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Lower limb injuries that present to podiatry are more frequently chronic or overuse injuries. These often occur due to repeated damage to tissues of the lower limb such as bone, tendon, ligament, fat pad, nerve and so on. Acute injuries will also present to podiatry such as sprained ankles, broken digits, gout and more.

The cause of acute injuries often has a clear mechanism of action. In the case of a sprained ankle, it may be rolling the ankle while changing direction. Or a midfoot break after kicking a ball or falling off pointe shoes in the wrong direction.

This process is complicated. The reason it happened can be multi-factorial. Research indicates that, more often than not, these injuries occur due to repetitive forces impacting the lower limb.

Adequate diagnosis and treatment requires thorough assessment of the individual, their movement patterns, intrinsic and extrinsic deficits and then formulating a plan to rectify these and in turn the condition. Ultimately, the aim is to return to activity pain free.

Not every injury or person requires the exact same treatment. Best possible treatment requires understanding the foundations of why the injury occurred and applying the most appropriate management strategies for the injury and the person. 

Chronic injuries are often less identifiable and can present as pain one day which wasn’t there last time e.g. pain first steps in the morning under the heel, shin pain after or during running, pain at the forefoot after being on your feet for a while, ‘random’ swelling after taking off your shoes.

Chronic injuries are often frustrating for a patient as they have been developing slowly over a period and it is difficult to assess how or why they have occurred in the first place. Most chronic injuries have occurred from micro-trauma to the tissues slowly over a period. The point of time when the pain occurs, is often when the tissue has reached its stress limit and is breaking down. The diagram here shows what is known as the ‘stress strain curve’ visually. The ‘failure point’ is the point of break down, there are stages that lead up to that failure point and as long as the body has enough time to heal between stresses it can return to the beginning of the curve with less concerns.

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