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Foot Drop Causes and Solutions

Have you ever been out and about and noticed someone dragging their foot? As orthotists, it is a condition we regularly treat in our clinics as there are so many different causes. Luckily, there are many treatment options available.

Foot drop describes the inability to raise the foot due to weakness caused by varying conditions which we’ll explain in this article. For individuals with this weakness in the foot, visually you may see the foot drag and unfortunately this can lead to trips and falls.

On a positive note, there are so many solutions for foot drop that no one should have to struggle! With these in mind, everyone should be able to take each step with confidence and without the risk of tripping over.

Causes

Foot drop can affect either one or both feet depending on the underlying problem and can be either temporary or permanent based on the condition causing the foot drop.

Neurological conditions such as Multiple Sclerosis, Stroke, Cerebral Palsy, Polio and motor neuron disorders often result in muscular weakness affecting the strength in the lower limbs.  

Injury to the spinal cord from trauma or spinal degeneration can also result in foot drop as the nerve that sends the message to pick the foot up may have been damaged and can no longer perform the action. If significant trauma has occurred this foot drop may be permanent. Sometimes following lower back surgery some individuals may experience some weakness in their legs resulting in foot drop, luckily our bodies can often heal those potentially damaged nerves and over the period of a few months, the foot drop has the potential to resolve.

A not so commonly known cause but an extremely important one is Diabetes, formally know as Diabetic Neuropathy. Nerve damage can arise from poorly managed diabetes and chronically high levels of blood sugar. Over time, Diabetic Neuropathy causes damage to the nerves including those that pick the feet up, again resulting in drop foot. Unfortunately, damage caused by Diabetic Neuropathy can not be reversed.

Treatment and Orthotic Intervention

Ankle Foot Orthoses (AFO)

A device commonly prescribed for individuals with foot drop is called an Ankle Foot Orthosis (AFO). These can be either custom made or off the shelf and can be made of different materials depending of the function required.

As technology has improved over time, so too has the materials that AFOs are made of. Some individuals may still use traditional plastic AFOs to manage their foot drop. Some more commonly used AFOs nowadays include AFOs that are made from carbon fibre. These types of AFOs (like the ToeOff) are extremely lightweight but also have some flexibility in them as opposed to being fixed or rigid. This flexibility allows the AFO to move and store energy, like a spring that is compressed when the pressure is released or as the weight is taken off the foot, the AFO actually helps to push the individual forward to take a step. There is still enough strength in the AFO to prevent the foot from dropping - individuals frequently note how natural their gait feels when using this type of device!

Functional Electrical Stimulation (FES) Devices

For some individuals who have foot drop caused by an upper motor neuron lesion such as Multiple Sclerosis, Cerebral Palsy, Stroke, or ABI, there are devices that use Functional Electrical Stimulation (FES) to stimulate the nerve when walking.

This stim will pick the foot up at the exact point whilst walking to prevent foot drop, amazing right! These devices require the user to only wear a cuff that sits just above the calf muscle rather than wearing a brace and a shoe. This gives the individual freedom to wear different shoes or walk barefoot, even allowing you to put your toes in the sand and walk in the water as they can be splash resistant.

There are so many more styles of AFOs and it is always best to have an assessment with a qualified orthotist so that the right brace can be prescribed for each individual.

At oapl we can help you navigate different funding options including the NDIS, SWEP, DVA, TAC or any other third-party funders. For more information, call us on 1300 866 275.

Photo by Andrea Piacquadio from Pexels

I am a physiotherapist with an additional degree in exercise physiology with nearly 30 years of experience almost exclusively in the treatment of musculoskeletal conditions.

I have travelled the world with a sport team for a decade, been involved with the treatment of Olympic athletes, professional football players, elite gymnasts, high level rugby players, low level soccer players and nursing home patients and assisted mums, dads, kids and grandparents with their pain and dysfunction so I’ve pretty much treated the full spectrum of the community and until recently I relied on my hands….and my hands alone.

"Over the course of my career I have trialled a number of various therapeutic devices, all promising miracle cures for my patients with the touch of a button, whilst a number of them did indeed have a positive therapeutic effect, they were never able to achieve the same results as I could achieve with my own hands……until I discovered the LymphaTouch."

I was shown the LymphaTouch by a colleague (the Director of Rehabilitation Services at a world renowned hospital) and on initial glance was not impressed. It looked like it was just a fancy, westernised form of Chinese cupping (which I had used previously in my career with some good effect but again, found better results with my own 10 digits with the added value of not leaving alien love-bite marks on my clients). More out of politeness and respect for my colleague, I agreed to trial the device as he was interested in my professional opinion and I suspect quietly smug that he knew, despite my well known distain for “toys” that I was going to be impressed. He was not wrong!

"I was able to assess the soft tissue of the next few clients before and after the application of the LymphaTouch and had to reluctantly but excitedly concede that the device had indeed made a significant difference to the activity of the tissue. More than anything however I was impressed at how the result was achieved without any form of discomfort to the patient."

Many times the manual soft tissue releases I have performed were incredibly effective but unfortunately also highly uncomfortable for the patient. I always maintained that if I could somehow achieve the same results that my hands did without the pain of treatment then I have hit the jackpot. With the LymphaTouch I have pretty much done just that.

I now have a team of staff, all of whom fight each other for possession of the LymphaTouch on a daily basis and, as a clinical educator for final year physiotherapy students from both Australia and the USA, each of them has left their clinical placement with me with the goal of getting a LymphaTouch into the first clinic they work is so that they can continue to provide clients with the same great results that they were achieving on their clinical placement.

"The application of the LymphaTouch is not only an asset for patient care (always the primary objective in my mind) but also alleviates stresses on the hands of the therapist. My hands wish I had discovered this device years ago..."

and whilst it cannot reverse the arthritic changes that have already occurred in my fingers, it most certainly will minimise further deterioration and already has reduced the pain I previously experienced on a daily basis.

My single greatest criticism of the LymphaTouch is that previously patients would be in awe of the relief that my hands would give their aching bodies. They would tell me how amazing and skilled I was. Now they tell me how clever the LymphaTouch is and how much they love IT! The true genius of this device is that even the worst manual therapist will still get fantastic outcomes using a LymphaTouch!

Natalie Perkins,
Physiotherapist

How does the LymphaTouch Work?

Negative Pressure Treatment – An Innovative Therapy Method for Faster Recovery

Author: Mira Väyrynen, PT, M.H.Sc

Recovery is an essential part of the training program for high-level performance and continued improvement (Dalleck 2019). Lack of recovery, trauma, overuse or prolonged stress of the tissue structures are common examples of the causes for sport injuries (Bahr et al 2015). There are several treatments that are usually performed after sports injury aiming to speed up the recovery process.

These treatments traditionally include e.g. hot or cold packs, therapeutic exercises, strapping, electrical stimulation and manual therapy techniques such as joint mobilization or massage (Lam et al 2015). Regarding manual techniques, we usually create positive pressure or stretching to affect soft tissue (Threlkeld 1992) and nowadays it is rather common to apply Instrument-Assisted Soft Tissue Mobilization (IASTM) to enhance mobilizing effect of tissue e.g. for scars and myofascial adhesions (Cheatham et al 2015).

One innovative approach in sport rehabilitation and muscle maintenance is to create controlled negative pressure and decompression as part of the manual treatment instead to mobilize the tissue and enhance the recovery process.

LymphaTouch^® negative pressure treatment was originally developed for healthcare and rehabilitation professionals to enhance lymphatic circulation and to reduce swelling and pain especially in cancer survivors who suffer from secondary lymphedema (Vuorinen & Airaksinen 2009). Lymphedema is defined as a condition in which extra fluid builds up in tissues and causes swelling. It may occur anywhere in human body, most commonly in an arm or leg if lymph vessels are blocked, damaged or removed by surgery (National Cancer Institute 2019). Lymphedema can also develop at birth known as primary lymphedema (Rockson 2001).

However, as a typical symptom of inflammation, swelling is also very common condition after acute trauma or injury such as contusions, muscle-tendon or ligament sprains and related ruptures (Kannus et al 2003; Szczesny et al 2003). Therefore, LymphaTouch^® is widely used outside of lymphedema care, since lymphatic swelling occurs in other conditions too, such as pre- and postoperatively, after acute injuries or in some chronic conditions.

Negative pressure treatment is not a completely new way of treatment since traditional cupping is also a very common example of this method. Donahue (2019) makes a good comparison between cupping and graded negative pressure treatment – In cupping, it is not possible to evaluate the amount of negative pressure inside of the cup and it may cause bruising and swelling rather easily for especially hypersensitive tissue.

LymphaTouch® treatment, on the other hand, provides an opportunity to control the decompression of the tissue (Donahue 2019). The operating principle of LymphaTouch® is rather simple (see the video above). Negative pressure expands and stretches the tissue pulling anchor filaments to dilate the endothelial openings of the lymphatic capillaries. Simultaneously, the expansion of fascial and connective tissue structures create space for blood circulation and lymph flow. The device is designed to support lymphatic drainage and to mobilize tissue by creating controlled negative pressure and mechanical high frequency vibration (Vuorinen & Airaksinen 2009).

LymphaTouch® negative pressure treatment has been used in several treatment areas and patient populations, such as:

• Sports athletes to reduce perception of DOMS e.g. after heavy resistance training, for muscle maintenance, recovery treatments, in acute conditions to enhance healing process and to reduce pain (Hietanen et al 2014, Nummela et al 2013, Tucker 2014)
• Orthopedic patients in pre- and postoperative rehabilitation to reduce swelling and pain (Guangmin et al 2018, Ping et al 2014, Saul et al 2020),
• Oncologic patients in lymphedema care to reduce swelling, to treat scar- and fibrotic tissue and to improve symptoms of chemotherapy-induced peripheral neuropathy (Gott et al 2018, Harris 2020, Murphy et al 2018, Vuorinen et al 2013),
• Musculoskeletal and neurologic patients in general rehabilitation to improve range of motion and overall functionality (Airaksinen et al 2011, Hietanen et al 2014, Kim et al 2018).

Also, fascial treatments are common to perform with LymphaToch®. Dr. Tucker (2014) writes about his experience of using the negative pressure device mainly from fascial perspective. He has utilized technology e.g. in acute and chronic local swelling and edema, trigger points, fascial tightness, muscle shortness and deficits in motor activity or control. Dr. Tucker (2014) describes the treatment as an extension of his hands for twisting and pulling the tissue while treating.

LymphaTouch® includes the main unit itself and five different sizes of treatment cups. The size of the treatment cup is chosen to fit the treated body part. Negative pressure can be adjusted between 20 and 250 mmHg depending on the treatment indication. In case of sensitive skin, the negative pressure can be adjusted lower and when treating tighter tissue or scars, the negative pressure can be increased. It is always good to start with lower negative pressure values and increase negative pressure gradually by following patient perceptions and tissue reactions.

LymphaTouch® Sport-upgrade allows even more intense treatments for versatile tissue mobilization with the possibility to increase the negative pressure up to 350 mmHg. With LymphaTouch® device it is possible to choose either pulsating or continuous negative pressure treatments.

Pulsating negative pressure activates the tissue and is used for local treatments when continuous mode is mostly used e.g. in fascial techniques to decompress the tissue efficiently or when redirecting extra fluid in edematous treatments. In case of e.g. treating tight tissue or scar tissue it is possible to combine negative pressure treatment with mechanical high frequency vibration with range of 20-90 Hz. Higher frequencies influence the superficial layers of the tissue and lower frequencies take the effect deeper into the tissue. It is possible to combine all different kind of settings with different treatment techniques which makes the device very versatile to use in various indications. The battery lasts up to 8 hours of continuous use and can be used while plugged in too. LymphaTouch® device is easy-to-use and it travels easily with the sports teams – thanks to its light weight and a convenient carrying bag.

LymphaTouch® treatment promotes overall recovery and can help to speed up the recovery by accelerating the lymphatic flow and creating decompression to the tissue (Vuorinen & Airaksinen 2009). LymphaTouch® negative pressure treatment gives professionals the opportunity to mobilize the tissue in an opposite direction what is possible to create with our hands and hence, provides a three-dimensional treatment (Donahue 2019). It also allows practitioner to assess for interrupted fascial gliding, improve fascial flexibility and to enhance lymphatic flow (Tucker 2015).

By combining the expertise and knowledge of the practitioners with other manual techniques and active exercise therapy, graded negative pressure treatment can provide a great potential for sports athletes’ injury prevention, muscle maintenance, faster recovery and overall performance.

View LymphaTouch package online

About the author:

Mira Väyrynen works as a clinical specialist at LymphaTouch Inc. She graduated as a physical therapist from Lapland University of Applied Sciences and also holds master’s degree in Health Science from University of Jyväskylä. She has a versatile experience from working with various patient populations from children to elderly, including patients with stroke, cancer, musculoskeletal-, neurological-, cardiovascular- and lung disorders. She has worked in both private clinics and public hospitals, such as Helsinki University Hospital. On her daily basis, Mira coordinates research projects, collects and shares information and experience with clinicians worldwide and provides trainings and workshops related to LymphaTouch negative pressure device.

References

• Airaksinen, O., Vuorinen, V.-P. & Raittila, S. (2011). Influence of LymphaTouch-treatment method for pain and edema in context of active physiotherapy. Internal Research Report.
• Bahr, R., Alfredson, H., Järvinen, M., Järvinen, T., Khan, K., Kjaer, M., Matheson, G. & Maehlum, S. (2012). Types and Causes of Injuries. In. R. Bahr, P. Mccoey, R. F. Laprade, W. Meeuwisse, L. Engebretsen (editors) The IOC Manual of Sports Injuries: An Illustrated Guide to the Management of Injuries in Physical Activity. The International Olympic Committee: Pp 1-24.
• Cheatham, S. W., Lee, M., Cain, M., & Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association, 60(3), 200.
• Dalleck, L. C. (2019). The Science of Post-Exercise Recovery. American council of exercise. Cited 18.6.2019. https://acewebcontent.azureedge.net/SAP-Reports/Post-Exercise_Recovery_SAP_Reports.pdf.
• Donahue, P. 2019. Manual Strategies: Optimizing Patient Outcomes in the Clinic. Performance Health Academy.  Cited 19.6.2019. https://www.performancehealthacademy.com/articles/manual-strategies-optimizing-patient-outcomes-in-the-clinic.html.
• Gott, F. H., Ly, K., Piller, N. & Mangion, A. 2018. Negative pressure therapy in the management of lymphoedema. Journal of Lymphoedema, 13 (1).
• Guangming, X., Xuemeng, X., Wengang, L., Yanyan, L. & Guocai, C. (2018). Observation on short term curative effect of PhysioTouch based on infrared thermography technology in postoperative treatment of TKA. Chongqing Medicine, (19) 11.                                
• Harris, A. (2020). LymphaTouch™ as a Preparatory Method for Chemo-Induced Peripheral Neuropathy and Radiation-Induced Fibrosis: A Case Study.
• Hietanen, S., Puustinen, T., Jouhki, I., Palomäki, K. & Taskinen, T. (2014). LymphaTouch® and PhysioTouch treatment as a part of Active Physiotherapy: Effect on Pain and Swelling. Internal report.
• Kannus, P., Parkkari, J., Järvinen, T. L. N., Järvinen, T. A. H., & Järvinen, M. (2003). Basic science and clinical studies coincide: active treatment approach is needed after a sports injury: A short review. Scandinavian journal of medicine & science in sports, 13(3), 150-154.
• Kim, K. R., Shin, H. S., Lee, S. B., Hwang, H. S., & Shin, H. J. (2018). Effects of Negative Pressure Soft Tissue Therapy to Ankle Plantar Flexor on Muscle Tone, Muscle Stiffness, and Balance Ability in Patients with Stroke. Journal of International Academy of Physical Therapy Research (JIAPTR), 9(2), 1468-1474.
• Lam, K. C., Snyder Valier, A. R., & Valovich McLeod, T. C. (2015). Injury and treatment characteristics of sport-specific injuries sustained in interscholastic athletics: a report from the athletic training practice-based research network. Sports health, 7(1), 67-74.
• NIH National Cancer Institute (2019). NCI Dictionary of Cancer Terms, lymphedema. Cited 18.6.2019. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/lymphedema.
• Murphy, S. L., Barber, M. W., Homer, K., Dodge, C., Cutter, G. R. & Khanna, D. (2018). Occupational therapy treatment to improve upper extremity function in individuals with early systemic sclerosis: a pilot study. Arthritis care & research, 70(11), 1653-1660
• Nummela, A. & Mikkola, J. (2013). Effect of PhysioTouch treatment on perception of DOMS and recovery after heavy resistance exercise. Research Institute for Olympic Sports -KIHU, Jyväskylä.
• Ping, W., Yindi, S. & Nong, W. 2014. Clinical observation of postoperative swelling of lower limb fracture. The 21st national symposium on integrated traditional Chinese and western medicine orthopedics and traumatology and the compilation of papers of the general meeting of the new branch of orthopedics and traumatology 2014.
• Rockson, S. G. (2001). Lymphedema. The American journal of medicine, 110(4), 288-295.
• Saul, D., Fischer, A. C., Lehmann, W., & Dresing, K. (2020). Reduction of postoperative swelling with a negative pressure treatment—A prospective study. Journal of Orthopaedic Surgery, 28(2), 2309499020929166.
• Szczesny, G., & Olszewski, W. L. (2003). The pathomechanism of posttraumatic edema of the lower limbs: II—changes in the lymphatic system. Journal of Trauma and Acute Care Surgery, 55(2), 350-354
• Threlkeld, A. J. (1992). The effects of manual therapy on connective tissue. Physical therapy, 72(12), 893-902.
• Tucker J. 2014. Lymphatic and Fascial System Treatment: Time to De-Compress. DC Practice Insights. Cited 19.6.2019.  http://www.dcpracticeinsights.com/mpacms/dc/pi/article.php?id=56846
• Vuorinen, V.-P. & Airaksinen, O. (2009). A new vacuum suction device for management of lymphedema. 22nd International Congress of Lymphology, Program & Abstract book pp. 121. September 21st-25th 2009. Sydney, Australia.
• Vuorinen, V.-P., Iivarinen, J., Jurvelin, J. & Airaksinen, O. (2013). Lymphatic therapy using negative pressure, A clinical study with the LymphaTouch device. Research Report #5320003/221, Finnish Funding Agency for Technology and Innovation, August 2013.

Orthotic Management of Paediatric Conditions

Orthotists help manage orthopaedic conditions in children with a conservative approach to provide support or alignment correction to reduce pain and optimise their movement.

To clarify, an orthotic is not just something that goes in your shoe! An orthotic is any type of brace that is fitted to any part of your body to support and restore function in the hope to improve mobility, reduce pain and improve overall quality of life both in the short and long term. Below are some of the common reasons why children would need to see an orthotist from a young age.

Neurological Conditions Including Cerebral Palsy

AFO is short for Ankle Foot Orthosis and these types of braces can be used to help position children’s feet who may have weakness or instability in their legs due to Cerebral Palsy and other neurological conditions resulting in foot drop. Traditional AFOs are made of plastic from a cast of someone’s leg which is then used to mould and produce the final device.

Alongside AFOs, there is also the WalkAide available to paediatric patients. The WalkAide uses small electrical stimulations to activate the nerves and muscles in the leg to pick up the foot for children affected with foot drop. Unlike traditional AFOs, the WalkAide is worn on the leg and therefore can be worn barefoot around the home and even on the beach. It works when children walk, run and play, so no matter what activity they are doing they will still be safe and supported.

OAPL are also able to help paediatric clients who require fracture boots, plaster and fibreglass casts, foot orthotics and general bracing for the neck, wrist, knees, and everything in between.

Helmets for Plagiocephaly

Deformational Plagiocephaly often presents as an asymmetrical or uneven head shape. The back of one side of the head will be flattened, often resulting in changes in the forehead and ear alignment. An abnormal head shape caused during the birthing process should begin to correct over time, however if any flat spots are still apparent or new flat areas occur some form of intervention may be required.

In moderate to severe cases of deformational plagiocephaly a cranial remodelling helmet may be recommended. These helmets assist the skull moulding process by removing the pressure over the flat area, allowing the skull to grow into the space provided. Helmets are most effective between 4-12 months of age and results show that helmet therapy can be highly successful in achieving a more symmetrical head shape. 

Fortunately, there is no need for a plaster cast when measuring for a remodelling helmet, all measurements are taken with a scanner on a phone and little bubs are free to move as they like! With access to 3D scans and measurements, the family can always track the remodelling process and decide the best course of treatment for their child moving forward.

Developmental Dysplasia of the Hip

Developmental Dysplasia of the Hip (DDH) is the dislocation of the hip due to the shallow and underdeveloped hip socket in some babies. There are various causes of DDH, including family history, breech delivery or a delivery that puts stress on the baby’s hip joints.

DDH is managed with an orthosis that is designed to put the baby’s hips and knees in a bent position to achieve optimal contact between the hip socket and the thigh bone for the hip joint to develop normally. 

Prosthetic Management of Paediatric Conditions

Upper limb

Prosthetists don’t just treat lower limb amputations but also treat those with upper limb differences. The majority of upper limb amputee children are the result of congenital limb deficiencies. This can be caused by genetic abnormalities, growth restrictions such as amniotic band syndrome, exposure to viruses in utero and more. A lot of congenital abnormalities don’t always have an explanation as to why and this is particularly the case with upper limb deficiencies.

The sooner a child can begin using a prosthetic arm the better long-term user they will be. Often the first arm will be fitted once the child starts to crawl because they will find it useful when moving around.  These arms would be described as ‘passive’ because they are a hand that doesn’t move. They are shaped to help the child crawl, move objects and carry small items.

Once the child starts to get a bigger and has more cognitive function prosthetists then look at incorporating a hand/hook that has movement. This is normally just the thumb that moves and allows the child to grip and carry objects. The hand/hook moves by the child wearing a harness over their contralateral shoulder and by pulling shoulders forward allows the hand/hook to open and close.

Once a child has mastered using an upper limb prosthesis there are a range of functional attachments for the end of their prosthesis that will give them greater function and ability to try new activities. These might include a tumbler attachment for gymnastics, a guitar pick holder or attachment that allows the child to hold onto the bicycle handle bars. 

Lower Limb

As with Upper Limb amputation, the majority of lower limb amputations in children are caused from congenital deficiencies at birth rather than trauma. Often children may be born with deficiencies that effect complete or partial absence of the fibula or tibia. This will result in the lower limb not forming correctly and can affect the length of bones, shape of limb and internal structures of the foot.

In many cases an attempt will be made to keep the limb, however in some cases, this is not possible and the limb will be amputated. If this is the case, it often happens when the child is still a baby.

Once the child has started crawling a cast for a prosthetic limb will be taken. This will be the time it starts to become useful and is often a simple design that is self-suspending.  This will allow the child propulsion when crawling but also let them progress to walking. Design wise, there are a vast range of fun designs that can be incorporated onto children’s legs to help encourage the child to wear them!

Children are amazingly resilient and because they have often grown up using a prosthetic limb they are often excellent walkers. They learn to walk using a prosthesis, grow up using a prosthesis and are able to participate in mostly any activity they choose. Once the child is old enough, prosthetists will endeavour to put them on componentry (Feet/Knees) that will enable them to participate in sport and play with their peers.

What is Heel Pressure?

Heel pressure can cause serious injuries to the skin behind the heel and if not managed correctly can lead to further ulceration. This happens to people who have poor skin integrity or when people are not mobilising and are experiencing prolonged bed rest. The area behind the heel is prone to breaking down because the heel bone, called the Calcaneus, has a distinct ridge at the back of the heel that makes it prominent. The skin over the area is also thin and does not have much padding, such as muscle or fat that protects the bone from the skin. 

Heel pressure occurs when people are laying down and the back of the heel is in contact with the bed. The weight of the leg is passed through the back of the heel where there is minimal padding or resilience to pressure. Movement of the heel on the bed will cause shear stress to the area and the skin can come red and inflamed. 

Heel pressure areas are a common occurrence for a range of people. Most often people are experiencing long term bed rest when heel pressures occur. The skin protecting the area is thin and there is little tendon or muscle soft tissue protecting the bone. When people have poor skin integrity and are not mobilising often, they are likely spending a lot of time in bed. When you think about the position they are resting in, you notice their heels are resting right on the bed. Add micro-movements to this time laying down and the skin will experience ongoing shear pressure on the sheets or bed. This can cause pressure areas within hours; It may appear like a red blemish or when you wear a new pair of shoes and develop a heel blister. Or it may be a burst blister and forming into an ulcer.

Symptoms & Causes

As mentioned above, the pressure may first appear as discolouration on the heel, colours to look for are red, purple and blue. Like a bruise, the blood is at the surface of the skin causing the discolouration. It is likely that fluid will develop in the skin like a blister; once the skin breaks, the person is at risk of infection or skin death (necrosis). 

There are several known factors that increase a patient's risk of developing a heel pressure ulcer, including:

• Inadequate/malnutrition - Poor vitamin intake and absorption from food can lead to thinning of the skin and therefore decreased blood flow.
• Advancing Age – Elderly people who spend an increased amount of time in bed can lead to shear and pressure in areas of poor skin integrity.
• Abnormalities of circulation – This may be due to vascular issues where blood flow is limited to the extremities and a lack of red blood cells to an injury will delay healing. This is also common in patients with diabetes.
• Sensory deficiency – For example, people with diabetes who may experience nerve damage are at increased risk of pressure sores. Nerve damage causing loss of sensation is called Diabetic Neuropathy.
• Immobility – May be caused by paralysis, stroke or severe illness. Fractures of the bones in the legs may also lead to immobility for a period of time. Common fractures to occur are the neck of the femur (NOF) fractures also known as a broken hip
• Major surgery - Heart, lung and some orthopaedic surgeries restrict mobility and hence increase time in bed. Long periods of time laying in bed increase chances of pressure sores.
• Multiple health problems (comorbidities) -  Particularly coronary or respiratory can lead to long term bed rest. Long periods laying in bed increases the chances of pressure sores.
• Dehydration - Hydration is vital for maintaining skin integrity and wound healing. Adequate fluid intake is necessary to support blood flow to wounded tissues and to prevent additional breakdown of the skin. 

Treatment & Prevention

Offloading is described as lifting or pushing an area of high pressure away from the cause of the pressure. To offload is to distribute the load to other areas which are not susceptible to pressure areas. Both the calf and foot can help with the offloading. Heel pressure is redistributed to both the calf, a soft muscle belly which can change shape to fit a supportive device as well as the foot.

Below are some examples of devices available for short term or long-term offloading of the heel.

oapl Heel Cushion

A basic all-rounder ankle, foot and heel relief device which acts as a snug cushion under the foot and ankle. A large hole under the heel allows for the pressure area to float in space and have minimal pressure in the heel region. The device is appropriate for prevention of pressures particularly in the ICU environment. The OAPL Heel cushion comes with a de-rotation wedge which limits rotation of the leg from the hip and keeps the leg in a neutral position. The device also comes with “AFO straps”, elastic straps which can be attached to the heel cushion (via Velcro) in a figure of 8 design, keeping the ankle at 90 degrees, avoiding plantar flexion and contractures occurring.

Heelift

Available in smooth or convoluted foam. The Heelift Suspension Boot is designed to provide an effective solution for prevention and assistive healing of pressure ulcers at the heel. The Heelift delivers positioning and alignment of the lower limb. It is made from latex-free medical grade foam with a friction free tricot (satin) base. This ensures it stays in place on the leg at all times as well as sliding through the bed sheets when required and not sticking. The convoluted design is in place to aid air flow through the device when under the bed sheets. Heelift comes with an extra pad to control hip rotation, foot drop or provide added elevation. One size fits all.

MPO (Multi Podus Orthosis) 

 The RCAI MPO 2000® with Transfer Attachment features a Sky Blue breathable foam liner that wicks moisture away from the skin while maintaining skin integrity. The MPO floats the heel to eliminate pressure or friction on the heel, enhancing blood circulation vital to healing. The dynamic flex action supplies continuous counter force to the plantar surface of the foot assisting in the correction of foot drop, foot and ankle contractures and deformity. The adjustable toe post relieves pressure on the toes and can be positioned to the side in the treatment of malleolus and lateral ulcers. The rotator bar positioned to the side, controls hip and leg rotation, providing functional alignment. The transfer attachment (brown sole) is provided for stand-up transfer and prevents cross-contamination from floor to bed. We do not recommend patients walk in the MPO boot.

People often ask how orthotists and prosthetists are involved in treating patients who have diabetes. As a condition that is primarily related to glucose levels in the blood. Having diabetes can lead to an array of health complications if not managed effectively.

Diabetes is a medical condition where the body cannot maintain healthy glucose levels in the blood. When you eat food that contains glucose, your pancreas produces a hormone called ‘Insulin’ that converts glucose from your food into energy. When your body cannot maintain healthy glucose levels, you could have diabetes, a non-curable medical condition that can be serious if not managed correctly.

Type 1 Diabetes

Type 1 diabetes is caused by an autoimmune condition where the body attacks and damages the pancreas and insulin cannot be produced as a result.

Type 2 Diabetes

Type 2 diabetes is caused by lifestyle factors and associated with obesity. It can be caused by the pancreas wearing out by overproducing insulin over a long period of time or if the pancreas has the ability to produce insulin but the muscles and liver prevent the insulin from working. About 1.7 million Australians have diabetes. 10% have type 1 diabetes and 90% of type 2 diabetes. If the glucose is not broken down, it will remain circulating in your blood. When sugar is present in the blood it is called glycemia, and if there is too much glucose in the blood that is unmanaged, it can cause damage to small blood vessels.

Complications of Diabetes

Diabetes can lead to damage of nerves and small blood vessels within the body. Damage to nerves that cause loss of sensation in the feet is called peripheral neuropathy. Those with a wound may not feel pain in their feet and therefore may not realise they have a wound under their foot. Poor sensation and blood circulation in the feet increases the risk for sores and skin break down due to poor skin integrity. Being overweight, having poorly fitted shoes or having debris inside your footwear can cause wounds to form. The damage to the body’s arteries and blood vessels lead to poor circulation and can severely affect one’s ability to heal. A normal immune system clears away damaged tissue, builds new skin and fights off infection. If diabetes is unmanaged, the Immune system is weakened and cannot fight off infection and generate new skin.

Management of Complex Diabetes

Diabetic and high-risk foot management involves multi-disciplinary team comprising of podiatrists, endocrinologists, vascular surgery, rehabilitation physicians, clinical psychologists, dieticians, care coordinators and orthotists. This robust team oversees patients with complex diabetic foot  wounds within the inpatient setting or the outpatient setting. The multi-disciplinary team implements evidence-based assessment and management of patients with diabetes related foot problems with the aim of reducing amputation rates, reducing lengths of stay and ensuring cost effective and appropriate use of hospital investigations and resources for this patient group.

Orthotic Management for Diabetics

What is an Orthotist?

An orthotist works with patients who require any form of bracing or support because of issues with the neuromuscular and skeletal systems. Ranging from sports bracing to complex custom supports, an orthotist will assess and treat patients who have physical limitations resulting from llnesses and disabilities. In everyday work, an orthotist will undertake assessments, prescribe, design, fit and adjustments of orthoses. The role of an orthotist within Diabetic and High-risk foot management is an extremely challenging yet important position.

What is an Orthotist’s role in diabetic and high-risk foot management?

Orthotists work with a multidisciplinary team involved in all stages of wound management of diabetic feet to heal wounds and prevent infections through a gold standard of treatment protocols. An orthotist can assess and fit specialised footwear and orthoses to manage active wounds and prevent wounds from recurring after it has healed. Wounds in diabetic patients are slow to heal due to a poor blood supply and reduced immune function. Therefore, there is an increased risk for bacteria to enter the wounds and lead to serious infection.

Pressure, shear or friction can cause break down of skin that has poor supply of oxygen and nutrients. Wounds are often found on the bottom of the feet from the body’s weight. Orthotists aim to reduce pressure under the wound to prevent the wound from getting worst without taking away the patient’s independence and allowing them to continue their day to day activities.

Wounds can be offloaded with a modified post-operative or wound care footwear with felt or a pressure relieving insole. The wound will be relieved by re-directing pressure and forces from weight bearing to a larger area of unaffected skin.

Orthotists can also fit a CAM walker to offload wounds on the bottom of the foot for a higher level of offloading. They also have the skill to apply a specialised cast, called a ‘Total Contact Cast’ with the wound protected by felt, layers of cotton and plaster. The cast can re-distribute pressure and weight in the foot and shear and friction during walking.

Even after a wound has healed, a diabetic patient will have a risk of having recurring wounds. An Orthotist is involved in the prescription of a custom insole and footwear that they can wear in the long term. It can be customised to mould the bottom of the patient’s foot, accommodate any deformities and reduce pressure going through areas of the foot that are at risk of foot ulcers. Orthotists work within a high-risk foot team to prevent diabetes-related amputations.

Diabetes and Amputations

Each year in Australia there are more than 4,400 amputations directly related to diabetes and this number is growing. Diabetes causes a decrease in blood flow to the peripheries (feet/hands) and results in reduced sensation and poor healing. Because of these symptoms, diabetic patients are prone to ulcers on their feet/lower limbs and this is the main cause of amputations. If a limb has needed to be amputated there is then far greater risk for the unaffected limb that remains. If the need for amputation is due to poor vascularity, this risk is due to its likely poor circulation, increased load that will be placed through it and the reliance the individual now has on their remaining ‘good’ leg. The chance of having a further amputation almost doubles once the first one has occurred.

Prosthetic Management for Diabetics

Diabetes and caring for your residual limb

After an amputation it is vital to maintain the health of your remaining limb. Due to decreased sensation and the reduction in blood flow, the skin can become more delicate, so its vital to check regularly to ensure there is no redness, rubs, dryness or breakdowns. This can be done by using a hand mirror so a full view of the residuum is possible and should be done at regular periods throughout the day.

What is a prosthetist?

A prosthetist is trained to prescribe, design and fit any prosthetic device used to replace part of a person’s body. They are involved in providing therapy and education around the use of a prosthetic device and how it should serve an individual’s requirements.

What role does a Prosthetist play in diabetic amputations?

After an amputation the individual will need to see a Prosthetist so they can educate the amputee on what they should expect during their recovery and, if appropriate, what the process is for them receiving a new prosthetic limb.

The majority of amputees with diabetes-related amputations will receive some form of prosthesis. It can be used to simply transfer between chairs or walk around the home, go back to work or even begin to play sports. This will all be determined by the amputee’s overall health, ability and goals.

Prosthetic design for patients with Diabetes

An amputee maintaining excellent stump health is vital to a success fitting of a prosthesis. Whilst volume fluctuations are common with all new amputees is can be particularly problematic with diabetic patients. This is because they need to be very diligent in adjusting the fit of their prosthesis with socks to either add or remove space and ensure there is no excess movement. Excess movement is the major cause of skin breakdown and with poor circulation that means delayed healing. This delay in healing will result in the amputee being unable to wear their prosthesis for risk of further skin breakdown and will slow their overall recovery.

Depending on the skin integrity and the level of the amputation the prosthetist will work with the amputee to ensure the most safe and comfortable fit can be achieved. This may be through using gel liners, special socks without seams and a variety of other methods.

The VACOped boot by OPED is revolutionising the way we manage foot and ankle fractures and is now considered the gold standard for treatment of Achilles tendon ruptures. Unlike conventional treatments, the VACOped allows the foot and ankle to remain dynamic while still providing the support necessary for a full and quick recovery.

The VACOped utilises VACO12 technology as a main feature of stabilisation. The VACO12 system within the VACOped uses as many as 20 million small polystyrene beads that each make contact with up to 12 other surrounding beads. Energy is transferred along the poly beads but is dispersed and weakened as forces are absorbed from bead to bead.

This limits the chances of movement within the boot due to impact. Like a bean bag, the liner is filled with polystyrene beads that mold around the foot and leg of the wearer. Air is vacuumed out of the liner so that the poly beads contour around the foot and ankle to provide customised protection. This works with a rigid plastic outer shell to make VACOped very cast stable for the wearer.

The VACOped is unique in that it can easily be removed and reapplied. Physicians are able to easily check the fracture site, and physiotherapy can be done at any time. The simplicity with which the VACOped can be removed and reapplied not only means that patients are also able to wash their limb, but the removable liners which cover the vacuum cushion can be easily washed and replaced.

The vacuum technology used in the VACOped's fracture stabilisation system ensures the boot will re-mold perfectly to the shape of a patient's limbs, no matter how many times it is removed. The removable sole of the VACO range of boots means they can also be worn at night without soiling bed linen.

The vacuum stabilising system VACOped consists of a modular, honeycomb shaped plastic shell and a vacuum inlay that together offer stability equivalent to a plaster cast. The co-operative patient can put on and remove the VACOped independently. Physical therapy is also possible to preserve dorsiflexion/extension in the ankle joint in the early post-operative phase. Various adapters on the posterior range of motion (ROM) hinge enable restricted dorsiflexion/extension while maintaining lateral stability.

What foot and ankle conditions does the VACOped address and how?

Achilles Tendon Repair

The VACOped was primarily designed and engineered for the treatment of the Achilles tendon rupture. The Range of Motion (ROM) hinge allows the practitioner to set the ankle at different angles of plantar or dorsiflexion and allows for free ROM or a controlled degree of ROM.

Controlled joint movement is an important part of the late rehabilitation phase, allowing the joints and muscles to gradually regain strength. Unlike other conventional treatments which do not allow for any movement, the VACOped ROM function can be set in increments of five degrees.

In the study by Dolphin et.al. Patients who were treated with the VACOped showed better tendon quality post-treatment as well as a decreased rate of re-rupture

Malleolus or Ankle Fractures

The frame design in collaboration with the vacuum cushion allows for cast stable immobilisation in the boot. Unlike other conventional treatments which do not allow for any movement, the VACOped‘s ROM (range of motion) function can be set to allow the patient to walk normally with the boot in situ and ROM at the ankle. This allows the muscles to regain strength and reduces the rate of thrombosis as the calf muscle contracts through gait and moves blood back to the heart.

How does the VACOped differ from existing technology?

Currently Achilles ruptures are treated in an emergency department with a plaster of paris backslab, the ankle is set in plantar flexion and a crepe bandage wrapped around. In the following days, the patient will attend an orthopaedic clinic where they will be fitted with a CAM walker and a heel wedge. Generally these heel wedges are a stack of 3 or 4 wedges connected to one another but which can be pulled apart. The wedge is positioned under the heel and encourages the ankle into plantar flexion. Because the wedges are bulky and the boot is designed for an ankle in the 90 deg position, the walker and wedge can become ill-fitting and uncomfortable for the patient

The alternate treatment to this is to use a goniometer to measure 30 deg of ankle plantar flexion and the patient has a full plaster cast or synthetic cast applied to the leg. Every two weeks the angle is adjusted by 15 deg until the patient reaches the neutral position. Limitations to this method are: Time to apply the cast, remove and re-apply at least twice. A skilled cast technician is required to set the cast and perform this method. Further limitations include the patient cannot weight bear at all in the cast, particularly when it is set in plantar flexion. This results in the atrophy of the foot and leg muscles.

Conclusion

The VACOped boot represents the modern standard of care for foot, ankle and Achilles injuries. With the ability to provide cast stable immobilisation and a short application time. The VACOped also offers an ankle range of motion function (-15° to +30°). Because the modular boot is designed to move and flex at the ankle it allows true plantar flexion without the ill-fitting nature of the walker and wedge method described above.

VACOped allows for greater freedom of movement than a plaster cast as it can be removed for hygiene reasons or a practitioner wants to check a wound. The total contact nature of the device can significantly reduce recovery times as seen in the study by Honigmann et al.

Clinical Evidence

VACOped Facts & Figures.pdf

• Functional dynamic bracing and functional rehabilitation for Achilles tendon ruptures: a case series Dolphin, P. (Philippa); Bainbridge, K. (Kelly); Mackenney P. (Paul); Dixon, J.(John). 2016
• Non-surgical treatment of Achilles rupture: Does duration in functional Weight bearing orthosis matter Randeep Aujla  MBChB *, Amit Kumar, Maneesh  Bhatia. 2015
• The dynamic vacuum orthosis: a functional and economical benefit? Jochen Franke & Sabine Goldhahn & Laurent Audigé&Henry Kohler&Andreas Wentzensen. 2007
• After treatment of malleolar fractures following  ORIF—functional compared to protected functional in a vacuum-stabilized orthosis: a randomized controlled trial Philipp Honigmann, Sabine Goldhahn, Jan Rosenkranz, Laurent Audigé, Daniel Geissmann, Reto Babst. 2005
• Cast Immobilization or Vacuum Stabilizing System? U. Stöckle, B. König, A. Tempka, N.P. Südkamp · Trauma and Reconstructive Surgery, Charité, Campus Virchow Klinikum, Humboldt University Berlin. Unfallchirurg. 2000

For more information on the OPED range of boots including the VACOped, VACOcast and VACOpedes, call us on 1300 866 275 or email info@oapl.com.au

The Lower back is a complex structure, made up of 5 lumbar vertebras that support the weight of the upper body. The spine is a crucial part of your body function. The spinal cord that connects the brain to the rest of your body, is protected by the bones in your spine. An injury to any of these structures can result in localised back pain or radiating pain if a nerve that sends signals to the extremity becomes compressed.

Symptoms

Low Back pain, or “Lumbago” can be caused by an injury to a muscle, ligament or joint around the lower spine, called the “lumbar” or “lumbosacral” spine, resulting in localised pain.

 

Mechanical low back pain can be caused by improper lifting, poor posture, repetitive stress, lack of exercise or fracture to the spine. You can be at higher risk of developing lower back pain from having more pressure or strain on your back by being overweight or pregnant. 

Lumbar sprain

Ligaments are the connective tissue that joins bones, joints and cartilage together and keeps the spine stable. The ligaments can be overstretched and tear from improper lifting or lifting something too heavy. 

Muscle Spasm

It would be hard for you to distinguish between a ligament or a muscle injury as both can cause significant pain and inflammation in the area. A muscle spasm is an involuntary contraction of the muscle that feels like cramping or tightening. The back muscle would spasm to protect itself or could mean that there is an underlying problem with the spine. 

Degenerative disc disease

The ‘disc’ is the layer between the vertebral body that contains a jelly-like substance which acts as a shock absorber in the joint of the spine. It is normal for this layer of disc to become drier and less flexible with age, therefore, your spine will not be able to move freely and can be painful. Your pain can be worst with sitting but can be relieved by standing up, changing positions or lying down. 

Ruptured, prolapsed or herniated disc

When the jelly-like substance in the disc bulges out of a tear in the outer casing of the disc, it is called a ‘herniated disc’. In most cases, a herniated disc is undetected as it does not cause symptoms. However, if the bulged disc pushes against a nerve, it will cause a significant amount of pain. Overtime, the herniated portion of the disc can get smaller, therefore symptoms will ease and go away. 

Diagnosis

Your doctor may request imaging to find the cause of the pain. An MRI scan can show whether you have an injury soft tissue, spinal discs and nerve roots. Whereas, a CT scan will provide cross-sectional images of your spine. 

An X-ray can provide clearer imaging of bone and can be used to rule out any fractures. This will help your doctor decide on how to treat it. 

Treatment

Bracing is a conservative approach that provides targeted compression to the muscles and ligaments that are causing pain. It helps relieve muscle tension and pain in your lower back. Bracing can also improve posture to redistribute weight in the spine and to lessen the strain on the muscles and ligaments around the back to provide pain relief during recovery of lower back aggravation.

Hot & Cold Therapy helps alleviate sore and tight muscles around the lower back. Applying heat to an inflamed area will promote blood flow. 

Physical Therapy Programs focus on strengthening the core muscle groups in the low back and improve flexibility and posture of the back.

Your doctor may prescribe medications such as pain-relieving medications or non-steroidal anti-inflammatory drugs for acute and chronic low back pain. 

OAPL Cool Fit Cinch

The oapl Coolfit Cinch provides lumbar spine support to help reduce low back pain and support the abdominal region. It features a ventilated mesh support with elastic segment and includes touch tape adjustment for easy application. 

Bioskin Back skin

Ideal for low back pain due to low back sprains, the Bioskin back skin provides overall compression to your lower back. Can be worn during activities to prevent re-injury by improving back posture. Can be purchased with a foam pad for targeted compression. 

Bioskin Vector

Provides targeted, vectored compression through a dual pulley cinching system through pulling the handles. This will pull the lumbar (lower spine) panel forward into the spine for the targeted compression. The Vector comes with a hot/cold pack that can be inserted into the back section of the brace to provide relief from flare ups from muscular strains and osteoarthritis of the lower back.

Oapl have a vast array of experience treating patients with lower back pain.

To book an appointment with one of our orthotists please call us on 1300 866 275 or view our clinical locations here.

 

Knee Osteoarthritis is a degenerative knee condition where the cartilage of your knee joint gradually wears away, exposing the underlying bone.

Early stages of knee Osteoarthritis (OA) is characterised by the onset of pain and mild inflammation around the knee. Usually pain is more severe in the morning and the knee may feel stiff and take a while to loosen up. These symptoms are also exacerbated when living in cooler climates.

So what is going on inside the knee joint?

Knee OA causes inflammation of the tissues in and around the joints. Cartilage, which is a strong and smooth surface that lines the bones and allows the joint to move without friction, can be damaged. Unfortunately for us cartilage does not regenerate.

Bony growths can sometimes develop around the edge of the joints called bone spurs and the alignment of your knee may change as the deterioration takes place. The continual erosion of cartilage can cause alignment problems and this may make you feel as if one leg is shorter than the other or your balance may be compromised.

When the cartilage is very worn (in the later stages of OA) you may feel a grinding in the joint, which is described as the feeling of bone rubbing on bone, or you may hear a clicking noise. Knee OA can be debilitating but there are many treatment options to keep you active and on your feet.

If you think you have OA and would like to know more, see your local GP, they will be able to refer you to have a suitable X-Ray to determine why you are experiencing knee pain.

Symptoms & Causes

There are many diverse causes of knee OA. We commonly see patients over the age of 50 who have lived active lives present with general wear and tear injuries.

Active people who have participated in weight-bearing sports involving lifting, running and directional change are the most likely to develop OA symptoms over their lifetime.

Past (sports) injuries will also play a part in the development of OA, particularly for those who have had prior surgeries for ligament or meniscus damage. In a lot of these procedures the surgeon will clean up and remove cartilage from the joint. As we know, cartilage does not grow back.

Contrary to those active patients, we see people who are overweight and not active enough. They are simply putting more strain through their knees, ankles and feet than the body can adequately deal with. This strain on the joints causes accelerated breakdown of soft tissue in the joint capsule.

Lastly, you could blame your parents… Genetics does play a part in the cause of your OA. Although you do not inherit the condition itself, if your parents have/had OA, you inherit an increased risk of developing the condition.

Treatment & Prevention

Unloader Bracing

Whether you have mild, moderate or severe OA, a knee brace may help to reduce pain by shifting your weight off the most damaged portion of the knee. These braces have hinges designed to push or pull the painful compartment of the knee open for relief. This will improve your mobility and help increase the distance you can walk comfortably. In most cases these braces will provide extra stability and improve balance for the wearer as well.

OA knee braces come in a variety of designs, but most are constructed with a combination of rigid and flexible materials — plastic, metal or other composite material for basic structure and support and mouldable foam for padding and positioning.

You may only need a light single upright brace to get an exceptional result. There are also dual upright braces available and if you have some severe malalignment or if you have an unusual shaped leg, custom bracing is also available.

In some Australian states there is government funding to assist with the cost of these braces, just ask your preferred clinician for more information.

Thermic Knee Braces

Thermic compression braces are designed to keep the knee joint and surrounding area warm and supported. With those affected by OA, heat can help to relax the muscles and in turn can provide some pain relief. These braces are usually knitted or made of neoprene (wetsuit material) and are circumferential in their design to provide a comforting, hugging sensation to the knee..

Orthotics

Orthotics are used to augment foot function and are designed to treat, adjust, support or accommodate various biomechanical foot disorders.

The most effective orthotics are custom-made as they are tailored to meet the specific needs of an individual. Custom orthotics are created using an impression of the foot (called a mould) which duplicates any misalignments in foot structure. Using the cast, scanning and computer technology, an orthotist will then create the foot orthoses to sit under your foot and support the muscles in your feet and legs. These orthotics can realign joints in the lower limbs and lead to decreases in knee, gluteal and lower back pain.

 

Creams, Topicals, Gels and Anti-inflammatory Tablets.

There are many topical creams and gels you can use for reducing the inflammation associated with knee OA. One you may not be familiar with is FlexiSeq, which is a gel containing very small particles to deliver bio-lubricating vesicles through the skin and directly into joints to coat the surface of the cartilage.

By reducing biomechanical stress and friction, Flexiseq reduces pain and restores joint function. This product does not use any active drugs and hence does not have associated side effects.

Oapl have a vast array of experience treating patients with Osteoarthritis of the knee.

To book an appointment with one of our orthotists please call us on 1300 866 275 or view our clinical locations here.

If you’re experiencing pain and stiffness along your Achilles area then chances are you may have Achilles Tendonitis. Achilles tendonitis is the inflammation of the Achilles tendon above the heel and can be caused by an increase in high impact activities such as running or jumping.

The Achilles tendon joins the calf muscle (Gastrocnemius) to the heel bone (Calcaneus) which is the largest and strongest tendon in the body; however, due to poor blood supply to the tendon, damage takes longer to heal than other soft tissue injuries.

Symptoms & Causes

Achilles tendonitis can present as pain anywhere along the tendon, localised warmth, mild swelling or pink/redness. Pain is intensified when you push up on your toes and lift your heel off the ground. This is due to the tendon contracting and being put under load. Achilles tendonitis is often worsened by:

• An increase in usual running distance
• Running uphill frequently which creates a repeated stretch on the Achilles tendon as the ankle is positioned in dorsi flexion (position where the toes point up towards the body)
• Pronation and over pronation. This is when the foot rolls inwards and the arch of the foot collapses, this position increases the strain on the Achilles and can cause injury
• Wearing high heels

Achilles tendonitis is a common overuse injury in athletes. The Achilles tendon can be put under stress from overuse of the calves in physical activities such as running and cycling. It is seen in runners who are doing excessive sprinting and speed work but not stretching enough when their calves are tight. Further to this, cyclists whom have their seat position too low are putting their Achilles tendon under stretch due to the foot and ankle being in a dorsiflexed position on the pedals.

Each time the Achilles tendonitis heals, it repairs with a small amount of scar tissue or adhesions. Adhesions will build up over multiple injuries to the Achilles tendon, making the tendon less flexible. Therefore, you should rest and treat the tendonitis as soon as possible. Here are some ways to prevent and treat Achilles tendonitis.

Treatment & Prevention

Stretching

It is important to always stretch the calves, hamstrings and Achilles to maintain strong and flexible leg muscles. One way to stretch the Achilles tendon is to stand with the knees very slightly bent, lean the body forward to reach for the floor. Take deep breaths in and as you exhale allow your body weight to move your torso closer to your knees and your hands will reach further towards your feet. You should feel an obvious stretch behind the knee. This is stretching the hamstrings and the calf muscles.

Another gentle stretch is keeping your feet and heels planted on the floor, shoulder-width apart whilst keeping the torso straight and upright, bend the knees forward. Aim to get your knees bending over the toes or further. This squatting position is stretching the Achilles nicely.

Footwear

If you have Achilles tendonitis, it is best to avoid wearing high heel as wearing heels puts the Achilles tendon in an excessively shortened position. This leads to premature tightness of the tendon and puts them at higher risk of tendon injury when you exercise. Ensure your running shoes are suitable for your foot type. It is important to wear shoes that support the foot and the motions made by the foot whilst running. If you are thinking of increasing your physical activity do it gradually to avoid stress or inflammatory injuries.

Heel Raises

In-shoe heel raises are suitable for pain relief in Achilles tendonitis. A heel raise is a wedge-shaped foam rubber insert, around 6-10mm in height and is placed in the shoe under the heel. Lifting the heel increases the ankle angle and slightly shortens the Achilles tendon to reduce the strain on the tendon. This allows the tendon to heal. You should also limit intense exercise when you have Achilles tendonitis to aid healing, as you risk putting impact and stress through the tendon which can increase the inflammatory response.

Visit www.oaplshop.com.au to see a range of products used in the treatment of Achilles Tendonitis

Trilaminate Heel Raise (Three in one)	Footbionics Heel Raises (5 Pack)	Bioskin Trilok Ankle Brace