Category: Orthopedics

Calcaneal Stress Fractures

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Calcaneal stress fractures are overuse injuries that affect the calcaneus, or heel bone, which is the largest tarsal bone in the foot. These fractures typically occur due to repetitive stress and microtrauma, rather than a single traumatic event. They’re most commonly seen in runners, military recruits, and athletes engaged in high-impact sports that involve frequent jumping or long-distance running. The underlying cause is usually a mismatch between repetitive loading and the bone’s ability to repair itself, leading to the gradual accumulation of microdamage.

Clinically, patients with calcaneal stress fractures often report a gradual onset of heel pain that worsens with weight-bearing activities and improves with rest. A key diagnostic clue is medial and lateral heel pain that’s tender to direct palpation, especially when squeezing the heel from both sides (positive “squeeze test”). Standard X-rays might not reveal the fracture in early stages, so MRI or bone scans are often needed for a definitive diagnosis, particularly in the early phase when the fracture is still incomplete or stress-related edema is the only finding.

Treatment is usually conservative, starting with activity modification, rest, and sometimes immobilization in a walking boot. The typical recovery time can range from 6 to 8 weeks, depending on the severity and the individual’s healing capacity. During this period, cross-training with low-impact activities like swimming or cycling may be encouraged to maintain cardiovascular fitness. Surgical intervention is rarely needed unless there’s a complete fracture or complications such as displacement. Preventative strategies include proper footwear, adequate training progression, and attention to bone health, especially in individuals with risk factors like osteoporosis or low vitamin D levels..

Useful Resources:
C is for the Calcaneal Squeeze Test (Podiatry ABC)
What is a calcaneal stress fracture? (Curation)
How to treat a calcaneal stress fracture? (Podiatry FAQ)
Causes of higher risk of stress fractures in female runners (Medical Dispatch)
Calcaneal Stress Fracture (PodiaPaedia)
Calcaneal stress fracture – forefoot or rearfoot strikers? (Run Research)
Do you have a stress fracture of the calcaneus? (Abilgic)
Calcaneal stress fractures in minimalist/barefoot runners (Podiatry Arena)
Calcaneal stress fractures in minimalist/barefoot runners (Foot Health Forum)

Metatarsalgia

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Metatarsalgia is a ‘waste bucket’ term that means pain in the forefoot or metatarsal region. It could be any number of things such as sesamoiditis, plantar plate dysfunction or a mortons neuroma

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Metatarsalgia is a general term that refers to pain and inflammation in the ball of the foot, specifically around the metatarsal heads—the bones just behind the toes. This condition often feels like a sharp, aching, or burning pain in the forefoot, especially during activities like walking, running, or even just standing for long periods. Many people describe it as feeling like there’s a pebble in their shoe or that they’re walking on a bruise. It typically develops over time due to repetitive stress rather than a single traumatic event.

There are a variety of causes and contributing factors for metatarsalgia. Improper footwear—like high heels or shoes with a narrow toe box—can concentrate pressure on the metatarsals. High-impact sports, foot deformities (like bunions or hammertoes), tight calf muscles, or having a high arch (pes cavus) can all shift weight abnormally to the forefoot. Additionally, carrying extra weight or experiencing age-related fat pad thinning under the metatarsals can make someone more prone to this condition. Sometimes, metatarsalgia occurs in tandem with other problems like Morton’s neuroma or stress fractures, complicating the diagnosis.

Treatment is usually conservative and focuses on offloading pressure and reducing inflammation. This includes wearing shoes with a wide toe box and cushioned soles, using metatarsal pads or custom orthotics to redistribute weight, and modifying activities to avoid prolonged standing or high-impact movements. Ice, NSAIDs (non-steroidal anti-inflammatory drugs), and stretching exercises—especially for the Achilles tendon and calf—can also help. In rare, persistent cases, surgical intervention may be considered to correct anatomical issues or relieve nerve compression. Early management is key to preventing chronic pain and long-term changes in gait.

Most Useful Resources:
Metatarsalgia (Podiatry Arena)
Metatarsalgia (PodiaPaedia)
Metatarsalgia (Foot Health Forum)
M is for Metatarsalgia (Podiatry ABC)
Metatarsalgia (Best Running Shoes)

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Magnetic Insoles

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Magnetic Insoles are pseudoscience nonsense. They are insole with magnets that have made up claims about the health benefits of walking around on magnets.

Magnetic insoles are shoe inserts embedded with small magnets, typically made from materials like neodymium or ferrite. They’re marketed with the idea that the magnets can interact with the body’s natural magnetic fields or stimulate specific pressure points in the feet. Most designs place these magnets at strategic locations, like the arch, heel, or ball of the foot, aligning with reflexology zones or acupuncture principles. While the science behind “bio-magnetism” remains controversial, these insoles continue to be popular in alternative wellness circles.

Supporters of magnetic insoles claim they offer a range of benefits, such as pain relief, improved circulation, and increased energy. The magnets are said to produce low-level magnetic fields that may help reduce inflammation or stimulate nerve endings. This is particularly appealing to people with conditions like plantar fasciitis, arthritis, or chronic foot pain. Some even suggest that consistent use can ease discomfort in areas beyond the feet—like the lower back or knees—by altering posture or gait mechanics.

From a scientific standpoint, however, the evidence is mixed at best. Several controlled studies have shown little to no difference between magnetic insoles and placebo (non-magnetic) versions in terms of pain reduction or functionality. Critics argue that any perceived benefits are likely due to the placebo effect or the general comfort of the insole rather than the magnets themselves. Still, because the risks are minimal, many users continue using them based on personal experience, even in the absence of strong scientific validation.

If you’re considering magnetic insoles, it’s worth taking a few factors into account. First, they shouldn’t replace medical treatments for serious foot issues. Also, not all magnetic insoles are made equal—some are cheaply constructed and uncomfortable. Look for well-reviewed products that fit your foot shape properly and provide adequate cushioning. If they help with your discomfort, great—but it’s best to approach them as a complementary tool, not a cure-all.

< Most Useful Resources:
Magnetic insoles ineffective for nonspecific foot pain in the workplace (Podiatry Arena)
Magnetic Insoles (PodiaPaedia)
Magnetic Insoles = Snake Oil (Foot Health Friday)
Magnetic Insoles (Foot Health Forum)
Do magnetic insoles work? (Dr The Foot Without the Doctor)
M is for Magnetic Insoles (Podiatry ABC)

LisFranc Injury

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The LisFranc injury or fracture occurs when there is a displacement of the metatarsals on the tarsal bone. Many different joint and bones are involved.

Lisfranc fractures are injuries that occur in the midfoot region, specifically involving the tarsometatarsal (TMT) joints, where the metatarsal bones meet the bones of the midfoot (cuneiforms and cuboid). The term “Lisfranc” originates from Jacques Lisfranc de St. Martin, a French surgeon who first described this injury in the 19th century. These fractures can range from subtle ligament sprains to severe dislocations with multiple fractures, and they are often misdiagnosed due to their sometimes vague presentation.

The mechanism of injury typically involves either a direct or indirect force. Indirect injuries are more common and usually result from a twisting motion of the foot, often when it’s plantarflexed (pointed downward) and an axial load is applied — like falling while wearing stirrups or stepping awkwardly off a curb. Direct trauma, such as a heavy object falling on the foot, can also cause a Lisfranc fracture-dislocation. Athletes, especially in sports like football and soccer, are at increased risk due to the high-impact and pivoting motions involved.

Diagnosis can be tricky and often missed if not carefully considered. Clinically, patients may present with midfoot pain, swelling, inability to bear weight, and bruising on the sole of the foot (plantar ecchymosis), which is a key indicator. Radiological evaluation typically starts with weight-bearing X-rays, but CT scans and MRIs are often required to fully assess the extent of the injury, especially in cases with subtle dislocations or purely ligamentous injuries. Missing the diagnosis can lead to chronic instability, deformity, and post-traumatic arthritis.

Treatment depends on the severity of the injury. Mild, nondisplaced injuries may be managed conservatively with immobilization and non-weight-bearing for 6–8 weeks. However, most Lisfranc fractures, particularly those involving displacement or instability, require surgical intervention. This may involve internal fixation with screws or plates, or in some cases, primary arthrodesis (fusion) of the affected joints. Postoperative rehabilitation is critical and often includes a lengthy period of non-weight-bearing followed by progressive physiotherapy to restore function and strength. Early and accurate management is key to achieving good long-term outcomes.

Most Useful Resources:
Outcome of surgically treated Lisfranc injury (Podiatry Arena)
LisFranc Fracture (PodiaPaedia)
LisFranc Fracture (Podiatry TV)
A fracture of the LisFranc Joint (Foot Health Friday)
LisFranc (Foot Health Forum)

Haglunds Deformity

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Haglunds deformity is an anatomic variation in which the back of the heel bone is larger than normal. Generally there is nothing wrong with that except that pressure from the shoes can be painful.

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Haglund’s deformity, sometimes nicknamed the “pump bump,” is a bony enlargement that develops on the back of the heel, right where the Achilles tendon attaches to the heel bone (calcaneus). It gets its nickname because it often affects people who wear stiff, high-backed shoes—like pumps or certain dress shoes—that constantly rub against the heel. That repetitive pressure and friction can irritate the area, causing inflammation, swelling, and sometimes blistering or redness over the bony bump. It’s not just limited to fashionable footwear, though—any tight or poorly fitting shoe can contribute.

So what causes Haglund’s deformity in the first place? It’s often a combination of factors. Some people are just anatomically more prone to it—like those with a high arch, a tight Achilles tendon, or a naturally prominent heel bone. These structural factors put more pressure on the back of the heel when walking or running, especially if combined with the wrong type of footwear. Over time, that repeated stress can lead to bone growth and soft tissue irritation, particularly in the bursa—a fluid-filled sac that cushions the tendon. When this bursa gets inflamed, it’s called retrocalcaneal bursitis, and it makes the whole area painful and swollen.

Symptoms typically include a noticeable bump on the back of the heel, pain where the Achilles tendon attaches, and swelling or redness around the area—especially after wearing shoes that aggravate it. The pain often worsens with activity, particularly walking uphill or climbing stairs, and can make certain shoes impossible to wear comfortably. If the tendon gets involved due to chronic friction or inflammation, it can lead to Achilles tendinopathy, which adds even more discomfort and stiffness.

Treatment usually starts conservatively: switching to softer, open-backed shoes, applying ice to reduce inflammation, using heel pads or orthotics to relieve pressure, and stretching the Achilles tendon to loosen it. Anti-inflammatory meds (like ibuprofen) can help, too. If conservative methods don’t bring relief, especially if there’s significant pain or tendon involvement, a doctor might recommend physical therapy, cortisone injections (though cautiously around the tendon), or in more persistent cases, surgery to remove the excess bone and inflamed tissue. The key to managing Haglund’s deformity is early recognition and adjusting footwear and activity to prevent long-term complications.

Most Useful Resources:
Haglunds Deformity (Foot Health Forum)
The Haglunds deformity or ‘Pump Bump’ (Foot Health Friday)
Haglunds in an elite marathon runner (Podiatry Arena)
The Pump Bump (Podiatry Ninja)
Haglunds Deformity (Best Running Shoe)

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Foot Pain

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Foot pain is what Podiatrists do. There are plenty of good and bad resources on the web on foot pain.

Foot pain is a common complaint that can arise from a variety of causes—ranging from overuse and injury to underlying medical conditions. The human foot is a complex structure with 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments, all of which must work together smoothly to support body weight and enable movement. When any part of this intricate system is stressed or damaged, pain can develop in different areas such as the heel, arch, toes, or ball of the foot. The nature and location of the pain often provide clues to its cause.

One of the most frequent culprits is plantar fasciitis, a condition involving inflammation of the thick band of tissue (plantar fascia) that connects the heel bone to the toes. This typically causes sharp pain in the heel, especially during the first steps in the morning or after prolonged periods of rest. Other common causes include bunions, flat feet, high arches, Achilles tendinitis, and stress fractures. Footwear plays a huge role too—shoes lacking proper arch support, cushioning, or fit can gradually lead to discomfort or exacerbate existing problems.

Systemic conditions like diabetes, arthritis, and gout can also manifest as foot pain. Diabetic neuropathy, for instance, leads to nerve damage that causes burning, tingling, or numbness, especially in the feet. Rheumatoid arthritis can cause swelling and deformity in foot joints, while gout results from a buildup of uric acid crystals, often striking suddenly with intense pain in the big toe. These types of foot pain usually require medical management beyond just physical therapy or orthotic support.

Treatment depends entirely on the cause. For overuse injuries or inflammation, rest, ice, compression, elevation (RICE), and non-steroidal anti-inflammatory drugs (NSAIDs) may offer relief. Proper footwear, custom orthotics, stretching exercises, and weight management can go a long way in preventing recurrence. Chronic or severe pain should always be assessed by a healthcare provider, as ignoring it can lead to long-term dysfunction or more serious conditions. If your foot pain lasts more than a few days or interferes with your daily activities, it’s best to get it checked sooner rather than later.

Most Useful Resources:
Foot Health Forum (Foot Health Forum)
Foot Pain Info (Foot Pain Info)
Foot Pain (ePodiatry)
Foot Health Friday (Foot Health Friday)
Dr the Foot Without the Dr (Dr the Foot Without the Dr)

Foot Manipulation

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Foot manipulation and mobilization is commonly used to treat a wide range of foot problems ranging from the chronic problems that develop after and ankle sprain to heel pain to cuboid syndrome to bunions.

Foot manipulations refer to manual techniques used by professionals—like podiatrists, physiotherapists, chiropractors, osteopaths, or massage therapists—to mobilize or adjust the joints, soft tissues, and fascia in the feet. These techniques are often aimed at improving mobility, reducing pain, enhancing alignment, and restoring functional movement. Because the feet have 26 bones and over 30 joints each, they can easily become stiff or misaligned, especially due to modern lifestyles, poor footwear, or injuries.

There are several types of foot manipulations, ranging from gentle mobilizations to more direct joint adjustments. Mobilization involves rhythmic movements to gradually increase joint range of motion, while manipulations often use quicker, more precise thrusts to reposition a misaligned joint. These methods are often used for conditions like plantar fasciitis, metatarsalgia, ankle sprains, and general foot stiffness. Soft tissue techniques may also be applied to muscles and fascia, helping release tension and improve blood flow.

Beyond injury treatment, foot manipulations can also benefit posture and overall biomechanics. Since the feet are the foundation of the body, misalignment or restrictions there can ripple upward, affecting the knees, hips, or spine. Some practitioners even include foot manipulations as part of holistic or preventative care. However, like any manual therapy, it’s important to have them done by a trained professional to ensure safety and effectiveness—especially if there’s an underlying condition like arthritis, fractures, or neuropathy.

Most Useful Resources:
Foot Manipulation (PodiaPaedia)
Manipulation (Podiatry Arena)
Foot Manipulation (Foot Health Forum)
Manipulation (Podiatry TV)
Does foot manipulation work?

Anterior Compartment Syndrome

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Anterior Compartment Syndrome occurs during sport when the muscle size expands from the activity and the tightness of the fascial sheath around the muscles prevents the muscle expanding resulting in pain.

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Anterior compartment syndrome is a condition often seen in runners, characterized by increased pressure within the anterior compartment of the lower leg. This area contains muscles such as the tibialis anterior, extensor hallucis longus, and extensor digitorum longus, along with blood vessels and nerves. When runners engage in repetitive, high-impact activities, swelling or bleeding can occur within this enclosed space, elevating intracompartmental pressure. Because the fascia surrounding the muscles is non-elastic, the pressure can compromise circulation and nerve function, leading to significant pain and dysfunction.

There are two main forms relevant to runners: acute compartment syndrome and chronic exertional compartment syndrome (CECS). Acute compartment syndrome is a medical emergency, usually arising from trauma like a fracture, and requires immediate surgical intervention. Chronic exertional compartment syndrome, on the other hand, is more common in runners and develops gradually during physical activity. Symptoms often include a dull, aching pain in the shin area that worsens with running, along with possible numbness, tingling, or weakness in the foot. Pain typically subsides after rest, distinguishing it from more urgent acute cases.

The underlying mechanism in CECS is thought to involve muscle expansion during exercise, which increases compartment pressure beyond what the fascia can accommodate. This impedes blood flow and compresses nerves, resulting in the hallmark pain and neurological symptoms. Risk factors for runners include overtraining, improper footwear, and running on hard or uneven surfaces. Biomechanical factors such as overpronation or muscle imbalances may also contribute to the development of the syndrome, making it a multifactorial condition.

Management strategies depend on severity. Conservative approaches include activity modification, gait retraining, physiotherapy, and shoe adjustments to reduce repetitive strain. However, these measures may provide only temporary relief for some athletes. In refractory cases, surgical fasciotomy, which involves releasing the fascia to relieve pressure, may be necessary and has shown high success rates in returning athletes to sport. Early recognition is critical, as untreated compartment syndrome—especially the acute form—can result in permanent muscle and nerve damage.

Most Useful Resources:
Anterior Compartment Syndrome (PodiaPaedia)
Effects of forefoot running on chronic exertional compartment syndrome (Podiatry Arena)
Chronic Exertional Compartment Syndrome (Podiatry Arena)
Should we transition all anterior compartment syndromes to forefoot striking? (Running Research Junkie)
Compartment Syndrome of the Anterior Leg in Runners (Runners Space)
Compartment Syndrome (Foot Health Forum)

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APOS Therapy

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APOS therapy is a type of footwear that is adjustable to change joint moments that are claimed to be helpful for problems like knee osteoarthritis. The extent of teh claims are not back up by the evidence.

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The APOS (AposTherapy) system is a non-surgical, non-pharmacological treatment designed specifically for patients with knee osteoarthritis (OA). It is based on biomechanical principles and focuses on altering the way forces are distributed across the knee joint during movement. The system involves a pair of individually calibrated shoes with convex pods attached to the sole. These pods can be adjusted to shift the center of pressure during walking, thereby reducing stress on painful areas of the knee and improving overall function. This approach addresses not just pain, but also the abnormal movement patterns often seen in OA patients.

One of the key advantages of the APOS system is that it provides both symptom relief and functional rehabilitation simultaneously. By redistributing load away from damaged joint surfaces, patients often experience reduced pain within a short period. At the same time, the therapy encourages proper neuromuscular training, which helps retrain muscles and joints to move more efficiently. Over time, this can enhance stability, coordination, and gait mechanics, potentially slowing the progression of osteoarthritis and improving quality of life.

Clinical research has demonstrated positive outcomes with APOS therapy. Studies suggest that patients using the system report improvements in pain, stiffness, and physical function, as measured by standardized OA assessment tools such as WOMAC (Western Ontario and McMaster Universities Arthritis Index). Additionally, some trials indicate that APOS therapy can reduce the need for analgesic medications, delay surgical interventions, and contribute to better long-term mobility. The non-invasive nature of the treatment makes it an attractive option for patients seeking alternatives to knee replacement surgery.

Despite its benefits, APOS therapy is not universally accessible and may not be suitable for every patient. The system requires specialist calibration and follow-up to ensure effectiveness, and its availability is limited to certain regions and clinical centers. Moreover, while evidence is promising, larger-scale and long-term studies are still needed to fully establish its role in standard OA management guidelines. Nonetheless, for individuals with knee osteoarthritis who want to avoid or postpone surgery, the APOS system represents an innovative and practical biomechanical approach.

Most Useful Resources:
Apos Therapy (PodiaPaedia)
The APOS System (Foot Health Forum)
The APOS System (Podiatry Arena)
AposTherapy Biomechanical Devices (Podiatry Arena)
A is for APOS Therapy (Podiaty ABC)
Apos therapy (Podiatry Arena)

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Achilles tendon rupture

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An Achilles tendon rupture is dramatic when it happens, but is surprisingly not often as painful as you might think. The diagnosis is obvious. The tretament can either be in a cast or surgical.

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Most Useful Resources:
Achilles tendon rupture (PodiaPaedia)
Achilles tendon rupture (Podiatry Arena)
Achilles tendon rupture (Podiatry TV)
Achilles tendon rupture advice (Podiatry Experts)
Achilles tendon rupture (Foot Health Forum)
Achilles tendon rupture (Dr the Foot)

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