Archive for September, 2017

What is Achilles Tendinopathy?

Achilles Tendinopathy is a common condition that presents itself typically as a sharp pain in the heel of the foot. The Achilles tendon is a large tendon located at the back of the heel which connects your calf muscles to your heel pain. When this tendon is injured, it is referred to as Tendinopathy. It occurs most commonly in middle-aged adults and in athletes.

What are the symptoms of Achilles Tendinopathy?

The most common symptom is a sharp pain at the back of the heel, but can also present itself as burning pain or a constant dull ache. It is usually worse when you get out of bed and put weight on your feet first thing in the morning, or if you walk or run after a period of inactivity. During an acute injury, there is often noticeable swelling around the tendon which may also be inflamed, which is characterised by redness and heat. It is often painful when gently squeezing the tendon compared with the non-affected side.

What causes it?

There is no single cause but instead a likely combination of risk factors. These can be described as 2 main factors; intrinsic and extrinsic:                                                                                        

Intrinsic factors include: 

• Feet with very high arches or very low arches
• Feet that roll inwards while walking
• Tight Achilles tendons or calf muscles
• Being overweight

Extrinsic factors include:

• Standing on your feet for a large part of the day – such as is the case for Teachers and Factory Workers
• Wearing footwear that does not support the foot correctly

How we can help with treatment:                                                                                                                                                                                                                                                             

Achilles Tendinopathy is definitely a treatable condition, with many different options available depending upon individual circumstances. A Gait Analysis appointment our Biomechanics Podiatrist will determine the causes of your Achilles Tendinopathy and recommend a treatment plan that is bespoke to you. This could include:

Orthotics: custom orthotics or insoles can be an excellent treatment option for Achilles Tendinopathy. Orthotics are suitable for people of all ages and because they are bespoke to your foot, offer the exact support required to aid your foot’s normal function and relieve the cause of your Achilles Tendinopathy.

Shockwave Therapy: This is an excellent treatment option for chronic or resistant cases and helps increase your healing capacity. This treatment works best alongside other treatments listed here:

• Physiotherapy: This is a crucial part of the treatment plan if you suffer from Achilles Tendinopathy. Physiotherapists may provide manual therapy, therapeutic ultrasound, acupuncture, and an individually prescribed exercise programme to help build strength in weak muscles that could be causing your Achilles Tendinopathy.
• Massage: If your Achilles Tendinopathy is caused due to tight calf muscles, our massage therapists can help to ease the tension in your muscles, thereby addressing the cause.

You can find more about our Gait Analysis service along with what to expect at your first appointment here

If you’re suffering from Achilles Tendinopathy, we can help. Book your Gait Analysis appointment online or by calling us on 01380 730473. Appointments are available at any of our clinics in Devizes, Marlborough, or Frome.

A Morton’s Neuroma is a swelling of one of the nerves in the ball of the foot. Typically you will know you have a neuroma if you start to experience pain the ball of your foot. People describe the pain as shooting, numbness, burning or stabbing. It is intermittent, meaning that it comes and goes. Generally the pain gets worse with time. At first, the area may become a little bit numb for a few minutes in a pair of tight shoes, but this could develop over weeks or months to the point where you have an intense stabbing pain in the foot every time you stand or walk for more than a few minutes.

There are a number of theories on what causes a neuroma. However, the cause is not well understood and there is very little evidence to suggest a consistent cause. What we do know is:

• The swelling is thought to be from trauma of the nerve i.e. pressure from surrounding bones
• The swelling is benign, not cancerous
• It is more common in women
• It is made worse by certain shoes or activities

DIAGNOSIS

A diagnosis of a neuroma can often be achieved by a podiatrist by taking a thorough history of symptoms and a range of clinical examination tests. A podiatrist can also differentiate your condition from a range of other common and more rare causes of pain in the ball of the foot. Achieving a correct diagnosis is very important in formulating the correct treatment plan for you.

Most neuromas affect the area behind and between the third and fourth toes. However, they can also affect the second and third toes and more rarely the fourth and fifth toes. Diagnostic imaging tests are sometimes required if the diagnosis is not clear enough from a clinical examination alone. The most common imaging test is an ultrasound which can help aid the diagnosis if required. It is important to mention that sometimes the neuroma cannot be detected with an ultrasound machine and therefore an alternative test may be considered such as an MRI.

TREATMENTS                                                                                                                                                                                                                                                        

There are many treatments available for neuromas. Here at Hatts, we can support you with the following:

1. Injection therapy – Sometimes an injection of steroid and local anaesthetic into the neuroma and around it, can relieve the pain and stop the neuroma from developing.

2. Orthotics – These can be of benefit when alleviating pressure from the nerve. To assess whether this is a viable option, a podiatrist will perform a biomechanical assessment and gait analysis to help determine whether an orthotic may be a suitable treatment for you.

3. Footwear choice – This is the simplest. If your neuroma only hurts when you dance in your favourite 4inch heel Jimmy Choos, then take them off to dance. This is a ‘no brainer’ and can stop your neuroma from getting worse.

After having seen one of our podiatrists, if necessary we can also refer you on for:

1. Surgery – When the pain warrants it, you can have the neuroma removed by a small operation. This is often done under local anaesthetic as an outpatient setting.

2. Cryosurgery – This is a new treatment and is used as an alternative to the traditional surgical method of excision. This procedure is less invasive and involves putting a small needle through the skin and into the neuroma which is frozen whilst it is in the foot. This is done under local anaesthetic. The success rate of this procedure seems to be equivalent to surgical excision and is thus, gaining increased popularity. There is only a small amount of clinical research compared with the excision option, therefore it is currently unknown whether there is a better option at present.

If you think you may have a neuroma or you have pain in your feet, please seek help from one of our podiatrists before it gets worse by calling 01380 730473.