Definitions of Lower Limb Conditions
Lateral Hip Pain / Trochanteric Bursitis:
Trochanteric bursitis is inflammation of the bursa (a small, cushioning sac located where tendons pass over areas of bone around the joints), which lies over the prominent bone on the side of your hip (femur).Trochanteric bursitis is characterized by painful inflammation of the bursa . The commonest cause is due to physical activities involving repetitive movements combined with poor biomechanics and muscle weakness.
Hip Flexor Tendinitis:
Also known as iliopsoas tendinitis, refers to inflammation of the iliopsoas muscle. This condition is largely caused by repetitive hip flexion, often observed in running and jumping.
Pes Anserine Syndrome
Meralgia Parathe tica
Ilio Tibial Band (ITB) Syndrome
Anterior knee Pain / Patalo-Femerol Pain
Groin / Adductor / Inguinal Pain
Overview: Plantar fasciitis is a disorder that results in pain in the heel and bottom of the foot. The pain is usually most severe with the first steps of the day or following a period of rest. The causes of plantar fasciitis are not entirely clear. While heel spurs are frequently found it is unclear if they have a role in causing the condition. Between 4% and 7% of people have heel pain at any given time, and about 80% of these cases are due to plantar fasciitis. Approximately 10% of people have the disorder at some point during their life and becomes more common with age.
Risk factors: Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, the presence of a leg length inequality, and flat feet. The tendency of flat feet to excessively roll inward during walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with plantar fasciitis and is an independent risk factor. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors.
First-line conservative approaches include rest, heat, ice, and calf-strengthening exercises; techniques to stretch the calf muscles, Achilles tendon, and plantar fascia; weight reduction in the overweight or obese; and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen.
Extracorporeal shockwave therapy (ESWT) Corticosteroid injections Custom orthotic devices Orthotic devices and certain taping techniques are proposed to reduce pronation of the foot and therefore reduce load on the plantar fascia resulting in pain improvement.
Moderate evidence exists to support the use of night splints for 1–3 months to relieve plantar fasciitis pain that has persisted for six months. The night splints are designed to position and maintain the ankle in a neutral position thereby passively stretching the calf and plantar fascia overnight during sleep.
Plantar fasciotomy is often considered after conservative treatment has failed to resolve the issue after six months and is viewed as a last resort.Heel spur removal during plantar fasciotomy has not been found to improve the surgical outcome.
Plantar heel pain may occur for multiple reasons and release of the lateral plantar nerve branch may be performed alongside the plantar fasciotomy in select cases. Possible complications of plantar fasciotomy include nerve injury, instability of the medial longitudinal arch of the foot, fracture of the calcaneus, prolonged recovery time, infection, rupture of the plantar fascia, and failure to improve the pain. Coblation surgery has recently been proposed as alternative surgical approaches for the treatment of recalcitrant plantar fasciitis.
Dry needling is being researched for treatment of plantar fasciitis
Botulinum Toxin A injections as well as similar techniques such as platelet-rich plasma injections and prolotherapy remain controversial.
Dry needling is also being researched for treatment of plantar fasciitis. A systematic review of available research found limited evidence of effectiveness for this technique. The studies were reported to be inadequate in quality and too diverse in methodology to enable reaching a firm conclusion.