Foot & Ankle Orthotics

The disease is caused when a reduced blood supply to the head of femur (the ball shaped top of the thigh bone) causes it to soften and become flattened or misshaped. It occurs in childhood as the bones are developing.

The Iliotibial band (ITB) is a band of connective tissue which runs along the outside of the leg from the Iliac Crest (hip bone) to the tibia (shin bone). As the knee bends and straightens, the ITB rubs past the lateral femoral epicondyle which is a bony prominence on the outside of the femur (thigh bone) immediately above the knee joint. Due to this action the ITB is prone to friction which, if excessive, leads to inflammation. The condition is particularly common in runners.

May be either Congenital or traumatic (caused by a sudden physical injury from an external factor). For further information on Congenital Dislocation of the Hip click here. Common causes of traumatic dislocation are falls, road traffic accidents or can be associated with hip replacements where a diseased hip joint is replaced with an artificial joint known as a Prosthesis. The hip dislocation may be associated with a fractured femur. A posterior (backward) displacement is the most common type accounting for approximately 90% of this type of injury.

An external trauma (bodily wound or shock produced by a sudden physical injury) is the most common cause. The trauma may be due to a fall or involvement in a road traffic accident etc. The injury cause a break in the femoral neck which is the part of the femur (thigh bone) joining the head (ball shaped top) to the shaft (the long part of the thigh). People who suffer from weakened bone structure e.g. women with osteoporosis can be more susceptible to this type of injury.

The condition can be caused due to incorrect development of the ball shaped head of femur (thigh bone) and/or the socket shaped cup of the pelvis (hip bone). Alternatively it may be due to weakness or laxity in the ligaments which stabilise the hip joint. The result is a hip joint which becomes displaced or dislocated.

A valgus or varus knee is often associated with degenerative conditions such as Osteoarthritis (OA) or Rheumatoid arthritis (RA). There may be a history of ligament damage which over time may cause knee instability. The knee position may be made worse by over pronation or over supination of the feet.

The PCL is one of four ligaments which together provide stability to the knee joint. It is a less common injury the anterior Cruciate ligament as it is a stronger than the ACL. The most common method of injury is a direct impact to the front of the tibia (shin bone) with a bent knee e.g. a tackle from the front.

The patella (knee cap) is a bone which is situated at the front of the knee. It sits in the tendon which forms at the bottom of the thigh muscles called the Quadriceps tendon and attaches to the tibia (shin bone) by the patella tendon. Maltracking occurs when the patella moves to one or other side of the knee as the knee is bent rather than staying in a central position. It can be caused by overuse, tight tissues attached to the outside of the knee, muscle imbalance, malformation of the patella or certain foot pathologies, particularly over pronation.

Occurring children (10 to 15 years old), particularly those involved in sport, the problem is caused by excess strain on the patella-femoral ligament, the ligament which connects the quadriceps (thigh) muscle to the tibia (shin bone) at its attachment just below the knee. Rapid growth may also contribute to the problem.

Whilst direct blows to the knee joint can cause injury, it is more prone to stretching or twisting injuries. Then the knee is subject to a bending or twisting stress in a particular direction, the particular ligament which is trying to control the knee can tear or rupture completely. Muscles or tendons around the knee may also be subject to injury.

The collateral ligaments are positioned either side of the knee joint. Injury to these ligaments is caused by a blow to the knee joint from a medial (inside) or lateral (outside) direction with the foot on the ground. A medial blow will cause a varus (outward bowing) stress and damage the lateral collateral ligament. A lateral blow will cause a Valgus (inward bowing) stress and damage the medial collateral ligament.

The semi circular or meniscus cartilages in the knee provide cushioning between the femur (thigh bone) and tibia (shin bone) as they move relative to each other. If the knee is subject to a forceful twisting action, typically in sports such as football or rugby, then the cartilages can be nipped or torn.

AKP is a term used for a range of conditions; there are a number of possible causes. Common causes of AKP include: over pronation, patella maltracking or patella tendonitis. It may also be related to overuse e.g. in individuals who are keen on sports such as running.

The ACL is one of four ligaments which together provide stability to the knee joint. ACL injury is typically associated with sporting activities such as football or rugby. The injury is cause typically when a twisting force is applied to the knee with the foot firmly in contact with the ground. Another common cause is a direct blow to the knee, usually on the outside of the knee e.g. in a rugby or football tackle.

It occurs when the head of the humerus (the ball shaped top end of the bone in the upper arm) becomes displaced from it’s normal articulation (position of movement) with the scapular (shoulder blade) and is mainly due to a fall or collision, it is more common to happen anteriorly (95-98%of cases) as the shoulder is pushed upwards and backwards e.g. a fall on an outstretched arm.

As a result of trauma (a bodily injury or wound caused by an external force), inflammation, or tumours to the nerves which originate near the neck and shoulder. Stretching or tears of the nerves at their spinal origin (where they exit the spinal column) are most commonly seen during high speed vehicle accidents, particularly involving motorcyclists, falls from heights but also at birth, when the baby’s shoulder gets pulled away from the head.

Spondylosis is also known as degenerative osteoarthritis affecting the vertebrae (bones) in the spine. Aging is the main cause of this disease as a consequence of repetitive strain, “wear and tear”. It can affect any area of the spine from the cervical (neck) area to the lower spine.

Spondylolisthesis is a condition in which one vertebra slips forwards relative to the vertebra below. There are 5 different recognized types: Displastic (Abnormal development), Ithmic or spondylolytic (Defective area at the back portion of a spinal vertebra (bone)), Degenerative, Traumatic and Pathological (Weakness due to disease).

Spinal fractures are usually caused by trauma (a body wound produced by sudden physical injury) such as car accidents and falls. They are most commonly seen between the middle and lower back. Depending on the severity they can cause spinal instability, spinal cord injuries and severe pain. Other types of spinal fractures are due to underlying conditions affecting the vertebrae (spinal bones), e.g. osteoporosis.

Increased pressure on the vertebral discs (the cartilage type structures between the bones of the spine) normally causes the connective tissue surrounding the discs (outer ring) to break down, allowing the softer part of the disc to swell and bulge out. As we get older the outer ring tends to become less flexible and is weaker.

Scoliosis is a term used to describe a lateral or sideways bending of the spine and can be caused by several factors. It can be classified as congenital (due to vertebral (spinal bone) abnormalities at birth), idiopathic (of unknown cause) or neuromuscular (as a consequence of a neuromuscular disorder such as cerebral palsy or spinal muscle atrophy).

There is a natural process in bones whereby bone is continually made and removed. When more bone is removed than is made, bone density reduces and this leads to the condition known as Osteoporosis. It is more common in women than in men. In women it is linked to hormone changes – a hormone is a substance produced by the body which exerts a specific effect on cell activity. In men, the cause is not as yet understood but may be linked to genetic factors.

It can be classified as postural or structural. Postural kyphosis can be caused by slouching and also by vertebral fractures. It is more commonly associated with older people, especially due to osteoporosis. Structural kyphosis is due to abnormality of the spinal structures such as vertebrae (bones of the spine), ligaments, nerve, intervertebral disc, or even muscles. The most common types are Scheuerman’s kyphosis, Congenital Kyphosis and Gibbus deformity.

If back pain has been present for over 3 months, it is described as Chronic low back pain, also known as lumbago. This is a very common condition and it can have several causes. These include: injury to the ligaments, muscles, vertebral disc and/or vertebrae (bones of the spine), as well as degenerative conditions such as arthritis, bone disease or osteoporosis.

The exact cause is not known but there is a strong genetic component to this disorder as 96% of sufferers share the same gene. It is a type of chronic (long term) inflammatory arthritis with an overactive immune response (the body’s response to the production of an antigen – a substance which produces antibodies to fight infections). It mainly affects the back but also the sacrum and pelvis area and it causes it to fuse and become rigid.

Also known as lateral epicondylitis, tennis elbow is caused by overuse of the extensors of the wrist and fingers. More recent research has also suggested that forceful pulls and/or extensions as well as direct blows to the lateral epicondyle (the bony prominence on the outer side of the elbow) are large contributors to this condition.

Also known as medial epicondylitis, this condition arises as a consequence of overuse of the muscles and tendons responsible for flexing the wrist, fingers, and thumb and also pronating the forearm (a movement which turns the palms of the hands into the body).

The most common cause of wrist fractures are from falls. As a person falls, the hand is automatically brought out to cushion the fall (called the saving reaction), causing the wrist to bend backwards.

Also known as wrist dropped, it is mainly caused by damage to the radial nerve. Most causes are due to injury, long term pressure on the nerve or swelling of surrounding tissues. Some of the most common causes are due to improper use of crutches, fractures of the humerus (the bone of the upper arm), and pressure on the arm whilst sleeping, in a coma or when a person is intoxicated (Saturday night syndrome).

Dupuytren's is a condition which affects the hands and fingers due to thickening of the connective tissue. This thickening causes the finger(s) to contract, causing it/ them to bend towards the palm. The cause of the contracture is unknown but it seems to run in families. This would suggest there is a strong genetic component to it. This condition seems more common in Northern European countries and is associated with diabetes epilepsy and alcohol dependence syndrome.

CTS is caused by compression of the median nerve at the “carpal tunnel” area of the wrist. It can be caused by a combination of factors, such as an injury that causes swelling, hypothyroidism, Rheumatoid Arthritis, mechanical problems of the wrist joint and genetic causes. Other external factors such as tumour or ganglions can cause pressure on the nerve.

CP occurs when there is damage to the developing brain. The damage can occur before, during or after birth and CP can affect people in many different ways. Causes of CP can be complex but include: Abnormal brain development, a bleed in the brain, oxygen starvation to the brain, an infection in early pregnancy.

It is estimated, over 225,000 people in Ireland are suffering from diabetes. The disease is caused by the body being unable to metabolise (use) glucose (blood sugar) either because the cells which produce insulin have been destroyed (type I diabetes) or the pancreas doesn’t make enough insulin or the insulin made doesn’t work correctly (type II diabetes).

MND is a disease in which the motor neurones (nerves which make muscles move) are attacked. It is a progressive degenerative disease. Its exact cause is not clear but may be liked to things such as the chemical processes within nerve cells or the cells ability to move nutrients in and waste products out.

MS is a disease of the nervous system. It is an auto-immune disease, a disease where the body’s immune system sees the body’s own cells as foreign and attacks them. In MS the tissue around nerves, called myelin, is destroyed either partially or fully. Myelin helps messages pass along nerves and so when it is destroyed, the message can be disrupted as it passes along the nerve or may not get through at all.

Osteoarthritis is often referred to as a wear and tear disease. It causes the smooth articular cartilage to become roughened and thinner. The underlying bone responds by thickening and growing outwards. The joint capsule also becomes thicker and inflamed. Many cases of ankle osteoarthritis are linked to a previous ankle injury which can damage the cartilage directly or alter the mechanics of the joint (how the joint works).

Polio is caused by an infectious virus which attacks the motor neurones (nerve cells which control muscle movement) causing damage or destruction of these cells. This can lead to muscle paralysis.

Rheumatoid Arthritis is a chronic (long term), progressive auto-immune disease (a disease whereby the body's cells are attacked by its own immune system causing damage). It causes swelling and damage to cartilage and bone around joints. Over time this leads to deformities of the affected joints. The exact cause(s) of RA are not yet fully understood. Osteoarthritis may also be present in conjunction with RA.

Spina bifida means “split spine” in Latin. It is caused by the incomplete closure of the developing spine during early pregnancy. This leaves the spinal nerves exposed to damage. What causes this incomplete closure is unknown but it has been shown that use of folic acid reduces the incidence of Spina Bifida by up to 70%.

Strokes are caused by ischaemia (lack of blood flow) due to a thrombosis (blockage) or hemorrhage (bleed) in the brain.

Over use or damage to the tibialis posterior tendon. Damage to the tendon can be caused by changes in the tendon which impair its ability to support the medial arch.

The cause of the most common type of shin splints, Medial Tibial Stress Syndrome (MTSS), is inflammation of the muscle tendon where it attaches to the thin layer of tissue (periosteum) which covers the tibia (shin bone) and is linked to over pronation. It is commonly termed an over use injury.

The condition is caused by irritation to the attachment of this tissue to the heel bone (calcaneus) at the Medial (inside) insertion (attachment point). A common reason for this irritation is increased stretch to the medial (inner) border of the tissue caused by over pronation but those with abnormal foot biomechanics such as over supination and pes cavus may also be susceptible to this condition. There can sometimes be an associated heel spur.

Over supination is far less common than over pronation and is associated with a high arch foot type which is unable to absorb shock and adapt to the ground when the foot initially contacts the floor.

Pronation (often referred to as flat foot) is an inward (medial) roll of the foot, particularly the arch and heel, which occurs naturally when the foot initially contacts the ground as a shock absorbing/adaptive mechanism. In over pronation this movement occurs excessively and the foot is unable to recover to its normal position.

Reduction in the fibro fatty padding protecting the metatarsal heads (the bones which form the ball of the foot.

The term refers to a difference in length between the left and right leg. It may be developmental, as the human body is rarely symmetrical, or can be as a result of trauma (usually resulting in a shortening of the affected leg) or joint replacement (sometimes resulting in a lengthening of the affected leg).

Ossification (the laying of bone) in the plantar fascia which is the strong sheet of connective tissue running underneath the foot. This occurs at its attachment to the heel bone and is caused by increased stress on the tendon from conditions such as over pronation.

Hallux limitus/ rigidus is a disorder of the joint at the base of the big toe (hallux). The joint becomes painful and progressively stiff. It is normally associated with degenerative osteoarthritis.

Foot drop is a simple term which covers a potentially complex problem. It can be caused by various factors including: dorsiflexors injuries (dorsiflexors are the muscles which pull the foot up), peripheral nerve (a nerve outside of the brain and spinal cord) injuries, CVA (stroke), diabetes.

Congenital Talipes Equinovarus (CTEV) is characterised by a positional deformity of one or both feet as the baby develops when in the womb. It is caused by an unbalanced tightness in the muscles and ligaments of the foot and ankle complex. The condition is commonly referred to as club foot.

Charcot Marie Tooth (CMT), sometimes also known as Hereditory Motor and Sensory Neuropathy, is a group of inherited conditions which cause damage to the peripheral nerves (those located outside of the brain and spinal cord).

Displacement (movement from its normal position) of the bones in the big toe (Hallux). The end (distal) bones move towards the smaller toes, and the closer bones (proximal) move in the opposite direction. This gives the appearance of a large bony growth on the side of the big toe. The cause is usually a biomechanical abnormality normally connected to over pronation of the foot. This prevents proper function of the big toe and, over time, results in the toe drifting across to the smaller toes creating the characteristic deformity. Poorly fitting shoes and high heels increase the likelihood of bunions forming.

Long-term over use, multiple untreated injuries resulting in chronic (happening over a long period of time) tissue injury, poor blood supply and unhealthy tendon.‍

An inflammatory condition of the achilles tendon caused by over stretching or over use and tightness in the calf muscle and tendon itself.

The term ankle injury is a general or umbrella term which covers a variety of problems with a variety of causes. An ankle injury can range from a relatively simple ankle sprain to a complex ankle fracture. The causes are equally varied, from a simple twisting motion of the ankle to a severe trauma (a serious bodily wound caused by sudden physical injury).

Ankle sprains are injuries caused when an unnatural twisting movement is applied to the ankle which exerts higher than normal stretching forces to the ligaments, causing damage. Ligaments are special tissues which connect bones to each other and allow controlled movement between them.

Flat Foot is a commonly used term for Over Pronation which is an inward or medial roll of the foot, particularly the arch and heel, which occurs naturally when the foot initially contacts the ground as a shock absorbing/adaptive mechanism. In Flat Foot this movement occurs excessively and the foot is unable to recover to its normal position.

Ulcers are a breakdown in the protective outer layers of the skin, exposing vulnerable tissues underneath. They are caused by the following conditions in various combinations: trauma, high pressure or prolonged application of pressure, nerve damage and a reduced or compromised blood supply to the area. Ulcers are very commonly, but not exclusively, associated with people who have Diabetes.

Traumatic Injury (injury caused by a sudden, external violent force), over use or repetitive strain resulting in stress fracture.

Pes Cavus is characterised by a high arch foot type which doesn’t flatten on weight bearing. It may be a normal variant (some people just have it); it may be hereditary or may be related to an underlying neurological problem.

Excess pressure or friction affecting a specific area on the foot, often on the ball of the foot or on the side of the big toe. Can be an indication of poor foot mechanics and is often associated with conditions such as Rheumatoid Arthritis, over pronation, Pes Cavus.

Usually caused by excessive, repetitive pressure under the front of the foot, from activities such as running or dancing, leading to Inflammation of the 2 small sesamoid bones (bones contained within the tendon that runs underneath the big toe) under the 1st Metatarso-phalangeal Joint (MPJ).

Also know as calcaneal apophysitis. Mainly seen in active children 8 and 15 years old, the cause is inflammation of the growing area (apophysis) of the calcaneus (heel bone) which itself is caused by aggravation due to the pull on the attachment point of the Achilles tendon. A growth spurt may also contribute to the symptoms as this can increase tension on the attachment of the Achilles tendon. At approximately 15 years old, this growth area fuses to solid bone.

Muscular or biomechanical imbalance of the toes causing the specific joints to move from their normal alignment and become deformed and may be associated with over pronation. Toe deformities can also be a secondary (resulting) complication of other conditions such as Rheumatoid Arthritis.

Particularly common in runners, hence the name, it is also referred to as Patella-femoral Pain Syndrome. It is caused by musc

The most common cause is overuse of the tendon but it can also be caused by Arthritis and infection.