Foot & Ankle

Plantar Fasciitis

 

 

 

 

 

 

 

What is it?      

Plantar Fasciitis (or fasciopathy) is a condition of pain and tissue damage at the attachment of the plantar fascia to the underside of the calcaneus (heel bone).
The plantar fascia is a band of connective tissue that runs along the sole from the heel to the ball of the foot. One of its main roles is to keep the bones and joints in position and enables us to push off from the ground. Bruising or overstretching this ligament can cause inflammation and heel pain.

What does it feel like?

  • Sharp pain in the inside part of the bottom of the heel, which may feel like a knife sticking into the bottom of the foot.

  • Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe.

  • Heel pain after long periods of standing or after getting up from a seated position.

  • Heel pain after, but not usually during, exercise.

  • Mild swelling in the heel.

Why does this happen?

Certain sports.  Activities that place a lot of stress on the heel bone and attached tissue, i.e. running, dance and aerobics.
Flat-footed or high arches.  People with flat feet may have reduced shock absorption, increasing strain on the plantar fascia. High arched feet have tighter plantar tissue, leading to similar effects.
Middle-aged or older. Heel pain tends to be more common with ageing as muscles supporting the arch of the foot become weaker, putting stress on the plantar fascia.
Overweight.  Weight places a greater mechanical load on the plantar fascia. There is evidence that overweight and inactivity lead to chemical damage to the plantar fascia, with a worsening of pain.
Pregnancy.  Weight gain, swelling and hormonal changes that accompany pregnancy may lead to mechanical overload of the plantar fascia.
Being on your feet.  People with occupations that require a lot of walking or standing on hard surfaces may suffer plantar fascia pain.
Wearing shoes with poor arch support or stiff soles.  Poorly designed shoes may contribute to problems.

Tibialis Posterior Tendinopathy

 

 

 

 

 

 

What is it?      

Tibialis Posterior tendinopathy is an often under-recognised source of medial foot and ankle pain, presenting as a reactive tendinopathy in runners and sporting populations, and commonly as a dysrepair or degenerative tendinopathy in slightly older patients.

What does it feel like?

  • Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area.

  • Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time.

  • Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot.

Why does this happen?

An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed.

The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use.

Sural Nerve Entrapment

 

 

 

 

 

What is it?      

The sural nerve passes between the heads of gastrocnemius and posterior to the peroneal tendons.12 Entrapment may occur at any site along the course of the nerve. 

What does it feel like?

Sural nerve entrapment may cause pain and paraesthesia along the postero-lateral aspect of the lower leg, extending behind the lateral malleolus and along the lateral border of the foot.

Tenderness may be localized to a region just lateral to the musculotendinous junction of the Achilles tendon.

Why does this happen?

Sural nerve entrapment may manifest following ankle sprain or due to a tethering of the nerve through the crural fascia and gastrocnemius muscle, and this may be noticed upon forced plantarflexion movements. In other sports that use tight fitting boots and bindings such as skiing and snowboarding, the nerve may be compressed. Furthermore, space occupying lesions such as ganglions, lipomas, scar tissue and myositis ossificans may potentially compress the nerve.

Tibial Nerve Entrapment / Tarsal Tunnel Syndrome

 

 

 

 

 

 

What is it?      

Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist.

Both disorders arise from the compression of a nerve in a confined space.

What does it feel like?

  • Tingling, burning or a sensation similar to an electrical shock

  • Numbness

  • Pain, including shooting pain

 
Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes and even the calf.

Sometimes the symptoms of the syndrome appear suddenly.  They are often brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising or beginning a new exercise program.

Why does this happen?

  • A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.

  • An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon or arthritic bone spur.

  • An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.

  • Systemic diseases, such as diabetes or arthritis, can cause swelling, thus compressing the nerve.

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