Achilles tendon Pain and Tears:

What is the Achilles Tendon?

The Achilles tendon (or heel cord) is the thick strap that can be felt running down the back of the calf into the heel. It connects the large calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). When the Achilles tendon pulls on the heel, it makes us go up on tiptoe, or helps push us forward when walking or running. If this tendon is not working properly due to swelling or a tear, it can be painful, be difficult to walk, and make the ankle feel weak. 

How does it get injured?

Most Achilles tendon problems are overuse injuries but in a few cases, other medical conditions contribute to weakening or irritating it. These include either high-arched or flat feet since often the heel is out of alignment and this increase the stress on the tendon.

As we get older, the tendon becomes less flexible and less able to absorb the repeated stresses. In some people, this combination of overdoing activity on a less flexible tendon leads to small "degenerative" tears in the tendon fibres. The body will often try to repair these tears and sometimes this process is successful. Often however this process fails due to continued stress upon the tendon, setting up a continual cycle of pain, swelling and weakness. This is called tendinopathy but you may hear it called Achilles tendinitis or tendinosis in other information sources.

Sudden activation of the calf muscle such as during sprinting or playing racquet sports may put so much stress on the tendon that it tears completely, causing an Achilles tendon rupture.

How would I know if I had an Achilles tendon problem?

Tendinopathy develops gradually. The Achilles tendon and the heel become painful and a swelling may develop in or around the tendon. Initially, the problem may only be during activity, but as the condition worsens, symptoms will present during minimal activity and even when resting.

If you had a complete rupture, you would probably feel a sudden pain in your heel or calf. Some people say this feels as though they had been kicked in the back of the leg. Usually the heel area becomes painful, swollen and bruised, and it becomes difficult to walk.

Ankle arthritis

What is Ankle Arthritis?

A joint is made up of bone covered with cartilage and joined by ligaments. In Ankle arthritis this cartilage is severely damaged often leading to the underlying bone being exposed and damaged.  In the ankle joint this is most often due to previous injury or wear and tear (osteoarthritis), but can be due to rheumatoid arthritis.

This can cause PAIN, SWELLING and DIFFICULTY IN WALKING.

Big Toe Arthritis:

What is big toe arthritis?

Seen at the ball of the big toe, as a swelling and restriction of movement, it causes pain. As with any arthritis it is a condition wherein the cartilage is worn out and the bony surfaces of the metatarsal and phalynx come together resulting in the above symptoms.

Commonest causes are osteoarthritis and rheumatoid arthritis.

Bunion

Bunion is a deformity of the big toe, with a soft tissue or bony eminence on the inner aspect of your forefoot. One shall notice not only a bump on the inner aspect of the foot with friction and difficulty in fitting shoes. The big toe itself can sometimes be rotated and with progression the lesser toes could be affected too. Some people could notice callosity (hard skin) underneath the big toe or the 2nd toe. It could lead to pain, limitation of movement and difficulty in activities of daily living.

Although pointed shoes have been blamed by many, the cause of the bunion is due to an unequal strength of toe muscles across the joint. The actual cause of the same in majority is unknown, although it can be seen in people having rheumatoid or even post traumatic.

Forefoot pain (Metatarsalgia) & lesser toe deformities

What is metatarsalgia? 

Metatarsalgia is pain in the ball of the foot. It is usually felt in the sole of the foot and sometimes feels like "walking on pebbles". Other people feel a more diffuse vague pain, ache or burning. Some people have trouble around only one or two toes, others have it throughout one or both feet.

  • It is most commonly found in people who:
  • Have a bunion or arthritis in the big toe since this can weaken the big toe and throw extra stress onto the ball of the foot.
  • Are overweight.
  • Wear high-heeled shoes
  • Have certain foot shapes such as a high-arched "cavus" foot in which the bones in the front of the foot (metatarsals) point down into the sole to an excessive extent.
  • Have a longer than normal metatarsal bone which takes extra pressure.
  • Have clawed or hammer toes which press the metatarsals down towards the ground.
  • Have a stiff ankle which cannot be drawn up to right angles with the leg but points the foot down to the ground.

What are lesser toe deformities? 

The toes which are not your big toes are known as the lesser toes. They become deformed when more pressure is exerted on them than their joints can resist. When the muscles that control the toes become unbalanced, so that one set pulls harder than others, this causes the toes to bend further. In some people the tissues in the lower part of the joint at the base of the toe (metatarso-phalangeal joint) becomes weak, allowing the base of the toe to drift upwards which further unbalances it.

The deformity that results depends upon which joints are affected and the toe may either be called a:

  • Hammer toe.
  • Claw toe.
  • Mallet toe

What problems to lesser toe deformities cause?  

The main problem is that they tend to rub on shoes, either on top of the toe or at the tip, or both. This rubbing may simply be uncomfortable, or the skin may be rubbed raw. If the MTP joint is bent upwards, particularly if it is stiff, the toe may press down and cause pain in the ball of the foot. This is known as metatarsalgia which was previously discussed overleaf.

Bent toes may also rub on one another or on the big toe, especially if the big toe is bent towards the second toe (hallux valgus or bunion).

Flat foot

What are flat feet? 

this is known as the "arch" of the foot. The height of this arch varies from one person to another. Small children do not have an arch; it develops between the ages of 3 and 10. People who have a low arch,or no arch at all, are said to have ‘flat feet.’

What causes flat feet?

They may be entirely normal or relate to an underlying disorder. In cases where it is normal, flat feet may run in the family, have a similar appearance on both feet and remain reasonably supple. Rarely, it is caused when the foot formed in the womb; a joint may be malformed or two or more bones may be fused together. These feet are stiff and flat, and the problem is usually obvious in childhood.

Occasionally a flat foot develops later in adult life. This may be due to a ruptured tendon (the tibialis posterior tendon), ligament, arthritis or an injury causing stiffness and distortion of the joints of the foot.

Some people with diseases of the nervous system or muscles such as cerebral palsy, spina bifida or muscular dystrophy may develop flat feet because some of their muscles are weak and their muscles do not work well together. Their feet are usually stiff and the deformity tends to get worse with time.

What are the common symptoms? 

Most flat feet cause no symptoms. Some people get an ache in the arch, or around the ankle. Shoes may wear out quickly. If there is an underlying disorder that develops in adulthood, then the foot may change shape by becoming more flat and sometime the heel may not sit in the correct place.

When should I consult a healthcare professional? 

Most flat feet cause no trouble and do not need treatment. You may consider consulting your GP or other healthcare professional if:

  • Your feet cause you a lot of pain that is not helped by wearing well-fitted shoes.
  • Your shoes wear out very quickly.
  • Your foot or feet seem to be getting flatter.
  • Your feet seem very stiff.
  • You cannot feel your feet normally, or they seem weak.

Heel Pain

What causes heel pain? 

Pain in the heel can be caused by many things. The commonest cause is plantar fasciitis but other causes include:

  • Being overweight.
  • Being on your feet for long periods (especially on hard surfaces or wearing hard-soled footwear).
  • Thinning of the fat pad of the heel.
  • Irritation of the nerves around the heel.
  • Arthritis in the ankle or heel (subtalar) joint.
  • Fracture of the heel bone (calcaneum).

What is plantar fasciitis?

The heel absorbs the shock of your foot striking the ground during walking. It is connected to the front of the foot by a number of strong tissues with one of the strongest being the plantar fascia. In some people, this plantar fascia becomes painful and inflamed. This condition is called plantar fasciitis and usually happens where it is attached to the heel bone, although sometimes occurs in the mid-part of the foot.

There commonest cause is constant stress so it is therefore commoner in people who spend all day on their feet or are overweight. Other causes include:

  • Stiffness of the ankle or tightness of the Achilles tendon.
  • High-arched ("cavus") feet or flat feet since they are less able to absorb the stress of walking
  • After an injury to the heel.
  • Rheumatic conditions such as rheumatoid arthritis or ankylosing spondylitis since inflammation may occur where tendons attach to bone (enthesopathy), and plantar fascitis in these people is part of their general condition.

Is the pain related to a heel spur?

In some people, a spur forms on the heel bone near the inflamed plantar fascia attachment. Although they are commoner in people with plantar fasciitis, they are frequently found in people with no heel pain. As such, it is not believed that the heel spur is the cause of the pain and removal is rarely advocated.

Mortons Neuroma

What is it?

Usually occurring between your third and fourth toes, it is an inflamed and enlarged swelling within the nerve leading to pain. People describe it as sometimes mild to severe pain, often with shooting and burning kind of sensation. It could be aggravated by tight fitting shoes or hosiery or by trauma

Ingrowing toe nail

What is it?

Most commonly involving the great toe, it can be a very painful condition wherein the nail edges dig into the surrounding skin. It can turn red (inflamed), express pus (infection) or in severe cases lead to deformed nail too.