Knee, Ankle and Foot Pain
The Iliotibial band is a long, thick, and fibrous extension of the fascia lata (band or sheet of connective tissue on the outside of the thigh). It serves as an attachment site for 2 muscles and proceeds downwards attaching to the outside of the knee helping to reinforce and stabilise the joint. The ITB can become inflamed and painful for numerous reasons and is particularly common in runners. Some causes of this condition include: Poor shock absorption (worn shoes/hard terrain), weak gluteals (buttock muscles) or over pronation (feet leaning inwards). Walking and running will often cause discomfort and it will feel particularly tender to touch about 1 inch upward from the outside of the knee.
The anterior and posterior cruciate ligaments lie deep within the knee joint providing crucial stabilisation. The posterior cruciate ligament is approximately twice as strong as its anterior counterpart making it less common to become damaged during injury. The ACL acts to limit the Tibia (the larger of the 2 lower leg bones) moving anteriorly (forward).
The ACL is thus most commonly injured by forcing the knee into hyperextension, e.g. being slide tackled from behind in football, or less severely, having to stop very quickly after sprinting. The PCL acts to limit the Tibia moving posteriorly and usually occurs from opposing ACL forces, such as a blow to the front of the tibia (forcing the leg backwards)
The menisci are 2 rings of cartilage covering the superior (top) surface of the tibia. They act as platforms for the femur (thigh bone) to place upon. This forms the tibiofemoral joint (knee joint). Menisci they enable shock absorption and aid congruency (smooth surface contact of the joint surfaces). The medial meniscus on the inner side has a greater function for stability. The lateral (smaller menisci on the outerside) has greater mobility. Tears can occur to either the medial or lateral, but injury to the medial is more common.
This is the most common type of ankle sprain where the ankle comes inward (inverts) creating great force to the structures on the outside of the ankle. 3 ligaments support this side of the foot. The anterior talofibular ligament is the most commonly injured. The peroneal tendons and capsule may also become torn further exacerbating symptoms and prolonging recovery.
The plantar fascia is a thickened web of connective tissue on the sole of the foot. It acts to stabilise the foot and support the arches. This can become shortened and inflamed causing pain when weight bearing and walking. Plantarfascitis is usually particularly painful first thing in the morning initially stepping out of bed. Tired, achy, painful feet toward the end of the day Is also common. Treatment often focuses on releasing calf muscle tension and encouraging dorsiflexion (ability for feet and toes to point upward). This can help stretch the plantar fascia and decrease inflammation.