Common acute and overuse sports injuries of the foot and lower leg
Pain felt under the ball of the foot, usually worse at end of the day or when barefoot. Described as the feeling of walking on a pebble. Can be as a result of poorly cushioned or worn out shoes, over overtraining. May require X-rays or MRI scans to rule out bursitis or neuromas (swollen nerves). Commonly treated with crescentic metatarsal pads, softer soled shoes, massage, referral to a Podiatrist or injections of steroid.
Metatarsal Stress Fracture
Usually occurs in the second metatarsal, pain is felt in the front of the foot after unaccustomed exercise or a too rapid increase in training. Only shown on X-rays after several weeks and may require an MRI scan for diagnosis. Treated with rest, inserts (orthotics) rocca soles shoes or in severe cases an aircast boot for four to six weeks. May also require a bone density scan if there are any risk factors for osteoporosis.
Plantar Fasciitis (Policeman’s heel)
Pain felt under the heel, usually worst first thing in the morning or arising after rest. Can be relieved after warming up. May require X-ray or MRI scan. Usually treated with rest, ice, stretches, anti-inflammatory medications, massage, ultrasound, heel cushions, or a steroid injection.
Pain and thickening usually worst first thing in the morning. May require an MRI scan to look for signs of cyst formation or impending rupture. Usually treated with rest, stretches, ice, ultrasound, acupuncture, heel lifts, night splints, physiotherapy, steroid injections or in severe and protracted cases, surgery to release scar tissue or to bypass the tendon with a synthetic ligament.
Pain felt on the outside or inside of the shin after running for a while, often worse running downhill. May require an MRI scan to exclude a stress fracture. Can be relieved by lacing shoes less tightly, stretching or exercising lifting the ankle up and down with a paint pot hooked under the big toe. May also require physiotherapy.
Patella Tendonitis (Runner’s or Jumper’s Knee)
Pain just underneath the kneecap, worse during exercise. May require an MRI scan to rule out cyst formation in the tendon. Usually treated with rest, massage, stretches, steroid injections or rarely in protracted cases (when there is cyst formation in the tendon) surgery to drain the cyst.
Pain felt in the front of the knee, often worse descending which may be associated with crunching or grating noises. Usually the result of excess pressure on the kneecap, in combination with tight outer soft tissues leading to imbalance. Often needs an MRI scan, and is usually treated with, rest (avoiding kneeling and squatting) stretches and exercises to strengthen the inside of the thigh muscle (so called VMO or Vastus Medialis Obliquus). Can rarely lead to keyhole in severe cases to smooth off the roughened joint surface (see separate section on Knee Arthroscopy).
Torn or Worn Washer Cartilage (Meniscus)
Medial Collateral Ligament Injury
Usually the result of an injury forcing the shinbone sideways or rotating outwards. A common skiing or contact sport injury. May require an MRI scan to measure the extent of injury and rule out other injuries. If only partial can be treated with rest and strapping, if complete, may require bracing for several weeks or if combined with cartilage tears keyhole surgery. In rare cases when there is in addition a complete tear of the anterior cruciate ligament (see next section), this may require surgery to reconstruct the ligament.
Anterior Cruciate Ligament Tear
Usually the result of the knee overextending, being forced forwards in a ski, or as the result of a severe sideways movement with outward rotation, again common in contact sports or skiing. The may feel stable on smooth dry surfaces, but will give way on uneven ground, when twisting or walking on a wet pavement. There is often pain below the kneecap and a reluctance to fully straighten the knee. May require an MRI scan to diagnose and rule out other injuries. May be treated with rest, and physiotherapy, which can leave up to two thirds of patients able to return to non contact sport.
It may need surgical reconstruction, if combined with other ligament injuries (See medial collateral ligament injury paragraph above) or cartilage injuries (see paragraph on cartilage injuries); or in patients who are unable to achieve a stable knee by these means. Surgery involves taking one or two of the Hamstring tendons via a small incision below your knee and then inserting this harvested graft through holes drilled in the shin and thighbone. It is held in place with a screw and a cuff-link like device called an endobutton. This is followed by intense physiotherapy and activities will need to be modified for several months afterwards.
Ilio-tibial Friction Syndrome
Pain felt on the outside of the of the thigh, either at the side of the thigh near the hip or lower down by the outside of the knee, often a curse of middle distance runners. Can occur as a result of overtraining, or orthotics for over-pronation that push the foot too far outwards. In other cases may be the result of a back problem, which has tilted the pelvis and tightened the outer soft tissues. Sometimes associated with a swollen sac of fluid near the hip (Trochanteric bursitis). Can be treated with rest, stretches, ice, lying on the side and rolling on a foam cylinder, physiotherapy, massage and steroid injections. May sometimes be confused with sciatica and need an MRI scan.
Pain felt in the buttock or rear of thigh, may be associated with pins and needles in the lower leg and can be confused with sciatica. It is a result of a tight muscle in the buttock that can pinch the sciatic nerve and usually responds to stretches and massage (an excellent self help massage being to sit on a tennis ball!)