Page 16 - Bauerfeind life magazine

magazine 2013/1
The foot is receiving a lot of attention at the
moment. Why is this?
Prof. Valderrabano:
There is certainly a
noticeable increase in the level of medi­
cal interest in the foot, but this has less
to do with us, the physicians, than with
patient behavior. Sports that involve put­
ting strain on the feet – and there’s more
than just a few of these – are very popular.
Untrained participants in sport very often
over­estimate their abilities. They want to
emulate Roger Federer on the tennis court,
even though they have the physical fitness
and neuromuscular skills of an office worker.
As a result, accidents happen. Furthermore,
people who are immobile and often over­
weight have to be taken into account. Every
excess kilo these people carry multiplies the
continuous load on the foot. Those are the
main factors...
and are these superseding knee problems
in medical practice?
Prof. Valderrabano:
Certainly not. However,
it is true that particular successes regard­
ing treatment for the knee, such as early
functional therapy, have contributed toward
a certain decline in the occurrence of knee
problems. Special preventive measures may
also play a role in this.
Can these successes be carried over to foot
Prof. Valderrabano:
The construction of the
foot is unique, and its structures consist of
extremely small components. If you make
even the slightest change to one compo­
nent, this can have an impact on the inter­
play of the entire structure. For example,
sprained ligaments in the hip or knee have
a less serious effect on the stability of the
joint in question than a sprained ligament
in the ankle. Here, even an elongation of
up to two millimeters is enough to cause
instability. An extra two millimeters quickly
increases the load on the ankle joint by 40
percent with every step, because the talus is
constantly subluxated. You can just imagine
what effect an extra three, four or five milli­
meters would have.
You and your Basel-based team see more than
feet every year. Is instability a major
Prof. Valderrabano:
Not exclusively in rela­
tion to feet. In the ankle, however, instabil­
ity following supination trauma, such as a
fibular ligament rupture – the most com­
mon sports injury of all – can very quickly
become chronic. This is particularly the case
when the instability is not diagnosed or is
treated incorrectly – with disastrous con­
sequences. Achilles tendon diseases are one
consequence, and osteoarthritis is poten­
tially another (
Valderrabano et al., see ref.
Are Achilles tendon problems directly con-
nected with foot or ankle injuries?
Prof. Valderrabano:
Yes, in fact there are
numerous cases in which both the ankle and
the Achilles tendon present or become a
major problem. The reason for this is that, in
the case of chronic instability, the move­
ment axes are not optimally positioned,
which results in a misalignment. Instability
in the lateral upper ankle joint, for example,
often leads to a varus angulation of the
hindfoot. In turn, this misalignment causes
the optimal line of tensile force in the Achil­
les tendon to be thrown off balance – and
achillo­dynia occurs.
If you narrow down this pain to the Achilles
tendon – what is the most important factor
Prof. Valderrabano:
Most tendon problems
are already present, such as problems with
the Achilles tendon attachment or tendin­
opathies, but overloading aggravates the
symptoms. Tendinopathies can also be
caused by all kinds of intrinsic and extrinsic
factors: idiopathic misalignments of the
hindfoot, inappropriate footwear, inadequate
training methods, imbalances, a lack of mus­
cular flexibility, aging. Haglund’s deformity
or bursitis in the tendon attachment area are
also common causes of tendon problems.
How long can the Achilles tendon withstand
these problems?
Prof. Valderrabano:
The Achilles tendon can
suffer for a long time. And then suddenly
the tendon structure is so altered and the
tendon is so necrotic that just one careless
movement is enough to tear it! Ruptures
are rarely trauma-related, and they rarely
occur in clean, healthy Achilles tendons. If
this happens, it is usually in the context of
professional sport or an accident. In three
quarters of all cases, however, the Achilles
tendon ruptures in diseased conditions.
How can you restore the Achilles tendon to a
healthy state?
Prof. Valderrabano:
When it comes to
therapy, it is always important to consider
the whole picture. If achillodynia occurs in
Chronic instability also affects
the Achilles tendon”
Ankle injuries and achillodynia
Specialists in sports medicine are finding themselves increasingly faced with problems in­
volving one of the strongest tendons in the human body. Ankle injuries and misalignments
can make life difficult for the Achilles tendon in the long run, says Prof. Victor Valderrabano,
Chief Physician of the Orthopedic Clinic at Basel University Hospital. According to
Prof. Valderrabano, who is a foot and tendon specialist, a treatment package consisting
of physiotherapy and orthopedically effective orthoses and supports can provide the
key to dealing with pathologies concerning the hindfoot.
Picture: Stefan Durstewitz