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Lower Limb Conditions: • Achilles Tendinosis
• Bunions (Hallux Valgus) The Achilles tendon is the largest tendon in the body. It connects the muscles of the calk to the foot through its junction at the heel. The Achilles tendon is critical for transmitting the force of contraction of the calf muscles to the foot: pushing the foot downwards as when stepping on a gas pedal. During locomotion, the Achilles tendon allows for the push-off phase during running. Achilles tendinosis is a condition where the Achilles tendon, at or near its insertion into the heel, becomes irritated and causes pain. The demands on the Achilles tendon are high in running and jumping sports. Pain is often felt with running hills, doing speed work or jumping activities. It is thought that over-pronation puts excessive pressure on the tendon of the calf muscle causing irritation of the Achilles tendon. A sudden increase in running mileage or overtraining of any sort contributes to this injury. Local tenderness is made worse by stretch and/or stretch and contraction. Achilles tendinosis may be viewed as a spectrum that ranges from initial overuse inflammatory changes to chronic degenerative breakdown. In the last stage of this condition the Achilles tendon can completely rupture. Rupture of this tendon is a devastating injury that heals very poorly. Thus properly treating Achilles tendinosis is essential. Treatment goals:
Bunions (Hallux Valgus) Bunions formation is likely accelerated by over-pronation because of the excessive weight placed on the big toe joint during the push-ff phase of gait, forcing the toe to further inward movement. It is advised to have this looked at early whish will lessen the chance of having to undergo surgery for it. Conservative treatment options include; Acupuncture, Low level laser therapy, Kinesiotaping, Orthotics, wearing wide-toes shoes, and stretching the Achilles tendon. back to top IT Band Syndrome Runners often note that they start out running pain free but develop symptoms after a reproducible time or distance, which can be made worse by running downhill. Early on, symptoms subside shortly after a run, but return with the next run. If ITBS progresses, pain can persist even during walking, particularly when the patient foes up or down stairs. ITBS tends to come and go but left untreated can be a nagging injury. Contributing factors include an increase in mileage, running on cambered surfaces, over-pronation, and hip abductor weakness. Treatment goals:
Metatarsalgia (pain under sole of foot) Metatarsal pain may be due to the number of factors. It appears that chronic stretching of the transverse ligaments may be the underlying reason. The transverse ligaments may be the underlying reason. The transverse ligaments help to form the arch that goes from the inside to the outside at the front portion of the foot. This may be the result of excessive weight, repetitive activity, hammer toes, over-pronation or over-supination. Direct trauma from jumping or landing on the toes with running or standing for long periods of time in high-heeled shoes may contribute to metatarsal pain. Shoes with too narrow a toe box will also cause compression and pain. Treatment is aimed at removing or modifying any underlying problems such as repetitive microtrauma or inappropriate footwear. Orthotics are often successful in treating this condition. The addition of a metatarsal pad to the orthotics is used to correct the fallen or dropped metatarsals. The metatarsal pad is a dome-shaped pad designed to lift and spread the metatarsals, recreating the transverse arch. Persistent pain that does not respond to treatment should be evaluated for a potential fracture. back to top Plantar Fasciitis / Heel Pain A number of factors contribute to the development of plantar fasciitis including: a leg length difference, overpronation, a supinated foot, inappropriate footwear, muscle tightness, overtraining and overuse. Because the condition is caused by repetitive microtrauma, most athletes experience plantar fasciitis as part of an overuse syndrome following changes in their training regimen. Treatment Goals:
Patellar Tendinosis (old term Tendonitis) Patellar tendinosis, or “jumper’s knee”, is a relatively common condition in patients who engage in sports that involve explosive lower-limb movements. The patellar tendon attaches the bottom of the kneecap to the top of the shin bone. Pain associated with this condition is located just below the kneecap. Initially, the pain occurs only after activity. As the condition progresses the pain occurs during the activity and then even at rest. Jumper’s knee may also e viewed as a spectrum that ranges from initial overuse inflammatory changes to chronic degenerative breakdown. In the last stage of this condition the patellar ligament completely ruptures. Prior damage to the knee from repetitive overuse or trauma, biomechanical factors, and the forces inherent in landing from a jump probably contribute to tendon fatigue and patellar tendon rupture. Treatment goals:
Patello-Femoral Syndrome or Runner’s Knee PFS is usually an overuse syndrome caused by doing “too much, too soon.” Other risk factors for PFS include poor biomechanics of the foot (over-pronation), ankle, knee, and hip, decreased strength or flexibility of the upper leg or hip muscles, poor alignment of the leg bones, or a combination of factors. Symptoms tend to come and go depending on the activity level. Treatment goals:
“Shin Splints” involves a muscular over-use scenario, where very small tears occur in the leg muscles at their point of attachment to the shin bone. They can occur on the outside (called “Anterior shin splints”) or inside portion of the shin bone (called “Posterior or medial shin splints”). Anterior shin splints involve the Tibialis anterior muscle of the front compartment of the leg while Posterior shin splints involve the Tibialis posterior muscle of the back compartment of the leg. Both of these muscles are involved in slowing down pronation during gait. If the foot over-pronates too rapidly, either or both of these muscles may be called upon to work harder than normal. As a result, fatigue sets in, leading to inefficient force production which leads to micro-tearing of the soft tissue and therefore an inflammatory reaction. The pain begins as a dull ache during or after running and may become more intense, even during walking, if ignored. The pain in posterior shin splints, also known as Medical tibial stress syndrome (MTSS) is described as being diffuse along the middle and lower portion of the tibia (shin bone). Typically this condition affects runners, although the condition is also seen in ballistic (ie. Jumping) activities such as basketball, dancing or racquet sports. Early in the condition the pain occurs at the beginning of a run, may resolve as the workout continues, and then recurs after the workout. The pain usually resolves with several minutes rest at this stage. In later stages the pain becomes more severe, sharper, and more persistent. In advanced stages of MTSS, the pain can complicate activities of daily living (walking, etc.) and can even occur at rest. Many of the risk factors are modifiable, thus giving ample opportunity for injury prevention. Extrinsic factors include training methods (too much, too soon, too fast), running surfaces, and improper shoe selection or old shoes. Intrinsic factors are unique to individual athletes and most commonly include over-pronation. MTSS is not a condition that you want to “run through” without proper diagnosis and treatment. MTSS occurs along a continuum of stress injuries and can lead to a stress fracture if training continues and the pain is ignored. Treatment goals:
Stress Fractures The most common sites for stress fractures are the tibia (shin bone), metatarsals (foot bone), and fibula (outside lower leg bone) and navicular (foot bone, especially with sprinters and hurdlers). Sports associated with specific stress fractures include rowing and golf (ribs), baseball pitching (humerus), and gymnastics (spine). Of the many risk factors for stress fractures that have been proposed, training errors are probably the most important. They include a sudden increase in the quantity or intensity of training, introducing a new activity (eg. Hill running), poor equipment (eg. worn-out running shoes), and change of environment (eg. changing surfaces from asphalt roads to cement sidewalks). Other risk factors include low bone density, increased age, dietary deficiencies (ie: low calcium intake), abnormal body composition, menstrual irregularities, disordered eating and biomechanical abnormalities (ie: excessive pronation). Often, a combination of factors is involved. Among athletes, females have been reported to be at 1.5 to 3.5 time’s greater risk of stress fractures than makes. Studies suggest that the difference is not related to athletes’ sex per se, but to factors such as amenorrhea (absent period), bone density, and diet. Often an X-ray will initially not show any signs of a fracture. It is only after it has begun the healing process that the fracture site will show up on X-ray as new bone formation. If the X-ray is negative, a procedure called a bone scan is then used. This procedure uses radioactive markers to detect stress fractures. When a stress fracture is diagnosed an immediate 6 weeks minimum rest periods is required. back to top |
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