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1. Lateral ligament injury (rolled ankle)

A lateral ligament injury usually refers to a tear of one or more of the ligaments on the outside (lateral aspect) of the ankle. The lateral ligaments consist of three bands which provide stability to the outside of the ankle joint. These ligaments as a group are referred to as the lateral ligament complex. The lateral ligaments are injured when they are overstretched (sprained). This commonly occurs when the foot and ankle are forcibly rolled inwards. This injury is often referred to as a ‘rolled ankle’. The ankle may be rolled during rapid changes in direction, on uneven surfaces, or treading on a ball or opponent’s foot.

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2. Plantar fasciitis

Plantar fasciitis is pain on the inside aspect of the heel. It is usually an overuse injury that causes inflammation of the plantar fascia at its attachment site on the heel bone. Plantar fasciitis occurs as a result of stretching or ‘pulling’ of the plantar fascia from its attachment on the heel bone. Activities such as running and dancing are commonly associated with the development of plantar fasciitis. This injury is called an overuse injury; it may happen over a long period of time before the patient decides to seek treatment.

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3. Gastrocnemius (calf) strain

The calf refers to the two muscles at the back of the lower leg that together form the Achilles tendon. The more superficial of these, gastrocnemius, provides the sudden explosive drive for the initial ‘take off in running. It is the more commonly injured of the two muscles, especially in people in their forties. A gastrocnemius strain refers to a tear in this large powerful muscle forming the bulk of the calf. A gastrocnemius strain typically occurs when the muscle is forcibly contracted whilst in a stretched position. This can occur when accelerating from a stationary position or when lunging forward, such as in tennis or squash. A gastrocnemius strain may also occur following stepping in a pot-hole whilst running. This may cause the heel to drop suddenly, overstretching the gastrocnemius muscle. Factors which may contribute to a strain of the gastrocnemius muscle include an inadequate warm- up, muscle stiffness or tightness, fatigue or overuse, an inadequate recovery period between training sessions, reduced muscle strength, and faulty biomechanics.

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4. Achilles tendinopathy

Achilles tendinopathy refers to degeneration within the large tendon which joins the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Achilles tendinopathy is a common injury in sports involving running and jumping, and results from overuse of the tendon. The function of the Achilles tendon is to transmit forces produced by the calf muscles to the heel bone. Repetitive use of the calf muscles and, therefore, the Achilles tendon can lead to microscopic tears within the substance of the tendon. To repair these microscopic tears, the body commences an inflammatory response. Although this response is initially part of the healing process, when the stresses are repeated, the inflammation is prolonged and so produces local tissue damage. Factors which may contribute to Achilles tendinopathy include a recent change in training (including frequency, duration, intensity, training surfaces), reduced rest times, biomechanical abnormalities, poor footwear, and decreased muscle flexibility and joint range of motion. These factors can lead to increased stress on the Achilles tendon, microtears and subsequent tendinopathy.

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5. Sever’s lesion

Sever’s lesion refers to an injury to the bone growth plate at the back of the heel bone (calcaneus) in young athletes. It is more a condition than a disease. The large calf muscles (gastrocnemius and soleus) attach to the heel via the Achilles tendon. The function of this tendon is to transmit forces produced by the calf muscles to the heel bone. In children, the portion of the heel bone into which the Achilles tendon inserts is separated from the bulk of the heel bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the calf muscles can injure the growth plate. This commonly occurs during a period of rapid growth where the muscles and tendons become tighter as the bones grow. This leads to increased pulling of the calf muscles and Achilles tendon on the heel bone and growth plate.

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