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Frequently Asked Questions

Other Soft Tissue Conditions

What is plantar fasciitis (plantar fasciopathy)?

Those diagnosed with this condition will be experiencing pain under the heel during weight-bearing activities. This is a complex condition with many associated factors, most being due to increased forces transmitted by the plantar fascia which is a strong band of connective tissue that supports the structure of the foot, connecting the heel bone (calcaneum) with the metatarsal bones in the forefoot (metatarsal bones link to the toes).

Onset of symptoms frequently follows a training program that demands rapid changes in load, or in response to starting a new physical activity after having been inactive for a while.

High body mass index (BMI) is also linked with the condition and may be influenced by an increased number of fat cells in the blood and connective tissue along with excessive load on the plantar fascia itself. Excessive rolling in of the foot (pronation) during weight-bearing may also be associated with this condition.

How do I know if I have plantar fasciitis?

Pain is frequently worse first thing in the morning with the first few steps taken after getting out of bed, ie after prolonged rest, and is most common in the 40-60 year age group where it frequently affects both feet.

Your physio will be able to diagnose the source of your pain and differentiate between a number of other conditions (eg heel spurs) which also cause pain in this region. Your physio will do this via a combination of questions and tests and their examination will include assessing the support structures of your foot as well as the range of motion at your ankle and toes. You are unlikely to be referred for X-rays or scans.

How can physio help my plantar fasciitis?

Once your physio has diagnosed the condition they will tailor an individualised treatment for you based on their assessment findings. They may incorporate the below, either individually or in combination:

  • load management
  • exercises
  • taping
  • hands-on therapies such as massage, mobilisation and dry needling
  • orthotics
  • advice on symptom relief

What is Dupuytren’s Disease?

This condition describes thickened lumps and cords that develop under the skin in the palm of the hand. These cords are made of thickened connective tissue in the hand called palmar fascia. Over time, these thickenings under the skin can pull the finger down into the palm, eventually leading to an inability to straighten the fingers.

While the cause of this condition is unknown, a number of factors are thought to increase the likelihood of developing Dupuytren’s, including being an older male, having diabetes, or the overuse of alcohol and cigarettes. Dupuytren’s disease is also believed to run in families with Scandinavian heritage which is why it is also known as Viking’s disease.

How do I know if I have Dupuytren’s disease?

Dupuytren’s disease has a characteristic look that is easily diagnosed by GPs and physios because the lumps and cords in the hand are easily identifiable and you may be unable to flatten your hand onto a table.

How can physio help my Dupuytren’s?

Physiotherapy is unable to straighten a finger bent by Dupuytren’s or alter the progression of the contracture. However, after surgery, physiotherapy is very important to soften scar tissue, to assist with regaining movement and straightening the finger, as well as restoring function by maintaining the strength of the hand and movement of the finger.

What is Morton’s neuroma (intermetatarsal neuroma)?

A Morton’s neuroma is a condition of pain arising from the nerves that pass between the bones that join on to your toes (metatarsals). Nerves pass between each of the metatarsal bones to supply the toes. Small fluid-filled sacs called “bursa” also sit in this gap to act like cushions.

The condition occurs most commonly between the second and third or third and fourth metatarsals. While it is referred to as a neuroma, there is no tumour in this condition. Pain is caused by a combination of irritation of the nerve, scar tissue that develops around the nerve, and inflammation and swelling of the bursa. This leads to a nerve entrapment where the nerve becomes compressed and cannot move as freely.

The condition is usually caused by excessive loading to the metatarsals and the reason for this may vary between people. For example, in runners it may be due to load on the metatarsal arch (different to the longitudinal larger arch of the foot). Morton’s neuroma is often the result of wearing narrow-fitting shoes and high heels, is up to 10 times more common in women and is most common in those aged 40-60 years.

How do I know if I have a Morton’s neuroma?

A Morton’s neuroma causes pain between the metatarsal bones of the foot when weight-bearing such as in standing or walking. The pain can often shoot down into the toes, sometimes feel like burning or tingling, and may also lead to numbness of the affected toes. Your physio will carefully diagnose the condition by questioning how your symptoms behave and they may attempt to reproduce your symptoms in weight-bearing positions, examining both foot posture and footwear. It is important they are able to differentiate between stress fractures and arthritis which can also cause pain in this area of the foot, but which require different management.

How can physio help my Morton’s neuroma?

Your physio will need to investigate the main cause of your pain in order to provide you with the most appropriate advice for symptom management, which may include the need to change your footwear to a wider style. You are likely to be prescribed exercises to strengthen your foot muscles and your foot may be taped and a padded dome placed under the middle of your forefoot to support the metatarsal arch. Where conservative treatment is not effective, surgical review may be advised.

What is infantile torticollis (wry neck)?

Torticollis literally means "twisted neck" in Latin. There are 3 types of torticollis in children. They are Congenital Torticollis, Acquired Torticollis and Positional Torticollis. As it is important to know what type of torticollis your baby has, your GP may recommend Xray or Ultrasound to assist with diagnosis.

How do you know your baby has infantile torticollis (wry neck)?

You may notice your baby has a tilted head or difficulty turning their neck. But most babies don't feel any pain as a result of their torticollis. Fortunately, the problem usually gets better with simple exercises that can be done at home. Three main things influence good outcomes in babies with torticollis, and these are how severe the torticollis is, how old your baby is when you start treatment and how well you follow through on your home exercise program.

A baby with torticollis might:

  • tilt their head in one direction (this can be difficult to notice in very young infants)
  • may have a strange head shape and asymmetrical facial features
  • prefer looking at you over one shoulder instead of turning to follow you with their eyes
  • if breastfed, have difficulty breastfeeding on one side (or prefers one breast only)
  • work hard to turn toward you and get fussy when unable turn his or her head completely

Some babies with torticollis develop a flat head on one or both sides from lying in one position, or they might develop a small neck lump which is similar to a "knot" in a tense muscle. Both of these conditions tend to go away as the condition improves.

How can physio help my baby’s infantile torticollis?

After confirming the diagnosis your physio will recommend an appropriate management plan that mainly focuses on 4 aspects - stretching, strengthening, positioning and motor control. Your physio will:

  • teach you how to encourage baby to turn their head in both directions, to help loosen tense neck muscles and tighten the loose ones - rest assured that babies cannot hurt themselves by turning their heads on their own
  • explain and demonstrate to you some exercises you can do for your baby’s condition and how to safely progress them
  • show you how to position your baby when he or she is feeding and the ideal positioning when putting your baby down to sleep
  • recommend you do the stretches and positions every day for the best results.
  • encourage you to get your baby to look to the affected side and tilt their head to the opposite side as much as possible

Most babies with torticollis get better on their own through position changes and stretching exercises. It might take up to 6 months to completely improve and in some cases can take a year or longer.

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