Peroneal Tendonitis

The peroneals pull the foot out and the post tib pulls the foot in. Together they help to keep the foot level so that the ankle can move through it’s full range of motion and the big muscles of the calf and upper leg can propel you forward off of your big toe. This is important! If there is a limitation in the ankle (either the joint itself is tight or your calves are tight or your big toe doesn’t extend all of the way), this mechanism will not work. The only way to keep yourself moving forward is to rotate the foot in or out. The same goes for the other end of the leg chain- the hip. If you can’t extend your hip all of the way and push off using the glutes, you end up with a short stride that doesn’t give the ankle enough time to move through it’s motion. The body will compensate by rotating that leg so that you don’t fall over your own two feet. If your motion seems fine in the ankle and hip and you’re still getting this- time to look at your shoes. Too much/too little support can have the same effect!

In this picture you can see how the foot twists out and effectively twists the whole leg. When this happens the peroneals can get cooked because now they are getting loaded with every step and trying to shock absorb and then push off instead of the gastroc/soleus. These are skinny little muscles that aren’t designed to handle that. Over time they will break down.

In this picture you can see how the foot twists in. Again, the whole leg twists to compensate for this. Here the posterior tibialis takes on the increased work load of shock absorbing and then trying to push off. The problem for the peroneal is that it is repetitively stretched out when this happens. The tendon can get irritated or the muscle itself trying to pull it back to it’s neutral position.

So what’s the take away from all of that? This is one of those injuries where you have two things to fix: 1) the injured muscle, and 2) the mechanism that caused it (tight ankle, tight calf, big toe, or tight hip). If you only fix the muscle, this will haunt you for a long, long time. Take the time to get to the root of the problem.

The outside of my calf hurts? NOW WHAT?

1) The first step is determining if it is truly a peroneal injury or something else. Remember, the goal of this series is not to keep you away from your doctor so that you can self treat everything. It’s to teach you how to catch the early symptoms and take care of them before it becomes a full blown injury. That being said, peroneal injuries can start as a gradual ache/pain during workouts or even after. It can also be one of those injuries where nothing is wrong until you sit down and stiffen up. Then all of the sudden- ouch!

Typical symptoms with peroneal injuries include pain or tightness on the outside of the calf  just below the level of the knee cap. They can move all the way down the outside of the calf to the ankle, as well as, into the bottom of the foot. Symptoms are typically worse with activity and better with rest, and swelling can occur at the lower tendon (between the lateral maleolus and foot) if the inflammation is severe enough.

Here are some guidelines for when seeing a doc should be your top priority: 1) If you see any bruising and/or swelling, and 2) numbness/tingling along the outside of the leg (knee to foot). An injury to the peroneals is a symptom of a bigger problem. Think of it like a link in the chain. Something stopped working and that chain got snapped due to the increased strain on it.

Pereneol Muscles

Before we get into the actual muscles, let’s look at the anatomy quick. I’m sure most have you have heard of or at least googled the bones in the lower leg. You have the big tibia bone which is on the inside and then you have the little fibula bone on the outside. In the picture below, #3 is the tibia while numbers 1 and 2 are the two ends of the fibula. #1 is the “head” of the fibula and #2 is the lateral malleolus. When talking about the peroneal muscles (we’ll be talking about two of them in this post), it’s important to realize that they are located just behind the fibula and run down behind that malleolus and into the foot.

For the sake of this post we’re going to talk about two peroneal muscles (the longus and brevis). The long muscle runs from the fibular head, down the outside of the leg, behind the lateral malleolus and wraps under the foot just before heel. The short muscle starts midway down the fibula and follows the same path.

Typical injuries for these muscles include a tendonitis at one end or the other (usually at the bottom end going into the foot), or a muscle strain in the middle.

So how did I hurt these skinny little muscles?

There are two ways to really hurt these guys. The first is an ankle sprain where you roll the ankle and stretch them to the point of injury. The second (and more common way in endurance athletes) is to beat them up until you end up with an overuse injury. When it comes to the peroneals the thing to remember is that they are a stabilizer muscle. They help the ankle and foot keep you upright when you hit uneven/loose terrain. They work as a pair with the posterior tibialis muscle.

What is kyphosis?

The spine has a series of normal curves when viewed from the side. These curves help to better absorb the loads applied to the spine from the weight of the body. The cervical spine (neck) and lumbar spine (lower back) are have a normal inward curvature that is medically referred to as lordosisor "lordotic" curvature by which the spine is bent backward. The thoracic spine (upper back) has a normal outward curvature that is medically referred to as kyphosis or the "kyphotic" curve by which the spine is bent forward. In this discussion, the term kyphosis will be used to discuss abnormal kyphosis.

The spine is normally straight when looking from the front. An abnormal curve when viewed from the front is called scoliosis. Scoliosis can occur from bony abnormalities of the spine at birth, growth abnormalities especially with adolescence, degenerative spinal changes in adulthood, or abnormal twisting of the vertebrae because of muscle spasm after an injury.

The normal curves of the spine allow the head to be balanced directly over the pelvis. If one or more of these curves is either too great or too small, the head may not be properly balanced over the pelvis. This can lead to back pain, stiffness, and an altered gait or walking pattern.

What are the symptoms of kyphosis?

The most common symptoms for patients with an abnormal kyphosis are the appearance of poor posture with a hump appearance of the back or "hunchback." Symptoms may include back pain, muscle fatigue, and stiffness in the back. Most often, these symptoms remain fairly constant and do not become progressively worse with time.

In more severe situations, the patient may notice their symptoms worsening with time. The kyphosis can progress, causing a more exaggerated hunchback. In rare cases, this can lead to compression of the spinal cord with neurologic symptoms including weakness, loss of sensation, or loss of bowel and bladder control. Severe cases of thoracic kyphosis can also limit the amount of space in the chest and cause cardiac and pulmonary problems leading to chest pain or shortness of breath with eventual pulmonary and/or heart failure.

What Is Bursitis?

What Is Bursitis?

Bursitis is the inflammation or irritation of the bursa. The bursa is a sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation.

What Causes Bursitis?

Bursitis is most often caused by repetitive, minor impact on the area, or from a sudden, more serious injury. Age also plays a role. As tendons age they are able to tolerate stress less, are less elastic, and are easier to tear.

Overuse or injury to the joint at work or play can also increase a person's risk of bursitis. Examples of high-risk activities include gardening, raking, carpentry, shoveling, painting, scrubbing, tennis, golf, skiing, throwing, and pitching. Incorrect posture at work or home and poor stretching or conditioning before exercise can also lead to bursitis.

An abnormal or poorly placed bone or joint (such as length differences in your legs or arthritis in a joint) can put added stress on a bursa sac, causing bursitis. Stress or inflammation from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions may also increase a person's risk. In addition, an infection can occasionally lead to inflammation of a bursa.

Who Usually Gets Bursitis?

Bursitis is more common in adults, especially in those over 40 years of age.

What Parts of the Body Does Bursitis Affect?

• Elbow
• Shoulder
• Hip
• Knee
• Achilles tendon

What Are the Symptoms of Bursitis?

The most common symptom of bursitis is pain. The pain may build up gradually or be sudden and severe, especially if calcium deposits are present. Severe loss of motion in the shoulder -- called "adhesive capsulitis" or frozen shoulder -- can also result from the immobility and pain associated with shoulder bursitis.

How Can I Prevent Bursitis?

If you are planning to start exercising, you will be less likely to get bursitis if you gradually build up  force and  repetitions. Stop what you are doing if unusual pain occurs.

How Is Bursitis Treated?

Bursitis can be treated in a number of ways, including:

• Avoiding activities that aggravate the problem
• Resting the injured area
• Icing the area the day of the injury
• Taking over-the-counter anti-inflammatory medicines

If the condition does not improve in a week, see your doctor.

Your doctor can also prescribe drugs to reduce the inflammation. Corticosteroids, also known simply as "steroids," are often used because they work quickly to decrease the inflammation and pain. Steroids  can be injected directly at the site of injury.  Injections are often, but not always, effective and can be repeated . However, multiple injections in a several month period are usually avoided due to potential side effects from the injections and the possibility of masking problems that need to be treated differently.

Physical therapy is another treatment option that is often used. This includes range-of-motion exercises and splinting (thumb, forearm, or bands).

Surgery, although rarely needed, may be an option when bursitis does not respond to the other treatment options.

Warning

Consult your doctor if you have:

• Fever (over 102 Fahrenheit) -- infection is a possibility
• Swelling, redness, and warmth
• General illness or multiple sites of pain
• Inability to move the affected area

These could be signs of another problem that needs more immediate attention.

Frozen shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Your risk of developing frozen shoulder increases if you're recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

• Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder's range of motion starts to become limited.
• Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
• Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren't sure why this happens to some people and not to others, although it's more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

What is Pes Planus

Flatfoot (pes planus) is a condition in which the longitudinal arch in the foot, which runs lengthwise along the sole of the foot, has not developed normally and is lowered or flattened out. One foot or both feet may be affected.

What causes flatfoot?

Flatfoot may be an inherited condition or may be caused by an injury or condition such as rheumatoid arthritis, stroke, or diabetes.

Who is affected by flatfoot?

Children as well as adults may be flat-footed. Most children are flat-footed until they are between the ages of 3 and 5 when their longitudinal arch develops normally.

What are the symptoms?

People who have flat feet rarely have symptoms or problems. Some people may have pain because of:

• Changes in work environment.
• Minor injury.
• Sudden weight gain.
• Excessive standing, walking, jumping, or running.
• Poorly fitted footwear.

Children sometimes have foot discomfort and leg aches associated with flat-footedness.

How is it treated?

Treatment in adults generally consists of wearing spacious, comfortable shoes with good arch support. Your doctor may recommend padding for the heel (heel cup) or orthotic shoe devices, which are molded pieces of rubber, leather, metal, plastic, or other synthetic material that are inserted into a shoe. They balance the foot in a neutral position and cushion the foot from excessive pounding.

For children, treatment using corrective shoes or inserts is rarely needed, as the arch usually develops normally by age 5.

Surgery is rarely needed.

You may be able to relieve heel pain by stretching tight calf muscles. See a picture a calf stretch  exercise.

• Stand about 1 ft (30 cm) from a wall and place the palms of both hands against the wall at chest level.
• Step back with one foot, keeping that leg straight at the knee, and both feet flat on the floor. Your feet should point directly at the wall or slightly in toward the center of your body. Keep the knee of the leg nearest the wall centered over theankle.
• Bend your other (front) leg at the knee, and press the wall with both hands until you feel a gentle stretch on your back leg (calf muscle).
• Hold for a count of 10 (increasing the count to 30 or longer as you continue over several weeks). Switch legs and repeat. Do this 2 to 4 times a day.

Foot-strengthening exercises done with a towel and weights. See a picture of atowel curl  exercise.

• Place a towel on the floor, and sit down in a chair in front of it with both feet resting flat on the towel at one end.
• Grip the towel with the toes of one foot (keep your heel on the floor and use your other foot to anchor the towel). Curl your toes to pull the towel toward you.
• Repeat with the other foot. To increase strength, later use 3 lb (1.5 kg) to 5 lb (2.5 kg) weights (such as a large can of fruit or vegetables) on the other end of the towel.

Torticollis

Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.

Causes

Torticollis may be:

• Inherited -- due to changes in your genes
• Acquired -- develops as a result of damage to the nervous system, upper spine, or muscles

If the condition occurs without a known cause, it is called idiopathic torticollis.

Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the baby's head was in the wrong position while growing in the womb, or if the muscles or blood supply to the neck are injured.

Symptoms

• Limited range of motion of the head
• Headache
• Head tremor
• Neck pain
• Shoulder that is higher on one side of the body
• Stiffness of the neck muscles
• Swelling of the neck muscles (possibly present at birth)

Exams and Tests

Tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show:

• Head tilts toward the affected side while the chin points to the opposite side
• Shortening of the neck muscles
• The entire head pulls and turns to one side (in more severe cases)

Tests that may be done include:

• CT scan of the neck
• Electromyogram (EMG) to see which muscles are most affected
• MRI of the brain

Treatment

Treating torticollis that is present at birth involves stretching the shortened neck muscle. Passive stretching and positioning are used in infants and small children. These treatments are often successful, especially if they are started within 3 months of birth.

Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Torticollis that is caused by damage to the nervous system, spine, or muscles is treated by identifying the cause of the disorder.

• Applying heat, traction to the cervical spine, and massage may help relieve head and neck pain.
• Stretching exercises and neck braces may help with muscle spasms.
• Medications may be used, including the anticholinergic drug baclofen.
• Injecting botulinum toxin can temporarily relieve torticollis, but repeat injections are usually needed every 3 months.
• Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. In some cases, surgery involves destroying some of the nerves in the neck muscles, or brain stimulation.

Outlook (Prognosis)

The condition may be easier to treat in infants and children. If torticollis becomes chronic, numbness and tingling may develop due to pressure on the nerve roots in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Possible Complications

Complications may include:

• Muscle swelling due to constant tension
• Nervous system symptoms due to pressure on nerve roots

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms do not improve with treatment, or if new symptoms develop.

Torticollis that occurs after an injury or with illness may be serious. Seek immediate medical help if this occurs.

Prevention

While there is no known way to prevent this condition, early treatment may prevent it from getting worse.