Plantar Fascia Tendinopathy

Planter Fascia Tendinopathy (previously called Planterfasciitis) is an over use syndrome to the Planta Fascia.  The Planta Fascia is a ligamentous structure on the sole of your foot that is responsible for maintaining your arch.   It helps to lock the foot so you have a solid base of support for push off.   When increased tensile or compressive forces are applied to this ligament it will develop tears that cause heel pain.

Causes: There are three main causes of Planta fascia Tendonopathy. A) A Pronatory foot type, or ‘flat foot’ will increase the distance between the attachment sites of the Planta Fascia and cause increased tensile forces. B) Decreased length of the Planta Fascia or of the calf muscles.  A shortened Planta Fascia will naturally have increased stresses, also tight calf muscles will restrict correct ankle movement during running and walking and increase the load through the Planta Fascia. C) Incorrect footwear; it is important to wear shoes that provide you with the correct arch support and enough cushioning.  Every foot is individual and some feet need less cushioning and more arch control (pronated feet), while others are ridged and need more cushioning (supinated feet) and minimal arch control.

Treatment: For correct treatment it is important to have your feet assessed by a trained professional to determine the cause of your pain.  In chronic cases it is common to need an orthotic insert to correct the foot biomechanics and unload the damaged Planta Fascia.  In acute cases or flare-ups ice should be applied immediately after exercise and rest from aggravating activities is recommended until the symptoms settle.

 

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral syndrome is pain caused by patella maltracking and is very common in younger athletes. PFPS normally causes pain in the front of the knee, although it can refer pain to the inside of the leg or behind the knee, particularly when going up or down stairs, squatting, kneeling or running. Contributing factors include overload and overuse, biomechanical problems at the knee or foot, and muscle weakness. Often it is a combination of these factors that contribute to the athlete’s pain. Incorrect footwear can also contribute to this condition as shoes with poor arch support or poor cushioning can predispose to PFPS.

Initial treatment consists of relative rest from aggravating activities and quadriceps stretching and strengthening exercises. If this does not reduce pain levels it is important to consult a physiotherapist who can assess biomechanics, muscle strength and running technique.

 

Osgood-Schlatter's disease

Osgood-Schlatter's is a traction injury at the growth plate at the tibial tuberosity. The tibial tuberosity is the bony prominence where the patella tendon connects the knee cap (patella) and the thigh muscles (quadriceps) to the shin bone (tibia).

The condition is caused by stress on the patellar tendon and is most common in 9-15 year olds where growth is at is fastest. Following an adolescent growth spurt repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature bony tibial tuberosity. This can cause weakening of the bone along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump. Os-Good Schlatters presents very similar to Patella tendonopathy (Jumpers knee) and the treatment for both is very similar. If not addressed it can lead to an avulsion fracture where the patella tendon becomes detatched from the bone.

Symptoms include pain and swelling over the tibial tuberosity (roughly three fingers below the base of the knee cap). Pain is aggravated by loaded knee extension activities i.e. sprinting and jumping. As the condition progresses symptoms may occur with less aggressive activities such was walking and stairs.

The majority of cases are managed well with conservative treatment that focuses on activity modification. Cessation of all exercise is not always necessary, long periods of rest have been shown to be ineffective in preventing further flare-ups.

For full and speedy recovery it is important to consult your physiotherapist to correct predisposing biomechanical factors (commonly quadriceps tightness or weakness) and for advice on appropriate training levels during your rehabilitation.

 

Sever's disease (calcaneal apophysitis)

Sever's Disease is a traction injury of the Achillies tendon insertion into the heel (calcaneum) and is the most common cause of heel pain in the growing athlete. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 12 years of age.

During puberty, the heel may grow faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. The pressure on the back of the heel bone can injure the growing part of the heel. The pain is made worse by physical activity, especially running or jumping, which causes overuse and repetitive microtrauma.

Risk factors to look out for are pronatory foot type (flat feet), tight calf muscles, recent increase in sports, playing multiple sports, running on hard surfaces, wearing inappropriate footwear.

Symptoms may be in one or both feet, and include; heel pain and tenderness over the insertion of the Achillies tendon, pain during activities than involve running and jumping, worsening pain after exercise, less pain when walking on tip-toes.

Severs disease is not expected to create any long-term disability however it can be very painful and it can recur after periods of rest, for example at the start of a new sports season, and multiple reoccurrences are not uncommon. For the best management of Severs disease consult your physiotherapist who will correct the predisposing biomechanical factors (such as need for orthotics, stretching and strengthening programs) and help monitor your return to sport to prevent reoccurrences.