One of the most common sports related injuries of the foot and ankle.

The scope and complexity of the injuries related to the Achilles tendon vary widely and the ability to distinguish among different pathologies is essential for an effective treatment plan.

Injuries are classified by the anatomical zone and divided into following pathologies:

• Paratenonitis

• Tendinosis

• Paratenonitis with Tendinosis

Anyone can suffer from Achilles injuries.

What are the signs and symptoms?

• Pain and discomfort in the heel and calf muscle

• Swelling and thickening of the tendon

• Increase in pain and discomfort with activity

In some cases, patients might experience a severe pain in the tendon, followed with a sudden swelling and inability to move the foot. This could indicate a case of tendon rapture and would require immediate medical attention.

A sprain is an injury to the ligament that can either be stretched or torn.

Inversion sprains (rolling the foot/ankle in) are quite common and involve an injury to the lateral ligaments, which are found on the outside of the ankle and foot.

In severe cases, the ligaments that attach to the bone can completely rupture. Sometimes, if the ligament is overstretched, the joint can become very unstable, which can lead to constant sprains. If the sprain is mild, there can be some swelling, skin discolouration and pain when standing or walking.

Anyone can suffer from ankle sprains.

Symptoms usually resolve much quicker if the treatment is offered as soon as possible, preventing further damage to the tissue.

What are the signs and symptoms?

• Pain and tenderness

• Swelling and Bruising

• Inability to walk

• Stiffness in the foot and ankle

• Coolness in the ankle/foot

• Numbness in the ankle/foot

Arthritis is a degenerative disorder of the joints and leads to the progressive loss of cartilage lining the joint surface.

It most commonly affects hands, feet and large joints, such as the knees, hips and spine.

As the cartilage breaks down, movement of the joint is greatly reduced and can cause severe pain and swelling. Arthritis can also be caused by a secondary condition, including diabetes, psoriasis, obesity, gout, etc.

In feet, arthritic joint changes are usually caused by foot and joint deformities, such as hammertoes, bunions, flatfeet, high arched feet or as a result of a trauma to the feet (running, injury, surgery, etc.).

What are the signs and symptoms?

• Pain and stiffness of joints

• Swelling, cracking and warmth of the affected joints

• Formation of bony enlargements within the joint

• Difficulty in shoe fitting

• Muscle atrophy

• Muscle spasm

Athlete’s foot is a fungal infection of the foot, also known as tinea pedis.

It’s a fairly common condition – about 70% of the population will suffer from it in their lifetime and is usually caused by a fungus present in soil.

There are four different fungal dermatophytes that can cause the infection but the most common is trychophyton rubrum.

Anyone can get athlete’s foot but it’s more common in people who are under a lot of stress, wear shoes that don’t fit well, have pedicures at nail salons or go barefoot in warm, wet areas, such as public showers, swimming pools and locker rooms.

The fungus can also spread through direct contact with infected individuals or with objects containing fungal spores such as socks, shoes, etc.

If left untreated, the fungus can spread to other parts of the body, including nails, hands, and legs.

If there is an excessive skin breakdown, a secondary bacterial infection can occur. This is potentially dangerous in individuals diagnosed with diabetes and those with a suppressed immune system.

What are the signs and symptoms?

Infection can occur on any part of the foot but is most commonly found between toes and on the bottom of the foot

The infection might appear wet or dry with redness, scaling, itching and burning but some people have no symptoms and are not aware they have a fungal infection.

A bunion or Hallux abductovalgus (HAV) is a large bump on the side of the big toe.

This bump is caused by the misalignment of the bones causing the big toe to point towards the other toes. It’s common to find the big toe overlapping or resting under the second toe.

Misalignment of the bones is usually followed with arthritic changes within the joint causing pain and discomfort.

Bunions are present in both men and women. However, there is a higher prevalence of bunions in females since this condition is often the result of wearing high heel shoes with a tapered toe box. Bunions are not inherited but they do tend to run in families.

Research indicates that bunions are more common in people with flat feet, which can lead to instability around the big toe joint causing the medial displacement of the first metatarsal bone.

This can lead to the abduction of the big toe (hallux), resulting in the big toe pressing against the second toe.

What are the signs and symptoms?

• Pain, mild to extreme, redness, throbbing

• Stiffness of the first joint due to arthritic changes within the joint

• Turning of the big toe towards the second toe

• Development of hammer and claw toes and other soft tissue lesions (callus, corns, bursa, ingrown nails, etc.)

Calluses or hyperkeratotic tissue is a result of high pressure points and friction against the skin.

To prevent further damage to these areas, skin responds by building up layers of thick, hard skin creating calluses.

They usually develop on the plantar surfaces (bottom) of the feet, ball of the foot, heels, or the top of bony protuberances.

If the pressure is not removed, a painful central core or plug of hardened skin forms creating a corn (heloma durum). A callus in combination with a corn can create a painful area.

Anybody can get corns and calluses, but your chances of developing them are higher if you have fallen arches, bunions, hammertoes or arthritis. Wearing shoes that don’t fit properly will also cause friction and high-pressure areas that can lead to calluses and corns.

What are the signs and symptoms?

Corns

Corns consist of deep central layers of cells called a nucleus that can be painful when pressed. The appearance will depend on the mechanical stress and location of the corn.

Hard corns are usually found over high pressure areas (bottom of feet, tip of toes (hammer or claw toes) while soft corns are usually located between toes.

Calluses

Calluses are mostly found in areas that experience a lot of friction and weight bearing pressure, such as the ball of the foot and heel.

They are often larger than corns but can become painful over time as the skin thickens.

There are many misconceptions when it comes to children with foot problems. Often, their foot problems are ignored unless their feet are severally deformed or troublesome.

Children’s feet are an important part of their overall developmental process as any abnormalities within the feet will affect their general posture causing changes within their skeletal structure.

Strong, healthy feet begin in childhood. Early recognition and management of the actual and potential foot problems will prevent a lot of medical and structural problems in later life.

Common children’s foot conditions:

• Toe walking (heels not touching the ground)

• In-toe and out-toe walking

• Flat feet

Chondromalacia patella syndrome is pain behind or beside the patella (kneecap) due to the softening or breakdown of the cartilage that lines the underside of the patella.

The pain becomes more pronounced with physical activity, climbing, squatting or after prolonged sitting.

It can be a result of a trauma (acute or over use), poor patellar tracking, poor alignment of the foot (flat feet, high arched foot) ankle instability, limb length discrepancy, muscle imbalance, and knee joint position (knocked knees, bowed legged).

Anyone can suffer from this condition but it is more prevalent in athletes, young adolescents, females and people suffering from biomechanical and misalignment issues.

What are the signs and symptoms?

• Grinding sensation when flexing the knee

• Tenderness and swelling in the knee area

• Pain after squatting and prolonged sitting

People diagnosed with diabetes often suffer from diabetic related foot problems.

In most cases, lack of sensation, weak circulation and foot injuries are the main culprit. Fortunately, most of these problems can be prevented with proper foot care and proper shoe selection.

All individuals diagnosed with diabetes should have their feet checked by a chiropodist or podiatrist on a regular basis to avoid serious complications.

Assessment should include a vascular and neurological exam. In addition, your skin integrity should also be assessed, especially between your toes and under metatarsal heads.

The presence of heavy callus and warmth may indicate potential breakdown areas. Bony deformities (bunions, hammertoes, etc.), joint mobility, and problems with gait and balance should be immediately addressed through the use of custom orthotics, braces or custom made shoes.

Diabetic foot problems are a leading cause of amputations of the lower limbs.

Worldwide statistics indicate that, every 30 seconds, a limb is lost due to diabetic complications. In most cases, open sores (ulcers) on the bottom of the feet lead to bacterial infection and possible amputation.

However, research indicates that most diabetic foot ulcers are preventable with regulated blood sugar control and regular foot care that addresses all potential factors leading to ulceration.

Anyone with diabetes can develop ulcers, but diabetics who suffer from the following have a greater chance of developing ulcerations and infections:

• Uncontrolled blood sugar levels

• Peripheral neuropathy

• Improper foot care

• Impaired circulation

• High callus build up, brittle nails and fissured skin

• Bunions, hammer and claw toes

• Flat or extremely high arches

• Exposure to excessive heat or cold

• Pressure from a poorly fitting shoe

Flat feet or pes planus is a common foot condition in both children and adults. It is characterized by an abnormally low or absent medial longitudinal arch, especially when standing.

There are many causes of flat feet. In many cases, it is a result of subtalar joint over pronation in the process of developmental unwinding or as a result of aging, injury or overuse.

It should be noted that it’s normal for infants and toddlers to have low arches, but they should be observed for any abnormal in-toeing, out-toeing, excessive limping, etc. Kids who over pronate often complain of night cramps, shin splints or heel pain.

What are the signs and symptoms?

• Lack of medial arch (flat feet)

• Pain on the inside of the ankle and/or lower limb

• Fatigue, night cramps, foot strain, tendonitis, shin splints, metatarsalgia, heel pain, sciatica

• Lateral displacement of heel pad

• Development of adventitious bursa

• In children, clumsiness when walking or running

A fungal nail (onychomycosis) is a fairly common foot condition.

It is estimated that 5% of the population gets fungal nail infections. It causes yellow, thick, scaly and foul smelling nails.

The fungus can be picked up anywhere and it has a tendency to spread quickly and considering that the infection is mostly in the nail bed underneath the nail plate, it is hard to get rid of this infection.

Anyone can get fungal infection, but it’s more common in people under a lot of stress, who wear shoes that don’t fit well or get pedicures at nail salons. People who go barefoot in warm, wet places, such as public showers, swimming pools and locker rooms are also at risk.

The fungus can also spread on direct contact with individuals or with objects containing fungal spores, such as socks, shoes, etc.

Untreated, fungus can spread to other parts of the body, nails, hands, legs, etc. If there is excessive skin breakdown a secondary bacterial infection can occur. This is potentially dangerous in individuals diagnosed with diabetes and those with a suppressed immune system.

What are the signs and symptoms?

• Changes in toenail colour (yellowish, green)

• Thickening, scaling and crumbling of the nail plate

• Presence of odour

A ganglion cyst is the formation of a fluid filled sack that usually appears around the tendon sheets and joints.

It usually feels spongy when pressed and, in most cases, contains a thick, sticky, jellylike substance.

Formation of ganglion cysts can be contributed to a trauma or to a flaw in the tendon joint sheet allowing the tissue to bulge out.

It is more common in people who have pronounced deformities such as hammertoes, claw toes, and other joint deformities since they are prone to constant irritation and repetitive motions.

Hammertoe is a condition where the middle of the toe bends upward.

Joints at the end or in the middle of the toe may be affected as well, causing the toe to contract and curl into the shape of a hammer.

Hammertoes vary in severity and in the number of joints affected.

Anyone can get hammertoes, but the most common causes are related to faulty foot biomechanics (flat feet or high arched feet), a muscle imbalance, tight fitting footwear, injury, arthritis and diabetes.

What are the signs and symptoms?

• A hammer/claw looking toe

• Difficulty wearing shoes

• Toe stiffness

• Pain and difficulty moving your toe

• Painful corns and blisters on the top of your toes and feet

Heel pain is one of the most common complaints in podiatric medicine. It is also known as heel spur or plantar fasciitis.

In most cases, the pain is caused by the inflammatory condition known as plantar fasciitis. Plantar fasciitis is caused by an inflamed plantar fascia (fibrous tissue on the bottom of the feet).

Plantar fascia is attached to the heel bone and fans forward inserting into the ball of the foot. The main function of the plantar fascia is to support the arch of the foot when walking.

The problem usually occurs when there is abnormal motion or stress resulting in the breakage of the fibres. This will result in pain and swelling.

With the pulling of the plantar fascia on the heel bone, development of the heel spur is common. The spur doesn’t cause pain, but overstretching, swelling and the degeneration of collagen fibres at the insertion point (heel bone) can.

Anyone can suffer from plantar fasciitis, but the most common causes are related to faulty foot biomechanics (flat feet or high arched feet), inflexibility in the calf muscle, poor footwear, arthritis, diabetes, irritation or repetitive micro trauma to the heel tissue, etc.

Symptoms usually resolve much quicker if the treatment is offered as soon as possible preventing further damage to the tissue.

What are the signs and symptoms?

• Heel pain that is usually worse first thing in the morning or after sitting for a long time

• Sharp pain tenderness on the sole and heel when standing, walking, running

• Presence of mild swelling

High arched or the pes cavus foot type is characterized by an abnormally high medial arch (also called instep) and can be found in both kids and adults.

There are a lot of different causes for high arched feet, ranging from structural/ developmental problems, stroke, neuromuscular disease, congenital lymphedema or poor footwear.

People who have this foot type are prone to walk or stand on the outside of their feet leading to instability and more pronounced stress on the outside of their skeletal system.

Due to the instability, it is not uncommon for people with high arches to suffer from constant ankle sprains or to develop chronic knee and lower back pain.

What are the signs and symptoms?

• Presence of abnormally high medial arch

• Pain in the arch or the heel due to the contracture of plantar fascia

• Ankle sprains and shin splints are very common

• Toes are often contracted and deformed (hallux valgus, claw toes, hammertoes, etc.)

• Calluses on the sole of the feet

• Pain in the ball of the foot, knees and lower back

• Presence of calcification on the back of the heel (Haglund’s deformity)

Ingrown toenail or onychocryptosis is a fairly common and recurrent foot condition.

It’s usually caused by abnormal external pressure on the nail bed causing the nail edge to grow sideways into the surrounding skin of the toe.

The toe is usually painfully red and infected. Any presence of infection can be very dangerous, especially in people diagnosed with diabetes and those with a suppressed immune system.

Anyone can suffer from ingrown toenails, but they are often the result of improper nail cutting, trauma to the nail, tight shoes, poor posture and gait problems (flat feet), fungal infections and abnormal nail growths, excessive foot sweating (hyperhidrosis), etc.

What are the signs and symptoms?

• Skin around the toe nail is shiny, red and tight

• Pain at the tip of the toe extending down the side of the nail, especially when pressure is applied

• Redness, swelling and thickening of the nail fold, possible presence of infection

• Infected area will likely have pus or presence of yellow drainage

Metatarsalgia is a general term that refers to the pain and inflammation in the metatarsal region of the foot (ball of the foot). Pain is usually worse when standing, jumping, running or wearing high heel shoes.

Anyone can suffer from this condition, but it is more present in people who are involved in high impact sports, wear ill-fitting shoes, have other foot problems (hammertoes, flat feet, high arched feet, bunions, etc.) or spend a lot of time standing on hard surfaces (concrete, ceramics, hard wood floors).

What are the signs and symptoms?

• Pain in the ball of the foot when weight bearing

• Sharp, aching pain

• Increased pain when walking barefoot or on hard surfaces

• Pain worsens when you flex your feet

Morton’s Neuroma is caused by the entrapment of the thickened nerve tissue between bones. It often occurs between the third and fourth metatarsal bones of the foot.

Thickening of the nerve is usually caused by an irritation and pinching of the nerve. Pain is usually worse when walking in high heel shoes or in shoes that have a tapered toe box.

In many cases, massaging the foot and not wearing narrow shoes brings some relief.

This condition is more prevalent in people who wear narrow, high heel shoes and individuals who have certain foot pathologies, such as bunions, hammertoes, flatfeet, etc.

It is fairly common in people who are involved in activities requiring constant irritation of the forefoot (e.g. soccer, running, tennis) Also, a trauma to the foot can result in irritation of the nerve and formation of the intrametatarsal neuroma.

What are the signs and symptoms?

• Pain in the toes and up the leg

• Tingling, burning, numbness

• Constant feeling there is something inside your foot or a rise inside the shoe

Excessive perspiration or hyperhidrosis of the feet is a fairly common foot condition, especially when you consider we have the highest concentration of sweat glands – over 250,000 – in our feet.

Excessive perspiration in combination with the presence of overgrown bacteria on the skin will result in unpleasant odour or bromidrosis emanating from the surface.

Anyone can suffer from these conditions, but men are more prone to foot odour than women.

Excessive sweating and foot odour can be contributed to high stress levels, obesity, diabetes, hyperthyroidism, or excessive stimulation of the sweat glands.

What are the signs and symptoms?

If you have a lot of foot perspiration and the presence of a foul odour, you may suffer from this condition

Peripheral Neuropathy is a condition that develops as a result of the nerve damage due to some underlying disease.

It is important to understand that peripheral neuropathy is not a disease itself but the symptom of the certain disease that is effecting your body.

The underlying disease can affect one or more nerves at the same time, causing changes in the sensory, motor and autonomic nerves.

Some conditions, such as diabetes, can affect all three types of nerves.

Sensory nerves (the nerves that control sensation) cause tingling, pain, numbness, burning, itching, etc.

Motor nerves (the nerves that allow power and movement) cause weakness in the feet and hands, loss of balance, muscle cramping and twitching.

Autonomic nerves (the nerves that control the systems of the body e.g. gut, bladder) cause changes in the heart rate and blood pressure or sweating.

Peripheral neuropathy caused by diabetes is one of the most common form of neuropathies.

Diabetic neuropathy is a result of the microvascular complications affecting nerves in an ascending manner. This means that the nerve endings furthest from the brain will be affected first.

In a lot of diabetic neuropathies, complications would be first noticeable in toes, feet and then the hands.

Changes in the nerve endings will affect sensation, leading to pain, muscle weakness, balance and can even interfere with sleep patterns. Lack of sensation can be a cause of falls, foot ulcerations and amputations.

The symptoms of peripheral neuropathy will depend on the nerve involved and the level of damage sustained. Some of the most common symptoms are:

• Numbness, tingling, pins and needles

• Hot/Burning sensation

• Abnormally sensitive skin

• Electric shock pain

• Generalized pain

• Muscle weakness

• Loss of balance

Neuropathy will generally worsen over time and it can lead to further complications and more pronounced symptoms.

What causes peripheral neuropathy?

Peripheral neuropathy can be caused by many different medical conditions or physical traumas. In some cases, a specific cause cannot be identified and neuropathies with no known cause are know as idiopathic.

Common causes are:

• Diabetes

• Alcohol and nutritional deficiencies

• Infections (HIV, Lyme disease)

• Autoimmune diseases

• Physical injury

• Complications from surgery

• Medications (especially chemotherapy)

Plantar warts are one of the most common viral skin infections.

Warts are caused by the human papillomavirus and, just like fungal infections, they are usually acquired through the use of unsterilized tools in nail salons or by walking in bare feet in warm, wet areas, such as locker rooms, public showers and around swimming pools.

They are contagious and care should be taken that they don’t spread to others or to other body parts by touching or scratching.

Anyone can be exposed to plantar warts, however, children, especially teenagers and people with a weakened immune system are more susceptible.

What are the signs and symptoms?

Depending on how deep they are and where they are located, they can be very painful and often appear as thick, rough skin with well-defined boundaries.

In many cases, there are dilated capillaries on the wart, which are usually seen as dark and brown spots within the skin and can appear very small or large in multiple clusters, covering different foot areas

As we age, we tend to have more health problems. Our feet are no exception.

Some foot problems are inherited, but most of them are a result of trauma and years of constant use. Fortunately, most of these problems can be treated so that you can remain active for the rest of your life.

Even a simple task of cutting nails may become a problem due to poor eyesight or difficulty bending down. If the nails are deformed and thick, a chiropodist or podiatrist can treat them for you and advise you on proper care.