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.
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.
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. There is certainly debate if it should be called Severs Disease or calcaneal apophysitis, but we will use Severs here as it is the most commonly used term. 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 pads 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, so some negotiation to achieve that is probably going to be needed.
As the condition is self-limited, these control of pain and load management strategies as well as managing expectations 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. Education is the key.
PodChatLive did a real deep dive into Severs disease, interviewing an expert:
