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Episode 035 Foot and ankle part 3

Episode 035 Foot and ankle part 3

By Jurmaine Health

For those who are fond of high heels, you must listen to this podcast! What activities can cause Achilles tendinitis? What does the hips have to do with a ‘broken’ ankle? Find out what the common injury is for women. What is toe-walking? Changes to the biomechanics of your body like arching back and forward knees – cause pain in the knees and lower back. The lower heels are kinder to your body than the higher heels.

JACKIE (01:50):
Achilles tendinitis is subdivided into two types. So you’ve got your non insertional meaning that the middle fibers that tend to degenerate with micro tears swell and thicken, and this is most often seen in the young and the active, and then you’ve got your insertional where the tendon attaches to the calcaneus, which often leads to bony heel spurs.

JACKIE (3:22):
A chronically tight plantar fascia can also lead to heel spurs, and it commonly does, as I mentioned in the previous episode, in both cases, the spur usually grows at the bottom of the calcaneus or heel, hence the name of a heel spur. So even the simplest of things such as walking can sometimes be painful, or even unbearable too when there’s large spurs present.

JACKIE (7:12):
The next condition we have is another overuse injury. But can you guess what else could cause it? That’s right, ill-fitting shoes again. Yes, I have a running theme in this episode, no pun intended. Metatarsals is a condition that affects the ball of your foot, your metatarsals. The name itself pretty much means pain of your metatarsals. So if you missed the episode on foot and ankle anatomy, your metatarsals are the five long bones that make up your mid foot.

Dr Jacqueline Swiatlowski is a qualified chiropractor with over 6 years of experience. She has worked in a range of different environments including roles within the allied health industry, professional sporting clubs as well as in her own private practice. With a Master of Clinical Chiropractic from RMIT University as well as a number of additional qualifications, including Active Release Technique (ART), Animal Flow and a Certificate III & IV in Fitness from the Australian Institute of Personal Trainers, Jacqueline is an expert in movement restoration and chiropractic care. In the past she has worked alongside local athletes, including players from the Western Eagles Soccer Club, Melbourne City Soccer Club and the Coburg Lions Football Club. In her role at Jurmaine Health, Jacqueline’s main focus is treating patients and looking after their health. “Jacqueline is also a TRE provider now and can offer TRE treatments to patients.”

Episode 035: Foot and ankle part 3

Podcast brought to you by Jurmaine Health

JACKIE [00:00]

This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We bring you topics on neuro psychology, neuro behavior, neuro musculoskeletal, neuro gastro, movement is well being, metabolism and microbiome, which are also some of the services that we provide.

So guys, in today's podcast, we'll wrap up the foot and ankle. So no pun intended here, as we won't be doing any foot binding today. But we'll finish up with a few more commonly seen injuries, most of which actually have a tendency to fade into each other. So once again, guys, it's a solid performance from me. So apologies for there being no reprieve from my voice from the entire legs of this episode. And with that, let's get started.

So to kick us off, we have Achilles tendinitis. So a quick anatomy refresher for those that missed the first episode of this foot and ankle series, it's the thickest and largest tendon in the body, and it's an extension of your calf muscles. So your gastrocnemius and your soleus and attaches to your calcaneus aka your heel bone. We talked about how theatrical it is when it ruptures in the previous episode, but in Achilles tendonitis can also be a precursor to a rupture. With Achilles tendonitis, the tendon most often nearest or at its attachment to the calcaneus is inflamed. It's usually an overuse injury that's common in sport with lots of jumping and or running, or in activities, I should say that require a lot of calf work, where the muscle is often in its shortened position in a plantar flexed position, so on your toes with the heel up off the ground, and over time, especially if it's left untreated, the tendon degenerates.

Achilles tendinitis is subdivided into two types. So you've got your non insertional meaning that the middle fibers that tend to degenerate with micro tears swell and thicken, and this is most often seen in the young and the active, and then you've got your insertional where the tendon attaches to the calcaneus, which often leads to bony heel spurs.

So insertional tendonitis can come on at any time and with anyone, but it's more often seen in people that are pretty much exposed to years of overuse the common symptoms of pain and swelling of the calf and Achilles, and this may extend into the foot if the heel spurs are present, or starting to form for that matter. There's increased pain and stiffness in the Achilles especially in the morning. There's increased pain during activity, and especially after activity or after exercise. It can be even worse the next day after you exercise rather than just directly after the exercise itself. And as we already mentioned, we've got the thickening of the tendon.

So simple modifications of activities, manual therapy, rest and a specific exercise program are often enough to resolve the issue. And then further patient education will help prevent it from recurring. So moving on to heel spurs since I just introduced them. So I mentioned that heel spurs may be the result of chronic Achilles tendonitis, or use or overuse of the Achilles tendon, they occur as a result of new bone being laid down in the area that the tendon attaches. Due to the tugging forces placed on the bone by the tight and shortened tendon, of course when it's being used.

A chronically tight plantar fascia can also lead to heel spurs, and it commonly does, as I mentioned in the previous episode, in both cases, the spur usually grows at the bottom of the calcaneus or heel, hence the name of a heel spur. So even the simplest of things such as walking can sometimes be painful, or even unbearable too when there's large spurs present.

As I said at the start of this, everything in this episode is linked, so too are the Achilles tendon and the plantar fascia through a continuous fascia connection that's pretty much localized around the calcaneus. So a fun fact for you guys, as we age this connection diminishes. So much so that in the elderly, very few fibers actually remain. So back to heel spurs themselves.

Once again, we've got pain and swelling in the foot and the heel may be seen with pain worse in the mornings and with activities. However, walking on hard surfaces and for longer distance may also be painful. We often see people that have had heel spurs that have been treated with cortisone injections for pain relief. However, more often than not, the initial culprits such as the tight calf muscles, the Achilles and the feet have often been left untreated.

So for the most part, heel spur flare ups can be controlled by avoiding aggravating factors and having their primary contributing culprits as I just mentioned, treated. However, in the cases of large heel spurs surgical intervention to remove the spur may be necessary, followed by an extensive rehabilitation program because as we learned in the previous episode, if rehab isn't done properly the integrity of the foot and ankle will remain minimal.

Okay, guys, I'm gonna take a slight detour now as for most, this may sound pretty true, but for us as clinicians, it can have real ramifications. So what I'm referring to now guys is bunions and bunionettes. So bunions affect your big toe, and bunionettes are the same structural formation, but they affect your little toe.

In both cases, there are painful bony bump at the respective joints that I just mentioned. They developed slowly, however, they can be progressive if they're not addressed, sometimes they are due to an inherited structural deformity, an arthritis or a previous injury to the joint. However, most commonly, they are due to ill-fitting shoes, which causes the toes to squeeze together. In advanced cases, the big toe can end up pushing up against the second toe, and the little toe can end up pushing up against the fourth toe, resulting in calluses between these toes due to the increased pressure on them.

Of course, these are easy to identify as there is a structural change visible. But one may also experience swelling, redness, or soreness around the mentioned toes, as well as restricted movement if arthritis is present, if the area is swollen, even wearing shoes may be painful as sheer contact increases pain.

And this is where we see real ramifications. Because what people don't realize is that when the bunion is having a flare up, as often, the pain is intermittent. They alter their gait. So they walk in pattern changes. And it's more often than not, it's a limp. And guess what your body is a kinetic chain. So any change in it, especially one that happens at your feet, will have ramifications all the way up.

So you know that hip pain that you're having may actually be a result of nontreated bunion. Of course, we are assuming we have a bunion here, and since I mentioned it's ill-fitting shoes that are often the biggest cause guess what can possibly be used to treat this or the best treatment option. No, that's right guys. Wearing good fitting shoes, not just shoes that are pretty, simple but effective.

The next condition we have is another overuse injury. But can you guess what else could cause it? That's right, ill-fitting shoes again. Yes, I have a running theme in this episode, no pun intended. Metatarsals is a condition that affects the ball of your foot, your metatarsals. The name itself pretty much means pain of your metatarsals. So if you missed the episode on foot and ankle anatomy, your metatarsals are the five long bones that make up your mid foot.

With the condition, pain, aching or burning in the ball of the foot may be experienced pain that's intensified with any activity. So this includes walking especially on hard surfaces, altered sensation in your toes, so we're talking tingling or numbness, or even feeling like you have a pebble in your shoe. As I said before, guys, it's an overuse injury. So as with most of today's episode, it's commonly seen in people that partake in lots of running and jumping sports. As we already know that the feet are the main shock absorbers in these, although uncommon, if left untreated and continued to be used, metatarsal injuries can lead to stress fractures because of the constant pressure on the bones.

Unfortunately sidelining I should say, the individual in a moonboot for much longer than it would have taken to change their shoes and decrease the demand that they were placing on their feet. So once again, a condition that can be easily addressed by simple modifications, but can have serious ramifications if not.

Guys I've got one more hot topic to cover today. And ladies, this one applies to you. Well, those of you that are fond of high heels that is so yes, I have high heels and their effects on our feet and body. I'm going to admit straight up that I'm most definitely am a heels person and have been known to wear fairly high stilettos. So I'm guilty of exposing my own body to these perils as well, so I just spoke about metatarsalgia, and bunions and ill-fitting shoes. Well, guess what our high heels fit into exactly these ill-fitting shoes category. Not only do they squeeze elf toes together, especially if your heels are those close pointy type, not mine. I like the open toes most often. These types predominantly expose them to bunions, but because of the toe walking position, they also place a lot of strain on our mid-foot and our forefoot exposing us to metatarsalgia.

Continuing on with the connections because of the toe walk position. No, okay, let's be anatomically correct, yeah, your plantar flexed position at the foot, ankle and leg is sustaining when wearing high heels. The Achilles tendon and plantar fascia can also become shortened, leading to again Achilles tendinitis and plantar fasciitis respectively. And of course, as with most foot and ankle conditions, wearing high heels has ramifications higher in the body as well, as it changes the center of gravity to a forward position, placing more strain on the knees.

Of course, to counterbalance this forward position, we have a tendency to arch our back to support ourselves that is, so we place more strain on our lower back. So again, we've got pain in the knees and pain in the back.

Guys, I have a fun fact to end on. Studies have shown that wearing high heels often leads to strengthening of the ankle muscles over the first one to three years of wearing. However, ladies don't get too excited as this changes after frequent wearing of high heels for four years or more.

Unfortunately for us, the ankles weaken, leading to decreased dynamic balance, increased likelihood of falls, and increased risk of ankle sprains. So the key take home message with heels is to try not to wear them too often and for too long. And the lower heels are kinder on our body than the high pretty ones are. Unfortunately, that's a big damn for me.

With that, I'm going to wrap this episode up as one I think you've had enough of my voice by now. And two, I've pretty much covered most of what we commonly see in the clinic relating to the foot and ankle in this series. If you missed the previous episode, guys go back and have a listen as it covers more of the common presentations that we see.

So guys, if you like what we're presenting, please give us a thumbs up a like or share it with one other person who you think we may be a help. For those of you who are coaches, dancers or athletes, and may find difficulty with expressing or executing movement patterns. Please do connect with us on our website, www.jurmainehealth.com.au and Jurmaine Health is spelled j u r m a i n e h e a l t h. Or please socialize with us on Facebook, which is Jurmaine Health or Instagram which is Jurmaine Health body. And last but not least, since this podcast is made for you, our clients, patients and fans, please do let us know what else you might like to hear about. Thanks for today guys. See you.

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