Inversion Ankle Sprains
What is it?
An inversion ankle sprain occurs when you ‘roll’ your ankle into an inverted position. This means the outside of the foot typically gives way and you end up twisting the entire ankle inwards. There is often instant pain around the outside of the ankle and into the foot, but the exact areas that are painful depend on which muscle, ligaments or bones have been damaged. Some ankle sprains cause very little pain, whereas others can be totally debilitating and require surgical repair, that is why they are graded on a scale of 1-3. The grading is as follows:
- Grade 1 ankle sprain:
- Mild
- Microscopic tearing of ligament fibres
- Minor tenderness and swelling
- Patient will be able to weight bear with minimal pain
- Grade 2 ankle sprain
- Moderate pain and swelling
- Bruising present
- Partial tearing of ligaments
- Ankle may feel loose or unstable when examined
- Patient will feel pain when weight bearing
- Grade 3 ankle sprain
- Extreme pain, swelling and bruising
- Complete tearing of ligaments
- Ankle very unstable
- Unable to weight bear
How is it treated?
A Podiatrist is an expert in ankle and foot injuries so will be able to get you walking again in no time. If you have sprained your ankle, your initial consultation will involve assessing the ankle so the degree of the injury is known. That means they will work out what structures have actually been injured, and how badly they are hurt. Inititally, the treatment will involve the RICE protocol – rest, ice, compression and elevation to reduce as much swelling as possible. It is important though to get the ankle moving the way it was intended, as soon as possible. If the ankle is immobilised for too long, it can lead to long term issues with reduced range of motion.
After the initial treatment, your Podiatrist will be able to give you appropriate exercises to restore the strength in and around your ankle. Unfortunately, once you have sustained an ankle sprain, if you fail to rehabilitate it properly, it can lead to weakness and continual recurrence of the same injury.
It is also very important to work on balance after you have sprained your ankle. There are lots of nerves in joints, muscles and tendons and after they have been injured, they don’t always send the right messages back to the brain which can lead to poor balance and the risk of re injury. This is called a loss of proprioception. Your Podiatrist will ensure that this is addressed during your treatment.
Morton’s Neuroma
What is it?
A Morton’s Neuroma is an enlarged nerve that is often swollen & inflamed which is often felt at the ball of the foot, most commonly between the 3rd and 4th toes. The pain is often “burning” or “sharp” and can spread to other surrounding areas, and can be worsened with shoes that are too narrow for the feet or high heels. It is a common condition that often affects middle aged women with an increased body mass index (BMI).
Why is it happening now?
There are a number of causes of a neuroma. Typically people with a very hypermobile, flexible foot will develop the condition because the joints in the forefoot will move around a lot and irritate the nerves. Also, if there is stiffness or a bunion present in the big toe joint, this shifts the weight over to the small joints and can result in the nerves becoming inflamed and swollen. Tight footwear can also mean that the forefoot is being squashed together and causing some nerves to get pinched.
Can it be fixed?
Yes! In most cases, the pain associated with neuromas can be controlled by offloading the area. We do this in a number of ways, such as:
- Better footwear choices offering more support to the forefoot region
- Adhesive padding that can be applied into shoes
- Orthotics
In a small number of cases, the neuroma will need to be surgically removed by an orthopaedic surgeon. This is a relatively straight forward procedure where a small incision is made and the effected portion of nerve is removed.
Sever’s Disease (Calcaneal Apophysitis)
What is it?
This is a condition common in active children from the ages of 9-13. When we are born, our heel bone is actually split in two parts, with a thick band of cartilage in between those 2 parts. As we get older and our feet grow to their full length, this cartilage starts to close over. If the Achilles tendon is pulling too much on the back of the heel, it can irritate this growth plate and cause considerable pain in kids.
Why is it happening now?
Inflammation of the growth plate with associated pain can occur from numerous contributing factors, such as:
- Tight calf muscles
- Very active kids that do a lot of running
- Sports that involve wearing boots such as soccer, football, etc
- Recent growth spurts
Can it be fixed?
Yes! Most kids with Sever’s disease will experience very significant pain and discomfort for approximately 1 season of their chosen sport, sometimes longer. Although this problem will often resolve, it is important to manage the symptoms in the meantime so your child can remain active and enjoy participating in sporting activities. Your podiatrist will be able to advise you on some of the ways this pain can be managed, such as:
- Stretching
- Icing
- Strapping of the foot and ankle
- Better footwear
- Orthotics
- Heel pads or raises
- Rest from activities
Verruca Pedis (Plantar warts)
What are they?
Warts are the most common infection of the skin caused by a virus. Plantar warts grow on the plantar, or bottom surface of the foot and they tend to be found in areas of pressure such as the heel and ball of the foot. Generally, warts go away on their own with time, but plantar warts often need intervention because they can be very painful given their location on the soles of the feet. Some common symptoms and presentations of warts are:
- Foot pain – feels like a lump under the foot
- Firm, rough, bumpy, and sometimes scaly lesions with tiny pinpoint dark spots inside
- Usually they are located over areas of pressure or bony point such as the heel and ball of the foot
Why are they happening now?
Warts occur as a result of the human papilloma virus (HPV). The virus attacks the skin through direct contact, the HPV then takes refuge in the skin. You can come into contact with the virus through a number of ways, such as:
- Use of public/communal showers or pools
- Skin trauma
- Weakened immune system due to illness or medications
Can they be fixed?
Yes! Some warts go away after only a few treatments; others become a much more long term issue that requires regular treatment for a number of months. It is always difficult to predict how a wart will react. Some techniques your podiatrist will use include:
- Sharp debridement to remove the scaly, hard, outer layer ok skin and wart tissue
- The use of mild acids to gently burn away the wart
- Needling (small needles are inserted into the wart to elicit an immune response so the body will react to the HPV)
Most of these techniques involve minimal discomfort. The needling is always done under a local anaesthetic to reduce any pain. Once the wart has resolved, some good strategies to help prevent them from returning include:
- Avoid walking barefoot in communal wet areas such as pools and showers
- Change shoes and socks daily
- Keep your feet clean and dry
- Avoid direct contact with warts from other people or from other parts of the body.
Plantar fasciitis
What is it?
Plantar fasciitis is inflammation of the plantar fascia which causes chronic pain in the heel. The plantar fascia is a thick, fibrous structure that runs from the big toe joint, right along the arch of the foot and inserts into the heel bone. Often the pain will be only be a short, sharp pain in the mornings, but overtime it can increase to the point where the heel and arch of the foot is painful all day.
Why is my heel hurting now?
The plantar fascia acts like a shock absorber in our foot. Every step that we take it lowers down and then when we lift our foot it retracts back up, similar to a spring. Sometimes, it stops working efficiently and can start to pull at the heel. This can occur for a number of reasons, such as:
- Sudden increase in exercise
- Being overweight
- Poor footwear or regularly going barefoot
Also, it is important to note that women are much more likely to suffer from plantar fasciitis than men.
Can it be fixed?
Most definitely! Although plantar fasciitis can be a long term chronic condition, the pain can be managed through various different treatments which your Podiatrist will advise you on. Some of these are:
- Stretching and strengthening regime
- Regular icing
- Improved footwear
- Compression therapy
- Orthotics
Posterior tibial tendon dysfunction
What is it?
The posterior tibial muscle is deep on the inside of the leg. The tendon for that muscle, which is the part that attaches onto the bone in the foot, wraps around the inside of the ankle and is responsible for keeping the arch of the foot in the correct position. When it stops working, the arch can flatten and it can cause considerable discomfort around the ankle. Often there will be swelling around the inside of the ankle and foot.
Why is it hurting now?
In some people, the posterior tibial muscle is put under a lot of strain. This is usually people with very flexible, flat feet. The reason is because the posterior tibial muscles job is to keep the arch up, but in people with flat feet, it is unable to do this so it is straining at all times trying to pull the arch into the right place. Eventually, the muscle is unable to do this anymore and it can tear causing considerable pain and making walking difficult. Some common contributing factors to developing this issue is:
- Being overweight
- Poor footwear
- Sudden increase in activity levels
- Family history of flat feet
Can it be fixed?
Posterior tibial tendon dysfunction is easily fixed if it is treated early. An orthotic that can help to stop the arches from collapsing so much, offloads the tendon so it can relax and is not constantly straining. Better footwear can also provide instant relief and your Podiatrist can provide you with the styles and brands of shoes that will suit you best. If the tendon is left untreated for a significant period of time, it can completely tear which leads to the bones in the foot collapsing and requiring surgical repair.
Sinus tarsi syndrome
What is it?
The sinus tarsi is a small bony canal with an opening on the outside of the ankle. Inside that canal is a structure called the interosseous ligament. When this ligament is strained, pain can develop around the outside of the ankle. Often there will be no specific area that is sore, but more a generalised feeling of discomfort. It is often worse first thing in the morning, or after a period of prolonged sitting, and as the area warms up, the pain will decrease. Other symptoms include:
- Difficulty walking on uneven ground
- Painful when running on a slope
- Pain and swelling over the lateral or outside part of the ankle
Why is it happening now?
Sinus tarsi syndrome commonly occurs in people with very flexible, flat feet because when the feet are very flat or pronated, this puts a lot of strain through the interosseous ligament which is located in the sinus tarsi. It also commonly occurs in people who have had either a single or repetitive ankle sprain. Common conditions such as gout and osteoarthritis can also lead to sinus tarsi syndrome as they cause inflammation.
Can it be fixed?
Yes! Instant relief can be obtained through the use of local anaesthetics and corticosteroid injections but your Podiatrist will also look at what was causing the problem in the first place. Some treatments would include
- Stretching and strengthening exercises
- Increasing ankle proprioception
- Strapping
- Orthotics
- Better footwear
Onychomycosis (Fungal toenails)
What is it?
Onychomycosis is a fungal infection that gets into your toenail. These infections are more common in adults older than 60 years of age, although people of any age can contract a nail fungus. People who have diabetes or circulation problems are especially prone to developing fungal nail infections. The fungal infection can cause the nails to discolour or become thickened and deformed. This can result in other problems such as ingrown toenails developing.
Why is it happening now?
Often it is impossible to determine where or how you got your fungal nail infection. Places that are warm and moist often allow a fungus to grow. Wearing heavy work boots that make your feet warm and sweaty can enable a fungus to grow inside the boot and eventually penetrate onto your nail. Walking barefoot in change rooms, especially at the pool, predisposes people to pick-up a fungus from the wet floors. Sometimes several people in a family will get a fungal infection in their nails at the same time. This can happen because their immune systems aren’t able to fight off the infection very well, or because the infection is being passed on, often using the same shower or bath mat.
Can it be fixed?
Of course! There are many, many different variations of toenail fungus so your Podiatrist will need to examine the affected toenails to be able to tailor a treatment plan specifically to you. Often physically thinning down the fungal nails with specialist equipment is a pain free, but very effective way to speed up healing times. There are also a number of topical ointments and lacquers that can be used, or oral medications can be prescribed. Although fungal nails are very persistent, they can definitely be resolved over time.
Onycocryptosis (Ingrown toenails)
What is it?
An ingrown toenail is also known as onychocryptosis. It is a common condition that occurs when part of the nail pierces the skin on the toe, which can often cause pain and sometimes an infection. The ingrown toenail can also cause discomfort without piercing through the skin because it can lead to increased pressure at the side of the toe/nail fold from the nail pinching on the toe. In addition to pain, there may be swelling, redness and discharge of clear or yellow fluid from the side of the toe.
Why it is happening now?
Ingrown toenails can occur from several factors. The most common cause is incorrect nail trimming technique. Other common causes of an ingrown toenail include:
- Congenital toenail/toe shape. ie. An involuted nail that is more curved from side to side
- Pressure from poor fitting shoes, neighbouring toes or tight socks/hosiery
- Poor foot hygiene
- Fungal nail infection
- Pregnancy or obesity which affects the size of the toe
Can it be fixed?
Yes! A skilled podiatrist can remove the corner of nail that has pierced the skin, often with very little discomfort. However, if the toe is very sore, local anesthetic may be used to ease the pain. It is important to remove the protruding piece of nail as infection is likely to persist and may worsen if it is not removed. Your podiatrist will also talk to you about some steps you should follow to promote healing of the toe, such as
- Trimming the nail straight
- Do not pick or tear the nail
- Avoid wearing shoes and socks/hosiery that are too tight
- Keep feet clean to avoid potential infections
- Regular treatment with the podiatrist
- Nail surgery
Achilles tendonitis
What is it?
Achilles tendonitis is inflammation in and around the Achilles tendon. This is often associated with pain and swelling at the back of the heel and leg. Some common symptoms which may indicate you are suffering from Achilles tendonitis are:
- Sharp and nagging pain above the heel
- Ankle stiffness
- Swelling at the back of the heel
Why is it happening now?
The main cause of Achilles tendonitis is caused by tightness in the calf muscles. The large calf muscles in the back of the leg come down to form the Achilles tendon. If these muscles are tight, they are causing the tendon to constantly pull at the back of the heel which over time can lead to tearing and degeneration of the tendon. Also, if the lower limbs are malaligned, it can lead to the tendon constantly rubbing on the heel bone which also causes pain and degeneration over time. Finally, poor footwear that irritates the posterior heel and can cause inflammation in the area, can also put some strain on the tendon.
Can it be fixed?
Most definitely! Your podiatrist will assess your painful Achilles tendon to determine which treatment is best suited to you. Some of these include:
- Rest, ice, elevation and compression therapy
- Stretching and strengthening exercises for the lower limb
- Better footwear
- Orthotics
- Heel raises
