Anatomy: The surfaces of the joints are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

Symptoms: Pain in the joint with movement under load. Occasionally swelling in the joint.

Examination: Normal clinical examination is often sufficient. However, it is also often necessary to perform an x-ray (or ultrasound scan or MRI examination) to make the diagnosis. Ultrasound scanning will often reveal inflammation surrounding new bone development at the joint surfaces.

Treatment: Treatment comprises relief from the painful activities until the swelling has gone down, after which training can commence with the primary aim to strengthen the muscles surrounding the joint and retain joint mobility. There is no treatment which can restore the damaged cartilage (and bone). Cartilage transplants are, as yet, not suitable for general degenerative arthritis. In cases of swelling in the joint, and with inflamed new bone development at the joint surfaces, inflammation of the synovial membrane can be attempted subdued by using rheumatic medicine (NSAID), or by draining the fluid and injecting corticosteroid. The injections can be performed to advantage by utilising an ultrasound guided method. Pain without swelling of the joints is best treated with paracetamol. In severe cases of degenerative arthritis where there is pain when resting (at night), it may be necessary to fix the joint by operation.

Rehabilitation: Rehabilitation is completely dependent upon the degree of the degenerative arthritis and in which joints it is located.
Also read rehabilitation, general.

Bandage: A supportive tape (Hollywood bandage) can be attempted to aid degenerative arthritis in small joints (toes) (tape-instruction). Tape provides no help to attacks in the ankle joint.

Complications: Degenerative arthritis which sits on the weight bearing parts of the joint is one of the most serious sports injuries, and often results in a termination of active sport. It is usually possible to continue sport activities with light strain on the joints (cycling, swimming), whereas it is advisable to participate in activities with great strains on the joint (running, ball games) with restraint. The diagnostic considerations in connection with degenerative arthritis include:

• Bone fracture
• Stress fracture
• Bone membrane tear (periosteal avulsion)
• Tendon luxation of the outer ankle knuckle (luxation of the peroneus tendon)
• Inflammation of the tendon sheath
• Concentration of fluid in the joint (traumatic arthritis/synovitis)
• Cartilage damage in the joint
• Metatarsus ligament rupture
• Inflammation of the bursa

Special: Shoes with shock absorbing inlays will reduce the discomfort of degenerative arthritis.

Anatomy: The flexing tendons of the big toe (musculus flexor hallucis longus & brevis) run under the sole of the foot and are attached to the bones of the big toe.

Symptoms: Pain in the metatarsophalangeal toe joint when walking. The pain is aggravated when the big toe is flexed backwards (extension). Often seen in girls in the 14-18 year age group.

Examination: Medical examination is not necessarily required in slight cases with minimal tenderness and no discomfort when walking. Examination is required in cases of more pronounced pain in order to confirm the diagnosis. The examination will show that the big toe can not be flexed upwards (extension), when the ankle joint is flexed 90 degrees, whilst the big toe can flex upwards when the ankle joint is stretched (flexion). In some instances it will be necessary to perform an x-ray or ultrasound scan, possibly supplemented with MRI examination (article).

Treatment: Treatment comprises relief with the aid of shoes with stiff soles (article). The treatment can be combined with rheumatic medicine (NSAID) (gel or crème). Furthermore, increased mobility of the joint is aimed at by active and passive movement of the big toe (hallux) within the pain threshold. Operations have been attempted, but have not yielded satisfactory results (article).  

Rehabilitation: Load or strain within the pain threshold is allowed. Shoes with stiff soles are recommended. The guidelines under rehabilitation, general should be followed. Passive and active movement of the big toe within the pain barrier.

Bandage: Taping which supports the metatarsophalangeal toe joint can be used to reduce the pain from sports activity and walking (tape-instruction). If this is not sufficient, special soles can be manufactured to support the big toe.

Complications: If there is not a steady improvement in the condition, medical assistance should be sought to determine whether the diagnosis is correct or whether complications have arisen:

• Bone fracture in the forefoot
• Stress fracture
• Hemorrhage in the muscles
• Ligament rupture in the metatarsus
• Inflammation of the bursa
• Bone membrane tear (periosteal avulsion)
• Fracture of the cartilage bone under the toe
• Degenerative arthritis
• Inflammation of the tendon sheath

Anatomy: Sesamoid bones are located in several places in the foot, embedded in tendons and ligaments. The sesamoid bones protect the tendons and ligaments against over load. There are almost always two sesamoid bones embedded in the flexing tendon of the big toe (musculus flexor hallucis brevis) under the metatarsophalangeal joint of the big toe.

Symptoms: Pain just below the metatarsophalangeal joint of the big toe which is aggravated when the big toe is flexed backwards. 

Acute treatment: Click here.

Examination: Clinical examination is usually necessary in order to make the diagnosis. The fracture can often be seen on x-rays, MRI examination (article), or ultrasound scanning.

Treatment: Treatment of a fracture of the sesamoid bone comprises relief, possibly in the form of shoes with a fixed sole.

Rehabilitation: Load or strain within the pain threshold is allowed. Shoes with stiff soles are recommended. The guidelines under rehabilitation, general should be followed.

Complications: It is unfortunately often seen that a fracture of the sesamoid bone does not heal, and frequently results in prolonged discomfort. If there is not steady improvement in the condition, consideration must though be given as to whether the diagnosis is correct or whether complications have arisen:

• Bone fracture
• Stress fracture
• Muscular bleeding
• Metatarsus ligament rupture
• Inflammation of the bursa
• Bone membrane tear (periosteal avulsion)
• Stiff toe syndrome
• Degenerative arthritis
• Inflammation of the tendon sheath

Surgical intervention can be attempted in cases with persistent discomfort, where one of the most used methods entails removal of one part of the fractured sesam bone (article).

Anatomy: The muscles often comprise a muscle belly and a muscular tendon, which are attached to a bone. The muscle belly is found on the back of the foot, between forefoot bones and under the sole.

Symptoms: Pain when pressure is applied, activating and stretching the damaged muscle. There is often a sense of the muscle being firm or filling out.

Examination: A medical examination is not required in slight cases. If satisfactory progress is not achieved a medical examination may be required in order to make the diagnosis. A normal medical examination is usually sufficient in order
to make the diagnosis, however, if there is any doubt concerning the
diagnosis an ultrasound scan can be performed.

Treatment: Bleeding on the muscles is treated with relief and rehabilitation. In instances where the bleeding is particularly excessive it may be necessary to perform draining.

Rehabilitation: Rehabilitation is totally dependent upon which muscle is injured. Running can normally be resumed as soon as the pain subsides. Until this is possible, the guidelines under rehabilitation, general should be followed.

Complications: If satisfactory progress is not achieved, an x-ray examination should be performed to exclude the possibility of:

• Bone fracture
• Stress (fatigue) fracture

Similarly, an ultrasound scan should be performed to exclude:

• Concentration of fluid in the joint (traumatic arthritis/synovitis)
• Metatarsus ligament rupture
• Bone membrane tear (periosteal avulsion) in the forefoot
• Degenerative arthritis
• Inflammation of the bursa
• Inflammation of the tendon sheath
• Infection
• Rupture of tendons

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx).

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Examination: X-ray examination will usually, but not always, reveal a stress fracture. The x-ray examination can be repeated after a few weeks as a number of stress fracture are not easily discernible in the early stages. Bone scintigraphy, ultrasound scanning and MRI examination can often diagnose a stress fracture much earlier than x-ray examination (Ultrasonic image), (Scintigraphy-image).

Treatment: Treatment is primarily relief and rest, and possible bandaging. Surgical intervention is only required in very special cases. It is imperative that shoes are equipped with impact absorbing soles (article).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical). Until the pain has subsided, the guidelines under rehabilitation, general should be followed.

Complications: If there is not a steady improvement in the condition a medical examination should be performed once more to ensure that the fracture is healing according to plan. In some cases, a false joint can develop which will require surgical treatment.

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx).

Symptoms: Pain when applying pressure (direct or indirect tenderness), and when applying load or strain.

Acute treatment: Click here.

Examination: X-ray examination will usually reveal the fracture. The fracture can in some cases first be seen after 14 days, thus the x-ray examination should be repeated if there is a continued suspicion of a fracture.

Treatment: Treatment is completely dependent upon which bones are broken, and whether there is a dislocation of the fracture. In some cases relief and rest without bandaging can be opted for, whereas other types of fracture require bandaging and possibly surgical intervention (article).

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (conservative or surgical). Also read rehabilitation, general

Complications: If there is not a steady improvement in the condition a medical examination should be performed once more to ensure that the fracture is healing according to plan. In some cases, a false joint can develop which will require (renewed) surgical treatment (X-ray picture), (X-ray picture).

Special: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.