A plantar plate tear is a common strain or tear of the strong ligament under the metatarsophalangeal joint of the foot. The symptoms are typically just over and just distal to the joint on palpation (see the typical spot illustrated in the diagram below):
A strange symptom that some with this describe is that it can feel like a sock is crunched up under the area, but when they check the sock is not like that at all. The cause of a plantar plate tear is not entirely clear, but it is an overuse problem.
Fixing a plantar plate tear is not difficult, but it can take a long time. The best approach is to use strapping to hold the toe plantarflexed. The tape needs to be used for up to 6 or so months of it to heal. A rocker sole shoe and also help restrict movement at the joint and also help. If this conservative approach does not help, then surgery to repair the tear is often indicated
Chilblains are a vasospastic reaction of the microcirculation to changes in temperature when the feet become cold. They start out a reddish coloured itchy lesions that turn a darkish blue cyanotic color if they become chronic
Do they work? That question gets asked a lot in various forums (see here and here). There is no clear answers if they really do help pr not. Some anecdotal claims are that they do help and some are that they do not help. The published research only shows a small change in the angle of the toe that may not be sustained in the longer term.
There is a lot of marketing hype around them. They will not make bunions go away. At best they appear to improve the angle of the big toe a little, but needs to be worn every night for a month or so to get that small improvement. There is no harm in trying the bunion correctors, as that small improvement may make quite a difference to the symptoms.
In Australia “thongs” are what the rest of the world call “flip flops”. These types of footwear are an important part of the lifestyle there. The Archies Thongs are flip flops that have an arch built into them, so they are proving popular as an alternative and as an adjunct to foot orthotic therapy.
The amount of support that they have is roughly the same as a pre-fabricated foot orthotic, so there is no reason why they can not be used as an alternative to foot orthotics when indicated. The Archies Thongs come in multiple colours and multiples sizes.
The exercise is useful for what it is designed for: to strengthen the intrinsic muscles in the foot. That is all. Nothing more and nothing less. It does not cure all the ails the foot, despite the claims by many of it supporters. It supposed to “cure” “overpronation” – it dosen’t. The evidence is clear on that. I can be useful in plantar fasciitis.
This is a condition in which the fascia that surround the muscles on the anterior part of the leg appear to be tight, so that during exercise when the muscle tries to expand, it can’t. This can become painful and gets known as anterior compartment syndrome or chronic exertional compartment syndrome. Typical the only satisfactory treatment for this has been a surgical release of the fascia as conservative treatments never seemed to work very well. This topic has been generating a lot of interest lately due to the using of changing the running gait appearing to be very successful at managing this. The trend has been to use forefoot striking rather than heel striking and shortening the stride length and increasing the cadence. A non-controlled study show that this is to be very effective and a lot of good clinical experience is supporting it use.
Grounding or earthing is junk science from the the alternative health movement that is based on the absurd belief that we need to be barefoot in contact with the earth to keep our ‘electrons’ in balance. If our ‘electrons’ are out of balance, then you get a whole range of health problems. If you can’t go barefoot on the earth, then sellers have some products to sell to help facilitate that grounding. Those that promote the concept have a financial interest in the concept!
The whole concept is biologically and physically impossible. The way that claims are made break some basic laws of physics. It is made up quackery and woo. The claims are bogus. For example you see claims that ‘electrons’ from the earth are better than the one in our own bodies! Electrons are electrons! They are the same wherever they are.
Posterior Tibial Tendinitis is not a common tendonitis, but typically occurs in runners. The main symptoms are either/or swelling and pain just above or below the medial malleolus. This is an overuse injury so the cause is when the load over time in the tendon exceeds what the tendon can take, usually when not enough time is given for the tendon to adapt to changes in load. It is typically associated with ‘overpronation’ if the forces of pronation are high.
This rant on video from Podiatry Soapbox a good overview of the condition and how it should be treated.
The management is not that difficult provided common sense and a logical sequence of events is followed, yet have been a lot of questions in forums and Q & A websites (eg here, here and here) with a mixture of the quality of advice being given online.
One of the biggest problems with posterior tibial tendonitis is runners is that in many places they confuse it with posterior tibial tendon dysfunction when they are two totally different beasts.
This is a concept that has been getting increased attention in recent years in clinical practice. It is a concept and clinical test of determining how hard it is to supinate the foot based on the assumption that the harder the force is, then if a foot orthotic is needed for something like, overpronation, then more force needs to come from the foot orthotic; so a rigid firm and inverted type foot orthotic is needed. Similarity if the force is low, then not much force is needed from the foot orthotic, so a soft flexible foot orthotic is indicated.
There has been some research done on it, but not a lot. This is probably limiting its more widespread use in clinical practice. The test for supination resistance does correlate quite well with some pathologies and not others.
