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

Corns and Callus

One of the most common reasons that patients attend clinic is due to painful corns or for callus removal. Corns and Callus are areas of thickened skin caused by excessive pressure or friction. They can cut anywhere on the foot, from the sole of the foot, in between toes, on top of the foot, or on the toes. Sometimes they can also be painful.

Callus-

An area of thickened and hard skin usually found on the soles of the feet.

Corns-

These are smaller areas of thick skin caused by pressure or friction. There are 5 types of corns:

1.     Hard corns (Heloma Durum)- These are the most common type of corn and typically can be found on the top of toe joints, on the end of toes, and on the sole of the feet. They usually appear due to deformity or excessive pressure. They are approximately the size of a small pea with an overlying layer of hard skin.

2.     Soft Corns (Heloma Molle)- These are caused due to pressure or friction, and are found between the toes. They appear white and are rubbery in texture due to moisture from sweat or inappropriate drying.

3.     Seed Corns (Heloma Mille)- These are tiny corns which can appear either singular or in clusters, and are usually more common in dry skin conditions.

4.     Vascular Corns- These can be hard or soft corns with blood vessels within them so tend to bleed very easily.

5.     Neurovascular Corns- These Corns are like vascular corns but also have nerve involvement. They tend to be very painful and are often inflammed.

Causes:

•      Foot deformity for example, Bunion, or hammer toes
• Poor fitting footwear
• Abnormal foot function
• Not wearing Socks
• Dry Skin
• Reduced Fatty padding

Symptoms:

• Pain
• Thick, rough area of skin

Treatment:

• Self treatment by use of foot file or pumice stone
• Apply foot cream daily
• If problem persists see a Podiatrist who can:

o   Remove any hard skin or corns

o   Give Footwear advice

o   Address poor foot function

o   Relieve any excessive pressure

For further information see:

www.completepodiatry.co.uk

07434 727952

0161 477 4747

info@completepodiatry.co.uk