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Peroneal Tendon Injury/Overuse

Summary

  • The peroneal tendons are two tendons that lie immediately behind the outside bone of the ankle. These two tendons are responsible for moving the foot outwards. They balance the ankle and the back of the foot and prevent the foot from turning inwards repetitively. These tendons can be injured due to overuse or acute injury. There is pain behind the ankle, swelling over the peroneal tendons, and tenderness of the tendons.

How did I get this?

  • It usually occurs because these tendons are subject to excessive repetitive forces during standing, walking, and running. History of ankle injury (e.g. blow to the ankle or ankle sprain) which can displace the peroneal tendons. Certain foot shapes such as a higher arched foot predispose to the development of injury as well.

What can I do about it?

  • Rest is key, often helped by supportive footwear such as a hiking boot or jogger.
  • Applying ice to the area can help to reduce swelling and help to control pain.
  • Short term use of anti-inflammatories and can reduce the swelling around the tendon.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist for footwear modification, strapping, bracing, orthotics or other measures to reduce stress on the tendons and allow for rest and inflammation to subside.
  • Orthopaedic surgeon for possible surgical repair if there are large tendon tears.

When will it get better?

  • Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Recovery after surgery involves several weeks of restricted weight-bearing and immobilization, depending on the type of surgery performed. Following immobilization, therapy can begin. Total time for recovery is usually 6-12 weeks, depending on the extent of surgery.

OsTrigonum Syndrome

Summary

  • Ostrigonum syndrome refers to pain in the back of the ankle. The Ostrigonum is an extra (accessory) bone that sometimes develops behind the ankle. The presence of an Ostrigonum in one or both feet is congenital (present at birth). It becomes evident during adolescence. Pain in the back of the ankle is the first indicator of Ostrigonum syndrome. The area in front of the Achilles tendon is sore to touch and the bony prominence may even be palpable. The diagnosis can usually be confirmed by x-ray views of the ankle from the side.

How did I get this?

  • Ostrigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players and other athletes.

What can I do about it?

  • Rest to stay off the injured foot to let the inflammation subside.
  • Applying a bag of ice covered with a thin towel to the affected area decreases inflammation process.
  • Short term nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may consider immobilization using a walking boot or splint to restrict ankle motion to allow healing.
  • Your doctor may prescribe cortisone injection into the area to reduce the inflammation and pain.
  • Foot and ankle surgeon for possible removal of Ostrigonum.

When will it get better?

  • Most patients’ symptoms improve quickly with non-surgical treatment. However, in some patients, surgery may be required to relieve the symptoms. There is usually persistent swelling and discomfort after the surgery so limiting activities is required until these symptoms settle.

Nerve entrapment / Neuroma

Summary

  • Thickening of the tissue that surrounds the nerve leading to the toes. Burning pain in the ball of the foot that may goes into the toes which generally intensifies with activity or wearing shoes. There may also be numbness or an unpleasant feeling in the toes.

How did I get this?

  • Anything that causes compression or irritation of the nerve can lead to the development of a neuroma (e.g. wearing high heeled or tight shoes). Foot deformities are risk factors. Injury and trauma to the feet can also lead to this condition.

What can I do about it?

  • Placing an icepack on the affected area helps reduce swelling.
  • Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
  • Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
  • Padding techniques provide support lessening the pressure on the nerve and decreasing the compression when walking.

What help can I get for this?

    • Podiatry consultation for treatments that include footwear advice, padding, orthotics, and may advise guided injections for alleviating the pain.
    • Surgery may be considered if not responded adequately to non-surgical treatments.

When will it get better?

  • Appropriate treatment can provide swift relief, but you will still need to consider long-term measures to help keep your symptoms from returning.

Medial Tibial Stress Syndrome

Summary

  • An overuse injury to the legs known as shin splints. Occurs most commonly in runners or aggressive walkers. This injury causes pain in the front of the outer leg below the knee. Pain is often noted at the early portion of the workout, then lessens, only to reappear near the end of the training session. Discomfort is often described as dull at first. However, with continuing trauma, the pain can become so extreme as to cause the athlete to stop workouts altogether.

How did I get this?

  • Sudden increase in distance or intensity of a workout schedule.
  • Tight Achilles tendon or weak ankle muscles are risk factors to develop this condition.

What can I do about it?

  • Rest from activity that causes the pain.
  • Application of ice packs reduces inflammation.
  • Gentle stretching exercises.
  • Properly fitted shoes.
  • A Neoprene calf sleeve help to reduce discomfort after training.
  • Calf support stocking (Shin Splint compression sleeve).
  • Heat applied to the shins may help particularly in the warm up phase prior to starting a workout.

What help can I get for this?

  • Podiatrist for footwear advice and orthotics, stretching/strengthening
  • Possible surgical option if conservative treatment does not work.

When will it get better?

  • In the vast majority of cases, the conservative treatments are sufficient to resolve the symptoms and allow a return to activity. However, there is always a risk of recurrence if your training programme is incorrect.

Kohler’s Disease (Navicular Avascular Necrosis in Children)

Summary

  • Kohler’s disease is a rare condition in which the bone in the arch of the foot becomes inflamed. Kohler’s disease usually affects children between the ages of three and five. It occurs more commonly in boys than in girls, and is often unilateral, affecting one foot. Bone tissue deteriorates due to an interruption of blood supply leading the bone into breakage into tiny fragments before healing and hardening. As a result, foot becomes swollen and painful, and the arch of the foot is tender.

How did I get this?

  • What causes avascular necrosis of the navicular bone is unclear, but a delayed ossification or hardening of bone may be partially responsible.

What can I do about it?

  • Rest and avoid excessive weight bearing.
  • Short term non-steroidal anti-inflammatory drugs (e.g.ibuprofen) for pain control.

What help can I get for this?

  • Podiatrist may prescribe soft arch supports or medial heel wedge, and removable cam walker.

When will it get better?

  • Kohler’s disease is self-limiting, meaning that it usually resolves on its own, without any long-term consequences. In children who are treated with rest and support, and who avoid putting excessive weight on the affected foot, the disease rarely lasts more than two years. Almost all patients eventually recover excellent function.

Jones Fracture

Summary

  • The Jones fracture is a fairly common fracture of the fifth metatarsal (The long bone connecting your little toe to the rest of the foot).
  • Jones fractures sometimes disrupt blood supply and can result in the permanent failure of a bone to heal.
  • Symptoms include pain, swelling, bruising, severe and pain while walking.

How did I get this?

  • Overuse, repetitive stress, and trauma are the leading causes of Jones fractures. Jones fracture is attributed to a twisting inversion injury to the foot. Inversion injuries happen when the foot or ankle twists inward.

What can I do about it?

  • Rest and stay off the injured foot (walking may cause further injury).
  • Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • An elastic wrap should be used to control swelling.
  • Elevation of foot should slightly above the level of your heart to reduce swelling.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may consider immobilization in a cam walker depending on the severity of the injury (crutches may also be needed to avoid placing weight on the injured foot).
  • Foot and ankle surgeon for surgical approach if the injury involves a displaced bone, multiple breaks, or has failed to adequately heal.

When will it get better?

  • In most cases, rehabilitation can begin once the cast is removed, and you will gradually be able to resume your normal activities. Rehabilitation may take an additional two to three weeks. Your age may also play a role in healing time. Younger people are known to heal faster from bone injuries.

ANKLE SPRAIN

 

Summary

  • An ankle sprain is a condition where there is partial or complete tear of the ligaments of the
    ankle due to sudden stretching. The pain is initially severe and can be associated with a
    “popping” sensation. Immediate swelling over the area of injury often occurs as the injured
    blood vessels leak fluid into the local tissue.

How did I get this?

  • This typically occurs when the ankle is suddenly “twisted” in a sports activity or by stepping off an uneven surface.

What can I do about it?

  • Ice packs.
  • Rest – Limiting the amount of walking and weight bearing on the injured ankle.
  • Elevate to reduce swelling.
  • Apply compression bandage.

What help can I get for this?

  • Seek the advice of a podiatrist for further assessment and strapping, bracing or immobilisation.
  • In case of severe injuries you may need immobilization in a cam walker.
  • Orthopedic surgery if there is complete tear.

When will it get better?

    • Recovery depends on the severity of the injury.
    • For minor injuries, people can usually return to normal activities within several days.
    • For very severe sprains it may take longer, possibly up to several weeks.