Podiatry Conditions

Lateral Ankle Sprain

The ankle joint comprises of Talus and the distal ends of the Tibia and Fibula. Stability of the lateral ankle complex is achieved by the structural alignment of the three bones forming the joint and also from the surrounding ligaments. There are three primary ligaments that provide stability to the lateral ankle:

• Anterior Talo-Fibular (ATFL)
• Calcaneo-Fibular Ligament (CFL)
• Posterior Talo-Fibular Ligament (PTFL)

These ligament allow a certain range of motion to occur at the joint however when these ligament are stretched beyond their normal range of motion they become sprained. The extent of the sprain is classified or graded dependant upon the severity and symptoms:

• Grade I: Stretched ligaments causing pain and swelling. Patient can usually walk without crutches.
• Grade II: Partial tear if the ligament which causes pain, swelling and bruising. Patients usually have pain when walking and can only take a few steps unaided.
• Grade III: Complete tear of the ligament which causes pain, swelling, bruising and instability. Walking can be difficult and due to gravity the bruising may extend down the lateral border to the toes.

Treatment of lateral ankle sprain primarily depends upon the severity of the injury and can range from wearing a supportive brace, wearing a walking cast or even surgery in more complex and severe cases. In the acute phase PRICE (Protection, Rest, Ice, Compression, Elevation) guidelines should be followed to facilitate the healing process and to reduce swelling. Ice should be applied for around 20 minutes every 3-4 hours however the main benefits of using ice will be achieved in the initial 48 hours following injury. Once the patient is able to begin rehabilitation, exercises should be implemented to regain proprioception, balance, stability and strength. During this time the patient may be at increased risk of another lateral ankle sprain so the use of strapping tape or an ankle support may help reduce the risk and restore the patient’s confidence in the stability of their ankle.

Products associated with the treatment of lateral ankle sprain:

Kinesiology tape

Thermoskin Ankle Wrap

Wobble Boards

September Podiatry Topic

Corns

Corns can affect patients of all ages and to varying degrees but what are they and why do they occur and how can we prevent them or reduce their rate of development? Callus is a yellowish plaque of hard skin and a corn is an inverted cone of similar hard skin which is pushed into the skin (Neale's Disorders of the Foot, 2002).

According to Springett (1993) and McKay and Leigh (1991) excess mechanical stress and loading duration on tissues during gait damages the skin. This trauma stimulates the local release of growth factors which brings about rapid epidermal transit however there is insufficient time for keratinocytes to mature normally. Springett and Merriman (1995) recognised that this callused skin has an altered structure to that in normal skin and is subsequently less efficient at withstanding mechanical stresses therefore the problem of callus and corn formation perpetuates.

Types of Corn:

Hard Corns (Heloma Durum) appear over boney prominances and plantar metatarsal heads (Merriman et al, 1986).
Soft Corns (Heloma Molle) appear interdigitally.
Seed Corns (Heloma Miliare) appear typically on the margins of weight bearing areas.
Vascular and Neurovascular Corns appear on areas taking high load (particularly torsion).

Management of Corns

Successful management requires removal of the cause followed by treatment aimed at reducing pain and restoring normal skin function. Pads (such as semi compressed felt) can be used to reduce the duration of tissue loading and redistribute mechanical stresses and manage pain (Neale's Disorders of the Foot, 2002).

"Heel Fissures"

With the summer season in full swing you might see an increase in patients suffering from Heel Fissures. Commonly caused by dry skin (xerosis), and made more complicated if the skin around the rim of the heel is thick (callus), cracked heels are usually a cosmetic concern and can be treated with a file and cream rich in urea, however if this condition is causing a patient pain, bleeding, with the potential for infection, further treatment may be necessary.

Products that could be associated with the treatment of Heel Fissures include:
Diamond Deb Foot File - to reduce the callus.
Creams rich in urea - to break down the keratin chains in the skin so the callus cannot form.
Sanding discs that attach to the mandrels - to sand down the callus and reduce the risk of further fissures.
Gel heel cups - to reduce any associated pain due to the padding provided.

Treatment advice provided by Mobilis Rolyan in-house Podiatrist Daniel Broadhead MChS HPC:
Depending on the severity of the individuals display of Heel Fissures I might use a scalpel to reduce the hard skin and would file further cracks before applying a cream with a high urea content. The patient would then need to continue to use a foot file and apply cream regularly to ensure the Fissures do not build up again. This procedure must be carried out by a qualified practitioner and I stress should not be undertaken at home. Each patient needs to be assessed on an individual basis and treatment will vary depending on the patients condition.

"PLANTAR FASCIITIS"

Plantar Fasciitis is an inflammation of the plantar fascia. The Plantar Facia is a thick band of tissue on the bottom of the foot. It extends from the heel bone to the base of the toes. Plantar refers to the sole of the foot. Fascia describes thin, fibrous, supportive tissue. It is a common foot problem, and is different from heel spurs. A person may have both of these foot problems at the same time.

Signs & Symptoms

Pain and tenderness in the heel and sole of the foot under the heel bone.
Pain often occurs after resting or after rising in the morning. There may be no pain when sitting.
One or both feet can be affected.
It hurts worse when running faster or when weight is on the ball of the foot.

Risk increases with

People over age 40. Women more often than men.
Athletes who over train, wear improper shoes or fail to warm up.
Running, jumping or walking on hard surfaces.
Having flat feet or high arches.
Previous foot or ankle injury.
Wearing high heeled, poorly fitting, or worn-out shoes.
Being on the feet for many hours a day.
Overweight.

Products that could be associated in the treatment of Plantar Fasciitis include those listed in the right-hand panel of this page.

Mobilis Rolyan will be detailing a Podiatry related condition each month, if you would like to suggest a condition for us to mention that you think may benefit other foot health professionals please send to web.team@patterson-medical.com.

Any information given on this site should not replace seeking appropriate advice from a medical professional for any injury or medical condition, nor should it replace instructions given by a therapist or medical practitioner for any injury or medical condition.