Posterior Tibial Dysfunction

People who suffer with Posterior Tibial Dysfunction often complain about a pain on the inside of the ankle, swelling in the area and often, they are unable to stand on their toes. This is more common in women over 40 years old, but it does happen to men too.

The posterior tibial tendon starts in the calf, passes down behind the inside of the ankle and attaches to bones in the middle of the foot. It provides support as you push off on your toes when walking. If this tendon becomes inflamed, or damaged, there is pain on the inner ankle and a gradual loss of the inner arch on the bottom of your foot, leading to flatfoot. This condition is also called 'Adult Acquired Flat Foot'. It is not hereditary but may be caused by an inherent abnormality of the tendon. Inflammation of the tendon may be caused  by excessive force on the foot, such as running uphill, or in sports where there is a rapid change of direction, for example football, hockey or tennis.

Those who are living with diabetes or inflammatory diseases such as rheumatoid arthritis are more likely to develop this condition, as is anyone with previous trauma to the foot. Obesity and pregnancy often put more pressure on the tendon and lead to inflammation.

An easy diagnostic exercise is to stand facing a wall. Support yourself against the wall and lift the unaffected foot out of

the way, whilst rising onto tiptoes of the other.  From behind, a companion will be able to see if the heel of the affected foot turns inward. If there is no inward rotation, then dysfunction of the posterior tibial tendon is indicated and a trip to your podiatrist is recommended.

Treatment of the disorder will involve orthotics, ranging from small shoe inserts to fixed ankle supports. Sometimes a walking boot is recommended.

Without treatment, the flatfoot that develops from posterior tibial tendon dysfunction eventually becomes rigid.  Pain increases and spreads to the outer side of the ankle and consequently, the way you walk may be affected causing pain in the hips knees and back.

If you think you may have this disorder, rest is recommended, especially reducing the amount of exercise which causes the pain. Utilise low impact exercise instead, such as swimming. Always warm up with stretches before exercising and using ice on the area can reduce inflammation. For specific advice on orthoses, a biomechanical assessment is recommended.

Please don't ignore this problem, it will get worse and your podiatrist can help you.

Shin Splints

"The pain starts when I begin running, but eases off after a while. My friend had some therapy for shin splints, maybe that's what I need?"

"I'm training for a marathon but haven't kept to the schedule. On  Sunday I ran for 20 miles through the city, to 'catch up'. I now have terrible pains in my shins - I'm worried I may have shin splints "

There really is no such syndrome as 'shin splints', although it is a commonly used terminology. As a diagnosis, it is almost as exact as using the term, 'foot pain'.  When people refer to 'shin splints' they are generally referring to pain in their 'shins', towards the inside of the leg. The pain spreads across quite a wide area of the lower leg and usually affects those people who are involved in intense exercise. It is in fact, self inflicted.

There are a number of specific disorders covered by this title, including  fractures, muscle strains or tears, nerve entrapment and artery entrapment.  Most commonly however, it refers to a condition entitled, Medial Tibial Stress Syndrome. (MTSS) . 

The pain experienced with MTSS is worse at the beginning of training and subsides during the session. As the condition progresses in time, the pain is present with less activity and it may even occur when resting. Running on hard surfaces makes it worse as does suddenly increasing the intensity or duration of training. It can develop into a stress fracture due to repeated trauma on the leg structures

It is more common in women, in whom it is 3x more likely to advance into a stress fracture. The cause is often associated with biomechanical abnormalities. 

To recap; pain in the lower leg is not a 'shin splint' but one of many different disorders.

So if you are suffering with this,

·         stop training,

·         rest the area,

·         use ice on the leg immediately after exercise and,

·         seek the advice of a podiatrist or biomechanist who will guide you through the recovery process.

Bursitis

Bursae are fluid filled sacs which help protect particular structures of the body from friction. In the foot there is only one naturally occurring bursa which lies between the Achilles tendon at the back of the heel and the heel bone (calcaneus). It helps the tendon slide easily over the bone.

Feet are constantly undergoing repeated stresses during walking and other normal activities. These stresses are compounded by ill fitting shoes. With every step, the pressures and shearing stresses upon the feet cause damage and the body responds by forming bursae. As a consequence there are many bursae on the feet. Again, their purpose is to protect the structures from further damage.

Common sites for these include over the big toe joint, commonly mistaken for a 'bunion' and over the tops of the toes.

From time to time. these bursae become inflamed due to even more pressure or trauma and produce the painful condition known as bursitis.

Bursitis may occur as a result of exposure to cold weather or injury during contact sports. The bursae may also be irritated as a result of any direct trauma, inadequate 'warming up' prior to exercise or excessive repeated exercise as in long distance running. They may be due to friction from a shoe.

 The naturally occurring bursa behind the heel often becomes inflamed in this way, due to the heel counter of a shoe rubbing against it. This is called Haglunds Deformity and is most common amongst females.

Pain occurs as a protective mechanism to warn you to stop doing whatever it is that is causing the pain, to prevent further destruction.  This is not always very easy, or practical. Try the obvious things first and attempt to reduce the inflammation with ice therapy and find some footwear that is comfortable.  Often, immobilising the affected area with some strapping (tape) may reduce the friction. Padded socks or soft gel toe protectors often relieve the symptoms.

If the pain refuses to subside, there may be an infection, arthritis or gout and a visit to your GP or a podiatrist will help to identify the problem.

 A biomechanical assessment may provide evidence of walking difficulties as a causative factor of bursitis, and corrective insoles could prevent the painful condition. 

Calluses

Hard skin on your feet is otherwise known as a callus. Calluses develop over areas of high pressure on the feet - and, in fact on any area of the body.  Often, people working constantly with heavy machinery develop calluses on their hands.  They are a natural form of protection for the body as they prevent  thinning of   the underlying skin when constant, repeated pressure is present. Sometimes they become more of a nuisance than a protection and may cause more serious problems such as ulcerations. Areas of high pressure are most often associated with bony prominences, which may be more pronounced due to bio mechanical difficulties.  These areas are commonly found over the toes or on the sole of the foot from downward pressure of the metatarsal heads. Other causes of high pressure include ill fitting footwear. Sometimes the inconvenience of a callus is almost negligible, but other times it can be crippling. Left untreated, the callus becomes harder and drier and there is a risk that it may crack, causing painful lesions which can become infected. This happens most often around the heel area, but can occur anywhere. There can be additional complications if the sufferer also has problems with the circulation in the feet, diabetes or in other cases where the nutrition of the skin is compromised. Once the cause of the callus has been identified, it is possible to limit the formation of the callus with padding. Sometimes small changes such as a thicker soled shoe and better fitting footwear can also alleviate the problem. Long term solutions for more difficult cases may be possible with a full biomechanical assessment and insoles. Moisturising feet with a good foot cream can maintain the condition of the callus and help prevent the skin from 'cracking'. Seeking professional advice is always advisable. Here is a fun video on feet!

Corns (And What You Should Do About Them)

If you suffer with corns, you will know about it!  They nip and rub and, every step you take will remind you that there's a problem. You will slip your shoes off under the desk at work and avoid getting up so that you don't have to put them on again. You will try every pair of shoes you possess to see if they're any better; in fact, the very last resort is usually to pick up the 'phone to a podiatrist and Make An Appointment

Corns are areas of thickened skin which have developed in response to friction and pressure. They are cones of hard skin with the tip of the cone at the point of the pressure, usually over a bony prominence. They don't have 'roots' and are quickly and painlessly removed by a podiatrist. They form to protect the tissues underneath them, as these structures are undergoing excessive pressure. If this excessive pressure is removed then the corn will not return. For example, a tight pair of  shoes may put a lot of pressure on a little toe causing a corn to develop. Once the corn is removed and wider shoes are adopted, the corn will not return. If the cause is not removed, it won't matter how many times the corn is taken out, it will be back to haunt you.

Some corns are not so easily eradicated. If the pressure is due to a fixed foot deformity or some  other biomechanical issue, it may take a little longer to sort out, but the corn can still be removed and relief obtained.

If they are left untreated, or worse, home remedies are applied, corns can ulcerate due to the unrelenting damage to the tissue.  This opens a whole new set of problems. 

Some corns develop between the toes and are referred to as 'soft corns'. They are not any less painful because of this terminology, they are softened because of their position, where they remain moist due to perspiration. They are still caused by rubbing and pressure.

You may have heard of 'seed corns' which are tiny areas of hardened skin usually on very dry areas which some podiatrists believe occur in inactive sweat ducts. Seed corns are not, as the name suggests, the 'start' of larger hard corns.   They are easily removed by professionals.  

There are other types of corn which will not be discussed here, but if this article strikes a chord with you because your shoes are currently hiding under your desk while your feet are throbbing, then PLEASE give us a call so that we can remove your corn, find out the cause and start the road to eradication!