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December 22 2013 Latest news:
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Foot and ankle specialist Adam Budgen explains how to keep a spring in your step this summer
Warmer holiday weather if it ever arrives usually prompts an irresistible urge to up our exercise levels.
Whilst regular daily exercise is good, a sudden routine change can influence the development of certain disorders of the foot and ankle. Traditionally little attention has been paid to them, but with advancements in treatment these conditions can now be alleviated.
A sudden pain in the Achilles area, for example, which feels like youve been shot in the back of the ankle, can herald an Achilles rupture. This typically occurs towards the end of a game of badminton, squash, tennis or football as the tendon heats up and tears with the last lunges of the game.
Treatment used to be immobilisation in plaster, but modern, minimally invasive surgery and early weight-bearing in a protective boot have been shown to be very effective and offer a lower risk of further rupture on removal of the plaster.
There has been a noticeable increase in Achilles tendinitis in recent years with large numbers of sufferers seeking treatment. Its generally caused by an increase in activity, less recovery time between activities, a change of footwear or training surface, weak calf muscles, running up hills or overpronation, where the feet roll in when running.
Wearing high heels shortens the tendon and calf muscles too, which means exercising in flat running shoes stretches the tendon beyond its normal range and places it under an abnormal strain.
Treatment starts with regular stretching exercises, sometimes supervised by a physiotherapist. Increasing the height of the heel can also help, as can shoe inserts.
If pain persists, however, increasing focus is being placed on extracorporeal shockwave therapy (ESWT). This is carried out in weekly outpatient sessions in some orthopaedic units its been used in York for five years to increase local blood supply, desensitise areas of inflammation and increase cell turnover.
Other treatments include supervised injection of platelet-rich plasma around the tendon or surgery to remove damaged tendon and calcium deposits.
Heel pain is increasing in incidence too. Its commonly associated with obesity, although its also often seen in long distance runners, and involves pain in the morning on weight-bearing, after prolonged recumbency and over the medial origin in the heel.
Treatment can be frustrating if its uncoordinated, so its best to seek assistance at a one-stop orthopaedic clinic which offers regular stretching exercises with a physio, night splints, custom-made orthotics, steroid injections and, after three months, ESWT.
Ankle impingement, or footballers ankle, involves pain at the front or side of the ankle which doesnt go after a sprain heals; weakness in the ankle; pain when the ankle is forced or passively moved with the toes and foot pointing upwards; and loss of upward movement in the ankle.
Patients also often complain of pain when squatting down in the skiing position. Treatments include medication, cold therapy, steroid injection, minimally invasive surgery to the lining of the ankle joint and good old fashioned rest.
Adam Budgen is a consultant orthopaedic foot and ankle surgeon. A pioneer of minimally invasive surgery, his skills are in high demand, especially from professional sportsmen and dancers. He works in York, Harrogate and Leeds.
For information, call 01904 691099, email email@example.com or visit yfac.co.uk.