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.
Category: Foot Disorders
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.
Severs disease is a common problem of the heel in children. It occurs when there is too much load on the cartilage growing area at the back of the heel bone leading to a condition that is possibly similar to a stress fracture. The classic symptoms are pain at the back the child’s heel, that is also painful to lateral squeezing at the back of the heel. The condition is self limiting as the growing area joins to the rest of the heel bone by the mid-teenage years. However, that is no reason to not treat it as its is painful and does affect quality of life.
The approach to it management to to treat the symptoms with some pain relief (ice, Oscon, anti-inflammatory drugs) and load management. Load management is related to things like heel raises to protect the painful area and a reduction of activity levels. In the child, managing this can be difficult as they like to run around and play.
As the condition is self-limited, these control of pain and load management may be all that can be done over the long term until the natural history of the growth area is to merge with the rest of the heel bone.