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Foot & Leg Problems

How can I improve my Walking and Running?

Walking / Running issues

Why is running so uncomfortable?

Running isn’t known for being easy, in fact its hard and often involves pain and/or injuries of some kind. However, there are many things you can do to make running more comfortable, reduce teething pains and ensure you aren’t running into injury. Running is only meant to be uncomfortable, not painful and should involve constant progress with fitness and improving comfort. If this is not happening it is likely due to imbalances or overusing certain muscles and joints. When the body doesn’t work together effectively, some structures may take on too much shock or stress, leaving you prone to injury and often leaking energy.

Pain when running or walking?

The expected discomfort is related to muscles building endurance, strength and conditioning. However, it is easy to start off imbalanced and thus get pain when muscles get overused or over-stressed as they are pushed to do what they aren’t conditioned for. Pain can be muscles or joints being irritated or injured. Prevention, muscle balancing and stability work are key to stopping pain and prevent injuries when walking and running.  Reducing your discomfort when walking / running starts with analysing your technique.

Want to build speed or endurance?

When you plateau with your speed or endurance, it can be due to energy leakage caused when muscles are inefficient at doing their job or the body compensates by using more energy than it needs to. For example, you may have run 2KM’s but your body has done 3-4km’s of work. Also if your body is skipping key structures used for propulsion and momentum, this will reduce your ability to gain speed and use endurance. To run more efficiently and give that competitive advantage, running starts with analysing your technique.

Running event coming up?

Running in an event of any distance or terrain requires dedication and preparation. Making sure you start well and cross that finish line begins with making sure your injury is low, your body is conditioned, and your muscles are loose and massaged.

TREATMENT

Treatment involves shoe advice and modifications, Joint mobilization to open up joint movement. Taping or strapping to reduce muscle tension and activate muscles and strengthening the joints. Padding or orthotics to help cushion and redistribute pressure or engage better biomechanical pathway. Ice (cryotherapy) and stone treatment for breaking down thickened tendons. Gait retraining to change how the body works and ensure it works together, and lastly manual therapy to release tight muscles, muscle stimulation, open nerve pathways, improve range-of-motion, prescribe drills and exercises or order ultrasound and x-rays.

Treatment for running injuries includes adjustments to training schedules, supplements (e.g. calcium), reducing muscle/joint/bone stress, gait retraining to offload or adjust how the structure works. Changing running terrain or orthotics.

Why are my Toes sore?

There are many reasons why our toes (especially the big toe) can get sore. Here are some common reasons:

Gout / Osteo-arthritis / Rheumatoid Pain

Gout is an inflammatory joint form of arthritis that comes on suddenly and can be severely painful. Gout is caused by an excess of uric acid in the blood (Uric acid is produced when the body breaksdown purines which are found in certain foods like poultry, seafood and alcohol).

Osteoarthritis is the breakdown of the big toe joint, reducing range of motion which causes stiffening, swelling and pain. This is usually caused by poor walking/running biomechanics and a jamming of the joint. Rheumatoid arthritis (RA) is an autoimmune form which occurs when the body attacks its own joint tissue by mistaking itself for foreign pathogens. This causes cartilage loss and joint pain, instability and deformity.

Toe Pain / Stress Fracture/ Metatarsalgia

Morton neuroma (thickened nerve) is when the tissue of the nerve gets irritated, compressed or damaged and thickens where it sits in the ball of the foot. This causes burning, tingling, numbness or shooting pain in the ball of the foot and to the toes.

 A stress fracture is caused by overuse when the bone is constantly under extraordinary stress. When enough stress is placed on the bone, it cracks. This can be due to muscle fatigues, imbalance or poor biomechanics, as muscles become irritated or tired, they stop absorbing shock and transfer all forces to the bones.

Bunion / Big toe joint Pain

Bunions are the bump (prominence) that results from the bones misalignment to the big toe joint and when the bursa (joint fluid cushion) gets irritated. The more angled the joint becomes, the more prominent the bump becomes, usually caused by poor walking/running biomechanics, poor balance and badly fitting footwear.

Turf toe

Turf toe is an injury that results from an over-extension of the big toe joint. It is usually caused by a direct injury that jams the joint (which often damages the cartilage underneath) with a popping sensation or from repetitive movements. There is pain when pressure is applied to the big toe, swelling, limited joint movements and an inability to “push off” are the most common symptoms.

Sesamoiditis

When the two small bones under the big toe (sesamoids) become irritated, imbalanced, or fractured (sesamoiditis). These act like pulleys, helping with reducing body weight stresses and allowing the tendons to slide and transfer force from your lower leg muscles to the end of the big toe. Sesamoid bones, like the other bones in your body can break, and the tendons that pass over these structures can cause soft tissue irritation and inflammation.

Hammer / Claw / Mallet toes

Hammer and claw toes are often caused by poor toe/biomechanics. The toes cope by bending into odd positions at either of the little toe joints. The joints become thickened and are prone to arthritis, corns and callous.

WHAT CAN I DO ABOUT Toe and Bunion pain?

Treatment involves a variety of methods based on your activity, biomechanics, whether it come on quickly or gradually and what the root cause is. Here are some treatment modalities that are used to treat toe problems.

What is causing my heel pain?

There are many reasons why the heel and foot can get sore. Here are some common reasons.

Heel Pain

Heel pain (Plantar fasciitis) can be caused by a range of different issues. Heel pain can be caused by the fat pad of the heel, or it could be a tendon irritation of the many foot muscles and fascia structure. The symptoms are usually pain on weightbearing, worst in the morning or after sitting to stand up. It can feel like a stone bruise or sharp like glass, and the foot feels tight.  

Arch / Instep Pain

Arch pain (Plantar fasciitis) can be caused by a range of different issues. . Arch pain can be related to the muscles that help the big toe, the bones that make up the “arch structure” can have extra bone that is irritating or rubbing in footwear and even the plantar fascia. The symptoms are usually pain with activity and get worse during the day.

Achilles Pain

Achilles tendon injuries commonly occur when there is an increase in sporting activities or poor running technique. Symptoms are typically a combination of pain and swelling in the Achilles tendon, thickening of the fibres and inability to perform strenuous tasks. Most patients with Achilles tendon injury respond well to conservative treatment, including some ruptures. There are different parts of the Achilles that can be affected such as

*Peritendinitis (inflammation of surround tissue of the tendon),

*Retrocalcaneal Bursitis (inflammation of sack of fluid that cushions the Achilles against the heel),

*Insertional Achilles tendonapathy (inflammation at the point where the Achilles tendon inserts into the heel bone), or

*Non-Insertional Achilles tendonapathy (inflammation at the middle of the Achilles tendon).  

Forefoot / Ball of foot Pain

The Forefoot (front ball of the foot) fat pad serves as a cushion and allows the front of the foot to shock absorb, but as we age or if you have more prominent joints under the ball of your feet, it begins to reduce. This often causes pain, fatigue and can lead to other issues like neuromas, callous, corns or deformities. There are a few conditions that put you at risk of this; geriatrics, diabetes, peripheral neuropathy, arthritis, vascular disease, collagen disorders and corticosteroid use.

WHAT CAN I DO ABOUT IT?

Treatment involves a variety of methods and is based on your activity, biomechanics, whether pain came on quickly or gradually and what the root cause is. Here are some treatment modalities that are used to treat foot, heel and Achilles problems.

Its important to make sure the diagnosis is right, and that’s where we come in

Why is my Ankle sore?

There are many reasons why the ankle can get sore. Here are some common reasons

Outer (Lateral) Ankle Pain

Peroneal tendonitis

The inflammation of the outer shin tendons (Peroneal tendonitis) which run behind the bony bit on the outside of the ankle (lateral malleolus). The term tendinopathy is probably more accurate than tendonitis in most cases because it is often degeneration of the tendon rather than acute inflammation. Symptoms include pain and swelling on the outside of the ankle, which get worse with exercises and improves with rest.

Sinus Tarsi

The sinus tarsi is a bony canal on the outside of the ankle – when the tendons running through it get irritated, the pain may be difficult to pinpoint, but it is mostly felt while turning or running around a corner. When the pain is in the outer side, an ankle impingement occurs when the tendons of the ankle get pinched between the ankle bones.

Stress fractures

Stress fractures can happen on the talus bone (the bone the ankle hinges on) or the fibula bone (the outer ankle bone). Symptoms include gradual onset of pain on the outside of the ankle, which gets worse with exercise, particularly running, and eases with rest.

Inner (Medial) Ankle Pain

Tibialis posterior tendinopathy

Is a degenerative condition of the inner shin muscle that helps turn and point the foot (Tibialis posterior tendinopathy). Pain can also radiate under the foot arch.

Flexor hallucis/digitorum longus tendinopathy

Is inflammation or degeneration of the muscles that flex the foot up (Flexor hallucis/digitorum longus tendinopathy). The symptoms experienced are pain on the inner side of the ankle and pain when flexing the foot or toes.

Tarsal tunnel and medial calcaneal nerve entrapment

Occurs when either the ankle nerve or foot nerve becomes impinged or pinched on the inside of the ankle (Tarsal tunnel and medial calcaneal nerve entrapment). This causes burning, tingling or shooting pain, that radiates into the arch of the foot, heel and sometimes toes. Some people get pins and needles or numbness in the sole of the foot. Pain may increase with activity or long periods of standing.

Front (Anterior) Ankle Pain

Posterior/anterior ankle impingement

Ankle impingement can happen either if poor healing after injury causing fibrosis (scarring) and bony fragments or when the soft-tissue gets trapped and irritated in the ankle joint capsule, or the joint’s ligaments or cartilage- this can thicken and accumulates over time from repetitive activities such as running and jumping. The soft-tissue or bony abnormality creates painful limitations of the ankle range of motion.

Referred pain

Pain on the inside of the ankle may be referred from injuries or conditions elsewhere in the body. For example, sciatic pain from the lower back can radiate down into the leg. Trapped nerves in the foot may also cause medial ankle pain .

WHAT CAN I DO ABOUT IT?

Treatment involves a variety of methods based on your activity, biomechanics, whether it came on quickly or gradually and what the root cause is. Here are some treatment modalities that are used to treat ankle problems. Although many are often misdiagnosed and all are treated very differently, its important to make sure the diagnosis is right.

Why is my Shin and Calf sore?

There are many reasons why the Shin and calves can get sore. Here are some common reasons

Shin Pain

Anterior tibial stress fracture

Occurs on the “leading edge” (anterior) of the shin and requires treatment as soon as possible due to risks the stress of weight-bearing pulls the crack in the bone apart. Symptoms include sharp and localized pain on the shin bone, muscular tightness too.

Compartment syndrome

Occurs when the sheath (connective tissue surrounding the muscle) around the shin muscle is too small, thus during exercise the blood flow to the muscle increases, the muscle swells up and pressure increases and presses against the sheath causing pain. Symptoms show as pain is a persistent on the outer side muscle of the shin, commonly accompanied by numbness, tingling, or a “pumped” or feeling “full” inside the muscle.

Shin Splints Pain

Shin splints is an exercise-induced pain condition in the lower leg, specifically along the shin, usually the inner (medial) side. There are many different views on what causes it, some believe it is caused by small tears in the structure of the membrane between the two bones of the lower leg (the tibia and fibula). While others suggest it is caused by overuse injury of tendons, muscle sprain, irritation and inflammation of the membrane surrounding the shin bones. The main symptoms include pain along the middle and lower shin, pain first comes on after running or exercising. Although if the pain is not treated it can come even during walking or climbing stairs.

Upper Calf Pain

Popliteal artery aneurysm

Is when the deep or superficial veins have a clot/thrombosis (Popliteal artery aneurysm) that occurs when the lower leg artery in the leg gets clogged. Symptoms experienced include an abrupt onset of foot coolness, foot or leg pain, and/or numbness. Ultrasound is the best diagnosis and should be done as soon as possible. Treatment is a mix of compression garments and prescription clot-breakdown medication.

Gastronemius muscle strain

Caused by the upper calf muscle, either inner or outer (called the gastronemius muscles) that helps point the foot and toes, and flexes the knee, is stretched beyond its limits or sudden stress that the muscle isn’t ready to or isn’t able to handle. This usually occurs during sport that has quick changes or sprinting, when the muscles are too tight or are weak and ill conditioned. The symptoms are centred around pain/tenderness in the upper calf, stiffness or tightness when walking, especially going onto tiptoes, and sometimes a popping sensation. Like all muscle strains they are graded from “overstretched” to tears and ruptures.

Popliteus/Plantaris muscle strain

Is caused by the muscles at the top of the calf and behind the knee (called the popliteus or plantaris depending on position) that helps rotate the lower leg, flex the knee and stabilize the back and outer sides of the knees is strained. Just like the ‘gastrocnemius’ strain, it is damaged when it is stretched beyond its limits or sudden stress that the muscle isn’t ready to or isn’t able to handle. This usually occurs during sport that has quick changes or sprinting, when the muscles are too tight or are weak and ill conditioned. The symptoms are centred around pain/tenderness in the back or outer side of the knee and is painful with resisted knee flexion or rotated inward. It is sometimes misdiagnosed as a hamstring tendon injury or lateral cartilage (meniscus) injury.

Lower Calf Pain

Soleus muscle strain

Is when the lower calf muscle is strain. The lower calf muscle forms out of the Achilles tendon (called the soleus) extends to the upper calf which helps point the foot/toes and push off the ground when walking. The soleus is important in blood circulation by pumping the blood back to the heart. being stretched beyond its limits or sudden stress that the muscle isn’t ready to or isn’t able to handle. This usually occurs during sport that has quick changes or sprinting, when the muscles are too tight or are weak and ill conditioned. The symptoms are centred around pain/tenderness in the upper calf, stiffness or tightness when walking, especially going onto tiptoes, and sometimes a popping sensation. Like all muscle strains they are graded from “overstretched” to tears and ruptures.

WHAT CAN I DO ABOUT IT?

Treatment involves a variety of methods based on your activity, biomechanics, whether it has come on quickly or gradually and what the root cause was. Here are some treatment modalities that are used to treat shin and calf problems. Its important to get the diagnosis right, and that’s where we come in

Why is my Knee and/or Thigh sore?

Inner Thigh/Knee Pain

Adductor muscle sprain

When the muscles that move the leg inwards to the body’s centre are strained. The adductor muscles also move the body from side to side and assist in kicking and jumping movements. Symptoms are a sharp pain in the groin and inside of the thigh, swelling, pain when moving the legs together or raising the knees.

Inner (medial) Meniscus injury

An inner Cartilage (Meniscus) injury occurs when the cartilage of the knee joint (that helps to shock absorb) is damaged by twisting the knee or in combination with larger more traumatic knee ligament injuries. Unfortunately, the menisci can be slow to heal as their blood supply is very limited and usually requires surgery. 

Outer Thigh/Knee Pain

Outer (lateral) Meniscus injury

An outer Cartilage (Meniscus) injury occurs when the cartilage of the knee joint (that helps to shock absorb) is damaged by twisting the knee or in combination with larger more traumatic knee ligament injuries. Unfortunately, the menisci can be slow to heal as their blood supply is very limited and usually requires surgery.

Knee osteoarthritis (OA)

Knee osteoarthritis (OA) is the breakdown of the knee joint cartilage, reducing range of motion and causes stiffening, swelling and pain. This is usually caused by poor walking/running biomechanics, exercise technique and jamming of the joint. Rheumatoid arthritis (RA) is an autoimmune form which occurs when the body attacks its own joint tissue by mistaking itself for attacking foreign pathogens. This causes cartilage loss and joint pain, instability and deformity. Knee pain while walking or running is the main symptom, a ‘crunching’ sound and thickening or swelling, with the joint becoming stiffer the longer it progresses, especially in the morning.

Iliotibial band syndrome (ITBS)

Occurs when the structure that connects the outer hip to the knee is irritated and inflammed, this can cause pain on the outside of the knee (direct irritation) or the inside of the knee (indirect change to knee function). This is called Iliotibial band syndrome (ITBS) and is an overuse issue when repetitive flexing and extending the leg is involved e.g cycling and running.

Back of Thigh/Knee Pain

Hamstring Muscle strain

Occurs when the muscles on the back of your thigh that helps flex the knee and extend the hip get irritated. Athletes are more at risk, especially in sudden stop and start sports. Symptoms include pain at the back of the thigh or knee, sometimes the sides of the knee, a “pop” sound, swelling, tenderness, sometimes bruising and discoloration on the back of the leg.

The posterior cruciate ligament (PCL) injury

This is when the ligament inside the knee that connects the thigh bone (femur) to the larger bone in the lower leg (tibia) is injured. Commonly occurs among athletes when they suddenly stops, turns or makes cutting moves, or jumps and lands awkwardly. Symptoms almost always feels like a “pop” or that their knee is giving way, followed by swelling and pain and often notice the knee is unable to continue exercise.

Under Knee Pain

Patellar tendon pain (jumpers knee)

Happens when the kneecap (patella) has too much stress force through it and the tendon that holds the kneecap to the tibia bone is damaged or irritated. Sometimes it can tear or come off the bone (avulsion fracture). Patellar tendon pain (jumpers knee) is caused either by too much jumping, running, or cycling, or due to a sudden activity that causes it to twist. Symptom start with pain and tenderness underneath and behind the kneecap. There will be pain with knee flexion and extension, as well as gait especially when going downhill. Other symptoms include swelling around the knee joint and reduced knee range of motion.

Above/Front Knee Pain

Quadriceps muscle sprain

Occurs when the quad muscles that connect the hip to the kneecap get irritated. These muscles are used for many movements, including walking, running, cycling, kicking, and jumping. Each muscle helps in direction-support based on its angle on the front thigh. A quad strain feels like a sharp pain on the front inner/middle or outer of the thigh or above the kneecap, followed by weakness and limping in the affected leg, and swelling. Often the pain begins at the top of the leg and radiates down to the knee.

The anterior cruciate ligament (ACL) injury

This is when the ligament inside the knee that connects the thigh bone (femur) to the larger bone in the lower leg (tibia) is injured. Commonly occurs among athletes when they suddenly stops, turn or makes cutting moves, or jumps and land awkwardly. Symptoms almost always feel like a “pop” or that their knee is giving way, followed by swelling and pain, and often notice the knee is unable to continue exercise.

Patellofemoral pain syndrome (PFPS or anterior knee pain syndrome)

Is an overuse condition often occurring in teenagers, manual laborers and athletes, and is typically caused by the wearing down, roughening or softening of the cartilage under the kneecap. Patellofemoral pain syndrome pain is felt in the front of the knee and around the kneecap, at first when jumping, running or climbing stairs, then later the knee might buckle or swell and stiffen until there is constant pain, even at rest.

WHAT CAN I DO ABOUT IT?

Treatment involves a variety methods based on your activity, biomechanics, whether it has come on quickly or gradually and what the root cause is. Here are some treatment modalities that are used to treat knee and thigh problems. Its important to make sure the diagnosis is right, and that’s where we come in

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