Category: Musculoskeletal

Plantar fasciitis – what happens at a cellular level?

Posted on March 9, 2023 by Steve - Frequently asked questions, Hindfoot, P

Plantar fasciitis is a condition that involves inflammation and damage to the plantar fascia, which is a thick band of connective tissue that runs along the bottom of the foot. At a cellular level, plantar fasciitis involves a complex interplay of inflammatory mediators and cellular responses.

One of the key cellular processes involved in plantar fasciitis is the release of inflammatory mediators, such as cytokines, from damaged tissue cells. These mediators trigger a cascade of cellular responses, including the activation of immune cells, the release of more inflammatory mediators, and the recruitment of additional cells to the site of injury.

As inflammation persists, it can lead to the breakdown of extracellular matrix components, including collagen and elastin fibres, which are important structural components of the plantar fascia. This breakdown can further weaken the tissue and contribute to ongoing inflammation and pain.

Over time, chronic inflammation and tissue damage can lead to the formation of scar tissue and the thickening of the plantar fascia, which can further exacerbate symptoms of plantar fasciitis.

Interventions for plantar fasciitis aim to address these underlying cellular processes by reducing inflammation, promoting tissue healing, and restoring normal biomechanical function to the foot and ankle. By addressing the cellular mechanisms involved in plantar fasciitis, treatment can help alleviate symptoms, prevent further damage, and promote long-term recovery.

Plantar fasciitis

Posted on March 9, 2023 by Steve - Hindfoot, P

Plantar fasciitis is a common condition that causes pain in the heel and bottom of the foot. It is caused by inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot and connects the heel bone to the toes.

Symptoms of plantar fasciitis include pain and tenderness in the heel or arch of the foot, particularly upon waking in the morning or after prolonged periods of standing or walking. The pain may be described as sharp or stabbing, and may worsen over time if left untreated.

Interventions for plantar fasciitis may include:

Stretching exercises: Specific stretches for the calf, Achilles tendon, and plantar fascia can help improve flexibility and reduce tension in the affected area.
Strengthening exercises: Strengthening exercises for the foot and ankle can help improve stability and support the plantar fascia.
Manual therapy: Massage, joint mobilisation, and other hands-on techniques can help reduce pain and improve mobility.
Footwear advice: Proper footwear can help reduce stress on the plantar fascia and prevent further injury.
Other Modalities: The use of modalities such as ice, heat, ultrasound, or electrical stimulation can help reduce pain and inflammation.
Activity modification: Modifying or avoiding activities that exacerbate the symptoms of plantar fasciitis can help reduce pain and promote healing.

It is important to consult with a healthcare professional if you are experiencing symptoms of plantar fasciitis, as early diagnosis and treatment can help prevent further damage and improve overall outcomes. With appropriate physiotherapy care, most individuals with plantar fasciitis can expect to make a full recovery and return to their normal activities.

Peroneal tendon instability

Posted on March 9, 2023 by Steve - Hindfoot, P

Peroneal tendon instability is a condition in which the peroneal tendons, which run along the outside of the ankle and foot, are not held in place properly and are prone to dislocation or subluxation (partial dislocation). This can cause pain, weakness, and instability in the ankle and foot.

Peroneal tendon instability is often caused by a combination of factors, including ankle sprains, chronic ankle instability, and anatomical abnormalities that affect the stability of the peroneal tendons.

Symptoms of peroneal tendon instability can include pain and tenderness along the outside of the ankle and foot, a feeling of snapping or popping in the ankle, weakness and instability, and swelling and stiffness.

Treatment for peroneal tendon instability may include non-surgical options such as physical therapy to strengthen the ankle and foot muscles, bracing or taping to provide additional support, and modification of activities to avoid aggravating the condition.

In some cases, surgical intervention may be necessary to repair or reconstruct the damaged peroneal tendons, particularly if non-surgical treatments are not effective or the instability is severe.

It is important to consult with a healthcare professional if you are experiencing symptoms of peroneal tendon instability, as early diagnosis and treatment can help prevent further damage and improve overall outcomes. With appropriate care, most individuals with peroneal tendon instability can expect to make a full recovery and return to their normal activities.

Peroneal tendon injuries

Posted on March 9, 2023 by Steve - Hindfoot, P

The peroneal tendons are two long tendons that run along the outside of the ankle and foot, connecting the muscles of the lower leg to the bones of the foot. Peroneal tendon injuries can occur due to a variety of factors, including overuse, trauma, or anatomical abnormalities.

Symptoms of peroneal tendon injuries can include pain, swelling, and tenderness along the outside of the ankle and foot, as well as weakness and instability. In some cases, individuals may also experience a popping or snapping sensation in the ankle.

Treatment for peroneal tendon injuries can vary depending on the severity of the injury. Mild injuries may be treated with rest, ice, compression, and elevation, as well as non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. Physical therapy may also be recommended to help strengthen the muscles and improve flexibility.

In more severe cases, immobilisation in a cast or brace may be necessary to allow the tendon to heal. In some cases, surgery may be necessary to repair or reconstruct the damaged tendon.

It is important to consult with a healthcare professional if you are experiencing symptoms of a peroneal tendon injury, as early diagnosis and treatment can help prevent further damage and improve overall outcomes. With appropriate care, most individuals with peroneal tendon injuries can expect to make a full recovery and return to their normal activities.

Os trigonum

Posted on March 9, 2023 by Steve - Accessory bones, O

The os trigonum is a small bone located on the posterior aspect of the talus bone in the foot. It is a sesamoid bone, which means it is embedded within a tendon or muscle, in this case, the flexor hallucis longus muscle tendon.

The presence of the os trigonum is a normal anatomical variation in some individuals, while others may develop it as a result of repetitive stress or trauma. When it is present, it can cause pain and discomfort in the foot, especially during activities that involve pointing the foot downward, such as ballet, soccer, or other sports that require frequent jumping or running.

Treatment for os trigonum syndrome may include rest, ice, physical therapy, and in some cases, surgery to remove the bone. A healthcare professional or a podiatrist can provide a diagnosis and recommend the most appropriate treatment plan.

Morton’s neuroma

Posted on March 9, 2023 by Steve - Forefoot, M, Neurology

Morton’s neuroma is a painful condition that affects the ball of the foot, usually between the third and fourth toes. It is caused by an enlargement of the nerve that supplies sensation to the toes, which can be due to compression or irritation of the nerve. This can result in symptoms such as pain, burning, tingling, or numbness in the affected area. The exact cause of Morton’s neuroma is not fully understood, but it is thought to be related to the mechanics of the foot and repetitive trauma or pressure to the nerve.

Treatment for Morton’s neuroma may involve conservative measures such as changing footwear, using orthotics or padding to reduce pressure on the nerve, or taking anti-inflammatory medications. In more severe cases, injections of corticosteroids or other medications may be used to reduce pain and inflammation. Surgery may be recommended in rare cases where conservative treatment fails to provide relief.

Midfoot arthritis

Posted on March 9, 2023 by Steve - M, Midfoot, Rheumatology

Midfoot arthritis is a condition characterized by pain and stiffness in the midfoot area, which includes the arch and the ball of the foot. It can be caused by wear and tear of the joints in the midfoot, rheumatoid arthritis, or trauma to the foot. Symptoms may include pain, swelling, stiffness, and difficulty walking or standing. Treatment options for midfoot arthritis may include over-the-counter or prescription pain relievers, physical therapy, shoe inserts or custom orthotics, and in severe cases, surgery to fuse the affected joints together or remove the damaged joints and replace them with an artificial joint. It is important to seek medical attention if you experience persistent foot pain or discomfort.

Metatarsus adductus

Posted on March 9, 2023 by Steve - M, Midfoot, Paediatrics

Metatarsus adductus is a foot deformity in which the front part of the foot turns inward, causing the toes to point inward as well. It can occur in both children and adults, and can range from mild to severe. Here are some key facts about metatarsus adductus:

Causes:

Metatarsus adductus is usually caused by abnormal foetal positioning in the womb, which can cause the foot to develop in a curved or angled position.
It can also be caused by genetic factors or conditions that affect muscle or bone development, such as cerebral palsy.

Symptoms:

Symptoms of metatarsus adductus can include a visible inward curve of the foot, with the toes pointing inward as well.
In more severe cases, the foot may be painful or may cause difficulty walking or wearing shoes.

Diagnosis:

A diagnosis of metatarsus adductus is usually made based on a physical examination of the foot and the patient’s medical history.
X-rays may be ordered to rule out other conditions or to assess the severity of the deformity.

Treatment:

Treatment for metatarsus adductus depends on the severity of the deformity and the patient’s age.
In infants, mild cases may resolve on their own with stretching exercises or the use of special shoes or braces.
More severe cases may require casting or surgery to correct the position of the foot.

Prognosis:

With appropriate treatment, most cases of metatarsus adductus can be corrected.
However, in some cases, the deformity may persist or may recur later in life.
Patients with metatarsus adductus may need to wear special shoes or orthotics to support the foot and prevent future complications.

Lisfranc injury

Posted on March 9, 2023 by Steve - L, Midfoot, Sports

A Lisfranc injury is a type of foot injury that occurs when there is a fracture or dislocation of the bones in the midfoot, where the metatarsal bones meet the tarsal bones. This area is known as the Lisfranc joint complex, and it is responsible for the stability of the foot during walking and other activities.

Lisfranc injuries can range from mild to severe, and may include sprains, fractures, or dislocations. They are most commonly caused by a twisting or bending force applied to the foot, such as a fall or a direct blow to the foot. Athletes who participate in high-impact sports, such as football or basketball, are at increased risk of Lisfranc injuries.

Symptoms of a Lisfranc injury may include pain, swelling, bruising, and difficulty bearing weight on the affected foot. If left untreated, a Lisfranc injury can lead to chronic foot pain, instability, and arthritis.

Treatment for a Lisfranc injury depends on the severity of the injury. Mild injuries may be treated with rest, ice, compression, and elevation (RICE), as well as the use of a cast or walking boot to immobilise the foot. More severe injuries may require surgery to realign the bones and stabilise the joint.

Recovery from a Lisfranc injury can take several months, and may require physical therapy to restore range of motion and strength to the foot. It is important to follow your doctor’s recommendations for treatment and rehabilitation in order to prevent long-term complications and ensure a successful recovery.

Jones fracture

Posted on March 8, 2023 by Steve - Fractures, J

Jones fracture is a type of foot fracture that occurs at the base of the fifth metatarsal, which is the bone on the outer side of the foot that connects to the little toe. It is named after Sir Robert Jones, a Welsh orthopaedic surgeon who first described the injury in 1902.

A Jones fracture is considered a high-risk fracture because the blood supply to this area is poor, which can slow down the healing process and increase the risk of complications such as non-union (failure to heal) or delayed healing. Jones fractures are commonly seen in athletes who participate in sports that involve running, jumping, and quick changes of direction, such as basketball, soccer, and football. They may also occur as a result of trauma or overuse injuries.

Treatment for a Jones fracture typically involves immobilisation of the foot with a cast or walking boot for 6-8 weeks, followed by a period of rehabilitation exercises to restore strength and range of motion. In some cases, surgery may be necessary to stabilise the bone and promote healing. It is important to seek prompt medical attention if you suspect a Jones fracture, as early treatment can help prevent complications and promote a successful outcome.