The posterior tibial tendon is located on the inside of your ankle and plays a major role in supporting and maintaining the arch on the bottom of the foot. Due to the high demands of the tendon with every day life, it can result in overuse of the tendon. This overuse is referred to as posterior tibial tendon dysfunction. When this occurs, patients will eventually develop a flat foot deformity and loss of arch height due to the weakened tendon no longer being able to support the arch. This condition is commonly seen in middle-aged women. Those with diabetes also have an increased risk.
The major problem with posterior tibial dysfunction is that it is a progressive disorder. This means that it will get worse overtime. The initial symptoms of the condition are pain and tendonitis; however there is normally no decrease in strength of the tendon or loss of arch at this stage. As it worsens, the tendon will develop tears and the patient will eventually end up with a decrease in the arch height and a flat foot. With early diagnosis, the progression can normally be slowed, or halted, through the use of orthotics, bracing, immobilization and physical therapy. If the dysfunction is left untreated, or progresses, then it may eventually have to be treated with surgical intervention.
–Dr. Colleen Law
A pump bump also known as a Haglund’s deformity is another source of heel pain. Opposed to plantar fasciitis where the pain is on the bottom of the heel, a Haglund’s deformity is a type of spur on the back of the heel, which results in pain. This pain can also be associated with some Achilles tendonitis and bursitis as well. While the exact cause is not confirmed, some thoughts on how a Haglund’s deformity is formed is through differences in people’s anatomy and biomechanical causes. It is also thought that those with higher arches may be more prone to them. Haglund’s deformities can occur in all ages, but are more common in the younger and middle-aged population. So why is a Haglund’s deformity also known as a pump bump? This is because one of the major sources of pain is from the spur rubbing on the back of your shoe and the spurs are located right where the back of high heel shoes would rub, hence the name pump bump.
Haglund’s deformities can be seen on x-ray. In addition, most people can generally feel the bump on the back of their heel. Conservative treatment is generally rest with anti-inflammatories. If the patient is able to wear backless shoes, this can also help decrease the irritation of the heel. For those who have associated Achilles tendonitis and/or bursitis physical therapy can be a good option. If conservative options fail over a few months, then surgical options to remove the spur can be discussed.
–Dr. Colleen Law
Stress fractures differ from regular fractures in that they are cracks in the bone opposed to a complete break through the bone. Stress fractures are very common in the foot and lower extremity due to the mechanical load from our bodies. In the foot they are most commonly seen in the second and third metatarsals. Overuse and repetitive forces cause stress fractures. This overuse can be from a runner who increases their mileage too quickly or from any increase in activity or change in activity.
People who suffer from stress fractures generally have pain in a very specific spot on their foot, ankle, or leg. Diagnosis can be a little tricky in that stress fractures are not seen right away on x-rays. This takes a couple of weeks to visualize and by the time it is seen on x-ray, the stress fracture has already started to heal. The healing of the stress fracture seen on x-ray is called callus formation. To get more of a definitive diagnosis of a stress fracture right away your doctor can order an MRI or bone scan.
Treatment for stress fractures is rest. If a patient was to continue their increased activity while having a stress fracture this could result in a complete fracture and would increase the recovery time. Sometimes your doctor may put you in a surgical shoe or walking boot in order to decrease the stress. Ice and elevation are also important for the recovery process. For those who wish to keep their conditioning up while recovering from a stress fracture, aqua jogging and swimming can be good options.
–Dr. Colleen Law
If your child or adolescent develops heel pain, chances are it’s due to Sever disease, which is also known as calcaneal apophysitis. Sever disease is one of the most common sources of heel pain in adolescents and most commonly affects children between the age of 6-13 who are active and involved in sports. Sever is an irritation or inflammation of the heel bone growth plate which is a result of the heel bone growing faster than the surrounding muscles and tendons. Along with repetitive microtrauma, these tight tissues cause increased pull on the growth plate, which results in pain. It is commonly seen in soccer players. Traditionally Sever used to be more common in boys; however, due to the increasing number of girls involved in organized sports, it is becoming more common in the female population.
Sever disease will eventually resolve on its own without any long-term complications. All treatments are symptom based and some children may have to decrease or take off some time from sports until the pain goes away. In some severe cases, children may have to be immobilized in a walking boot for a couple of weeks until the pain subsides. Sever patients commonly have a tight Achilles tendon, so stretching exercises are very important to help try to decrease some of the pull on the growth plate. Anti-inflammatories and ice are also recommended. Return to activity is based on relief of symptoms and should be done gradually. When returning to play, gel heel cups can be used in the cleats or sneakers in order to help provide some cushion.
—Dr. Colleen Law
Lateral ankle sprains are the most common type of ankle sprains. These sprains happen after an inversion injury or inward rolling of your foot on your ankle and affect the ligaments on the outside of your ankle. They most commonly occur in sports, especially seen in basketball and football, but also can occur in everyday activity. The lateral ankle is composed of three major ligaments, the anterior talofibular ligament (ATFL), the calcaneal fibular ligament (CFL), and the posterior talofibular ligament (PTFL). There are varying degrees of severity of ankle sprains, but the most commonly injured ligament is the ATFL.
Certain people are more prone to ankle sprains than others, especially those with a higher arch foot or those who have had a severe or multiple sprains in the past. It is normal after suffering from a sprain to have varying levels of swelling and bruising. The most important thing following a sprain is over the first 24-72 hours to practice the pneumonic RICE. RICE stands for rest, ice, compression, and elevation. Studies also show that initiation of early range of motion is key in the recovery process. Once the swelling goes down, then strengthening of the muscles around the ankle joint should be initiated to help prevent chronic ankle instability. Taping, bracing, and balancing exercises also can help in preventing re-injury. Most people start to feel better after a sprain over a couple of days, but in the case of severe sprains this could take several weeks to recover. If you develop a sprain that is not improving over a couple days, especially if you have followed the pneumonic RICE, then make sure you schedule an appointment with your doctor.
-Dr. Colleen Law
If you begin to develop a nagging pain without significant change in your mileage or training, you must consider your shoe gear. Running shoes typically are good for about 300-500 miles depending on running surfaces, experience, and size of the runner. These first few signs of a nagging pain is usually a way of your body telling you that you need a new pair of sneakers.
Another important way to prevent injuries when it comes to running shoes is to find a type of shoe that is most compatible with your foot structure. Everyone’s feet are different so a type of shoe that works well for your friend, may not work as well for you. People who have a flatter arch and overpronate need more of a motion controlled stability type shoe, whereas those who have a high arch and underpronate do better with more cushioned and neutral type shoe. Especially if you are new runner, I would recommend going to your local running store to help you find a pair of sneakers. These stores typically have experienced runners who will evaluate your foot type as well as running goals to help find you a shoe that would work the best for you. Once getting your new sneakers, make sure you take a couple of days walking around in them prior to running in order to help break them in. Also, another good tip is to buy two pairs at once and alternate running in them every other day in order to slow down the wear of an individual pair.
-Dr. Colleen Law
I am very excited to be joining Dr. Murray, Dr. Chang, Dr. Baglio, and Dr. Schustek and the rest of the team at Blue Ridge Foot and Ankle Clinic in July! I graduated from Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania and completed my residency at St. Luke’s University Health Network in Allentown, Pennsylvania. While at St. Luke’s, I had experience training in both the inpatient and outpatient setting, as well surgical training in elective and non-elective foot and ankle surgery, and experience with wound care and diabetic limb salvage.
I am interested in treating a variety of different pathologies in the foot and ankle, but one area that I am particularly interested in is sports medicine. In college, I competed on the cross country and track teams at Lehigh University. After suffering from a foot injury, which required surgery during my freshman year, I was introduced to the field of podiatry. I really like that I can relate my love for running with my job as a podiatrist and understand what it is like recovering from an injury and returning to activity.
In my free time I like to spend time with my husband Matt and viszla, Zoey. We enjoy running and other outdoor activities and look forward to getting involved with the Charlottesville community.
I am really excited about the move to the Charlottesville area and am eager to start meeting and working with patients in July!
-Dr. Colleen Law
The frequent rising on the toes of an aerobics routine often creates pain and tightness in the large muscles in the back of the legs, which can create pain and tightness in the calf and inflammation in the Achilles tendon. Again, stretching the calf muscles gently and gradually before and after the workout will ordinarily help alleviate the pain and stiffness.
Aside from ankle sprains, shins splints are perhaps the most common injury to the lower body, as the muscles attached to the shin bone bring the foot up and down. The pain is usually an inflammation of the shin muscle and tendon due to stress fractures. Treat shin pain with cold compress immediately after a workout to reduce inflammation. Proper stretching before the workout should prevent the onset of shin splints. Strengthening of muscles also helps reduce shin splints.
What is Sesamoiditis?
Sesamoids are sometimes referred to as the ball bearings of the foot. They are a set of accessory bones found beneath the large first metatarsal bone. Incredible forces are exerted on the sesamoid bones during aerobics, and inflammation and fractures can occur. Proper shoe selection and custom orthotic devices can be useful in treating sesamoiditis.