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Sports Podiatry

Posted January 1, 1970

Sports Podiatry


By Phil Pearson 

What is MSK?

As a profession, there is many different terms used for MSK which can be very confusing for our patients. Some call it sports injury, some biomechanics, some (like ourselves) stick to MSK or musculoskeletal medicine.

Essentially, they are all the same thing, the diagnosis and management of various disorders that affect bones, joints and soft tissue like muscles, tendons or ligaments.

But how can we help as podiatrists? We, like other health care professionals are experts at what we do…and that’s not just looking after your nails and hard skin. We have a vast array of skills that allow us to specialize in lower limb conditions, starting with evaluating the way you walk or ‘gait analysis’. We can look at the pressure and direction the foot hits the ground, the muscle strength, and even your joint’s motion. Many conditions will cause fluctuations in your natural walking cycle causing pain or injury. Therefore, the understanding of your ‘gait’ is highly important in the treating of such conditions.

Common complaints that we may see in our clinic are Achilles tendon damage and heel pain as well as lower back problems. However, you may ask “how can my back be affected by the way I walk?” The answer is fairly simple – compensation. And no, I’m not talking about legal compensation from a trip or fall but soft tissue compensation. Bones are the strong structures that hold our bodies together but without the muscles, tendons and ligaments surrounding them, you would literally be a bag of bones. The soft tissue has an ability to naturally offload painful areas by loading other healthier structures nearby. Therefore, a painful lower back can be caused from a small compensation in the pelvis – which could be as a result of a tightness in the gluteal muscles in your bum. This tightness can be picked up on when we analyse your gait or test muscle strength and flexibility. Even hard skin or callous on the bottoms of your feet can tell us a great deal about the way you walk. High pressure and increased ground force can cause a build-up of callous, reducing the load in these areas can have a massive effect in managing this hard skin.

As mentioned previously heel pain is one of the most common complaints that we may see. Did you know there are more than 40 causes of heel pain…40! But if you think about it, the heel is a very specialized structure. It is the single point of contact during the initial contact phase of your walking cycle, it takes a real pounding especially with the types of footwear we routinely wear. Many of these conditions are as a direct result of injury to surrounding structures that are involved in the heel’s motion. Imagine putting your whole weight through one point on your body… every day, while wearing a hard shoe and walking on an even harder pavement. As you can imagine the jarring effect must be immense, and it is.

 

So what can we do? As podiatrists an MSK assessment allows us to look at you walking or running, we can compare your muscle strength, your ligament laxity, essentially we find the cause of your pain or discomfort and then create a management plan with you in mind.

 

How can you prepare for an MSK appointment?

History is important! We will ask a multitude of questions, the timing of the injury, changes in footwear, are there any fluctuations in daily routine, does the pain get worse/better, the type of pain, and please don’t be offended if we ask about your personal life. Anything and everything is relevant. We can never get too much information. So, before your 1st appointment, please think about these things as it can make it much easier to diagnose the root cause.

Alongside this is your medical history, the medications you may be taking or have taken in the past and any surgeries you may have had. You will be amazed how some things may seem so detached from the presenting injury that they are never mentioned but can be the most important piece in the puzzle.

Is there anything else? Well, yes! Shorts! And apologies in advance if it’s a bit chilly outside, but we need you to get your legs out. To do a full gait analysis on a patient we need to see the motion of every joint and muscle in your leg and as such shorts or tight leggings can help with this. Please bring some with you to change into prior to your appointment.

What we may need to do during your MSK appointment?

An MSK appointment is quite a hands on affair, we will give your joints a wee wiggle, we may check the strength of your muscles by getting you to push against us, and we may have to give you a prod and poke while stretching your legs in strange ways. Please don’t be offended, if you are self-conscious please let us know but we will ask your permission to do any of these types of tests. The reasons for these tests are to gauge if there is any imbalance between the opposing sides of your body that may be causing the injury or if there is any specific tightness that could be remedied.

Treatments that we may offer in your management plan

As podiatrist we are able to offer a multitude of treatments for your personal MSK management plan. We readily use acupuncture to assist in soft tissue healing and reducing inflammation. We use manipulation and mobilisations to release joint stiffness. We may also ask that you start wearing an orthotic insole in your footwear to help reduce stressed areas. Stretches and strengthening exercises may be provided to help in rehabilitation. Taping can help in particular cases to reinforce your natural strength and lessen strain on localized soft tissue structures. However, every management plan is unique to each individual and as such will be created with you specifically in mind.