Tag Archives: tarsal coalition

Sinus Tarsi Syndrome

Summary

  • The sinus tarsi is a small cavity located on the outside of the ankle. This cavity contains numerous anatomical structures including ligaments and joint capsule. These structures may be injured following an ankle sprain or due to the repetitive strain associated with an excessively pronated (flat) foot. When this occurs, the condition is known as sinus tarsi syndrome. Patients with sinus tarsi syndrome typically experience pain over the outside of the ankle. There may also be swelling and tenderness in the region. Symptoms are typically worse in the morning and may present as pain and stiffness that slowly improves as the patient warms up. Symptoms may also be aggravated during walking or running especially on slopes or uneven surfaces.

How did I get this?

  • Sinus tarsi syndrome usually occurs following an ankle sprain or due to the repetitive strain associated with walking or running on an excessively flat foot.

What can I do about it?

  • Rest sufficiently from any activity that increases your pain.
  • Icing and short term anti-inflammatory medication (e.g. Ibuprofen) may help to significantly reduce inflammation.
  • Elevation of the affected foot to decrease inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe an ankle brace, appropriate footwear, and orthotics, along with strengthening exercises.
  • Your doctor may prescribe a steroid injection.

When will it get better?

  • Most patients with this condition heal well with an appropriate treatment program. This can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early treatment is vital to hasten recovery and ensure an optimal outcome.

Tarsal Coalition

Summary

  • A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet. While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to 16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life. Symptoms include Pain (mild to severe) when walking or standing, tired or fatigued legs, muscle spasms in the leg causing the foot to turn outward when walking, flatfoot (in one or both feet), walking with a limp, and stiffness of the foot and ankle.

How did I get this?

  • Most often, tarsal coalition occurs during foetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.

What can I do about it?

  • Rest from activities that cause the pain.
  • Short term nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be helpful in reducing the pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe orthotic devices for distributing weight away from the joint, limiting motion at the joint and relieving pain. Footwear modification such as a stiff rocker sole may be effective.
  • Podiatrist may consider immobilization to give the affected area a rest. The foot is placed in a cam walker, and crutches may be used to avoid placing weight on the foot.
  • Your doctor may give steroid injections to reduce the inflammation and pain.
  • Foot and ankle surgeon for surgical management if symptoms are not adequately relieved with nonsurgical treatment.

When will it get better?

  • Treatment by a podiatrist may result in symptom relief within 6-8 weeks.
  • Depending upon the type and location of your surgery, a cast will be required for a period of time to protect the surgical site and prevent you from putting weight on the foot. Although it may take several months to fully recover, most patients have pain relief and improved motion after surgery.

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Posterior tibial tendon dysfunction

Summary

  • Posterior tibial tendon dysfunction (PTTD) is an injury involving overstretching or rupturing of the posterior tibial tendon, leading to tendon inflammation, weakness, foot deformity and arthritis. The posterior tibial tendon extends from the deep layer of muscle at the back of your leg. It runs along the inside of your ankle and down the inside of your foot to underneath your arch. This tendon, along with some strong stabilising ligaments, is one of the major supporting structures of the foot. In PTTD, the tendon’s ability to perform that job is impaired, often resulting in a collapsed arch or ‘flat foot’. PTTD is the most common type of flat foot developed during adulthood, and is also known as adult-acquired flat foot.
  • Symptoms include pain and swelling on the inside of your ankle which grows worse with increasing activity, tenderness over the midfoot especially during activity, weakness or an inability to stand on your toes, a collapsed arch and development of a flat foot, and gradually developing pain on the outer side of your ankle.

How did I get this?

  • Often occurs in women over 50 years of age and may be due to an inherent abnormality of the tendon. But there are several other risk factors which include obesity, diabetes, hypertension, previous surgery or trauma, inflammatory diseases, and arthritis. The tendon may also become inflamed if excessive force is placed on the foot, such as when running on a banked track or road.

What can I do about it?

 

  • Rest.
  • Short term nonsteroidal anti-inflammatory drugs such as ibuprofen.

What help can I get for this?

  • Podiatrist may advise immobilization of the foot for six to eight weeks with a removable boot to prevent overuse.
  • Podiatrist may prescribe shoe inserts such as a heel wedge or arch support.
  • Podiatrist may recommend that you use a custom-made orthotic or support.
  • Foot and ankle surgeon for surgical management such as tendon repair or ankle joint fusion if conservative treatments don’t work.
  • A program of exercises and therapy to help rehabilitate the tendon and muscle following immobilization.

When will it get better?

  • The success of nonoperative treatment first requires the assessment of the flexibility of the flatfoot deformity. It is common for a patient to take 4-6 months to achieve much of their recovery and 12-18 months before they reach their point of maximal improvement after surgery.

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Peroneal Tendon Injury

Summary

  • The peroneal tendons are two tendons that lie immediately behind the outside bone of the ankle. These two tendons are responsible for moving the foot outwards. They balance the ankle and the back of the foot and prevent the foot from turning inwards repetitively. These tendons can be injured due to overuse or acute injury. In preoneal tendon injury there is pain behind the ankle, swelling over the tendons, and tenderness of the tendons.

How did I get this?

  • It usually occurs because these tendons are subject to excessive repetitive forces during standing, walking, and running. History of ankle injury (e.g. blow to the ankle or ankle sprain) which can displace the peroneal tendons. Certain foot shapes such as a higher arched foot predispose to the development of injury as well.

What can I do about it?

  • Rest is key, often helped by supportive footwear such as a hiking boot or jogger.
  • Applying ice to the area can help to reduce swelling and help to control pain.
  • Short term use of anti-inflammatories and can reduce the swelling around the tendon.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist for footwear modification, strapping, bracing, orthotics or other measures to reduce stress on the tendons and allow for rest and inflammation to subside.
  • Orthopaedic surgeon for possible surgical repair if there are large tendon tears.

When will it get better?

  • Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Recovery after surgery involves several weeks of restricted weight-bearing and immobilization, depending on the type of surgery performed. Following immobilization, therapy can begin. Total time for recovery is usually 6-12 weeks, depending on the extent of surgery.
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