The lifestyle of early humans caused the evolution of their feet towards enabling them to be in an upright position. There was no longer a need for an opposing thumb-like big toe, which facilitated gripping while moving through trees. Instead, there was a gradual lengthening of the first ray of the foot, which allowed for free standing and bipedal movement.

“The human foot is a machine of exquisite design and a work of art.”
Leonardo da Vinci

The complexity of the structure of the foot is evident in numbers. The human foot consists of:
– 26 bones
– 33 joints
– 29 muscles
– 107 ligaments and tendons

It is also the only part of the body that remains immobile on a daily basis, thanks to footwear. Foot-specific exercises are a rare addition to training programs, even among active individuals. This leads to a situation where even 30% of the population experiences some foot pathology and pain. It has been shown that prolonged compression on the forefoot caused by footwear leads to changes in the structure of the foot, and 86% of shoes have narrower toe boxes compared to the anatomical width of the foot.

The most common disorders affecting the foot and ankle include:

Flat Feet

Flat feet are characterized by a lowered medial longitudinal arch and a valgus alignment of the heel. Clinical examination, imaging studies (X-rays), or podoscopic examination are used to diagnose flat feet. At MIRAI, we also use a device for functional analysis of the spine and posture in motion, which allows us to visualize foot loading in standing, walking, or running positions, along with monitoring the parameters of pelvic and trunk alignment. This enables us to comprehensively assess the functional status of the foot and its impact on the musculoskeletal system of the patient.

Risk factors for flat feet include genetic predisposition, wearing shoes from early childhood, obesity, and urban living.

In flat feet, there is a loosening of the ligamentous and muscular support that maintains the foot in a neutral position. This has consequences for the entire musculoskeletal system. Flat feet commonly lead to knee valgus alignment, increased adduction and internal rotation in the hips, which can also contribute to pain in distant areas of the body.

The treatment of flat feet primarily involves physiotherapy targeting the underlying cause of the pathology. The selection of appropriate corrective exercises, manual therapy aimed at mobilizing restricted joints, patient education regarding their daily activities, or, in some cases, custom orthotics, provide great chances of success in treating flat feet.

Ankle Sprain

An ankle sprain most commonly involves damage to the ligaments on the lateral side of the ankle joint, which occurs in an inversion mechanism. We distinguish three degrees of ligament damage:

Grade I sprain – ligament stretching without disruption of its continuity and without signs of ankle instability.
Grade II sprain – partial ligament tear with signs of ankle instability.
Grade III sprain – complete rupture of the ligament with existing ankle instability.

Epidemiology: It is a very common injury, affecting 1 person per 10,000 daily.

Symptoms: The most common symptoms include pain, swelling, and bruising in the injured area. After the injury, mechanical instability or stiffness of the ankle joint may also be experienced. Even one-third of individuals who have experienced an ankle sprain may experience chronic pain, swelling, or re-injury within a few years of the initial injury.

Diagnosis: The basis for diagnosis is a clinical examination and ultrasound examination, which allows the assessment of the extent of injuries to the injured ankle joint. X-ray, especially in children under 15 years of age, is also a first-line examination to exclude bone fractures that may occur during the injury. Diagnosis can also be expanded with magnetic resonance imaging or computed tomography.

Treatment: During the first few hours after the injury, it is advisable to apply cold therapy to reduce bleeding. For the next few days, elevating the leg and applying appropriate compression to the injured area can help reduce swelling. Electrical stimulation is very helpful in removing excess fluid from the joint by activating the muscle pump and lymphatic system. Avoid overloading the leg during activities that cause pain. It is important to establish a collaboration with a physiotherapist from the beginning who will prescribe exercises appropriate to the degree of damage, time since the injury, and your clinical condition.

Achilles Tendinopathy

The Achilles tendon is the largest tendon in the human body. It is an extension of the gastrocnemius and soleus muscles. It withstands significant forces, especially during dynamic activities such as running or jumping. The collagen that makes up the tendon can be damaged due to chronic overuse or, conversely, insufficient daily load and sudden increase in activity level. Damaged collagen fibers do not efficiently transfer force, leading to the ingrowth of free nerve endings and, as a result, pain. The pain is not solely caused by inflammation but primarily by degenerative changes that develop within the tendon.

Epidemiology: This is a very common overuse injury that affects active individuals, particularly those involved in running or jumping activities. Among middle-distance runners, the percentage of athletes who have had or currently have this injury can reach 83%. However, it is important to note that it is not a condition exclusive to athletes. Even in clinical practice, 65% of Achilles tendinopathy diagnoses are unrelated to sports-related individuals. The development of tendinopathy can be influenced by footwear that tightly compresses the heel and activities that require significant dorsiflexion of the ankle joint, such as uphill walking. This leads to high tissue compression in the Achilles tendon area, resulting in overloading.

Symptoms: Key symptoms of Achilles tendinopathy include morning stiffness, which can also occur after prolonged sitting, tenderness of the tendon upon touch, pain during walking, running, or jumping (depending on the stage of tendinopathy), and reduced calf muscle strength. In competitive athletes, a decline in performance, such as slower running times or poorer jumping results, often precedes the onset of pain.

A common clinical presentation is pain that initially occurs at the start of activity, subsides during exertion, and returns after exercise. It is important not to wait until the pain completely prevents participation in favorite sports. The earlier appropriate physiotherapy is initiated, the greater the chances of a quick return to full function with a lower risk of disease recurrence.

Diagnosis: The diagnosis is primarily made through a clinical examination. Tenderness with palpation of the tendon is a sensitive and specific test for evaluating the presence of Achilles tendinopathy. Complementary diagnostic imaging, such as ultrasound or magnetic resonance imaging (MRI), can provide a visual assessment of the extent of degenerative changes within the tendon fibers. The duration and intensity of symptoms, along with imaging results, form the basis for selecting appropriate treatment methods and predicting the duration of treatment. Rehabilitation in advanced cases can last several months or even longer. In cases with significant structural changes and severe pain, surgical intervention may be necessary.

It is crucial to identify the underlying causes of tendinopathy. The most common factors include training errors, improper movement technique, limited range of motion or muscle strength in the upper ankle joint or adjacent joints. Therefore, during the clinical examination, a comprehensive assessment of the musculoskeletal system is necessary to diagnose any abnormalities that may contribute to Achilles tendon overload.

Treatment: The foundation of treatment is physiotherapy. Targeted training aimed at strengthening the tendon and re-educating movement patterns that contributed to the development of the condition has a high chance of success in conservative management. In the initial phase, isometric exercises are mainly utilized, followed by exercises with high resistance and slow execution. Correction exercises for any associated joint dysfunctions and specific training to improve running technique may also be incorporated into the treatment plan.

At MIRAI, Jakub Olewiński is responsible for this area of the body.

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