Common Injuries & Ailments

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Erick Nelson
5 years ago
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2 Common Injuries & Ailments

3 Basic Understanding Tendonitis/ Soft tissue injuries Tendonitis is an inflammation of a tendon. It typically has a pattern of pain when it s cool, improves when it warms up, feels bad again when it cools down. As it progresses, pain may occur during activity even when it s warmed up. This is typical of any soft tissue injury. Bone Constantly breaking down and remodeling in a 6 week cycle. Chronic tightness of a tendon can contribute to bone spur development

4 Hallux Valgus - Bunions What is it? A subluxation of the 1 st MPJ with a deviation of the great toe towards the second with an enlargement of the medial first metatarsal head. Causes: Excessive pronation and narrow footwear. Higher incidence amongst women than men. Hereditary factors are listed in some literature. Symptoms: Reddened skin over the base of the great toe. Pain over the joint where the great toe joins the foot (MPJ) Effect on Gait: Degraded toe off, excessive pronation due to 1 st ray instability. Subluxation: Incomplete Dislocation of

5 Hallux Valgus - Bunions Solutions If caused by overpronation, stability or motion control shoe/insert. Educate on proper non-running footwear choices and preaccommodation for a bunion. Calluses may be trimmed. Icing may help bursitis and pain symptoms (Surgery is above our pay grade)

6 Hallux Limitus / Rigidus What is it? Limitus is diminished motion in the first MPJ (Metatarsal Phalangeal Joint). Rigidus is a continuation. Ideal ROM at MPJ at toe off is degrees. In overpronated foot it is more like 30 degrees or less. Symptoms Great toe pain and stiffness Abnormal gait. Toe off must come from a different part of the foot.

7 Hallux Limitus / Rigidus Solutions: Over the counter foot orthotic, custom orthotic for more severe conditions. Metatarsal bar reduces pressure Rocker Bottom For severe cases shoe modification done only be certified professionals excavation.

8 Hammer Toe / Mallet Toe What is it? Crooked, bent or buckled toes causing joints to protrude. Hammer Toe: Generally found on the second toe, it is a contracture of the MPJ with a dorsiflexed proximal phalanges and a plantarflexed medial phalanges. Mallet Toe: The tip of the toe (distal phalanges) is turned downward (plantarflexed). Causes: Imbalance of intrinsic and extrinsic muscles, hereditary factors, excessive pronation, poorly fitted shoes, and bunions.

9 Hammer Toe / Mallet Toe Symptoms: Often asymptomatic but calluses or corns can develop and be painful. Solutions: Calluses can be trimmed. Corn pads and removal of corns can reduce irritation. If caused by overpronation, a stability or motion control shoe/insert may be helpful. Shoe with a wide toe box and well placed overlays

10 Hammer Toe / Mallet Toe Hammer Toe Mallet Toe

11 Metatarsalgia What is it? Literally means pain in the metatarsals. Causes: Several possible causes. Some include; forefoot running, excessive training, hammer toes, flat feet, high arch, over pronation, and a decreased transverse arch. Symptoms: Pain or tenderness on the plantar aspect of the foot in the metatarsal area generally in the 2 nd, 3 rd, or 4 th MPJ. Possible burning, tingling or loss of sensation (Morton s Neuroma)

12 Metatarsalgia Solutions: Adequate space in the toe box of the shoe. Metatarsal pad to lift and separate affected MPJ Forefoot shock absorption Proper shoe fit flex-points Orthotic

13 Plantar Fasciitis What is it? Plantar fasciitis is the most common injury occurring at the hind foot. An irritation and swelling of the fascia on the plantar aspect of the foot. Pain generally located at the posterior and medial aspect of heel. Causes Plantar fasciitis can be found in both rigid and hyper mobile feet. With excessive pronation the plantar fascia is overstretched as the medial longitudinal arch collapses. In a rigid foot, the calf muscles might be tight, limiting the dorsiflexion and putting more strain on the fascia as the foot moves into toe off.

14 Plantar Fasciitis Causes Other contributors are obesity, sudden weight gain, shoes with poor cushioning or support, occupations with prolonged standing/walking and a sudden increase in activity intensity, time or type.

15 Plantar Fasciitis Symptoms: Burning pain at the attachment of the plantar fascia on the heel. Pain is usually worse in the morning and with push off. May develop into a heel spur if chronic. Solutions If caused by excessive pronation, suggest a stability or motion control shoe along with an orthotic insert. Heel cups may relieve pain symptoms. Suggest stretching for tight calf muscles. Icing, massage, taping. Strassburg Sock

16 Achilles Tendinitis What is it? Inflammation of the attachment of the calf muscles on the calcaneus. Causes Overpronation, improper training techniques, changes in running surfaces Symptoms Pain and tenderness at the attachment site at the heel. Pre-activity pain and morning stiffness with a decrease in symptoms as the tendon warms up. May develop into a heel spur if chronic.

17 Achilles Tendinitis Solutions If caused by overpronation, consider a stability or motion control shoe/insert 1 2 week heel lift Calf stretches Icing Massage of tendon Educate on proper training techniques

18 Post Tibial Tendinitis What is it? Irritation and inflammation of the tibialis posterior tendon. Cause can be overpronation which overstretches the tendon.

19 Post Tibial Tendinitis Symptoms Pain behind the medial malleolus, possibly radiating down to the medial aspect of the foot Solutions Correct footwear Over the counter or custom made orthotic to control overpronation

20 Patellar Tendinitis What is it? Irritation and inflammation of the patellar tendon which is the common quadriceps tendon attaching on the tibia Causes: Overpronation Overuse Strength imbalances of the quadricep muscles

21 Patellar Tendinitis

22 Patellar Tendinitis Symptoms Pain just below the patella Improves after warming up, worse after sitting down or inactivity Solutions If caused by overpronation, consider stability shoes/inserts Try patella tendon strap Consider referral to physical therapist for further evaluation

23 Shin Splints What is it? Anterior-lateral and posteriormedial Catchall term for overuse problems affecting the legs Anterior-lateral is overuse of the dorsiflexor muscles including the tibialis anterior Posterior-medial, also called medial tibial stress syndrome effects the tibialis posterior muscle and soleus Causes Sudden changes in running surface, distance, speed may all contribute to the development of shin splints.

24 Shin Splints Causes Anterior-lateral and posteriormedial A major factor for the posterior shin splints is overpronation. The tibialis posterior controls pronation and is excessively stretched during overpronation. Anterior shin splints may be caused by weakness in the anterior tibialis muscle and tightness in the calf muscles. Symptoms Pain typically at the start of activity and then decreasing as the muscles warm up. Pain typically reoccurs after the activity is done. Point tenderness along the affected muscles.

25 Shin Splints Solutions Anterior-lateral and posteriormedial Education on proper training techniques and when to switch shoes out ( anterior/lateral ) If caused by excessive pronation, consider a stability or motion control shoe/insert ( posterior/medial ) Icing, friction massage. Physical Therapist may suggest strengthening exercises.

26 Iliotibial Band Syndrome What is it? The ITB is a broad band extending from the Tensor fascia latae and gluteus muscles in The hip to the lateral side of the proximal tibia. The ITB is though to be a hip and knee stabilizer. Excessive tensile stress on the ITB will create Friction between the band and the lateral aspect of the femoral epicondyle as it crosses over it.

27 Iliotibial Band Syndrome Causes Poor training techniques Large Q angle Sacroiliac joint dysfunction Genu valgum ( knock kneed) Leg length discrepancies Strength imbalances in the hip inductors Overpronation

28 Iliotibial Band Syndrome Symptoms Prominent area of pain is the lateral side of the knee. Initially pain may only be present when running. As the syndrome progresses, pain may be felt when not running. Solutions If caused by excessive pronation, consider a stability or motion control shoe/insert. Stretching, icing, and massage of ITB may be helpful. Consider the Stick or foam rollers for self-massage. Consider ITB Strap. Orthopedists and Physical Therapists typically check leg length, strength, and sacroiliac joint dysfunction.

29 Chondromalacia Patella Patellar tracking dysfunction What is it? Chondromalacia patella is a degeneration of the cartilage located on the underside of the patella caused by excessive compressive forces or by improper patella tracking. Causes As the knee flexes and extends, the patella glides inferiorly and superiorly. If the patella is not tracking correctly, the cartilage will degenerate as it is irritated by the medial femoral condyle.

30 Chondromalacia Patella Patellar tracking dysfunction Causes There are several potential reasons for poor patella tracking including: Weakness in he medial aspect of the quadriceps muscle. A large or small Q angle Excessive pronation alters tibial rotation affecting tracking of the patella.

31 Chondromalacia Patella Patellar tracking dysfunction Symptoms Mild swelling, pain or aching after sitting Limp Grinding or clicking sound Buckling or locking sensation in the knee Can be asymptomatic

32 Chondromalacia Patella Patellar tracking dysfunction Solutions Treatment depends upon the cause. If caused by overpronation consider a stability or motion control shoe/insert. If the customer does not appear to have poor foot biomechanics or their condition has not improved with a change of shoes and an insert, refer to an orthopedist or physical therapist for a more thorough evaluation.

33 What is it? Diabetes Failure of the body to use carbohydrates and sugars properly. Pancreas doesn t secret enough of the enzyme insulin to metabolize sugar in the diet. Type 1 starts in childhood, Type 2 is adult onset.

34 Diabetes Symptoms Frequent urination, excessive thirst and hunger Three common complications Nephropathy- destruction of kidney tissue Retinopathy destruction of the retina of the eye Neuropathy destruction of the peripheral nerves, leading to sensory loss. Especially in extremities.

35 Diabetic sensory neuropathy Usually in extremities Diabetes Can range from tingling, burning, numbness to complete loss of sensation (usually in the feet) Combination of loss of sensation, impaired resistance to infection and impaired wound healing sets diabetics up for ulceration of skin and underlying tissue

36 FIT Process for footwear Diabetes Right stability to reduce stress on tissue Right size and width Breathable mesh with few overlays - seamless Give feedback on any lesions, skin breakdown, toenail issues you see on the feet. Refer to health care provider if necessary Medicare approved products Brooks Addiction

37 Insoles Diabetes Consider stabilizing insoles to reduce stress on tissue May have diabetic insoles to reduce pressure points Socks Wicking quality, proper fitting, seamless, no constricting bands

Common Foot and Ankle Conditions: How Can You Find Relief?

Common Foot and Ankle Conditions: How Can You Find Relief? Your Feet and Ankles are Workhorses They bear a lot of weight They perform various movements Common Conditions That Cause Foot/Ankle Pain Plantar