  

          required

·         Footwear advice

·         Orthotic prescription

For more information see:

www.completepodiatry.co.uk

07434 727952

0161 477 4747

info@completepodiatry.co.uk