In-toe walking, also known as “Pigeon toes”, is a condition whereby a child is walking with their toes pointing inwards and facing each other. This condition is considered a form of gait abnormality and is one of the common causes of frequent tripping and falling in young children. It is also one of the most common paediatric conditions that parents often neglect even after noticing the problem.
Knock knees, medically termed genu valgum, is a congenital structural abnormality that affects the angle of the knees. Parents often refer to knock knees as “X-shaped” legs, where the knees are touching one another whilst the feet are wide apart when standing.
Knock knees are determined by either the angular difference between the thigh bone (femur) and the leg bone (tibia) through an x-ray or by measuring the gap between the ankles when someone is standing with their knees together.
If within the normal reference range and age, knock knees are part of the normal development of a child. Children are expected to have mild knock knees after the age of 2 years, and peak at the age of 4 years.
Sever’s disease or calcaneal apophysitis is a type of osteochondrosis that causes heel pain in children between the age of 8 to 14 years. This condition occurs when the Achilles tendon (the tendon that attaches to the back of the heel) pulls on the growth plate of the heel bone (calcaneal apophysis), resulting in swelling and inflammation of the growth plate.
Sever’s disease often occurs in active children and is more common in boys than girls. Children affected by Sever’s disease commonly complain of pain under the heel or at the back of the heel. In the early stages, the pain would normally occur only after high-impact activities or sports, but as the condition gets worse, the pain would eventually cause the child to limp even without activity.
Posterior Tibial Tendon Dysfunction (PTTD) or known as Adult Acquired Flat Foot is a progressive flat foot condition that causes pain in the ankles or the arch. It is due to inflammation, tear, or degeneration of the Posterior Tibialis Tendon. This tendon runs from the back of our lower leg and attaches to the navicular bone, and it is responsible for supporting and raising our arch when we stand or walk.
Patients with PTTD will experience pain and swelling along the inner side of the ankle or the arch region during standing or walking. They will also have trouble standing on their toes or balancing on one foot. The condition can progress to developing severe flat foot deformity if left untreated.
Medial tibial stress syndrome (MTSS), commonly known as shin splints, is a condition that causes leg pain along the inner side of the tibia (shinbone), particularly nearer to the ankle. This condition commonly affects runners and patient often reports throbbing pain or ache during runs.
Bunions or hallux abductovalgus, are a joint deformity where the big toe curve towards the lesser toes. People with bunions often complain of difficulty fitting into shoes due to the wide forefoot caused by bunions. Bunions are a progressive condition and cause overlapping toes to develop at their severe stages. It can affect adults and children, with the latter known as juvenile bunions.
Bunions affect the function of our big toe joint in walking, causing stress to other foot or toe joints and disrupting the pressure distribution under the foot. Commonly associated conditions caused by bunions include corns or calluses, plantar plate injury or hallux rigidus.
A Morton’s neuroma is a ball of thickened nerve tissue that occurs in the digital nerves of the foot, often referred to as a benign nerve tumour. The most common neuroma occurs between the third and fourth toe and is a painful condition that causes shooting pain or numbness down to the affected toes.
Chronic ankle sprain, also known as chronic ankle instability, occurs due to an inadequate treatment method during the acute ankle sprain phase. It is characterized by feeling “loose” in the ankle and recurrent ankle sprain. Patients often complain that they will twist their ankles every now and then. Patients with chronic ankle sprains may also have other underlying ankle injuries that contribute to the swelling and pain of the ankle, such as talar dome injuries.
Knee osteoarthritis is a degenerative joint disease that causes knee pain, swelling, and stiffness. It is one of the most common knee conditions for the elderly, often explained as a “wear and tear” problem, and can severely impact their quality of life. Knee osteoarthritis occurs when there is a loss of articular cartilage within the knee, causing the joint space within the knee to narrow and eventually lead to bone-on-bone grinding during movement. As the condition progresses, bony spurs will develop and patients are often able to feel these painful bony lumps around the knee joint.
It’s important to note that not everyone who experiences osteoarthritis in their knees has experienced a traumatic injury or overuse of the joint. Some people simply have a genetic predisposition to developing knee osteoarthritis as they age.
Iliotibial band syndrome (ITBS) is a condition that causes pain at the lateral (outside) knee joint and is exacerbated by activity. It is an overuse condition resulting from repeated extension and flexion of the knees and therefore commonly affects runners and cyclists. It also tends to occur in individuals with a sudden increase in activity level.
The iliotibial band (ITB) is a thick fascia band that runs from the outside hip to the outside knee and helps to provide rotational stability to the hip and knee. The cause of ITBS is often multifactorial and if left untreated, it can affect your ability to walk, run or climb stairs.
Patellar Tendonitis, also known as “Jumper’s Knee” or “Patellar Tendinopathy”, is a condition that causes anterior knee pain due to the inflammation of the patellar tendon. The patellar tendon connects the kneecap to the shin bone and it tightens when you extend (straighten) your knee. This condition can be classified into 2 stages – acute or chronic.
Acute patellar tendonitis usually presents with swelling, and redness (signs of inflammation) and indicates an early injury to the tendon. If left untreated and undiagnosed, it can lead to chronic patellar tendinopathy, where the patellar tendon is thickened and degenerated and will take longer to recover.
Meniscus tear or injury is a common cause of knee pain in the medial (inside) and lateral (outside) sides of a knee joint. The knee meniscus is fibrocartilage that helps to “cushion” the shock between the thigh and shin bone when weight-bearing and prevents damage to the joint cartilage.
A meniscus tear can increase the risk of developing knee osteoarthritis if left untreated. It also changes the biomechanics and stability of the knee joint, resulting in an increased risk of developing other knee conditions.