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Pain on the side of the ankle - Foot Healthcare

Pain on the side of the ankle - Foot Healthcare

Chronic Lateral Ankle Pain

Chronic lateral ankle pain is recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle. Other conditions, however, may also cause chronic ankle pain.

Signs and symptoms include:

Ankle instability.
Difficulty walking on uneven ground or in high heels.
Pain, sometimes intense, on the outer side of the ankle.
Repeated ankle sprains.

While ankle sprains are the most common cause of chronic lateral ankle pain, other causes may include:

A fracture in one of the bones that make up the ankle joint.

Arthritis of the ankle joint. Inflammation of the joint lining.

Injury to the nerves that pass through the ankle.

In this case, the nerves become stretched, torn, injured by a direct blow, or pinched under pressure.

Scar tissue in the ankle after a sprain.

The scar tissue takes up space in the joint, putting pressure on the ligaments. Torn or inflamed tendon.

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Complaints: Protecting Pennsylvanians - Pennsylvania Office of Attorney General

Complaints: Protecting Pennsylvanians - Pennsylvania Office of Attorney General


We receive referrals from a number of different sources: the insurance industry, businesses, employees, concerned citizens and other state or law enforcement agencies. If you suspect someone is committing insurance fraud, you are encouraged to submit an Insurance Fraud Referral Form.

INSURANCE INDUSTRY should use one of the following:
Instructions for Insurance Industry FormAdobe AcrobatINSURANCE INDUSTRY Printable Referral FormAdobe AcrobatINSURANCE INDUSTRY Online Referral Form
PRIVATE CITIZENSshould use one of the following:
Instructions for Private Citizen FormAdobe AcrobatPRIVATE CITIZEN Printable Referral FormAdobe AcrobatPRIVATE CITIZEN Online Referral Form
Or you may request a form by contacting:

PA Office of Attorney General

Insurance Fraud Section

16th Floor, Strawberry Square

Harrisburg PA 17120

(717) 787-0272 (phone)

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Chronic Achilles Tendonitis

Chronic Achilles Tendonitis
by Prodyut Das
Chronic Achilles Tendonitis Physiotherapy Treatment
What is Chronic Achilles Tendonitis?

Chronic Achilles tendonitis, also sometimes calledAchilles tendinitis , is a painful and often debilitating inflammation of the large tendon in the back of the ankle (achilles tendon). It is a common overuse injury that tends to occur in middle-age recreational athletes. The overuse causes inflammation that can lead to pain and swelling. Furthermore, it can lead to small tears within the tendon, and make it susceptible to rupture.

Achilles Tendon Dysfunction

The Achilles tendon is the largest and strongest tendon in the body. The tendon has no true synovial sheath but is encased in a paratenon of varying thickness. The vascular supply to the tendon comes distally from intraosseous vessels from the calcaneus and proximally from intramuscular branches. There is relative area of avascularity 2-6 cm from the calcaneal insertion that is more vulnerable to degeneration and injury. Achilles tendon injuries are commonly associated with repetitive impact loading due to running and jumping. The primary factors resulting in damage of the Achilles tendon are training errors such as sudden increase in activity, a sudden increase in training intensity (distance, frequency), resuming training after a long period of inactivity, and running on uneven or loose terrain . Achilles dysfunction can also be related to postural problem (e.g., pronation), poor footwear (generally poor hindfoot support), and a tight gastrosoleus complex.

Causes of Chronic Achilles Tendonitis

There may be several factors leading to Chronic Achilles Tendonitis. These are:
Overuse of the Achilles tendonTight calf musclesLots of uphill runningIncreasing the amount or intensity of sports training, sometimes along with switching to racing flats, which are racing shoes with less heel liftOver-pronation, a problem where your feet roll inward and flatten out more than normal when you walk or runWearing high heels at work and then switching to lower-heeled shoes for exerciseAn Achilles tendon may tear when you move swiftly and forcefully. For example, the tendon might tear when you jump or start sprinting.
There are three stages of tendon inflammation:
PeritenonitisTendinosisPeritenonitis with tendinosis
Peritenonitis is characterized by localized pain during or following activity. As this condition progresses, pain often develops earlier on during activity, with decreased activity, or while at rest.

Tendinosis is a degenerative condition that usually does not produce symptoms (i.e., is asymptomatic). It may cause swelling or a hard knot of tissue (nodule) on the back of the leg.

Peritenonitis with tendinosis results in pain and swelling with activity. As this condition progresses, partial or complete tendon rupture may occur.

Symptoms of Chronic Achilles Tendonitis

The main complaint is pain over the back of the heel. This is 2-6 cm above the point where the tendon inserts on the heel bone. Patients with Chronic Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also experience pain while participating in activities, such as when running or jumping. Chronic Achilles tendinitis pain associated with exercise is most significant when pushing off or jumping. It may cause swelling over the Achilles tendon. Patient complains of pain when rising up on toes and pain when stretching the tendon. The range of motion of ankle may be limited.


In diagnosing Chronic Achilles Tendonitis, examine the patient's foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.

Differential Diagnosis of Chronic Achilles Tendonitis
Partial rupture of Achilles tendonRetrocalcaneal bursitis (of retrocalcaneal bursa)Haglund's deformity (pump bump)Calcaneal apophysitisCalcaneal exostosisCalcaneal stress fracture (positive squeeze test)Calcaneal fracturePTT tendinitis (medial pain)Plantar fasciitis (inferior heel pain)
Achilles Tendonitis Treatment

Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon.

In the early stage, when there is sudden (acute) inflammation, one or more of the following options may be recommended:
ImmobilizationIceOral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofenPhysical therapy.
General guidelines for chronic Achilles tendonitis

-Correct underlying training and biomechanical problems
Stop rapid increase in mileageStop hill runningCorrect functional overpronation and resultant vascular wringing of the tendon with a custom orthotic that usually incorporates a medial rear foot post.Stop interval trainingCorrect improper intensity of training, duration, schedule, hard surface, poor shoewear
-Soften a hard heel counter or use shoe counter heel cushions to minimize posterior "rubbing" symptoms.

-Begin a runner's stretching program before and after exercises.

-Oral anti-inflammatories (COX-2 inhibitors).

-Avoid cortisone injections ; this will cause weakening or rupture of the tendon.

-Cryotherapy (ice massage)after exercise for anti-inflammatory effect.

-Correct leg length discrepancy if present. First try 1/4 inch heel insert for a half inch leg length discrepancy; if not improved, go to 1/2 inch insert. Overcorrection (too rapid an orthotic correction) may worsen symptoms.

-Shock wave Therapy

-If symptoms persist after 4-6 weeks of conservative measures, immobilization in a removable cam boot or cast may be required for 3-6 weeks.

-Slow, painless progression to preinjury activities
swimmingdeep water runningbicyclingwalkingeccentric exercises for Achilles strengtheninglight jogging
-Eccentric strengthening of Achilles tendon should condition the tendon and make it less susceptible to overuse injuries; however these exercises are not used until the patient is assymptomatic and painless for 2-3 weeks.
toe raises in poolplantar flexion against progressively harder therabandsmultiple sets of very light (20 pound) total gym or slider board exercises.
If these treatments fail to improve symptoms, surgery may be needed to remove inflamed tissue and abnormal areas of the tendon.


The best treatment of Chronic Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint. Problems with foot mechanics can also be treated with devices inserted into the shoes.
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Return from Achilles Tendonitis to sports physical therapy

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Book Appointment
Consult Dr Prodyut Das (PT)

HOD Physiotherapy & Fitness center
NIMT Hospital, Greater Noida
Former Physio ISIC Hospital

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Prevent and Treat | Runner's World

Prevent and Treat | Runner's World

No one said runners' feet were pretty. But at least blisters, calluses, and black toenails are cosmetic issues that rarely interfere with our running. Bunions, on the other hand, can be as uncomfortable as they are unsightly. A bunion is the enlargement of the big toe joint. Under repetitive pressure, this joint can move out of place, swell, and turn inward, causing a stiff, painful bony protrusion on the side of the foot. Overpronators are especially prone to bunions because they put excessive stress on this joint during the push-off phase of running. Too-narrow shoes can cause bunions, and genetics play a role as well. Severe cases can bring you to a standstill, requiring surgery to repair the joint, which is why we advise the following program at the first sign of redness or discomfort.


Taping your foot in a normal position before a run can reduce pain and stress on a bunion. Put a toe separator (available at drug stores or between your big and second toe and tape the pad to your big toe. The two exercises below will increase blood flow to the joint, helping it heal. Although they may not improve the way the joint looks, they will reduce stiffness and soreness, which will allow you to run comfortably.

Big-Toe Adductor: Sit with your exercising leg bent, foot flat on the ground. Keeping your heel on the surface and pivoting from your heel, raise your foot. Using your hand, gently pull your big toe out to the side--away from your other toes. Hold for a second or two. Do this 10 times and repeat on the other foot if necessary.

Toe Extensors: From the same position as the previous exercise, raise your foot and curl your toes tightly down toward the ground. Using your hand, gently push down on your toes. You can flex each toe individually or do them as a group. Hold for a second or two. Do this 10 times and repeat on the other foot if necessary.


It's important for all runners to have a properly fitting shoe, and a roomy toebox is essential for those who overpronate. Also, when you run, avoid going up on your toes, which puts pressure on the big toe. Focus instead on planting your midfoot down with every step.

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´╗┐Plantar Fasciitis Stretches

Plantar fasciitis is the most commonly occurring heel pain seen in runners, obese people and pregnant women. The thick band of tissues in the bottom of your feet get inflamed, causing pain. The heel pain is usually felt on the inside of the heel. The pain is also felt along the arch of the feet and along the border of the heel. You feel a stabbing pain, especially, in the morning as the plantar fascia tightens up. The pain reduces as the tissues stretch, but it may worsen if you stand, walk or run. This condition is seen in athletes, dancers and jumpers.

That was nearly seven years ago - and although I am still as active as ever - I haven't had any problem with plantar fasciitis since then. However, as the saying goes, nothing lasts forever. Three weeks ago, I began to have minor pain again - this time, in both arches and heels and am now in full-fledged agony once again (mainly, in my left heel) which is the reason I sat down to write this column in the first place. Maybe my painful experience can help some poor souls through out there to deal with the nagging illness themselves.

How a shoe fits is crucial. Wearing small shoes may aggravate the symptoms of plantar fasciitis When choosing shoes or trying on shoes that have been purchaed and delivered online, patients should ensure they do so in the afternoon or evening. This is because as the day progresses, feet swell and become slightly bigger than they are first thing in the morning. Furthermore, one foot is often slightly larger than the other. If this is the case, patients should check for proper fitting on the larger foot. It is better for shoes to be slightly too large (on the smaller foot) than vice versa.

Pain can sometimes cause a lot more than just discomfort. It can often significantly impact daily activities since any weight placed on the affected area can deliver serious pain which can prevent you from doing daily activities and exercise. Plantar fasciitis causes an aching pain that can be localized in the heel, but also radiate throughout the foot. In most cases, pain is most noticeable and serious in the morning when getting out of bed, or after standing up after prolonged sitting. This is because pain in the inflamed area subsides after the plantar fascia relaxes.

Icing your heel will decrease inflammation that accumulates while you walk during the day, and to prevent more inflammation while you sleep. Apply ice to the sore area for 20 minutes two or three times a day to relieve your symptoms. Do not go barefoot or wear flip-flops. Only wear shoes with a moderate heel that do not bend through the arch. Always wear shoes when walking, even in the home. If you have custom orthotics, or over-the-counter inserts, wear them in your shoes at all times. The majority of people with plantar fasciitis improve tremendously after just two months of initial treatment.plantar fasciitis stretches

Foot Orthotics, is the only non-surgical therapy to have been supported by studies rated by the Center for Evidence-Based Medicine as being of high quality. Landorf et al. performed a single-blind experiment in which patients were randomly assigned to receive off-the-shelf orthotics, personally customized orthotics, or sham orthotics made of soft, thin foam. Patients receiving real orthotics showed statistically significant short-term improvements in functionality compared to those receiving the sham treatment. There was no statistically significant reduction in pain, and there was no long-term effect when the patients were re-evaluated after 12 months.

In the Journal of Foot and Ankle Surgery, Rodney Tomczak lists several complications of the surgery due to damage of nearby structures. Nerves that supply sensation to the bottom of the foot can be cut, producing numbness. The cut nerve ends may form painful neuromas as they try to heal. Incisions, especially on the bottom of the foot, can heal with excess scar tissue or keloids. This produces pain with walking and shoe wearing. After bone spurs are removed, the calcaneus, or heelbone, may become weak and fracture. You Might Also Like Lateral Column Pain

To carry out this stretch, stand with your weight on your left foot and place your right heel on a table or bench at or near waist height. Face straight forward with your upper body and keep both legs nearly straight. As you stand with your right heel on the table and your left foot on the ground, rotate your left foot outward (to the left) approximately 45 degrees, keeping your body weight on the full surface of your left foot (both heel and toes are in contact with the ground). You are now ready to begin the stretch.

Plantar Fasciitis is a rather common condition of the foot causing significant heel pain and proximal foot arch pain. The most common presentation of plantar fasciitis is when a patient experiences pain with their first step in the morning. This initial step incurs the most pain that the patient will feel throughout the day, but there will be continual pain in those who suffer from plantar fasciitis Typically people describe the pain as relating to the sensation of walking on glass. These initial steps incur tremendous pain near the proximal aspect of their foot where the plantar fascia inserts into the heel bone.

After stretching the related or connected parts of the plantar fascia, you can now head to a cross leg stretch that actually focuses on the arch of the foot. To do such a plantar fasciitis stretches, you need to sit down on a comfortable surface. Take one leg, bend it and place it on top of the other foot, currently stretched. Pull your toes up and hold the back of the foot with the other hand. Feel the stretching of the back of the feet. This directly applies a stretching pressure on the plantar fascia and can be very good in keeping it in good shape.plantar fasciitis shoes

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