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Conditions of the Foot
by Dr. Mark H. Tompkins

 

Running Injuries

Dr.Tompkins has an extensive background and experience in reconstructive foot and ankle surgery and is board certified by the American Board of Podiatric Surgery. He is also a Diplomat of the American College of Foot and Ankle Surgeons (ACFAS), and previous Division XII, ACFAS Vice President in Pittsburgh , PA. Dr. Tompkins also specializes in sports related injuries, and preventative biomechanics. He has worked extensively with area high school, college, and professional athletes.

Common Foot and Lower Extremity Running Injuries For ease of presentation, conditions will be separated into seven distinct categories representing individual organ systems. Subsequently, abbreviations regarding the treatment and prevention of each condition will be listed. Abbreviations are listed at the end with limited explanations. The treatments and preventions given are intended for general medical background knowledge for the beginner or active runner. They are in no way considered thorough and complete and should be utilized only to help the individual runner better recognize various ailments, and their treatment and preventative measures. Persistent or moderate to severe problems should be addressed by a medical specialist.

 

Muscles

Condition
Treatment
Prevention
Overuse rest/ice-heat/stretching stretching/training
*Myositis rest/ice/stretching/straping stretching/terrain/support/shoe
Strains/mild pulls rest/ice/nsaids/pt stretching/training/support/shoe
Severe pulls/tears rest/ice/nsaids/immob/doctor stretching/training/support/shoe

 

Ligaments

Condition
Treatment
Prevention
*Sprain/partial tears rest/ice/brace/ROM exercises stretch/strengthen (SS)/training/shoe
*Complete tears/ruptures rest/ice/immob./doctor SS/support/shoe/doctor
*Plantar fasciitis rest/ice/massage/support/doctor stretching/support/shoe/doctor

 

Tendons

Condition
Treatment
Prevention
Tendonitis(mild) rest/ice-heat/nsaids/ROM stretching/training/terrain/support/shoe
*Tendonitis (severe) rest/immob./nsaids/doctor stretching/training/terrain/support/shoe
Partial ruptures rest/immob/nsaids/doctor stretching/training/support/shoe
Complete ruptures rest/immob/doctor stretching/training/support/shoe
*ITB Syndrome (runners knee) rest/ice-heat/support/SS/doctor SS/support/shoe/terrain/doctor

 

Bones

Condition
Treatment
Prevention
*Periostitis (bone bruise) rest/ice-heat/massage stretching/terrain/support/shoe
*Heel Spurs rest/ice-heat/nsaids/support/doctor stretching/support/shoe/doctor
*Bone Spurs-other rest/padding/support/doctor stretching/support/shoe/doctor
*Stress fractures immob/doctor stretching/training/support/shoe
Overt fractures immob/doctor stretching/training/support/shoe

 

Nerves

Condition
Treatment
Prevention
*Neuritis rest/nsaids/massage/pt/doctor stretching/training/support/shoe
*Neuroma rest/nsaids/support/doctor stretching/training/support/shoe
*Nerve entrapment rest/nsaids/support/doctor stretching/training/support/shoe
*Neuropraxia rest/massage/remove source shoes/ padding/support/shoe

 

Integument - (skin and related structures)

Condition
Treatment
Prevention
Blisters puncture/gentian violet/cover socks(Thorlo®)/shoe/ training
Callous/corns pumice stone/Carmol HC®/ doctor Thorlo®/shoes/pads/doctor
Ulcers antisepsis/ATB cream/cover/doctor Thorlo®/support/shoes/doctor
*Hematomas puncture/ATB/cover/doctor Thorlo®/support/shoes/doctor
Nail conditions nail care/ATB/cover/doctor Thorlo®/nail care/doctor
Athletes foot antisepsis/AF med./air/doctor Thorlo®-clean/air/med./doctor
*Dermatoses antisepsis/ATB/doctor Thorlo®-clean/air/med./doctor
Xerosis/excoriations skin care/Carmol HC®/pads Thorlo®/air/skin care/pads

 

Other

Condition
Treatment
Prevention
*Chrondromalacia Patella rest/ice-heat/stretching/support/doctor stretching/strengthening/support
*Trochanteric Bursitis rest/ice-heat/stretching/nsaids/doctor SS/terrain/support

 

What causes RS and what can be done to prevent them?

The primary cause of RS is hereditary in nature. However, a number of environmental factors play an important role in the progression of RS.

Lower extremity, and predominantly foot, anatomical structure (and function to a certain degree) are something that we inherit from our parents. Various foot anomalies, combined with leg and/or lower leg functional limitations, highly predispose certain individuals to develop RS.

The most common anatomical condition that increases the risk of developing RS is referred to as equinus. Equinus deformity is a lack of motion of the ankle joint that allows (or doesn’t allow) the foot to dorsi-flex (move upward) on the ankle. This puts a tremendous force and pressure at the back of the heel-at the insertion of the achilles tendon with the heel bone-with every step taken. Over-pronation (biomechanical) anomalies within the bones/joints of the foot also predispose individuals to RS. For more information regarding various biomechanical factors which affect the foot, visit our webpage site at: Metatarsalgia

Certain environmental factors can also increase the probability of developing RS….the most important being physical weight. Increased weight, combined with the above anomalies, are the most common denominators in people who develop chronic pain associated with RS.

There are a number of things that can be done to lower the propensity of developing chronic pain from RS.  Early recognition, and appropriate treatment, of foot and/or leg/lower leg anomalies is paramount. Shoe modification and orthotic therapy, along with rigorous stretching/strengthening exercises, will go a long way in slowing the development of RS. It goes without saying; maintenance of an appropriate weight to height ratio will also greatly reduce the progression of RS.

What can be done to treat RS?

Again, early recognition of RS symptoms and appropriate treatment is the most important factor in preventing, and limiting, the progression of calcification within the attachment of the achilles tendon.

If chronic irritation and pain at the back of the heel exists/persists, professional treatment is warranted. Professional treatment is based upon the severity of the symptoms of individual patients. I categorize conditions as mild, moderate, or severe.

Mild cases of RS can normally be treated by a combination of shoe modification, insert (orthotic) therapy and/or heel lifts, stretching/strengthening exercises, OTC and/or prescription-strength oral anti-inflammatories, physical therapy, and weight reduction (if applicable).

Moderate cases of RS are typically treated by a combination of the above noted methods, with the addition of corticosteroid injections and various levels of immobilization. However, it must be noted that injection therapy for RS is of limited long-term value. This is due to the fact that multiple steroid injections into the attachment of the achilles tendon can lead to significant weakening of the tendon/attachment and possible rupture. Immobilization may include a hard-soled trauma shoe, various types of cam-walkers or an AFO’s (ankle-foot-orthosis), or BK (below-the-knee) fiberglass/plaster casting.

Severe cases of RS, again, are treated with a combination of the above noted methods as for mild and moderate conditions. If continued and progressive pain persists at a level which causes significant alterations in the patient’s gait pattern, shoe wear, and life-style, surgical intervention is a viable alternative.

Surgical treatment for severe cases of RS is an extremely gratifying procedure for patients who have been through the above noted treatments and continue to experience considerable pain and problems. However, the procedure requires a significant amount of healing time and patient inconvenience.

The surgery is typically performed in an out-patient facility under general anesthesia. Surgical time varies on the severity of the condition but rarely is longer than 45 minutes to 1 hour. The surgery involves the partial detachment of the achilles tendon, resection of the RS and any calcified tendon, and reattachment of the achilles. Additionally, if there is a severe, symptomatic, equinus deformity (as noted above) present, I will also perform some type of achilles tendon lengthening procedure-referred to as a TAL.

The patient is placed in a BK (below the knee) cast and is required to be NWB (no-weight on foot) for anywhere from 4 to 12 weeks depending on the severity of the condition, level of detachment-and reattachment of the achilles, and/or the type of TAL procedure performed. At that time, progression into an AFO (ankle-foot-orthosis) for 2-4 weeks; this is followed by a surgical shoe. Physical therapy is typically recommended and rehabilitation of the calf muscle and achilles can take a number of weeks to months. As one can see, the surgery if fairly involved, and should be limited to the most severe conditions. However; long-term results are extremely favorable, and reoccurrence is limited.

RS is a relatively frequent condition seen in my office and can be managed very successfully if diagnosed early. It is important to remember that RS is a distinctly different condition than plantar heel spurs, frequently referred to as plantar fasciitis.

 

OTHER COMMON
FOOT PROBLEMS

Athletes Foot

Bio-Mechanical Pain

Bunions

Calluses & Corns

Diabetic Foot

Flat Feet

Hallux Limitus/Rigidus

Hammer Toes

Heel Pain/Heel Spur

Ingrown Nails

Metatarsalgia

Morton's Neuroma

Neuropathy

Orthotics

Plantar Fasciitis

Plantar Warts

Running Injuries

Sclerosing Injection Treatments

Sesamoiditis

Severs Disease

Shin Splints

Sweaty Feet/Odor

Toenail Fungus

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Dr. Mark Tompkins | 4402 Vance Jackson, Suite #146 | Phone: 210-341-2202

Copyright © 2001-2009 Dr. Mark H. Tompkins.  All rights reserved.