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The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump.
Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration.
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including:
• Sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance
• Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon
• Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain
A bone spur that has developed where the tendon attaches to the heel bone.
Common symptoms of Achilles tendinitis include:
• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spur (insertional tendinitis)
• Swelling that is present all the time and gets worse throughout the day with activity
If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.
Three different groups of nerves can be affected by diabetic neuropathy:
• Sensory nerves, which enable people to feel pain, temperature, and other sensations
• Motor nerves, which control the muscles and give them their strength and tone
• Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.
Diabetic peripheral neuropathy doesn’t emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.
The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.
Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.
For sensory neuropathy:
• Numbness or tingling in the feet
• Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet
For motor neuropathy:
• Muscle weakness and loss of muscle tone in the feet and lower legs
• Loss of balance
• Changes in foot shape that can lead to areas of increased pressure
For autonomic neuropathy:
• Dry feet
• Cracked skin
First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.
Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.
In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.
At our clinic we see an increase of diabetic patents every year, our goal is to help manage and educate our patients regarding foot care and now relief from peripheral neuropathy symptoms. We use FREMS technology to help manage the symptoms of diabetic peripheral neuropathy.
Principles of Managing Neuropathy at Step By Step
The principles we are trying to achieve with pain free technologies is 1) to retrain the nerves to function at normal thresholds therefore requiring normal level of stimulation to function, 2) to repair damaged tissues by increasing circulation by revascularization, improving existing blood flow thus allowing more nutrients and most importantly oxygen to damaged tissue to improve healing. 3) The final step is to re-educate the nerves to communicate with surrounding tissue therefore getting improvement in function and bring balance back to life.
- Routine management of nails and skin
- Ulcer Management
- Peripheral Neuropathy Management
- Diabetic Specific Footwear
Diabetic Assessment and Treatment
On your initial visit the Chiropodist will do a series of exams and tests.
- A detailed history of your lifestyle
- Past and current medical status
- Neurological exam on both feet to determine level of neuropathy
- Vascular exam to determine status of blood flow
- Perform a biomechanical and gait exam to determine level of stability
- Assess your footwear
- Explain in detail the status of your current foot health
- Explain to you the best management plan according to the results of the above mentioned exams / tests.
- Answer any questions and concerns regarding your foot health
- Trim toe nails and clean up any callus areas that are present
- Advice you on do’s and don’ts that pertain to you
Bunions are common in professions that involve continuous standing and walking, e.g. police, postal workers, hairdressers and waiters. Women tend to be more prone to bunions due to their choice of shoes which are often high heeled, narrow and unsupportive.
Other causes: obesity, flat feet/over pronation, pregnancy.
Chilblains are thought to be caused by an abnormal skin reaction to cold. People at risk from Chilblains are those who are susceptible to cold temperatures, e.g. people with poor circulation or unhealthy diets.
Chilblains typically last a few days and then gradually ease and go over a week or so, unless the exposure to cold continues.
Causes include: hot, dry weather; constantly walking with no shoes or just sandals; inactive sweat glands; and obesity.
Pes Planus, or Flat Feet, are most commonly a congenital condition but can also be acquired as a result of the foot being repetitively subjected to hard surfaces, eventually weakening the arch of the foot. In today’s world of concrete and tarmac it is therefore not surprising that this condition is becoming more and more frequent in people of all age groups.
It is important that treatment is sought for these conditions as they can lead to further problems. When the foot’s ability to absorb shock diminishes the foot is subjected to increased pressure, which can cause other foot, knee and back problems.
Other causes of flat feet can include: obesity and pregnancy.
Ulcers or any open wounds should not be left untreated, as they are a common cause of lower extremity amputation. If they are caught in the early stages they can be treated by a Podiatrist/Chiropodist who will use methods such as debridement (surgical removal of dead skin) and will provide padding and orthotic devices (special insoles) to relieve pressure from the ulceration to allow it to heal.
A Chiropodist will also provide information about diabetic foot care.
As Gout can occur suddenly and can be very painful, the best treatment is often prevention. Contact a Chiropodist to learn more about prevention and treatment.
Symptoms of Hallux Rigidus include stiffness in the big toe when walking or swelling around the big toe joint. A bump such as a callus or bunion could also be suggestive of this condition, as can limitation in the range of motion.
Possible Medical Causes: osteoarthritis; trauma; excessive pronation; high arched feet; poor footwear; splitting osteochondritis of the first metatarsal head; gout or pseudogout.
Hammertoes can be very painful, especially if irritated by a tight fitting shoe and can often lead to corns, calluses and sufferers can sometimes experience cramps in their toes and feet.
Causes include: ill-fitting shoes; reumatoid arthritis; pronation (flat feet); high arched feet; hereditary causes.
“Itis” usually refers to the inflammation of a certain part of the body. Bursitis refers to the constant irritation of the natural cushion that supports the heel of the foot (the bursa). Bursitis is often associated with Plantar Fasciitis, which affects the arch and heel of the foot.
Other causes can include: ill fitting shoes; obesity; biomechanical problems (e.g. mal-alignment of the foot, including over-pronation); gout; rheumatoid arthritis.
If the toenail becomes thick and discoloured turning yellow or brown, you may have acquired a fungal infection, therefore it is advised that you contact a Chiropodist for advice.
Symptoms include a swollen knee and a grinding sensation occurs, accompanied by a clicking noise. Excessive pronation or flat feet are the most common cause of knee pain. Excessive pronation is where the arch of the foot collapses, leaving the foot in a flattened state. This causes the foot to roll inwards in order to gain contact with the floor and support the weight of the body. This biomechanical problem affects the positioning of the patella (knee cap), which is subjected to excessive stress eventually weakening the surrounding muscles and ligaments.
Partaking in any high impact physical activity without wearing the correct footwear can also be the cause of this particular condition, as well as other foot conditions such as: arthritis; excessive pronation/pes planus (flat feet), hallux abducto valgus, hammer toes, Morton’s neuroma.
If you suffer from pain related to Morton’s Toe, seek advice from a Chiropodist, who may recommend an orthotic insole to place in the shoe.
The pain usually begins as a dull ache but increases with activity to a throbbing sensation in the ball of the foot.
Sesamoiditis usually occurs when an individual suddenly increases their level of physical activity. This places the feet under additional stress as they try to accommodate this change.
A biomechanical cause of Sesamoiditis is high arches that cause a person to exert more stress on their forefoot. This increases pressure to the Sesamoid bones.
People with bony feet may also suffer from Sesamoiditis as they have little protective fat on their feet, therefore less shock absorbing qualities.
High heel shoes can also be a cause.
People who run on tiptoes or partake in sports that involve a lot of jumping are susceptible to this particular condition, as these activities cause an imbalance in the distribution of pressure and add stress to the joints. Biomechanical problems such as over pronation or supination can cause the muscles to exert themselves in order to retain balance. This constant stress can causes the muscles to tear, resulting in shin splints.
Symptoms include: lower leg pain; tender shins; swelling or redness around shin area; lumps covering the bone; pain when toes are pointing towards the floor.
Today’s footwear consisting of synthetic materials are a primary cause of sweaty feet. Shoes and socks manufactured from man-made materials lead to excessive perspiration and increased bacteria that can result in sweaty, smelly feet and sometimes Tinea Pedis – Athletes Foot.
Sweaty feet can also be triggered by stress, both physical and emotional. Pressure placed upon the foot due to strain or fatigue is a common cause, as is emotional distress and turmoil. Sweaty, smelly feet is also often associated with teenagers and changing hormonal levels, which can lead to over active sweat glands.
However, the reasons are not always this complex. A change in the weather, hot or cold, can be enough to initiate excessive sweating.