ACHILLES TENDINITIS

A Tendon is a connective tissue present at the end of the muscle & connect muscle to the bone. The Achilles tendon connects the calf muscle to the heel bone.
Inflammation of this tendon is termed as Achilles Tendinitis. It is characteristically an overuse injury. It results due to a sudden or gradual increase in repetitive activity which involves function of Achilles. But since the tendon is not exercised to bear the exerted stress, its fiber go into micro trauma. This micro trauma continues to accumulate overtime & results in injury to the tendon as the the body does not get the adequate time & rest required for healing.

Achilles tendinitis is more common in athletes involved in sports which require running & jumping activities. Therefore any such athletes who undergoes less than appropriate conditioning are more prone to such injury.

Apart from them another population in whom such common are the 'weekend athletes' i.e. who play sports occasionally without proper training. Another important variant is the type of shoes used while indulging in high impact sports. Not many people are aware about this predicament & hence damage their body. Therefore it is vital to select shoes which suit your arch type.

Symptoms:

• Pain & swelling over the calf region or above the heel bone.
• Early morning stiffness on walking after rest.
• Difficulty on standing & walking for long duration.

Ankle Pain

Ankle pain is a wide term that includes many causes which predispose to the pain in the ankle joint, however some of the common causes of ankle pain may include fracture, tendon inflammation, arthritis, gout, ligament injuries and the list goes on….

But the most common and predominant cause of ankle pain, include injury to the ligaments that surround the ankle joint which could otherwise be called ankle sprain or ligament sprain.

What are ligaments??

Ligaments are band of tough elastic tissue around our joints. They connect bone, give our joints support, and limit their movement.

So, when there is an excessive movement to the joint, the ligaments gets stretched or eventually tears which leads to ligament sprain.

ANKLE SPRAIN

Similarly when excessive stretch is put to the ligaments of the ankle which could either be caused due to faulty alignment of the foot, walking patterns on different terrains or sudden ankle twist as in the case of sport injuries can cause ankle sprains.

There are medial (Inner side) ligaments (deltoid) and the lateral (outer side) ligaments that surround the ankle joint. The most common injury is at the lateral ligament is less common which is caused due to outward rotation of the foot (Eversion).

                There are 3 grades of sprains depending upon the severity of injury.

The most commonly affected ligament is the anterior talo-fibular ligament & gets affected due to injury resulting in inward rotation (inversion) of the ankle.

A less common type of ankle sprain occur due to outward rotation (eversion) of ankle & injuries the deltoid or medial ligament.
Foot arch is responsible for supination (High arch) & pronation (Flat Feet) throw ankle more outer

border or inner border of foot respectively. Chances of inversion ankle sprain in supinator which is more common & eversion ankle sprain in pronators are more.

Causes:

• Trauma or fall is the most common cause.
• Weak musculature.
• Increased laxity &/ reduce stability of ligaments.
• Walking in high heels or footwear with inappropriate platform.
• Walking or running on uneven surface.
• Faulty foot alignment.
• Impaired balance.

Symptoms:

• Pain & swelling over ankle.
• Inability to bear weight over affected limb.
• Stiffness in the joint.

Treatment:

The most basic approach is to follow the PRICE protocol. This abbreviation stand for the following:

P- Protection- which can be attained by use of brace while walking or standing activities. Selection of the brace should be according to the grade or level of ankle sprain. 

R- Rest- which is required for allowing healing. If the patient attempts to walk with the present injury then the chances of further damage are high.

I- Ice pack- This helps in reduction of inflammation & helps in draining out of the end product which helps in pain reduction.

C- Compression- which also can be achieved by the use of braces that provide adequate support.

E- Exercise- which is the most important aspect. 

•  Physiotherapy for the ankle sprain includes strengthening of the weakened muscles around the ankle joint. Muscles around the ankle joint plays a very important role in maintaining the integrity of the ankle joint).
  
• Balance Training

• Proprioceptive Training

Similarly as mentioned earlier, the type of the foot (Flat Feet / High Arch) also plays a very important role in stability. Depending on the type of Arch, shoe modifications with proper insoles and firm ankle grip is important to prevent re-occurrence of the Ankle Sprain.

Apart from the above if the cause of ankle sprain is faulty foot alignment then it is necessary to administer appropriate treatment for the cause or consult podiatrist.

HAMMER TOES

Hammer toe is a deformity which affects the second, third, fourth & fifth digit resembling a hammer. It affects both the proximal & distal interphalangeal joint.

It occurs most commonly due to ill fitting or improper size of shoes. While buying shoes people consider only the length variable & do not pay attention to the width of the shoe. Hence they end up buying shoes which are narrow or too long. In addition while buying shoes we usually consider the length of the great toe as it is the longest but in some cases the other toes are longer than the great toe. Hence the longer toe is always cramped inside the shoe. This is another other important factor that leads to hammer toe deformity. 

The digit that undergoes this deformity is also susceptible to problems such as pain & inflammation, corns & calluses & infection.

Therefore it is extremely important to take the advice of your podiatrist while buying shoes.

Metatarsalgia

METATARSALGIA

 Metatarsalgia is described as excessive pain which occurs over the toes & forefoot.
Most commonly, the first metatarsal head is affected- the ball of the foot just behind the big toe. In the foot there are small toe nerves between the metatarsal bones. When the head of one metatarsal bone is pressed against another, the small nerve is caught between them & start to become inflamed, thus causing metatarsalgia.

These can cause metatarsalgia or Contribute:

• Ill fitting footwears- Footwears that is tight around the toes or has high heels that can add pressure on the ball of the foot as it is forced into tight space.
• Overweight- Overweight people may suffer this pain as the excess weight can strain on the foot.
• Age- As a person ages several degenerative changes occur in the body, one such is reduced shock absorption. Metatarsalgia can subsequently develop as the foot has less protection from the strain of impact & load.
• High Impact Exercise- People who run or play high impact sport are at risk of metatarsalgia. When we running our feet absorb large amounts of force.
  

• Shapes of the foot & toes- Having a high arch in your foot or a second toe longer than the big toe can add to the pressure on the metatarsals.
• Stress fractures- These are small breaks in the toe bones or metatarsals. They can cause pain when weight is put on the foot- the individual compensates by changing the way they put weight on his/her foot.

Medical conditions that can cause Metatarsalgia:

• Bunion- this is a painful swollen bump that occurs at the base of the big toe.
• Rheumatoid Arthritis- swelled joints in the foot can cause metatarsalgia.
• Morton's Neuroma- is entrapment & irritation of the inter digital nerve which passes between 3rd & 4th metatarsal bones.
• Diabetes- the small nerves in the foot can become irritated, thus causing metatarsalgia. 

Common symptoms of metatarsalgia:

• A burning pain
• Sharp aching
• Pain in the ball of the foot.
• Pain increases when walk bare feet.
• Pain that worsens when standing or moving around but decreases at rest.

Treatment:

• Apply ice pack to the area approximately 15-20 minutes 2-3 times a day. Wrap ice in something to protect your skin from direct contact to ice.
• Avoid high impact sports & exercise that puts pressure on the feet. Try something lighter on the feet i.e. Cycling or swimming.
• Try to keep pressure off the feet, when resting try putting your feet up.
• Be sure to exercise your ankle & keep stretching the Achilles tendon.
• Use fitted insoles (Orthotics) as these will reallocate pressure or reduce pressure, improve foot function & guard the ball your foot.
• Change to better fitting flat headed shoes.

Success Story of Metatarsalgia Click here- http://vcarerehab.blogspot.com/2018/03/success-story-of-metatarsalgia.html

HIGH ARCH

High Arch

High Arch

Pes cavus foot type is the complete opposite pattern to that of flat feet. People with pes cavus foot type have well defined & deep arch. The only areas of contact with the ground are the heel & forefoot.

Arch Patterns

Consequently these people have a tendency of bearing more weight on forefoot. As mentioned earlier the arch pattern influences gait pattern. As a result these people load on the outer border of foot while walking as there is no contact on the inner side of the foot with the ground, which is termed as "SUPINATOR". 

people with high arch are more susceptible to develop knee problems owing to hard heel strike which causes excessive pressure to act 

on the heel & knee.

Deviations

Most common problem faced by people with high arch are:

• Heel pain/Plantar fasciitis

  

  Shoes Worn Out in Supinators

• Early OA of knee.
•  Ankle sprains.
• Corn and calluses on the outer border of foot.
•  Weakening of the Transverse arch leading to further complications such as Bunion, Meta tarsalgia and Morton’s Neuroma.

INGROWING TOE NAIL

INGROWING TOENAIL

An in grown toe nail is curved on either of the edges/borders and pierces the surrounding skin. The in-growing nail usually irritates the skin due to continuous pressure and often results in pain, redness, swelling and inflammation over the surrounding healthy tissue. If left unattended it has a potential of developing infection.

Causes:

 Skin and Nail Conditions: Few percentage of population has a natural tendency to attain skin infection which recurs even after treatment. Overtime these infections start affecting the nail which starts to grow abnormally.

     

Improper type and size of footwear:
The most common notion we follow while buying any footwear
in comfort, a factor which is highly subjective and hence land
up buying incorrect type of footwear. There are two impor-
tant factors which should be considered while buying foot-
wear—Foot length and Width. Mostly people tend to
buy shoes which are too short, tapering from front or ill fitting.

     

Faulty Foot Alignment: Faulty foot alignment like flat feet, week transverse arch & high arch can lead to excessive fore foot pressure which can results in ingrowing toenail.

Trauma: Occasionally in-growing results due to any injury/trauma to the nail such as an object falling over the toe, stubbing of toe or being involved in repeated activity which puts an impact on the toes such as running or kicking.

        

     

Inappropriate trimming: The most common cause of in-growing is incorrect trimming of toe nail. Some people tend to cut their nail too shirt so that when it starts to grow it begins to pierce the surrounding skin.

           Treatment:

•  In case of infection, the most essential step is to control the ongoing infection. Once the infection is under control then further debridement of the in-growing can be carried out. It requires a team effort of a Dermatologist and Podiatrist.
• Using appropriately sized shoes is an important long term treatment plan. It is advisable to use correct offloading orthotic device to avoid recurrence of the situation.
• Proper and timely trimming of toe nail is another important management aspect. The correct method is to trim the nail in a straight and clean cut. Avoid curving on the edges as it invariably results in in-growing.

Success Stories of Ingrowing toe nail

Morton's Neuroma

Neuroma is a term used to describe the enlargement or thickening of the tissue that surrounds the nerve. Morton's neuroma is entrapment & irritation of the interdigital nerve which passes between 3rd & 4th metatarsal bones. Hence it is also termed as intermetatarsal neuroma.

SIGNS & SYMPTOMS:

• Pain on weight bearing - a shooting pain affecting the contiguous halves of two toes. Sometimes there may be a dull pain rather than a sharp one. 
• Burning
• Numbness
• Paresthesia - tingling, pricking, or numbness with no apparent long-term physical effect. Commonly known as pins-and-needles.
• A sensation that something is inside the ball of the foot

Causes:

• High-heeled shoes - especially those over 2 inches (5cm), or a pointed or tight toe box which
  
  squash the toes together. This is probably why the condition is much more common in females than in males.
• High-arched foot.
• Flat feet.
• A bunion.
• Hammer toe.
• Some high-impact sporting activities.
• Injuries - an injury or other type of trauma to the foot may lead to a neuroma.

Treatment:

• Resting the foot.
• Using an ice pack on the affected area.
• Changing footwear- wearing shoe according to foot size like wide shoes & or no heeled shoes.
  
• Orthotic correction (Arch support)-  The arch support of the foot, removing pressure from the nerve. The doctor may recommend a custom-made, individually designed shoe-insert, molded to fit the contours of the patient's foot. 
• Modifying activities - avoiding activities which put repetitive pressure on the neuroma until the condition improves.
• Body weight management - if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with foot problems, such as flat feet, who successfully lose weight experience considerable improvement of symptoms.