Tibialis posterior tendonitis most often occurs as a result of degenerative changes in the tendon. It occurs most often in overweight, middle-aged people. The tendon can rupture partially or completely with pain below or behind the inner ankle bone (medial malleolus). A flattened arch is oftentimes noted as well. Physical therapy treatment, orthoses, and surgical debridement of the tendon are common treatments for this condition.
Plantar fasciitis is inflammation of the covering (fascia) on the bottom of the foot and is one of the most common causes of heel pain. There are many causes of plantar fasciitis including, but not limited to, poor flexibility of the calf muscle, lack of arch support, sudden increase in activity level, poor footwear, excess weight, excessive pronation, or repetitive stress (such as during running). Pain is typically noted over the heel area and can also extend throughout the arch of the foot. Ultimately, there is micro-tearing of the plantar fascia at its attachment on the base of the heel bone. Pain from plantar fasciitis is often worse in the morning when taking the first steps out of bed since the fascia tends to shorten during sleep. If the plantar fasciitis is chronic, a bone spur may even appear on X-Ray. It is now thought that a bone spur occurs as a result of the body’s healing process instead of the source of the pain.
Stress fractures result from repetitive loads through the foot, ankle, leg which are typically the result of overuse. They are very common in runners and female athletes. Common areas for a stress fracture to occur are the lower leg and metatarsals in runners, calcaneus, talus, and the big toe. Signs and symptoms include pain and point tenderness as well as relief with rest. X-Rays do not always show a stress fracture and MRI’s and bone scans can be helpful in their determination. Most stress fractures heal with rest, immobilization, and activity modification (such as cross-training). Wearing good shoes and avoiding high-impact workouts can help the healing process also.
Fractures can occur over the outside or inside of the leg. Signs and symptoms include pain, swelling, and bony deformities. An X-Ray is required, and “setting” the bone (a reduction) is necessary for healing. At times, an open reduction surgery is needed with use of plates and screws to stabilize the fracture.
The Achilles tendon attaches the calf muscle to the heel and helps raise the heel off the ground. Achilles tendonitis is an acute injury due to a quick stretch or tearing of the tendon fibers during activities. Achilles tendinosis is more of a chronic condition due to excessive stress, microtrauma, and degeneration to the tendon. Activities that can cause this condition include prolonged walking, excessive running, excessive jumping, or walking hills. Treatment often consists of rest, non-steroidal anti-inflammatories, ice, stretching, strengthening, and gradual return to activities.
An ankle sprain is a very common injury which usually occurs when the foot is turned forcefully in or out. There are three grades for a lateral ankle sprain – Grade 1 is a minor tear, Grade 2 is partial tear, and Grade 3 is a complete tear. Signs and symptoms include lateral ankle pain, swelling, and instability. X-Ray may be perform to rule out any fracture. Treatment of an acute ankle sprain includes rest, ice, compression, elevation, and bracing. Early rehabilitation greatly assists in a rapid recovery. Surgery is indicated only after repeated sprained ankle with significant ligament damage.