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Ankle-foot Orthosis (AFO)

Ankle-foot Orthosis (AFO)

Solid AFOs

Ankle-foot orthosis (AFO) are braces for the lower leg and foot that are often prescribed to patients with gait abnormalities. They are lightweight plastic braces composed of a plastic material that can be secured to the calf with the use of a strap; this strap also runs along and under the foot. The foot itself sits in an accommodative shoe, thus AFOs possess a characteristic L-shape, which in effect assists by holding the foot and ankle in the appropriate position when performing certain tasks. Individuals suffering from disorders that severely affect muscular function, i.e. stroke, spinal cord injuries, cerebral palsy, and polio patients have a greater need for such devices in order to reedy irregularities that may occur in movement, especially during gait. AFOs can work in two ways: either correctly positioning a limb with contracted musculature in the normal position or supporting the waist or weak limbs.

Articulated/hinged AFOs

Articulated or hinged AFOs are made up of two separate components that are not continuous with each other but instead “articulate” with one another with a hinge mechanism. While the components themselves are composed of plastic, the joints/hinges are usually made with metal or other composite materials. The hinged moment present in these AFOs allow unrestricted and free movement of the ankle joint. These AFOs are often prescribed to reduce the rigidity in movement so that patients can perform daily tasks (e.g. walking up the stairs or rising from a chair).

Richie Braces

Richie braces is a custom ankle brace that is made by taking a patient’s cast. This type of brace is also used to treat chronic conditions of the foot and ankle, where the muscles are not working effectively. This brace can also be used for a number of conditions including drop-foot, ankle injuries, severe flat foot, and tendon damages. It is a lightweight sports design that is preferred by patients who are very active. It comes with leg uprights for maximum support and as it is custom-made, it perfectly fits the ankle joint axis of a patient’s foot. Moreover, it has an orthotic base that is also specifically moulded to your foot.

However, with all the AFOs they do need to wear proper shoes to fit into. Shoes with an adjustable strap, wide heel cup and stable back and base are preferred. This brace provides a wonderful non-surgical option to complex pathologies of the leg, foot, and ankle.

Overall, the ankle-foot orthosis is an efficient therapy for weak lower extremity musculature areas and can effectively substitute for weak muscle groups in the leg. However, considerations are necessary to ensure that the AFO chosen will be able to successfully remedy the given condition.

Ankle-foot Orthosis (AFO)

Photo credit: AliMedSolid AFOs Ankle-foot orthosis (AFO) are braces for the lower leg and foot that are often prescribed to patients with gait abnormalities. They are lightweight plastic braces composed of a plastic material that can be secured to the calf with the...

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Preventing Falls

Falls can occur anywhere and anytime but as you grow older you are more risk of falling down during day to day activities and are likely to injure yourself. There are number of reasons for falls in elderly patient’s. As you grow older your vision becomes impaired,...

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What to Do If You Have Suffered a Sporting Injury

What to Do If You Have Suffered a Sporting Injury

Types of Foot Sporting Injuries and How We Can Help You Recover From Them

Sporting injury is a blanket term for anything concerning injuries that are experienced during or after playing any sport or exercise. They can occur at any time, whether running a marathon, playing a round of tennis, or even doing yoga. These injuries can happen because of an accident but more often than not, because of poor form, wrong equipment, overextending the body, and performing without warming up or conditioning the body for exercise. In other words, a huge percentage of being able to prevent a sporting injury is well within the control of the athlete or any person leading an active lifestyle.

What Are the Signs of an Injured Toe, Foot or Ankle?

  • Bruising, tenderness, swelling, or inflammation in the affected area
  • Arch or heel pain
  • Ingrown, discolored, or crumbling toenails
  • Calluses and bunions
  • Itching, stinging, or burning sensations on the soles of the feet or between the toes
  • Lower back pain
  • Shin, knee, and hip pain
  • Mild to severe foot/ankle pain
  • Instability and difficulty moving your foot or ankle
  • You heard a popping sound in the affected area during the injury

Sports Injury

What We Can Do to Help With Your Sporting Injuries

No matter the sport, we can all agree on one thing: almost all of it involves our feet. This is why when it comes to an active lifestyle, whether you’re an athlete or a person committed to doing regular exercise, podiatrists play a big role in maintaining your performance and preventing sporting injuries. Here are ways we can help you:

Diagnose and Treat Existing Symptoms and Problems

An injury is not always a cataclysmic event that instantaneously happens. More often, injuries can be traced from a simple problem such as a bunion or an ingrown toenail, which forces the body to compensate to mask the pain. We conduct a complete physical examination and interview our patient to identify possible injuries and to also check for certain conditions that may increase your risk for injuries. As part of this process, we may use our new Body-Tech machine, which uses a combination of a treadmill, pressure sensors, and slow motion video to analyse the way you walk or run, your stability and your posture. We then recommend the best treatment options based on the findings. Some treatment options include anti-inflammatory treatments, massages, physical therapy, orthotics, and recommending appropriate footwear and exercises to promote recovery and prevent future injuries. We also use a Thor Medical Laser to help treat injuries and speed up recovery and rehabilitation. Football Injury

We Go Beyond the Feet

Contrary to popular belief, podiatrists don’t just assess your feet. We understand the correlation between the body’s posture and alignment and the direct effect of these to one’s feet. Anything that’s not right on the body impacts the feet and vice versa. For example, we study how a runner’s form and how this impacts the feet. A wrong landing of the foot can lead to serious problems such as sprains. We evaluate such conditions and help you achieve the proper posture and alignment to prevent pain and injuries.

We Provide Preventive Maintenance

Aside from treating sports injuries, we help prevent future injuries and maximise performance by correcting existing problems and educating patients on the best exercises, therapies, and footwear for their activities.

Don’t Hesitate to Get in Touch and Find Relief

Think you may have sporting injuries or are prone to sustaining one? Schedule an appointment with us to get proper evaluation and care. Contact us today on (08) 9316 3010 for more information.
Common Foot Injuries of Dancers

Common Foot Injuries of Dancers

Dancers are a special type of athlete whose art form is physically rigorous. They possess extraordinary physical attributes and abilities; the feet and ankles comprise just one region of the body where this is true. Foot and ankle injuries make up approximately 50-70% of all injuries that dancers sustain. Overuse injuries are more common than traumatic injuries, given the repetitive load requirements of dance coupled with the inability of the body’s tissues to withstand the demands that are imposed on them. The foot/ankle/lower leg area is vulnerable to a wide range of injuries, including stress fractures, tendon injuries, sprains, and strains.

Tendinopathy

Ballet DancersTendinopathy is commonly an overuse injury whereby the tendon becomes painful, stiff and swollen. The Achilles tendon and the Flexor Hallucis Longus tendon are two tendons that are commonly affected in dancers. Factors that contribute to the development of this condition include extrinsic factors such as flooring, changes in training schedule or poor technique. Intrinsic factors include tendon vascularity, gastrocnemius-soleus function and age/weight. Treatment includes rest, use of electro-physical agents such as low level laser therapy, activity modification, orthotic therapy and strengthening exercises.

Posterior Ankle Impingement

Posterior ankle impingement is a condition characterised by tissue damage at the back of the ankle joint due to compression of these tissues during maximal ankle plantarflexion. This condition is commonly associated with ballet dancers who require extreme range of motion in their ankle joint to achieve the en pointe position.  The impingement may be associated with poor ankle joint mobility causing the tissues to become damaged when forcing the foot to an en pointe position. Soft tissue impingement can be caused by thickening or irritation of the FHL tendon, posterior joint capsule thickening or synovitis. In other cases a separate extra bone (os trigonum) may develop or extra bony growth on the talus may prevent the dancer from obtaining full ankle plantarflexion. Initially conservative management should be the first line approach. This includes a period of rest and occasionally an immobilising boot be may be required. Physical therapy such as myofascial release, low level laser therapy, joint mobilisation and taping can help settle symptoms. Rehabilitation should address any biomechanical anomalies, muscular weaknesses or poor athletic technique that may be contributing to the development of the syndrome. In extreme cases or cases that do not respond to conservative care, a surgical opinion may be required.

Stress Fractures

Dancers BalletStress fractures are incomplete breaks of the bone. A stress fracture of the metatarsal typically occurs over time with excessive weight bearing activity such as running, sprinting, jumping or dancing. It is commonly associated with changes in the intensity of activity (i.e. sudden increase of activity) or changes in the training conditions (such as footwear, surfaces, etc.). It may also be caused traumatically such as a poor landing from a jump in dancers or landing from a height. Poor calf muscle strength can cause excessive forefoot loading and fatigue of these muscles in dancers may contribute to the development of this condition. It commonly affects the 2nd and 5th metatarsals. The management of stress fractures requires a rest period from weight bearing aggravating activities for 6-8 weeks. In the initial phase of treatment an offloading walker is used for two to four weeks. Low level laser therapy may be useful in reducing pain, swelling and increase bony remodelling. Orthotic therapy may be required to help reduce abnormal load from poor foot mechanics. Exercises to improve the function of the intrinsic and extrinsic foot muscles may help to prevent recurrence.

How Your Podiatrist Can Help

Podiatrists are equipped to diagnose, treat, manage and prevent these injuries. We have the ability to refer for imaging if necessary, such as x-ray, ultrasound and other modalities if required. We also have a broad range of manual skills including, joint mobilisation, dry needling, myofascial release, strapping/taping along with rehabilitation and strengthening exercise prescription. We also offer the common podiatry modalities such as skin and nail debridement. The Perth Foot and Ankle Clinic offers Low Level Laser Therapy as an adjunctive therapy. This is a painless, effective and drug free treatment option that can be beneficial to the dancing population whereby other treatment options such as orthotics cannot be used.
Should “RICE” be replaced with “MEAT”?

Should “RICE” be replaced with “MEAT”?

Most people are familiar with the RICE (Rest, Ice, Compression and Elevation) principle for treating sports injuries. It is widely advocated and commonly used for the treatment of acute injuries such as ankle sprains. However some of the medical community are moving away from this principle as it is now thought that this protocol may delay recovery from tendon/ligament injuries. Tendons and ligaments are naturally avascular structures meaning that they have poor blood supply in comparison muscle fibres. Further reducing blood and nutrient supply with the use of the RICE principle may cause delayed healing. Should RICE be replaced with MEAT The doctor who invented the RICE treatment protocol in the 1970s has now stated that the use of ice and rest may delay healing and has recanted its use.
  • Rest (no movement): Movement is required to promote lymphatic drainage (drainage of fluid and waste products) and bring fresh oxygenated blood flow and nutrients to the injured tissue.
  • Ice: There is also a lack of evidence for the use of ice or cryotherapy for soft tissue injuries and Bleakley et al (2004) found that it may delay or slow healing by decreasing the metabolic rate.
Researchers tested whether applications of ice were helpful in recovery after strength training. When the tissue is cooled through icing, peripheral blood flow can be reduced. After the ice is removed, the blood perfusion may then return but the blood vessels may not open for many hours after the ice application. This research found that these fluctuations can cause the tissue to die due to lack of blood flow. It can also lead to temporary or permanent nerve damage.Therefore, ice application does not boost recovery after exercise and can instead cause tissue and nerve damage. Tseng et al (2013) found that topical cooling significantly increased the levels of muscle damage markers in elite athletes as well as causing muscle fatigue. The new injury protocol mnemonic that some practitioners are now in favour of is MEAT. Meat stands for:
  • Movement: It is thought that early movement stimulates healing, promotes nicely aligned collagen fibres and leads to faster recovery times. Kerkhoffs et al (2002) Cochrane review showed that patients improved quicker and had a faster return to activities with functional treatments versus their immobilised counterparts.
  • Exercise: The reasons behind this are the same for movement but establishing an exercise program after the acute injury is important to prevent long term joint instability and improve functional outcomes.
  • Analgesia: Is the use of pain relieving drugs that do not cause delay in healing. Some medications such as NSAIDs have been show to delay or inhibit healing. Acetaminophen can help with pain relief but not block the inflammatory cascade/process, although it does come with risk factors (liver toxicity). Natural pain relieving treatments such as acupuncture/dry needling and low level laser therapy have shown to be very effective at providing pain relief.
  • Treatment: Treatment includes any form of manual or electro-therapy modalities such as myofascial release, ultrasound, low level laser therapy, acupuncture/dry needling and mobilisations. These all promote blood flow, tissue healing and pain relief.
The RICE/ICE principle should still generally be used for acute muscle injuries as there is risk of developing compartment syndrome. Ligaments and tendons are not at risk of developing this pathology. There are elements of both protocols that are beneficial – e.g. compression from the RICE principle is beneficial for lymphatic drainage and reducing oedema but without immobilising the joint. It is important to consider the type of injury and the symptoms that the patient presents with before implementing a treatment plan.

References

Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly KD, Struijs PAA, van Dijk CN. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Malone T, Engelhardt D, Kirkpatrick J, Bassett F. Nerve injury in athletes caused by cryotherapy. J Athl Train. 1992; 27(3): 235–237. Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai C, Harris MB, Kuo CH. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res. 2013;27(5):1354-61. doi: 10.1519/JSC.0b013e318267a22c
Why Isn’t My Injury Getting Better?

Why Isn’t My Injury Getting Better?

Injuries are frustrating at the best of times. They are common in athletes or people involved with any type of physical activity but particularly high impact sports. When your injury isn’t getting better there are some important aspects to consider.

You are trying to go it alone or mis-diagnosed your own injury

Foot Stretch ExerciseOften we see people present with injuries that are months old or even longer. People often think that the injury will heal and the pain will eventually go away. In some instances the injury can become chronic. When injuries become chronic they are not likely to heal themselves over night when you eventually do see a health professional. Long term injuries are most likely going to take long term to resolve. Your health professional team are there to correctly diagnose your injury and provide a suitable management plan. Self therapy like icing and rolling may help temporarily but doesn’t address other factors like strength and proprioception, biomechanical influences etc.

Inadequate Nutrition

Nutrition is a very important factor in the healing process. When you are injured your body’s protein needs increase as well as requiring all of the essential vitamins and minerals that are key to to promoting cellular repair and growth. Eating too little or consuming processed foods have been shown to have a detrimental effect on cell healing. If you feel that your diet could be improved or altered its best to talk to a qualified health professional that specialises in this area as increasing your intake of certain proteins, vitamins and minerals can also have a detrimental effect particularly if you suffer from certain health conditions.

Alcohol

Foot After RunWe know now from clinical studies that alcohol has a negative effect on muscle repair. Drinking alcohol affects your sleep and this in turn affects the amount of a hormone called Human Growth Hormone that is released when you are asleep and is responsible for repairing muscle and cell growth. Alcohol consumption can reduce the release of this hormone by 70%!

Attitude

You need to be committed to doing your rehabilitation exercises and whatever other management/ treatment advice your treating clinician has recommended. Your rehab exercises aren’t going to be effective if you skip multiple days without doing them or if you aren’t doing them with correct technique.

Stopping Activity All Together

Depending on your injury, it’s best not to stop physical activity all together (but you should stop the aggravating activities!)  E.g if you develop plantar fasciitis (heel pain), you can still maintain aerobic fitness by cycling, swimming or rowing, which are not high impact on the heel. You can always work around a specific injury. Tendons, muscles and joints do not respond well to long periods of rest or immobilisation. Conversely if you are still doing the aggravating activities or not allowing enough time to recover, this will reduce your injury healing time.

Working with a good team of health professionals and looking after yourself in terms of nutrition, sleep and committing yourself to the rehab process your injury will soon be a thing of the past!

For further reading:

Laser Therapy For Sports Injuries

Get Tips on Treating Your Athletic Injury at Home in Our Sports Foot and Ankle Blog