Knee Pain

What is Patella Tendinopathy?

Patellar tendinopathy, also referred to as Jumper’s knee or Patellar Tendinitis, is a condition that arises following increased loading of the patellar tendon at the front of the knee. The patellar tendon joins the large quadriceps muscle group to the tibia, just below the kneecap.

Tendinopathy, a term describing tendon overload, causes cellular changes within the tendon that ultimately results in tendon pain and dysfunction.

What are the symptoms of Patella Tendinopathy?

Patellar tendinopathy is characterised by pain at the front of the knee felt either at the lower border of the kneecap or within the tendon itself.  The pain is usually present during activities that cause increased loading through the patellar tendon, such as jumping and squatting.  

Characteristic signs and symptoms may include: 

• Anterior knee pain over the patella tendon
• The pain made worse with jumping, landing or running activity and sometimes with prolonged sitting.
• The onset of pain is usually gradual and commonly related to an increase in a sports activity.
• Localised tenderness over the patella tendon
• Often the tendon feels very stiff first thing in the morning.
• The affected tendon may appear thickened in comparison to the unaffected side 

What are the causes of Patella Tendinopathy?

As mentioned, patella tendinopathy will most likely occur during activities which place a significant load through the patella tendon. For this reason, patellar tendinopathy is common in volleyballers and basketballers, with up to 45% of athletes in these sports being affected.  Males are up to four times more likely to develop patellar tendinopathy compared to females.

Lower limb biomechanics can play a further role in aggravation, with foot posture playing a large role in shock absorption during landing, and as a result increasing the load on the tendon.

What is Forefoot Bursitis?

A forefoot bursitis is an inflamed bursa which is located within the metatarsals on the forefoot. Forefoot bursitis differs from a neuroma as the bursitis does not involve any nerve structures.

What are the symptoms of Forefoot Bursitis?

The symptoms of a forefoot bursitis can be similar to a neuroma. Patient’s will often report feeling a lump in between their toes with throbbing and aching occurring when walking barefoot or in shoes. There are usually no signs of nerve irritations present, with the absence of pins, needles or burning pain in patients with bursitis. 

What are the causes of Forefoot Bursitis?

A forefoot bursitis can occur due to a broad range of issues. These may include:

• Poor and ill-fitting footwear with narrow toe boxes (creating inflammation of a bursa).
• High heeled footwear increasing the strain on the forefoot.
• Flat feet / over pronation or high arched feet can make you more susceptible to bursa compression and irritation.
• Digital deformities (bunions, claw and hammer toes) can alter the forefoot biomechanics and increase your risk of bursa irritation.
• Calf tightness can also increase the pressure on your feet and result in a bursa becoming inflamed and irritated.

What is Sesamoiditis?

A forefoot bursitis is an inflamed bursa which is located within the metatarsals on the forefoot. Forefoot bursitis differs from a neuroma as the bursitis does not involve any nerve structures.

What are the causes of Sesamoiditis?

Sesamoiditis is defined as the painful inflammation of the sesamoids which are located under the big toe joint. The sesamoids are two small bones which assist in the function of the big toe, as well as absorbing load during high impact activities. 

Sesamoiditis will often present with a mild or intense throbbing pain aggravated with activities including walking, running and jumping. Presentations may include swelling and redness all localised to the big toe joint. 

What are the causes of Sesamoiditis?

Sesamoiditis can be caused by any activity which places force on the ball of the foot. These can include sports such as football, netball or dancing – as well has water-based sports including swimming (pushing off the wall during a tumble turn). 

Footwear and biomechanics can both play a role and should be assessed once this condition occurs. 

What is a Plantar Plate? 

The plantar plate is a thick ligament type structure with attachments which inserts into the base of our phalanges (toe bones) in the area of the ball of the foot. Injuries of the plantar plates include partial tears through to complete rupture. Plantar plate tears will most commonly occur under the 2nd toe. 

The plantar plate is designed to protect the head of the metatarsal from pressure and prevent over extension of our toes.

What are the symptoms of Plantar Plate Tear?

Patient’s who present with a plantar plate tear will often report a painful stone-like feeling under the 2nd, 3rd, 4th or 5th toe joints. The pain or stone-like feeling will not subside and often worsens throughout a day of activity. 

If untreated the symptoms of a plantar plate tear will continue to increase until compete rupture occurs. Once ruptured, the effected digit will begin to drift and overlap other toes. 

What are the causes of Plantar Plate Tear?

The causes of a plantar plate tear can include:

• Morton’s toe – the second digit being longer than the first. 
• Digital deformities including bunions, hammer or claw toes increasing strain on other digits. 
• Certain footwear (high-heeled shoes, football boots) increasing the force on the second toe. 
• Over-pronation resulting in more force being placed on the second digit resulting in an overload of pressure.  

How does Elite Foot Care treat Plantar Plate Tear?

At Elite Foot Care we pride ourselves in ensuring you’re back on your feet, feeling fit and healthy, as soon as possible.

Plantar plate pathologies are often diagnosed through a thorough history and clinical examination. If suspected, our podiatrists may utilise an x-ray and ultrasound scan to assess the integrity and health of your digital joints and plantar plate.

Once diagnosed, conservative treatment for plantar plate tears may include:

• A period of relative rest and activity modification. Our podiatrists can discuss alternative activities which you can still do while rehabilitating your foot injury. 
• In-shoe padding to offload the inflamed bones
• Custom foot orthotics to provide a long-term treatment and offloading of the plantar plate – ensuring prevention in the future. 
• Shockwave therapy utilised to ease the soft tissue inflammation and improve your comfort.
• Footwear recommendations to ensure you’re well equipped during your daily activities.