Achilles Tendonitis

Most people know where to find their achilles tendon.

 It is positioned at  the back of the leg, a thick chord like structure which connects the muscles of the back of the calf to the calcaneum  or, the heel bone. The action of these muscles bends the knee and points the toes at the ankle joint. When the tendon becomes tender , sore or painful, it is described as Achilles Tendonitis. This may  not be a true scientific description of the  pain, but it will serve our purposes.

Damage to the achilles tendon is responsible for an estimated 11% of all running injuries. A typical runner who jogs one mile experiences 1,500 heel strikes.  This  is very demanding on the Achilles tendon and overuse injuries are commonplace.    They are exacerbated by wearing footwear that lacks support and has poor shock absorption . It is estimated that even high quality running shoes decrease their shock absorption by approximately 40 percent after about 300-400 miles. That isn't very far for someone training for the marathon!

Sometimes overzealous training, especially, too much, too soon  after an injury, causes problems as the  tissues do not have a chance to adapt to the increased demands and decreased recovery time.

Achilles tendonitis can be caused by running on hard ground, by hill training and running on uneven surfaces.

The injury itself is graded from 1 - 5.

At grade 1 there is no pain during activity, but pain in the Achilles tendon is felt after sports training has ended and any tenderness usually clears up within 24 hours. At grade 5 the Achilles tendon pain will interfere with daily activities the Achilles tendon becomes deformed and muscle function is lost.

It is important to stop activity immediately if you have problems with your achilles tendon and apply ice to the affected part. A podiatrist or physiotherapist will be able to strap it for you and use of a heel lift can ease the pain. It is wise to rest the area and stop all jumping and twisting movements. A visit to a biomechanics specialist is always recommended as they can prescribe custom made orthotics to help prevent' over twisting' within the foot and prevent re-injury.

Once the acute stage of injury has passed, light exercise using a rocker board is very useful for initial exercise and then slowly reintroduce sports activities on soft, flat surfaces with an emphasis on stretching and strengthening exercises. Normal activity can be resumed when the tendon is free of pain.

Cracked Heels

The sunshine is here and so are the sandals!  The problem is, those heels you have been hiding in shoes and socks all winter are now going to be on display.

But the appearance of your heels is only the tip of the iceberg. Dry skin is at best uncomfortable and in more severe cases can lead to infections and even ulcerations. Dry skin is often termed 'anhidrosis' which covers a whole spectrum of disorders, including dry skin which is not limited to the feet, but can cover much of the body.

The key to alleviating dry skin is moisturising regularly. This is at least daily, but preferably twice a day, concentrating on the heel area, but not between the toes.

If your skin has reached the stage in the photograph with hard cracked skin, then help from a professional podiatrist is advised. Your podiatrist will be able to remove the hard skin from the surface and from either side of each crack or 'fissure'. This is an essential part of the healing process as this skin is essentially dead and, until fresh healthy tissue is reached the fissure will not repair.

If the heels are not attended to, the fissure is so hard and dry, it often cracks even further breaking the healthy skin underneath making it sore and often it bleeds. Once the skin is broken there is a pathway open to infection.

After your podiatrist has removed the callused skin, a daily routine of moisturising is essential. Any moisturiser you have at home is better than none at all and there are many foot creams on the market. 

We highly recommend 'Soothe your Skin' from Bodyessentials.

The ingredients in this product make your skin sing just by reading about them! It is an aromatherapy product  containing   sandalwood, lavender and chamomile. There are many health benefits from these essential oils and they are all bound in a base cream with essential fatty acids, vitamins A and E and minerals.

It is a lovely cream to use, easily absorbed and smells simply gorgeous.

What more could you ask for as the sun shines and you slip your newly refurbished feet into sandals? (Paraben and SLS free!)

Plantar Plate Rupture

"There's a pain on the sole of my foot and the toes are swelling."

"My toes are moving apart and they are painful when I walk"

The plantar plate, like any structure in the body, is something nobody thinks about, until it goes wrong.

There is a ligament that holds all of the metatarsal heads together across the forefoot and there are small sections at the head of each of the metatarsals that fasten the metatarsal to the phalanx - the bone at the base of the toe. This is the plantar plate.

If this plantar plate tears, the two bones are able to move independently of each other. Apart from pain, a sign that this has happened is that the foot swells and the toes move away from each other. Sometimes the toe lies lower than the other toes, other times it moves to the side and may even overlap the next one. The pain is often described as a dull ache.

Very commonly, this tear affects the second toe (the one next to the big toe) and is caused by trauma - commonly a history of tripping up.  People with long second toes and very short big toes are more prone than others and those living with Hallux Valgus (bunions) are also more likely to rupture the plantar plate. Individuals who have diabetes or arthritis are also in the 'high risk' group.

Your podiatrist can usually diagnose this problem without  the use of an x-ray and the treatment for it may not involve surgery. A simple diagnostic test involves moving the two bones to analyse how much movement is present. Sometimes this is called, 'Subluxation'.

The aim of treatment is to realign the toe, which may be achieved through taping the joint. A strong tape is passed from the metatarsal head, around the affected toe and back to the affected joint. This forms a type of sling which supports the structures in the absence of the plantar plate. Padding is often used to complement the strapping which will  relieve the painful joint, avoiding pads which allow the joint to point towards the floor.

The role of biomechanics cannot be stressed too highly when dealing with a plantar plate rupture. As the tear usually occurs as a result of the natural architecture of the foot in combination with other predisposing factors, an orthotic will aid in supporting the foot whilst healing and lower the risk of it all happening again.

If you have a swollen foot and a pain like a dull ache in the metatarsal area of your foot, you may well have a plantar plate rupture, so seek professional advice as soon as you can!

Mortons Neuroma

A neuroma is a benign growth of tissue on a nerve. The most common neuroma in the foot is an interdigital neuroma or a 'Morton's Neuroma' which most often forms between the 3rd and 4th toes, although this is not the only site for a neuroma.

The nerve becomes 'pinched' between the metatarsal heads and is swollen and painful.

There is often a 'clicking' effect which is known as Mulders Sign, but it isn't always present. The clicking is actually the nerve moving up and down between the two bones.

Patients complain of a burning or a sharp pain.  The pain can become intense, affecting every step. Sometimes pain travels forward into the toes and occasionally the affected toes become numb. The pain is often relieved temporarily when the foot is rested without footwear. The site of the pain is easily palpated and sometimes a small lump can be felt through the skin.

Mortons neuroma can be caused by the specific architecture of the foot.  For example, hammer toes may cause the metatarsal heads to take excessive pressure during the walking cycle and press against each other. A neuroma may be due to occupational factors, such as excessive kneeling which causes  an 'overpull' on the structures. It is also caused by tight footwear, especially high heels which have the same effect on mechanical structures as kneeling and hammer toes. Even flat shoes may cause the problem if the toe box squeezes the metarasal heads and causes friction.

The discomfort from Mortons Neuroma can be relieved by separating the metatarsals which can be achieved conservatively. The first line of treatment is to assess footwear and decide if one particular pair of shoes is causing the problem. If the neuroma is more established and relief cannot be obtained through a change in footwear alone, your podiatrist can help often through the use of orthotics.

A podiatrist will advise on the best orthotic for your foot, although these do require extra space in the footwear and a shoe with more room for your forefoot is still a requirement. Sometimes the problem is so painful that surgery may be required; but often, once the inflammation subsides, the problem is more easily managed.

If you think you may be suffering from Mortons Neuroma, seek professional help, today!