Your Body

Understanding the Foot and Ankle

Achilles Tendinopathy

The exact cause of Achilles tendinopathy is not fully understood, however it is agreed that a tendinopathy occurs when the tendon is unable to adapt to the strain being placed upon it.

The Achilles tendon is the link that joins the calf muscles (gastrocnemius and soleus) to the heel (calcaneus). When the calf muscle contracts to produces a pointing motion of the foot (tip toes if standing).

Achilles_Tendinopathy

The majority of problems in this area arise from overuse to the tendon as a result of increased duration demands or an increased intensity of training; most Achilles tendinopathies are normally associated with sports that involve running. The excessive repetitive overload of the tendon is regarded as its main pathological driver. This repetitive overload may cause the tendon to respond by inflammation of its sheath (surrounding connective tissue), degeneration of its body, or a combination of the two. Damage to the tendon can occur even when the stress to the tendon is within physiological limits; this can be by frequent cumulative microtrauma which does not leave enough time for the tendon to repair. The microtrauma can be as a result of abnormal load causing friction between its fibres that make up the tendon.

Other things apart from exercise that may affect the load on the tendon are:

  1. Gender (higher prevalence in men)
  2. Age ( common in middle age)
  3. Weight (high with increased body weight)
  4. Tight or weak calf muscles
  5. Poor endurance of calf muscles
  6. Poor control of hip and knee mechanics
  7. Joint stiffness of foot
  8. Diabetics have an increased risk to developing tendinopathy
  9. Poor footwear, lack of variation of training, and increasing training load too soon are all amongst other factors that may also have an adverse effect on the tendon health.

Investigations

Diagnosis can often be made on clinical examination alone, but other complementary investigations can help to confirm diagnosis (like imaging). The most popular modality used for imaging for this structure is ultra sound although MRI can also give an indication of pathology (this modality is more time consuming).

The exact cause of Achilles tendinopathy is not fully understood, however it is agreed that a tendinopathy occurs when the tendon is unable to adapt to the strain being placed upon it.

The Achilles tendon is the link that joins the calf muscles (gastrocnemius and soleus) to the heel (calcaneus). When the calf muscle contracts to produces a pointing motion of the foot (tip toes if standing).

 

Plantar Fasciitis

Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis is pain of the plantar fascia. Your plantar fascia is a thick, strong band of tissue on the underside of your foot which stretches from your heel bone to the base of your toes. Its main job is to support the arch of your foot and to act as a shock absorber for the foot.

 

What are the symptoms?

Pain is the main symptom. This can be anywhere under your foot. The pain is often worse first thing in the morning when you take your first steps or when you put your foot down after sitting. Being on your feet for a long time can also make the pain worse.

 

What causes plantar fasciitis?

Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause. The pain is most often where the plantar fascia attaches to the heel bone.

Often there is no clear cause for plantar fasciitis but there are some things that can contribute towards it.

  • Spending long periods of time on your feet, especially on a hard surface
  • Wearing shoes with poor cushioning and poor arch support.
  • Being overweight will put extra load on your feet
  • Having tight calf muscles.

 

What can I do to ease the pain?

Usually the pain will ease with time but you can help speed up recovery.

  • Wear supportive footwear such as trainers or walking shoes to support the foot and provide shock absorption.
  • Try gel heel cups to help shock absorption, or innersoles for support of the arch.
  • Lose weight to reduce the stress on the heel.
  • Stretching exercises for the plantar fascia and calf muscles have been shown to be very effective in easing the symptoms and speeding up recovery. 

Home Exercises – For best results repeat 4-5 times a day

 

Home Exercises1

Stand facing a wall. Put your toes up against the wall keeping your heel on the floor.

Bring your knee forwards and hold for 60 seconds.

Home Exercises2

Lean on a wall or chair with the leg to be stretched straight behind you and the other leg bent in front of you. The back foot MUST point directly forwards.

Lean your body forwards and down until you feel the stretching in the calf of the straight leg.

Hold for 60 seconds.

Home Exercises3

Sit on a chair. Cross the ankle over the other knee. Using your thumb massage across the plantar fascia and around the painful area firmly.

Do this for two minutes.

Home Exercises4

Sitting with your foot on a bottle (can be frozen), can or tennis ball.

Push down and roll backwards and forwards underneath the foot.

Repeat for 2 minutes.