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04 Nov 2014 
Anyone who's ever played hide and seek knows what a thrill it is to be well-hidden somewhere, perhaps only a breath or two away from the soft shoe scuffs of the seeker, almost bursting out laughing because you know if they just twitched the curtain aside, took one step behind them, or shifted the branch slightly they'd see you, grinning, right before you dashed off to whatever upended pot, tree stump or floor-strewn sweatshirt was 'safe.' Possibly jealous of these childhood exploits, the arches in your feet may want to get in on the hide-and-seek action.


Ingrown nails cause pressure and pain along the nail edges. The most common cause of ingrown toenails is pressure from shoes. Other causes of ingrown toenails include improperly trimmed nails, crowding of the toes, and repeated trauma to the feet from activities such as running, walking, or doing aerobics. Severe problems with ingrown nails may be corrected with surgery to remove part of the toenail and growth plate. Plantar warts — Plantar warts look like calluses on the ball of the foot or on the heel. Plantar warts are caused by a virus that infects the outer layer of skin on the soles of the feet. If you are not sure if you have a plantar wart or a callus, let your health care provider decide. Wash your feet in warm water every day, using a mild soap. Dry your feet well, especially between the toes. If you have poor blood flow, it is especially important to do a daily foot check.


Below is a series of questions that podiatrists commonly ask in order to find the source of the pain and how to better treat it. Patients should think about some of the answers to the following questions before and during the appointment in order to better assist the podiatrist in finding the source of the problem. Aside from treating the source of the problem, the podiatrist may offer treatment that can alleviate pain. Josie, now 2 years old, still has some health conditions and has had several close calls in her young life.


Go for those, which provide support, cushioning, and enough room for the toes to move. People with flexible flat feet have arches that disappear when they put weight on their feet, but which reappear when the feet are not weight-bearing, or when they go up on their toes. In fact, this reappearance of the arch while the foot is non-weight bearing is really what separates this type of flatfoot from other types. It's as though the arches take toe-standing as a general call of olly-olly-oxen-free: time to come out and tease the seeker about how great your hiding place was. Visit Cure Athlete's Foot In 7 Days.


When a patient suffers a foot or lower leg injury they should see a podiatrist as soon as possible to receive the appropriate advice and treatment. The podiatrist will need to understand the cause of the injury, any previous injuries and the level of activity prior to the injury occurring. A comprehensive biomechanical assessment of the patient walking or running will then be carried out to outline any issues with foot/knee or hip alignment that may be causing or contributing to the condition. Podiatrists care for any skin and nail problem involving the feet. The skin may turn red, and start peeling.


Since plantar fascia gets tightened while one is asleep, the sudden movement causes stretching of the ligament as one takes the first few steps. While structural foot abnormalities such as high arches or fallen arches can make one more susceptible to plantar fasciitis, wearing old worn-out shoes can also cause stress to the plantar fascia. Those suffering from plantar fasciitis are also at an increased risk of developing heel spurs. Heel spurs, also known as osteophytes, are abnormal bony outgrowths that may develop along the edges of the heel bone. Heel spurs form when the plantar fascia starts pulling at the heel bone or gets torn due to excessive stress. If the heel spurs start impinging on any of the surrounding nerves or the tissues, one is likely to suffer from pain. Plantar fasciitis and heel spurs surely affect one's ability to move about freely. This is the best way to support the arch of the foot. Pain then sets in and you may need surgery.


Using Listerine for severe foot conditions can be wrong for example, for example, if you have cuts and wounds in case of toenail fungus, cracked heels, warts, corns and calluses, you must go for taking medical assistance to get relief from this painful and severe condition of feet. But some says feet skin gets green spots on feet while using cool mint Listerine. So it can be used confidently as it is reliable home remedy to treat feet problems. Plain cornstarch makes a great foot dusting powder.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain
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04 Nov 2014 
Elderly individuals (can be called geriatric) are susceptible to a number of foot specific conditions Some of these conditions can leave individuals disabled if they are not prevented and/or taken care of. Some of these common foot related conditions include: arthritis, ingrown toenails, fungal nails, diabetic ulcers, and corns/calluses. It is an interesting fact that if you were to go barefoot every day of your life, you would not suffer with feet corns.


Podiatrists treat bunions, hammertoes, and all sources of toe and forefoot pain more than any other condition, save for heal pain and nail disease. There can be many complex mechanical causes for these conditions, as genetics has only an initial role in most cases of bunions and other toe and foot deformities. These conditions are successfully treated all day long by podiatrists, and should be the obvious first choice in care when foot pain develops. Sprains are a common injury, and often occur in the evenings or weekends after most medical practices are closed. It is very appropriate to present to an urgent care center or emergency room for serious foot and ankle sprains to ensure there is no fracture. These products can burn your skin.


When this happens, the big toe will either bend up like a claw or slant severely toward the second toe. When a sesamoid bone is fractured in a sudden injury, surgery may be done to remove the broken pieces To remove the sesamoid on the inside edge of the foot, an incision is made along the side of the big toe. The soft tissue is separated, taking care not to damage the nerve that runs along the inside edge of the big toe. The tissues next to the sesamoid are stitched up. Then the soft tissues are laid back in place, and the skin is sewed together. Surgery is similar for the sesamoid closer to the middle of the foot. The only difference is that the surgeon makes the incision either on the bottom of the big toe or in the web space between the big toe and the second toe. The surgeon makes an incision along the inside edge of the main joint of the big toe. You should also pamper your feet.


The Superfeet Green are recommended for footwear used in running/jogging, walking, hiking, alpine skiing and industrial type footwear. The term 'sinus tarsi syndrome' is a clinical finding characterized by lateral hindfoot pain and instability, that might be experienced due to trauma to the foot, especially in case of lateral inversion injuries. Supination, which refers to under-pronation or outward rolling on the foot, is less common when compared to overpronation. The procedure can address a range of problems.


You might find some comfort in knowing that you are not the only one who has contracted toenail fungus; podiatrists estimate that six to eight percent of the population has onychomycosis, too. Topical creams: The ointments that you apply directly to the toenail aren't strong enough to combat this extraordinarily stubborn foot fungus.


Even when you are experiencing ankle, knee, leg or back pain podiatry Windsor can often help. Podiatry Windsor is really no different than a dentist; we should all get regular checkups, even when nothing seems wrong, to ensure we take care of the health of our feet. However some of the important reasons to get a consultation with a Podiatrist are; persistent foot or ankle pain that won't go away with rest, ice or anti-inflammatories, a wound or sore that does not heal, foot discolorations (if one foot is a much different color than the other), any pain or swelling, and numbness, burning or tingling in the feet. An important thing to point out is that podiatry Windsor is a very good preventative practice. Below is Dr Foot's 20 foot care tips.


Wear shoes that fit your feet well and allow your toes to move. After years of neuropathy, as reflexes are lost, the feet are likely to become wider and flatter. Cover your feet (except for the skin between the toes) with petroleum jelly, a lotion containing lanolin, or cold cream before putting on shoes and socks. For persons with diabetes, the feet tend to sweat less than normal.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain
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28 Oct 2014 
While there is a lot of awareness about the need to wear diabetic or therapeutic footwear, there is little information available on how to differentiate the real from the phony ones. Foot corn can be extremely painful and can obstruct your day-to-day activities.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain


Unlike edible fungi or mushrooms that live on dead vegetable matter, the fungi and yeast that infect the feet are specialized dermatophytes, meaning that they only feed on keratinized tissue such as hair, skin and nails. Fungal infection in the foot can be confined to the nails and may then spread to the skin, or the other way round, starting on the skin and then infecting the nails. Other names are tinea unguium, dermatophytic onychia, dermatophytosis of the nail, or ringworm of the nail. In the case of dermatophyte fungi and yeast, small invasions are usually dealt with by your body's own natural resistance or defence mechanisms, provided you have a healthy immune system at the time. The first sign of fungal infection in the nails is a slight discolouration of the nail plate. Remember that pressure or friction is the cause of callous.


If you have diabetes or another condition that causes poor circulation to your feet, you're at greater risk of complications. Corns are smaller than calluses and have a hard center surrounded by inflamed skin. Corns usually develop on parts of your feet that don't bear weight, such as the tops and sides of your toes. Corns can be painful when pushed or may cause a dull ache. Calluses usually develop on the soles of the feet, especially under the heels or balls, on the palms, or on the knees. Calluses are rarely painful and vary in size and shape. They can be more than an inch in diameter, making them larger than corns. When shoes are too tight or have very high heels, they compress areas of your foot. Repeat two to three times; switch feet.


This condition is usually caused by abnormal stress along the plantar fascia from excessive pronation of the foot. Feet that roll in at the ankle will cause a pull along the plantar fascia, usually at the heel. Repeated pulling will damage the fibres of the fascia and lead to the pain of ‘plantar fasciitis'. Symptoms: Plantar fasciitis often leads to point tenderness on the inside portion of the heel where the heel and arch meet. This pain is usually worse in the morning when you first place your foot on the ground.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain


A pain in foot often indicates that there is something wrong with the interaction of internal structures of the foot as the foot is the foundation of athletic movements of the lower human body. Pain is an unpleasant feeling that tells us there is something wrong in our body system and pain in foot can signify how the foot is interacting with its internal influences. It can be really simple when you just find the problem and address it instead of going through various foot pain relief options trying to find the one that works without ever finding the cause. In addition to plantar fasciitis, other foot conditions like bone spur, heel spur, and heel injury might also be the cause of the foot pain. This post covers diverse foot wounds. Additionally, it gives you information about how these kinds of pains are brought about and suggests exactly what aspects of the foot may take a hit. There are causes of foot can be quite tricky to determine. There are several results of heel pain. Your own tools.Plantar Fasciitis,Pes Planus,Mallet Toe,High Arched Feet,Heel Spur,Heel Pain,Hammer Toe,Hallux Valgus,Foot Pain,Foot Hard Skin,Foot Conditions,Foot Callous,Flat Feet,Fallen Arches,Diabetic Foot,Contracted Toe,Claw Toe,Bunions Hard Skin,Bunions Callous,Bunion Pain,Ball Of Foot Pain,Back Pain
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20 Mar 2014 



How to manage achilles tendinopathy | RunningPhysio

Written by Tom Goom, senior Physio at The Physio Rooms Brighton. Follow Tom on Twitter.

The Achilles Tendon is a common sore spot for runners and can be a difficult area to treat. Here we'll look at common diagnoses, causes and treatments.

What is a Tendinopathy?

Tendinopathies are not limited just to the Achilles. They can be a problem in a number of areas throughout the body and runners might suffer patella tendinopathy, posterior tibial tendinopathy or peroneal tendinopathy to name but a few. Much of our bodies are in a constant state of building new tissue (synthesis) or breaking down tissue. It happens in muscle, bone, ligaments and tendons. How much stress or load we put on a structure plays a huge role in how much synthesis and breakdown of tissue there is. It's a balance.

If the load we put on a tendon is too much and we continue to do this frequently then the amount of tissue breakdown starts to exceed tissue synthesis. The structure of the tendon then starts to change and becomes less efficient at dealing with load and you have a vicious circle.

Tendinopathy is usually divided into stages. Initially you have a reactive stage. This is usually a response to rapid increase in loading. The tendon may visibly swell and will be painful. In more chronic cases there is often a more degenerate tendinopathy and the tendon's structure is changed considerably - it may be thickened and develop nodules. If untreated the degeneration of the tendon can reach a level where it really can't handle any load, as a result it fails and you develop a partial or total Achilles tendon rupture. This is a gradual process and usually a painful one but sometimes it can occur without pain with the first sign of a tendon problem being a sudden unexpected rupture. Working out the stage of the condition is important to determine the best treatment - see our article on staging tendinopathy.

Sounds like a bleak picture doesn't it?! It needn't be. If the problem is identified and treated early it often fully resolves but it is something that needs acting on. It probably won't go away on it's own.

Symptoms

Runners usually describe a gradual onset of achilles pain during or after a run. Gradually the pain becomes more frequent and can start to be a problem on a daily basis when not running.

Usually the tendon itself is painful if you squeeze it between 2 and 6 cm from the heel bone. There may be swelling initially or thickening of the tendon.

Activities that load the tendon will increase pain, this can include going up or down stairs, walking on tip toes, squatting and of course running.

There might be tightness in the calf and pain on taking weight first thing in the morning.

What else could it be?

Part of the reason that this is now called tendinopathy and not "tendinitis" is because of the ongoing debate as to what this condition entails. It's a bit more complex than you might think! We no longer believe the condition involves inflammation which is why we've changed the "itis" at the end (a word ending in "itis" usually suggests inflammation). We now know that instead of inflammation the tendon has a reactive response which thickens and stiffens it and acts as a "stress shield" to reduce load.

There are other issues around the tendon that can be involved. These include the insertion of Achilles into the heel bone (insertional tendinopathy) or inflammation of the bursa at the base of the achilles (retrocalcaneal bursitis). There is also another tendon, called plantaris that is sometimes embedded within the Achilles and can cause irritation. Insertional tendinopathy usually presents with more pain at the attachment of the Achilles to the heel bone rather than the mid section. It's management is quite different from mid Achilles tendinopathy - for example it is often aggravated by stretching or "heel drops". We will tackle insertional Achilles tendinopathy in a separate article.

The other condition that can be misdiagnosed as Achilles Tendinopathy is Posterior Tibial Tendon Dysfunction (PTTD). The pain tends to be more on the inside of the Achilles tendon and the Achilles won't be sore when you pinch it. A lot of the treatment principles are similar though so you might find the treatment you would use for the Achilles will work for PTTD.

Managing a reactive Achilles tendinopathy

Generally speaking if you have acute mid achilles pain after an increase or change in training it's likely you have a reactive tendinopathy. Your inital aim is simply to calm it down and settle symptoms. The most important treatment is simply load management. Reduce the stress on the achilles to a level that the tendon can manage and the tendon may settle in as little as 5-10 days. For mild cases you may be able to continue some running as long as you're able to keep it pain free. Bare in mind though that a tendon may take 24 hours to respond to load so may not hurt until the next day. If you can't find a way to run pain free then it's usually sensible to rest for a few days until you can. Other treatments may also settle symptoms;
Anti-inflammatory medication - ibuprofen has been recommended for reactive tendinopathy. Although there may not be inflammation present it can help reduce the tendon's reactive response and decrease tendon swelling. As with any medication consult your GP or pharmacist first.Isometric calf exercises - in standing slowly push up onto your toes on both feet, use support if needed. Hold this position for around 5-10 seconds. Slowly lower again. Start with around 5 reps and gradually build up to 10. As you progress try to place more of your body weight on the weaker leg during the 'hold' part of this exercise. In too painful pushing up or coming down do this part with more weight on the weaker leg.Ice - for maximum of 15 minutes at a time to reduce pain - see our article on ice application.Offload the tendon with a gel heel raise in your shoe all the time, not just for running. They're easily available online or from shoe shops, the idea is to use it as a temporary measure when things are sore in the early stagesOffload the tendon with kinesiology tape (details below). Again the aim is to reduce load on the tendon in the early stages, we mentioned above that this can be used when running but, like the heel raise, you may need to use it when walking if things are very sore. Long term though you want to wean off it as you gradually increase the load on the tendon.Massage or foam roller the calf muscle to reduce tightness. Avoid massaging the tendon itself if it's sore.See a Physio for acupuncture or ultrasound? The jury is out on this, if you've responded well to ultrasound or acupuncture in the past it may be an option for you. Personally I would try the methods mentioned above and consider these two if the others don't work.
Yep. That there is my skinny little ankle!


Once symptoms have settled ensure your return to running is gradual and follow the guidance of your health professional. Tendons are sensitive to load for some time after a reactive tendinopathy and can react painfully again if you increase mileage too rapidly. Make sure you explore the causes of your tendinopathy to prevent recurrence or progression to a more degenerate tendon.

Managing a degenerative Achilles tendinopathy


If you're an older athlete and have had a grumbling tendon for some time with periods of flare ups in your pain it's likely you have a more degenerate tendinopathy. Your Achilles may be chronically thickened with 'nodules' you can feel within the tendon. That said this condition is more of a scale from reactive, through into tendon dysrepair and then degeneration rather than a case of either a reactive or degenerate tendon. In fact a flare up in symptoms from a chronic tendon problem can be a reactive response from non-degenerate parts of the tendon. If you're in one of these flare ups then first settle symptoms with the advice in for reactive tendinopathy above.

There are aspects of degenerate tendinopathy that are irreversible. Some of the structural changes won't resolve with exercise. That said, symptoms may well improve even despite this. If you've had chronic Achilles' tendon problems it's likely you'll need an ongoing management plan to keep the symptoms under control.

Load management is an important part of degenerate tendinopathy - if you continue to overload the tendon it will remain painful and may potentially lead to severe degeneration or tendon rupture - see below for details of avoiding overload through training error.

Improve your tendon's ability to handle load - this can be achieved through eccentric loading and strength and conditioning work as well dealing with what has caused the initial problem.

The idea behind eccentric loading is that it actually helps to reverse some of the effects of a tendinopathy. The tendon seems to respond to this type of exercise by reorganising the structure of the tissue so that it's more capable of dealing with load. Excellent. The original research showed promising results and recent research suggests that this type of exercise is effective both in the short term and at 5 year follow up.



Taken from Alfredson et al 1998.

These "heel drops" involve pushing up onto the toes of both feet, then lower over the edge of a step on the weaker foot. The exercise is done with the knee straight and repeated with the knee flexed, so there are essentially 2 exercises. The original research recommends doing both with 3 sets of 15 reps of twice per day. However this isn't set in stone, Many people will need to start by doing the lowering part on both legs too as it may be too sore to work just the weaker leg. Also you may need to do lower reps and sets, for example starting with 3 sets of 5 on both legs and building up to 3 sets of 10 on both before progressing to onto 3 sets of 5 on just your weaker side. Be guided by your pain and gradually increase as able. Unlike many exercises it is usually ok to have some pain during eccentric loading. If you rate your pain out of 10, where 10 is the worse possible pain and 0 no pain, it shouldn't be more than 5.

Strengthening the calf muscles is also likely to help. With guidance from your health professional you can also progress to high load eccentric work, isometrics and plyometrics all of which can help to improve muscle and tendon function.

Causes of Achilles Tendinopathy

As with many running injuries establishing the cause is essential for recovery and prevention of recurrence. If you just focus on treating the pain then there is a risk the problem will come back once you run again. This is a challenging area of rehab and you may need guidance from a Physio for this. There are many factors that you can work on but I would recommend finding the key issue and focussing on that first. To watch a very detailed assessment of a runner and treatment of his Achilles issues check out this Running Times article here.

Usually the cause of Achilles tendinopathy is continually putting too much load on the tendon and not allowing enough time for the tendon to recover. Its not just about distance otherwise all marathon runners would have achilles issues which they don't. Several factors will lead to a runner putting more load on the Achilles than it can cope with;

Training error

The classic too much, too soon.

Research suggests that training error is involved in 60-80% of cases of runners with tendon problems.

A rapid increase in mileage doesn't allow the tendon time to adapt to deal with the load and as a result it starts to breakdown. Hill work also places greater stress on the Achilles and doing too much can also also cause this issue. Increasing speed, changing stride length and not having enough rest can also play a part. Commonly it's not just doing one of these things but a combination of a couple of factors that lead to a problem.

Solution

Stick to the usual recommendation of only increasing your weekly mileage by 10%. Be cautious when doing hill or speed work not to over do it. Work on just one training modality at a time. By this I mean if you're doing endurance work do just that. Don't try and do your long runs quickly in an attempt to improve fitness. Likewise with speed work these are not meant to be long workouts. Either work speed or endurance not both together. For long runs you should be comfortable and easily able to chat, it should be around 60-90 seconds per mile slower than your race pace.

You can use a recent race time to approximate speeds for each run using the Macmillan Calculator. I know people have mixed views on this but it just gives you a little guidance. RW's training schedules also include recommended paces so you can use those too.

What I've found is that sometimes you feel great running and you just want to go for it. Sometimes you worry that you've not ran any real distance at race pace and that anxiety makes you push yourself on the long run. I've done it myself, I ran a 20 miler at 7:27. My race pace for the marathon is around 7:15 (hopefully!). I felt great at the time, the last 3 miles I pushed close to 7:00 per mile. What's the problem then? It took my legs nearly 3 weeks to recover and I had to drop a few runs here and there to prevent injury. I've learned from it that training for a marathon is about the whole programme not each individual run.

Another part of this which is really important is have a rest day. I can't stress how important rest is for this condition. Research has shown that if you don't have at least 24 hours between each run that the tendon doesn't have enough time to rebuild new tissue. The balance between tissue synthesis and breakdown is lost and you have a greater amount of breakdown. That isn't to say you need a rest day between each run but if you can plan your running to prevent multiple consecutive days of running it will help. Some programmes "bracket" the long runs with rest days before and after, this makes sense to me. I sometimes wonder about the wisdom of a "recovery run" loading fatigued tissues the day after a long run.

For some simply amending any clear training errors may be enough to allow your Achilles to settle and for you to continue running. You may not even need specific rehab if your training was the sole cause. For others you may need to adjust your running to find a way to do it pain free. You can try offloading the tendon when you run using a gel heel raise or taping technique (details above). Try varying running surface, speed, distance, stride length or running form (aim for quiet, controlled running). Try and find a level that you can manage without pain during running or for 24-48 hours after.

What if you can't do this? If there is no way you can find to run pain free then I'm afraid you'll need to rest until you can and aim to settle your symptoms. It may take a few days or a couple of weeks depending on severity. During this time you can cross train following the same guidance as you're running - it should be pain free during and 24-48 hours after.

Continuing with the causes...

Biomechanics

Lots of potential causes here, they include leg length difference, over pronation, high foot arch and poor mobility in the foot and ankle. Running "form" plays a part here, in theory if a runner heel strikes and then the foot overpronates then this places "whipping action" on the Achilles.

Solution

This excellent piece of research recommends video gait analysis and provision of the correct footwear to support the foot, ankle and Achilles tendon. It's a long read but if you've got a spare 30 mins or so it covers everything from achilles tendon to stress fractures (man alive, I'm such a geek!).

So, if you haven't already, get a running shop or health professional to assess your gait. I would suggest that simply watching you run without the aid of slow mo video is probably not enough. A lot of running shops will assess you on a treadmill with slow mo video for free, but bare in mind their ultimate goal is to sell shoes. The only way to really find out if it's the right shoe for you is to run in it, some shops will give you a 30 day running trial with a money back guarantee which gives you the opportunity to properly test it out.

In theory a shoe with a higher heel drop (the difference in height between the heel and the middle of the shoe) should have less stress on the Achilles. I say in theory as there is very little research evidence to support this idea. Some shoes are designed to encourage you to mid foot strike and again in theory this should help. A stability or motion control shoe or orthotic insole to reduce overpronation should also help but again the evidence here is far from conclusive.

Poor movement control

Hand in hand with biomechanics comes movement control. If you have poor control of movement then that can lead to increase stress on the Achilles tendon. "Eccentric" control is often thought of as very important. This essentially means how well you control how a muscle lowers your body weight. Think of a squat, that's eccentric control of the quads (among other things). Each time your foot lands a host of muscles including the calf have to control the impact and utilise the force to propel you forward. The whole leg is involved at different levels so an issue at the hip or knee can affect the ankle and Achilles.

Solution

Identifying your own control issues isn't easy. A Physio assessment is certainly helpful here. There are a few things you can look at, see how easy each one is, how well you can control it and how it compares to your non-painful side (if you have one!).

Single leg balance - can you do this and keep the leg and trunk steady? What about with your eyes closed or on a pillow?

Single knee dip - your knee should move fluidly over your second toe without drifting in towards the other leg.

Calf raise - you should be able to do this with knee straight and knee bent. You should be able to lift the heel the same height off the ground on both sides and control lowering the heel too. Note; if you have pain this may well limit this test.

If you find a balance difference work on it. With control work the focus is on quality not quantity there is little point doing hundreds of wobbly single knee dips, it's better to do 5-10 controlled movements. Details here on assessing balance and movement control.

Muscle Strength/ Endurance

The main culprits here are usually the 2 calf muscles gastrocnemius and soleus. You can test the endurance of each by doing repeated single calf raises to fatigue. First though ensure that your pain has settled otherwise you can flare up your symptoms and it's unlikely the test will reveal much as pain will stop you before fatigue does.

Use a little support for balance and do repeated calf raise with the leg straight first with your good leg, then your weaker side. Count how many it takes to reach fatigue and note the effort needed. Repeat with the knee bent 30-40 degrees.

Solution

Once your symptoms are under control you can strengthen any weakness you've found. To improve endurance the recommended dosage is usually 15-25 reps (or to fatigue) 3 sets each separated by a rest period of 1-2 minutes. This can be done around 3 times a week with a rest day between. Of course this isn't set in stone, there are a host of different programmes recommended and you will need to stop if you get pain. More here on calf strengthening for runners.

Tissue Flexibility/ joint range of movement

It's important that the ankle has a full range of movement to prevent excessive stress on the Achilles. Ankle movement is a combination of 4 main directions - upwards (dorsiflexion) downwards (plantarflexion) inwards (inversion) and outwards (eversion). Compare your range of movement between both sides and again work on any deficit. Particularly important is dorsiflexion. When your foot hits the ground the ankle has to dorsiflex first, any loss in range can increase stress on the Achilles. Dorsiflexion range is commonly lost after ankle fracture or sprain or due to calf muscle tightness. Try stretching your gastroc and soleus, see if one side feels tighter. You can also do the knee to wall test and compare left and right.

Solution

Regularly stretch gastroc and soleus. Nice video from on stretches from RW here. Ensure the calf is stretched dynamically pre-run. Video of this coming soon, until then I like these dynamic calf stretches. If the ankle range of movement is restricted, some simple ankle range of movement exercises may be adequate to loosen it up.




Final summary: managing Achilles tendinopathy can be a challenge. First determine what stage of the condition you have as this will effect treatment. Load management is key at any stage and identifying the cause is important to prevent relapse. Eccentric loading and strength exercises can be useful in helping the tendon deal with load.

Many runners will try and self treat tendon problems but some guidance from a Physio can be really helpful. As with any condition on RunningPhysio if in doubt get it checked out!
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18 Mar 2014 



Bunions and Foot Pain - Symptoms, Causes and Treatments of Bunions and Foot Pain
In general terms, most people think of bunions as a painful bump on the side of their foot. This is true, in part.
It's a bit confusing, but the word bunion actually refers to three different medical conditions: soft tissue enlargement, hallux abducto valgus and metatarsus primus varus. All three of these problems usually occur together and are what most people think of as a typical "bunion."

Soft Tissue Enlargement Is Hallmark Sign of a BunionThe true definition of the word bunion,is an enlargement on the side of the foot near the base of the big toe (hallux). The enlargement is made up of a bursa (fluid-filled sac) under the skin. Technically, the term bunion is just the soft tissue enlargement that occurs.Take a look at more bunion photos.
Two Other Conditions Often Affect Bunions, Too
The soft tissue enlargement usually occurs because of two structural deformities in the foot bones, called "hallux abducto valgus" (HAV) and "metatarsus primus varus (MPV).

HAV is a fancy way of saying that your big toe (hallux) is rotated and leaning toward your other toes.Sometimes the deformity becomes really severe and the big toe can either sit on top or underneath your second toe.

The other condition, metatarsus primus varus, involves the first metatarsal becoming rotated and leaning too far toward your other foot.The hard bone you feel when you touch the bunion (the side of your big toe joint) is the head of the first metatarsal that has shifted out of position.

Bunions are much more common in women than in men.Some suggest this is due to the poor fitting shoes women wear.

Causes of "Bunions"Are shoes to blame? Yes and no. Research studies have shown that in countries where people do not wear shoes there are not as many bunions, but bunions are still found in some non-shoe wearing people.In countries where people do where shoes, there is a greater number of people who have bunions, but not everyone who wears shoes gets bunions.That means there must be other factors besides shoes that contribute to bunions.
Studies have shown that 63-68% of people who have bunions have a family history of bunions. So, heredity definitely plays a part.You do not inherit the bunions, but you inherit the foot type that may lead to bunions. Certain foot types cause the bones to change position and go out of alignment.This in turn allows the muscles and tendons to take advantage over other muscles and tendons and over time these changes may lead to bunions.Take a look at the feet of your grandparents, parents, aunts, uncles, sisters and brothers.There may be bunions in your family that you were not aware of.

Other possible causes of bunions:
Shoes (especially high-heeled shoes)Flat feet (pes planus) and pronation (foot rolls in) Metatarsus primus varus (first metatarsal bone rotates) Short or long first metatarsal bone Round first metatarsal head Hypermobility (excess motion) of the metatarsocuneiform joint Amputation of the second toe Neuromuscular disorders (cerebral palsy, poliomyelitis) Rheumatoid arthritis Contracture (shortening) of the achilles tendon Ruptured posterior tibialis tendon Ehlers-Danlos syndrome (hyperelasticity)
Signs & Symptoms of "Bunions"Bunions are usually termed mild, moderate or severe.Just because you have a bunion does not mean you have to have pain.There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Pain on the inside of your foot at the big toe joint (1st MTPJ)Swelling on the inside of your foot at the big toe joint Redness on the inside of your foot at the big toe joint Numbness or burning in the big toe (hallux) Decreased motion at the big toe joint Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint Pain while wearing shoes - especially shoes too narrow or with high heels Pain during activities Corn in between the big toe and second toe Callous formation on the side or bottom of the big toe or big toe joint Callous under the second toe joint (2nd MTPJ) Pain in the second toe joint
Diagnosis & Tests Your foot doctor (podiatrist) will ask you questions about the symptoms you are having while examining your foot.You will also probably be asked to stand and walk barefoot to further assess your foot function.The presence of a bunion is usually obvious, but sometimes there is more going on than just a bunion, so your podiatrist will usually take an x-ray.The podiatrist will measure angles between the bones to help determine the stage of the bunion.Bunions are usually termed mild, moderate or severe.It is considered normal if your big toe bends up to 15 degrees toward your second toe.If the angle is more than 15 degrees, then it is considered hallux valgus.Bunions can start out mild and progress to severe. There is no clear-cut way to predict if a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.
Go to the next page to read about treatment options for bunions.




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