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Turf Toe

Summary

  • It is simply a sprain of the ligaments around the big toe joint. It’s a condition that’s caused by jamming the big toe or repeatedly pushing off the big toe forcefully as in running and jumping. The most common symptoms of turf toe include pain, swelling, and limited joint movement at the base of one big toe. The symptoms develop slowly and gradually get worse over time if it’s caused by repetitive injury. If it’s caused by a sudden forceful motion, the injury can be painful immediately and worsen within 24 hours. Sometimes when the injury occurs, a “pop” can be felt. Usually the entire joint is involved, and toe movement is limited.

How did I get this?

  • The name “turf toe” comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf the foot can stick to the hard surface, resulting in jamming of the big toe joint. There has also been some indication that less-supportive flexible shoes worn on artificial turf are also to blame.

What can I do about it?

  • Initial treatments include rest, ice, compression, and elevation. (RICE), as well as a change to less-flexible footwear.
  • Podiatry consultation for further management.

What help can I get for this?

  • Podiatrist may use measures to limit great toe motion such as stiff soled shoes, or a cam walker to protect the injured tissue while it heals.
  • Podiatrist may consider taping the big toe and using a Morton’s extension splint may be beneficial in protecting the toe.
  • Orthopaedic surgeon for surgical correction if nonoperative approach does not work with the symptoms.

When will it get better?

  • In many cases, if adequate compliance is achieved, conservatively and surgically treated patients can return to their preinjury level of function. However, some disability is possible with either form of treatment.

Tarsal Tunnel Syndrome

Summary

  • The tarsal tunnel is located inside the ankle next to the ankle bones. Its job is to protect veins, arteries, tendons and nerves. When this tibial nerve is squeezed, or compressed, it results in a condition called tarsal tunnel syndrome (TTS). Many patients experience a tingling or burning sensation inside the ankle or in the sole of the foot while others experience pain in the ankle, heel, toes, arch, and even up the calf.

How did I get this?

  • There is no one specific cause for tarsal tunnel syndrome, but inflammation is the most recognized reason for TTS. Since the tibial nerve is encased in the tarsal tunnel, anything that takes up extra room like inflammation causes swelling in the tissues and puts pressure on the nerve.

What can I do about it?

  • Rest may be suggested to control the symptoms initially.
  • Ice or heat treatment.
  • Activity modification.
  • Anti-inflammatory medications help reduce the inflammation and swelling of the tissues around the tibial nerve.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may prescribe padding or strapping, specialized orthotics to relieve the symptoms, and give footwear advice.
  • Orthopedic surgeon for surgical management if nonoperative approach fails.
  • Physical therapy for specialized strengthening exercise for up to eight weeks after surgery.

When will it get better?

  • An improvement in your symptoms may take about 2-3 months.
  • Surgery causes release of pressure on the nerve, so by the time the sutures are removed you may already have had relief of your symptoms.

Tarsal Coalition

Summary

  • A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet. While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to 16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life. Symptoms include Pain (mild to severe) when walking or standing, tired or fatigued legs, muscle spasms in the leg causing the foot to turn outward when walking, flatfoot (in one or both feet), walking with a limp, and stiffness of the foot and ankle.

How did I get this?

  • Most often, tarsal coalition occurs during foetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.

What can I do about it?

  • Rest from activities that cause the pain.
  • 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 prescribe orthotic devices for distributing weight away from the joint, limiting motion at the joint and relieving pain. Footwear modification such as a stiff rocker sole may be effective.
  • Podiatrist may consider immobilization to give the affected area a rest. The foot is placed in a cam walker, and crutches may be used to avoid placing weight on the foot.
  • Your doctor may give steroid injections to reduce the inflammation and pain.
  • Foot and ankle surgeon for surgical management if symptoms are not adequately relieved with nonsurgical treatment.

When will it get better?

  • Treatment by a podiatrist may result in symptom relief within 6-8 weeks.
  • Depending upon the type and location of your surgery, a cast will be required for a period of time to protect the surgical site and prevent you from putting weight on the foot. Although it may take several months to fully recover, most patients have pain relief and improved motion after surgery.

Stress Fracture

Summary

  • Stress Fractures occur when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces that often lead to microscopic cracks in the bone.

How did I get this?

  • Generally, it is repetitive stress (i.e. running, marching, sport etc.) although some bone diseases can pre-dispose to thin bones which therefore fracture more easily. In people with osteoporosis (thinning of the bone) there is an increased risk of stress fracture.

What can I do about it?

  • Rest the area and stop sporting activity.
  • Wear good fitting shoes with adequate support and cushioning.
  • Avoid high heels.
  • You can try a protective pad.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may advise appropriate shoes, consider prescribing orthotics, consider immobilisation, and advise on surgery.

When will it get better?

  • In the majority of cases, conservative care allows the bone to heal and normal activity can then be resumed. Surgery is sometimes necessary to stabilise the fracture site which allows longer time to resume activity.

Sever’s Disease

Summary

  • It is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 to 14 years old, because the heel bone is not fully developed until at least age 14. When there is too much repetitive stress on the growth plate, inflammation can develop. Symptoms include pain in the back or bottom of the heel, limping, walking on toes, and difficulty running or jumping.

How did I get this?

  • Overuse and stress on the heel bone through participation in sports is a major cause. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer/football, running, or basketball are especially vulnerable.

What can I do about it?

  • Rest.
  • Ice pack application.
  • Calf and hamstring stretches.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist will confirm the diagnosis and advise appropriate shoes, exercises, and orthotics.

When will it get better?

  • Use of orthotics and supportive footwear usually provide relief within a few weeks.
  • The condition is self-limiting. Once the growth plate has closed the condition will resolve.

Retrocalcaneal bursitis

Summary

  • Retrocalcaneal bursitis is a condition characterized by tissue damage and inflammation of the retrocalcaneal bursa (a small fluid filled sac located at the back of the heel) causing pain in the heel region. Risk factors include poor foot biomechanics (particularly flat feet), inappropriate footwear (e.g. excessively tight fitting shoes), muscle weakness (particularly the calf, quadriceps and gluteals), muscle tightness (particularly the calf), joint stiffness (particularly the ankle or foot), bony anomalies of the heel bone, inappropriate or excessive training or activity, inadequate recovery periods from sport or activity, inadequate warm up, inadequate rehabilitation following a previous Achilles injury, change in training conditions or surfaces, inappropriate running technique, inadequate fitness, poor pelvic and core stability, poor proprioception or balance, and being overweight.

How did I get this?

  • Compressive forces and friction may be placed on the retrocalcaneal bursa during certain ankle movements or by wearing excessively tight shoes. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur.

What can I do about it?

  • Rest.
  • Massaging the calf muscles.
  • Stretching.
  • Ice packs.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe padding or strapping, appropriate footwear/modification, exercises, or orthotics
  • Orthopaedic surgeon for surgical removal of bone spur (if present), removing the thickened inflamed retrocalcaneal bursa, and debriding the Achilles tendon.

When will it get better?

  • This condition usually gets better in several weeks with the proper treatment.

Posterior tibial tendon dysfunction

Summary

  • Posterior tibial tendon dysfunction (PTTD) is an injury involving overstretching or rupturing of the posterior tibial tendon, leading to tendon inflammation, weakness, foot deformity and arthritis. The posterior tibial tendon extends from the deep layer of muscle at the back of your leg. It runs along the inside of your ankle and down the inside of your foot to underneath your arch. This tendon, along with some strong stabilising ligaments, is one of the major supporting structures of the foot. In PTTD, the tendon’s ability to perform that job is impaired, often resulting in a collapsed arch or ‘flat foot’. PTTD is the most common type of flat foot developed during adulthood, and is also known as adult-acquired flat foot.
  • Symptoms include pain and swelling on the inside of your ankle which grows worse with increasing activity, tenderness over the midfoot especially during activity, weakness or an inability to stand on your toes, a collapsed arch and development of a flat foot, and gradually developing pain on the outer side of your ankle.

How did I get this?

  • Often occurs in women over 50 years of age and may be due to an inherent abnormality of the tendon. But there are several other risk factors which include obesity, diabetes, hypertension, previous surgery or trauma, inflammatory diseases, and arthritis. The tendon may also become inflamed if excessive force is placed on the foot, such as when running on a banked track or road.

What can I do about it?

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  • Rest.
  • Short term nonsteroidal anti-inflammatory drugs such as ibuprofen.

What help can I get for this?

  • Podiatrist may advise immobilization of the foot for six to eight weeks with a removable boot to prevent overuse.
  • Podiatrist may prescribe shoe inserts such as a heel wedge or arch support.
  • Podiatrist may recommend that you use a custom-made orthotic or support.
  • Foot and ankle surgeon for surgical management such as tendon repair or ankle joint fusion if conservative treatments don’t work.
  • A program of exercises and therapy to help rehabilitate the tendon and muscle following immobilization.

When will it get better?

  • The success of nonoperative treatment first requires the assessment of the flexibility of the flatfoot deformity. It is common for a patient to take 4-6 months to achieve much of their recovery and 12-18 months before they reach their point of maximal improvement after surgery.

Posterior Heel Spur

Summary

  • The Achilles tendon inserts into the back of the heel bone. If there is excessive pull at the attachment, the area can become painful. In some instances a bone spur can form at the back of the heel. There is pain directly over the bone at the back of the heel.

How did I get this?

  • Overuse particularly in sport. However, bone spurs can take many years to form without being painful.

What can I do about it?

  • Rest.
  • Ice.
  • Heel raises can help.
  • An Achilles heel protector can be of benefit.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may advise appropriate shoes, stretching, heel raise , and possible guided injection for symptoms control.
  • Orthopaedic surgeon for surgical removal of bone spur.

When will it get better?

  • This can be a very difficult condition to treat and can take several months to settle. Whilst the treatment options can be of benefit, they will not reduce any bone spur. With surgery, it often involves a long recovery (6-12 months).

Plantar Fibroma

Summary

  • A benign small nodule that grows on the bottom of the foot. This feels firm to the touch. This mass can remain the same size or get larger over time, or additional fibromas may develop. People who have a plantar fibroma may or may not have pain.

How did I get this?

  • The cause is unknown but thought to have a genetic component.

What can I do about it?

  • Wear appropriate comfortable footwear.

What help can I get for this?

  • Podiatrist for shoe padding or orthotic devices to relieve the pain by distributing the patient’s weight away from the fibroma.
  • Foot and ankle surgeon for surgical treatment to remove the fibroma if the patient continues to experience pain following non-surgical approaches.

When will it get better?

  • Return to unrestricted activity and shoe wear is in the one- to two-month range after surgery if measures are strictly followed.

Plantar Fasciitis

Summary

  • An overuse injury that affects the sole of the foot. Symptoms include severe pain in the heel after the first few steps out of bed in the morning, or when standing up after sitting for long periods of time. Pain subsides while walking, but returns after spending long periods of time on your feet.

How did I get this?

  • Low arched foot, abnormal strain caused by long hours on the feet, unsupportive shoes, and obesity are factors in developing this condition. Other causes include an underlying inflammatory condition, bone disease, infection, stress fracture, and nerve entrapment.

What can I do about it?

  • Rest.
  • Ice application and massage with a golf ball.
  • Calf Stretches.
  • Wear supportive footwear.
  • Avoid going barefoot.
  • Short term anti-inflammatory medications (ibuprofen) decrease inflammation and relieve the pain.

What help can I get for this?

  • Podiatrist may prescribe padding and strapping to soften the impact of walking, support the foot and reduce strain on the fascia. This may be followed by orthotic devices to correct underlying structural abnormalities. Dry needling, foot mobilisation and extracorporeal shockwave therapy have been found to be effective.
  • Podiatrist may prescribe a night splint to maintain an extended stretch of the plantar fascia while sleeping, reducing the morning pain experienced by some patients.
  • Your Doctor may advise injection therapy to help reduce the inflammation and relieve pain.
  • If after several months of non-surgical treatment you continue to have heel pain, surgery may be considered.

When will it get better?

  • No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.