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Common Disorders
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- Foot & ankle
© Donald Budge 2001
FOOT AND ANKLE
FLAT FOOT (Pes Plano-Valgus):
Flat foot is the collapse of the medial longitudinal arch of the foot, combined with eversion. Almost everyone is born with flat feet. The arches form gradually as supportive ligaments and muscles in the foot develop. They are not fully developed until the age of six. The arches provide a stable "springy" base for the body. However, age, overweight, and bad posture can result in muscle weakness and stretching of the many ligaments supporting the bones forming the arches. Pain is normally felt on the inside of the foot and increases when the patient weight bears. However in some cases, when the subject attempts to compensate their gait or posture, pain may also occur in other areas including the calf, front of the leg, knee, hip or even in the lumbar region. Treatment will consist of toning and strengthening all the muscles supporting the arches, combined with exercises and joint mobilisation. Arch supports in the shoes will also assist.
BUNIONS
Bunions describe the formation of a thickened, fluid filled bursa (pad) overlying the "big toe" joint. The underlying cause is referred to as Hallux Valgus, in which the joint of the base of the big toe projects outward while the toe itself faces inwards. The condition is often inherited and tends not to give a problem until middle age. The condition is also aggravated by badly shaped shoes or too short tights. Arthritic conditions can develop. Treatment will come in the form of massage, mobilisation, exercises, properly fitting shoes, splints, or in more severe cases, surgery.
MORTON'S DESEASE (Metatarsalgia)
Refers to pain in the underside of the front of the foot and is usually caused by a collapse of the transverse arch or a displacement/fracture of one of the "metatarsal" bones forming the transverse (across the foot) arch. It is more common in middle aged women, probably due to the wearing of high heeled, fashionable shoes. Pain may be dull and aching, intermittent and excruciating, radiating through the foot and/or calf. The affected area is acutely painful with pressure. Calluses may form on the underside of the foot. Treatment is similar to that for flat feet.
HEEL SPUR (Plantar Fasciitis)
A condition known as heel spur is common with runners and people with a stretched or torn plantar fascia which forms the "longitudinal arch ligament". Pain is felt where this "ligament" (aponeurosis) attaches to the underside of the heel bone. At this point a bone growth or "spur" grows and when weight is applied, pain occurs. Treatment aims to stop the constant pulling on the heel, so rest is important. Changing footwear with padding and also stretching the calf muscles will assist relief.
SHIN SPLINTS
A condition characterized by pain in the front and sides of the lower leg that develops or worsens during excercise. It also covers conditions resulting from stress fractures to overuse of the tibialis posterior muscle with resultant tendinitis. Tibialis anterior assists with maintaining the medial longitudinal arch. The muscle will become strained if overused by a runner with a pronated foot. Pain may not come on until 2-3 hours after exercising, it is painful to touch and is relieved by rest and ice in the acute phase and massage thereafter. The condition often occurs when a sportsman increases his training or changes his shoes or running surfaces.
VARICOSE VEINS
Refers to enlarged, tortuous, or twisted superficial veins, common in the legs. The condition may be hereditary or caused by long periods of standing. The veins dilate and lenghthen, become twisted and the valves are drawn apart and become incompetent. The damaged veins allow regurgitation, the volume of blood increases which further dilates the veins, drawing the valve cusps further apart. Thrombosis may then occur. The condition can cause pain, aching and fatigue in the legs with cramp in the thighs if the veins lie deeply. Treatment involves the wearing of support stockings, use of essential oils, sitting with feet up, rest and stress management. Massage should be light and aimed at improving circulation and relieve congestion. Deeper massage can be applied above and below the dilated veins. Treatment will also include walking and excercises.
ILIO-TIBIAL BAND SYNDROME
The Ilio-tibial band is a thick band of fibrous tissue stretching between the pelvis and the knee. Pain in this region is usually caused by problems in the feet. Excessive pronation will cause the ilio-tibial band to rub against the lateral condyle of the thigh bone. Stretching and frictioning will assist in treating this condition, however, it is recommended that disorders of the foot are corrected. The condition is common among long distance runners.