Orthopaedic Blog

CUBITAL TUNNEL SYNDROME

Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated.

Anatomy
The ulnar nerve is one of the three main nerves in the arm. It travels from the neck down into the hand.

At the elbow the ulnar nerve travels through a tunnel of tissue (the cubital tunnel) that runs under the inside of the elbow, the medial epicondyle.

The spot where the nerve runs under the medial condyle is commonly referred to as the “funny bone”.

At the funny bone the nerve is close to the skin and bumping it causes a shock like feeling.

Beyond the elbow the ulnar nerve travels under muscles on the inside of the forearm and into the hand on the side of the palm with the little finger.

As the nerve enters the hand it travels through another tunnel (Guyon’s Canal).

The ulnar nerve gives feeling to the little finger and half of the ring finger.

It also controls most of the of the little muscles in the hand that help with fine movements and some of the bigger muscles in the forearm that help make a strong grip.

Common Places for Compression

The ulnar nerve can be constricted in several places along the way such as beneath the clavicle or at the wrist.

The most common place for compression of the nerve is behind the inside part of the elbow.

Ulnar nerve compression at the elbow is called CUBITAL TUNNEL SYNDROME.

Cause
In many cases of CTS the exact cause is unknown.

The ulnar nerve is especially vulnerable to compression at the elbow because it must travel through a narrow tunnel with little soft tissue to protect it.

COMMON CAUSES OF COMPRESSION
There are several things that can cause pressure on the nerve at the elbow.
1. When the elbow is bent, the ulnar nerve must stretch around the bony ridge of the medial condyle. This stretching can irritate the nerve, keeping the elbow bent for long periods or repeatedly bending the elbow can cause painful symptoms.
2. In some people the nerve slides out from behind the medial condyle when the elbow is bent. Over time this sliding back and forth may irritate the nerve.
3. Leaning on the elbow for long periods of time can put pressure on the nerve.
4. Fluid buildup can cause swelling that may compress the nerve.
5. A direct blow to the inside of the elbow can cause pain, an electric shock sensation and numbness in little and ring finger. This is commonly called “hitting your funny bone.”

Risk Factors
Some factors put you more at risk for developing CTS include:
• Prior fracture or dislocation of the elbow
• Bone spurs/arthritis of the elbow
• Swelling of the elbow joint
• Cysts near the elbow joint
• Repetitive or prolonged activities that require the elbow to be bent or flexed.

Symptoms

Sleeping with the elbow bent can aggravate symptoms of ulnar nerve compression and cause a person to wake at night with a sensation that their fingers are asleep.

CTS can cause an aching pain on the inside of the elbow, most of the symptoms, however, occur in the hand.
1. Numbness and tingling in the ring finger and little finger are common symptoms of ulnar nerve entrapment, often these symptoms come and go. They more often happen when the elbow is bent, such as when driving or holding the phone.
2. Some people wake up at night because they feel numbness in the fingers.
3. The feeling of the ring and little finger ‘falling asleep’, especially when the elbow is bent.
4. In some cases it may be harder to move the fingers in and out or to manipulate objects.
5. Weakening of the grip and difficulty with finger co-ordination (such as typing or playing an instrument) may occur. These symptoms are usually seen in more severe cases of nerve compression.
6. If the nerve compression is very severe or has been compressed for a long time, muscle wasting in the hand can occur.

Medical History and Examination
Past Medical History – any fractures, arthritis, spurs in the elbow?
Enquire about work activities and medications.

Examination of the arm and hand to determine which nerve is compressed and where the compression is.

Findings on Physical examination may include:
• Tinel’s sign – A shock sensation of the little and ring finger when tapping over the nerve at the funny bone.
• The ulnar nerve may slide out of normal position when the elbow is bent
• Movement of the elbow may cause symptoms
• In severe cases, feeling and strength in the hand and fingers are affected

Investigation
• X-Rays – Most causes of compression of the ulnar nerve cannot be seen on an x-ray. However, X-Rays of the elbow may show bone spurs, arthritis or other reasons of nerve compression.
• Nerve conduction studies – Help to determine how well the nerve is functioning and help to identify where it is being compressed. Several places along the nerve will be tested and the area where there is delayed conduction is likely to be the place where the nerve is compressed. Nerve conduction studies can also determine whether the compression is also causing muscle damage. Muscle damage is a sign of more severe nerve compression.

Management
In most cases symptoms can be managed with non-surgical treatments like changes in activities and bracing. If non-surgical methods do not improve symptoms or if the compression is causing muscle weakness or damage in the hand, surgery may be necessary

Non-Surgical Management
If symptoms interfere with normal activities or last more than few weeks see a doctor.

There are a few things patient can do at home to relieve symptoms.

• Avoid activities that require you to keep the arm bent for long periods of time.
• If you use a computer, make sure your chair is not too low. Do not rest the elbow on the arm rest.
• Avoid leaning on your elbow or putting pressure on the inside of the arm e.g., do not drive with the arm resting on the open window
• Keep the elbow straight at night when sleeping. This can be done by wrapping a towel around the elbow or wearing an elbow pad backwards.

Non-surgical treatment
• NSAIDS can reduce the swelling around the nerve
• STEROIDS such as cortisone are also effective as anti-inflammatories. Steroid injections are generally not used because there is a risk of damage to the nerve.
• BRACING OR SPLINTING padded brace or splint to wear at night to keep the elbow in a straight position
• NERVE SLIDING EXERCISES may improve symptoms, also prevents stiffness in the arm and wrist

Surgical Treatment
Is indicated if:
1. Non-Surgical methods have not improved the condition.
2. The ulnar nerve is very compressed.
3. Nerve compression has caused muscle weakness or damage.

SURGICAL PROCEDURES
There are different options, often done on an OPD basis.
1. CUBITAL TUNNEL RELEASE in this operation the ligament roof of the cubital tunnel is cut and divided. This increases the size of the cubital tunnel and decreases the pressure on the nerve. After the procedure the ligament begins to heal, and new tissue grows across the division. The new growth heals the ligament and allows more space for the ulnar nerve to slide through. The Cubital tunnel release tends to work best when the nerve compression is mild to moderate, and the nerve does not slide out of the bony ridge of the medial epicondyle when the elbow is bent.
2. ULNAR NERVE ANTERIOR TRANSPOSITION in many cases the nerve is moved from its place behind the medial epicondyle to a new place in front of it. This prevents it from getting caught on the bony ridge and stretching when the elbow is bent. The nerve can be moved to lie under the skin and fat but on top of the muscle (subcutaneous transposition) or within the muscle (intermuscular transposition) or under the muscle (submuscular transposition)
3. MEDIAL EPICONDYLECTOMY another option to release the nerve is to remove part of the medial epicondyle. Like ulnar nerve transposition this technique also prevents the nerve from getting caught on the bony ridge and stretching when the elbow is bent.

SURGICAL RECOVERY
Depending on the type of surgery a splint may be needed after the operation. A submuscular transposition usually requires a longer time (3-6 weeks) in a splint.
Physiotherapy to help regional strength and movement.

SURGICAL OUTCOME
The results of surgery are generally good. Each method of surgery has a similar success rate for routine cases of nerve compression. If the nerve is very badly compressed or there is muscle wasting, the nerve may not be able to return to normal and some symptoms may remain even after surgery. Nerves recover slowly and some may take a long time to know how well the nerve will do after surgery.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is caused by pressure on the median nerve as it travels through the carpal tunnel.

Symptoms of Carpal Tunnel Syndrome

Symptoms of carpal tunnel syndrome may include:

Numbness, tingling, burning, and pain in the thumb and index, middle, and ring fingers.
Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers.
Pain or tingling that may travel up the forearm toward the shoulder.

If left unattended, it can result in damage to the median nerve and thus cause symptoms such as

Weakness and clumsiness in the hand, resulting in difficulty performing fine motor movements.
Dropping thing, resulting from weakness, numbness, or a loss of proprioception

Symptoms of carpal tunnel syndrome generally begin gradually and gets progressively worse over time. With patients experiencing symptoms that come and go at first. However, as the condition worsens, symptoms may occur more frequently or be continuous.

Night-time symptoms being very common, due to people bending their wrists during sleep, awakening the patient. During the day, repetitive movements or movements requiring the wrist to bend will aggravate the symptoms. Examples include using a mouse, driving, reading a book.

Many patients find that moving or shaking their hands helps relieve their symptoms.

Anatomy

Watch the animated video.

Carpal Tunnel Syndrome Animation

What are the causes of carpal tunnel syndrome?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve.

Contributing factors include

Repetitive hand movement, repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve. Mechanical problems in the wrist joint, repeated use of vibrating hand tools
Trauma to the wrist that caused swelling, such as sprain or fracture.
Hormonal imbalance – an overactive pituitary gland or an underactive thyroid gland, fluid retention during pregnancy or menopause
Rheumatoid arthritis
Heredity, there may be anatomic differences resulting in a narrowed carpal tunnel.
Development of a cyst or tumour in the canal.

Physical Exam

Pressing down along the median nerve on the inside of the wrist will cause numbness or tingling in the fingers (Tinel sign)
Wrist-flexion (Phalen test), press the back of the hands together while the wrists are bent, pointing the fingers down. Carpal tunnel syndrome is suspected if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.
Test sensitivity in the fingertips and hands by lightly touching them with cotton wool with the patient’s eyes closed.
Check for weakness in the muscles around the base of the thumb
Look for atrophy in the muscles around the base of the thumb. In severe cases, these muscles may become visibly smaller.

Diagnostic tests

Nerve Conduction studies, this will help determine how well your median nerve is working and whether there is too much pressure on the nerve. This test will also help to exclude other nerve condition, such as neuropathy, or other sites of nerve compression.

Ultrasound, an ultrasound of the patient’s wrist may be helpful to evaluate the median nerve for signs of compression.
X-rays, X-rays may be ordered to exclude other conditions, such as arthritis, ligament injury, or a fracture.

Carpal Tunnel Syndrome Treatment

Non-surgical treatments

Splinting, usually a splint worn at night.
Avoiding daytime activities that may provoke symptoms, take frequent breaks from aggravating tasks.
Anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, these provide temporary relief.
Corticosteroids, such as prednisone or the lidocaine can be injected directly into the wrist to relieve pressure on the median nerve.

Surgery

Carpal tunnel release which involves severing a ligament around the wrist to reduce pressure on the median nerve. Many people require surgery on both hands. Almost always there is a decrease in grip strength, which improves over time. Recurrence of carpal tunnel syndrome following treatment is rare. Most patients say that their hands feel normal post-surgery.

Experiencing Hip and Knee Pain?

Most people at some point in their life will experience hip or knee pain. These large joints have an extremely demanding task. They carry the full weight of the body while also allowing for a wide range of motions.

This puts them at risk for wear and tear.

Some common causes of chronic hip and knee pain are osteoarthritis, bursitis, ligament tears, and fractures.

5 Symptoms You Shouldn’t Ignore in your Hips or Knees

When it comes to your hips and knees, the below are 5 symptoms you shouldn’t ignore. If you delay seeing an orthopaedic surgeon, your condition could worsen.

You should make an appointment if you have any of the following:

Not being able to maintain your normal active lifestyle. If you find yourself unable to do the normal activities you enjoy, such as certain sports, cycling, or walking, you should see an orthopaedic surgeon.

Difficulty doing simple tasks. Some patients will experience difficulty putting on shoes and socks or doing other simple activities, such as bending down.

Pain that worsens at night and interferes with your sleep. Inflammation can trigger higher levels of pain.

This could also be a sign that the cartilage in the joint is breaking down. The cartilage may wear out completely if it is left untreated.

Catching, popping, or locking.These are signs that the cartilage in the joint has torn or that bits of cartilage have broken off in the joint space. The cartilage may wear away completely if it is left untreated.

Often people delay seeing an orthopaedic surgeon, because they fear that they will require surgery. This generally isn’t the case as conservative measures are often enough.

Generally, the earlier you see an orthopaedic surgeon, the better your outcome. Conservative measures generally involve medication, physiotherapy and rehabilitation. If you require surgery, it is discussed with you, and you are in full control of your treatment plan.

Do You Have Pain in your Knees?

There are several causes for pain in your knees. It can be caused by a sudden incident such as a fall or twisting of the knee. It can also be caused by overuse, or an underlying diagnosis like osteoarthritis. Some common pathologies are wear of the cartilage, torn ligaments or muscle imbalances.

Your treatment will depend on the cause and the resultant pathology.

Do You Have Hip Pain?

There are many causes of hip pain. The hip is a large ball and socket joint, surrounded by muscle, ligaments and cartilaginous structures. The surfaces of the joints are lined with cartilage to allow smooth movement. Issues in the joint or the ligaments that hold the joint together can cause pain in the hip. Usually, pain or pathology from the hip joint are felt in the groin region, thigh or buttocks. Some common causes of hip pain include:

Arthritis – breakdown of the cartilage that cushions the joint.
Bursitis – inflammation of fluid sacs between tissues such as bone, muscles and tendons
Tendinitis – inflammation or irritation of tendons that attach muscle to bone.
Muscle or tendon strains due to overuse
Hip fractures due to weakened and brittle bones, weakened bones are more likely to fracture.

What Can You Do for Pain in Hips and Knees?

The first recommendation is to see an orthopaedic surgeon so that they can assess you, make a diagnosis and recommend appropriate treatment. If you do high impact exercises, consider changing to low-impact exercise, like a stationary bike, rowing machine, stepping machine, yoga or swimming.

Sometimes all you will need is an orthotic insert in your shoe to help distribute weight away from your arthritic joint. Other non-surgical solutions include oral anti-inflammatories medications. Braces can also be helpful, however long-term use can cause muscle wasting. Pain can also be controlled through corticosteroid injections that will decrease the inflammation in that joint. Physiotherapy can strengthen muscles, and as a result improve the range of motion of the joint.

If conservative measures don’t work, surgery may be the best option. In severe osteoarthritis, hip or knee replacement surgery can be considered.

Dr. van der Berg provides a wide range of surgical procedures for the treatment of hip and knee conditions. These include the Arthroscopic surgery, ligament reconstructions and joint replacements.

If you are interested in scheduling an appointment, contact our practice for further information.

Steroid Injections

Doctor recommended a steroid Injection?

Here is why:

Steroid injections can help reduce inflammation and pain in the affected joint.
They are effective treatment option for conditions such as osteoarthritis, rheumatoid arthritis, and bursitis.
The medication is delivered directly into the affected joint, which thus produces targeted relief.
Steroid injections can also help improve joint function and mobility.
They may be used as stand alone treatment or in combination with other therapies.

Will I experience pain Post Steroid Injection?

Steroids are used to reduce inflammation and pain, however, they can also cause temporary inflammation at the injection site. This can cause pain and discomfort for a few days after the injection.

These symptoms are temporary and will improve over time.

What can I do, to help with the pain?

You can place ice packs on the injection site to reduce inflammation. You can also take pain medication.

However, if the pain persists or worsens, or if you develop other symptoms such as fever or increased redness or swelling at the injection site, it’s important to contact your doctor.

Plantar Fasciitis

What Is Plantar Fasciitis?
A tough band of tissue (the plantar fascia) runs along the sole of your foot, connecting your heel bone to your toes. When it becomes irritated or inflamed, you get plantar fasciitis—one of the most common causes of heel pain.

Causes
Overstretching or small tears in the plantar fascia lead to inflammation and pain. Common triggers:

Sudden increases in activity (e.g. starting a running programme)
Unsupportive footwear (flat shoes, worn-out trainers)
Hard or uneven walking surfaces
Being overweight, which adds extra strain
Foot shape quirks (very high arches or flat feet)

Risk Factors
Certain things make plantar fasciitis more likely:

Age: Most common between 40–60 years old
Exercise type: Long-distance running, ballet or aerobic dance
Foot mechanics: Flat feet, high arches or unusual walking patterns
Obesity: Extra pounds stress the fascia
Occupations: Jobs with long hours standing or walking on hard floors (e.g. teachers, factory workers)

Recognising the Symptoms

Stabbing heel pain, especially on the underside
“First-step pain”: worst on getting out of bed or after sitting
Pain often eases as you move, but returns after long activity
Going barefoot or in flat shoes can make it feel sharper

Diagnosis, Heel Spurs, & Complications

Your doctor rules out other causes (stress fractures, nerve irritations).
Heel spurs (small calcium deposits) often show up on X-rays at the fascia’s heel attachment—but they usually aren’t the pain culprit. Spurs simply signal long-term tension on the fascia, and you don’t need to remove them unless you’re having surgery anyway.
If you ignore it, chronic heel pain can alter the way you walk. That changed gait may then lead to problems in your feet, knees, hips or back.

Treatment Options

Rest and activity changes: Avoid or reduce activities that aggravate your heel (e.g. running, jumping). Give your feet breaks and cut back on standing or high-impact exercise for a few days or weeks. In the meantime, try low-impact exercise like swimming or cycling to stay active without stressing the heel.
Ice and cold therapy: Apply ice to the heel for 10–15 minutes, 2–3 times a day. For example, roll your bare foot over a frozen water bottle or wrapped ice pack. Cold reduces inflammation and numbs pain. Always protect your skin with a thin cloth.
Footwear changes: Wear supportive, well-cushioned shoes at all times. Athletic shoes with arch support help distribute pressure evenly. Avoid flat sandals, flip-flops, or walking barefoot on hard floors. Replace worn-out shoes regularly.
Over-the-counter pain relief: Non-prescription NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen or naproxen can ease pain and swelling. Use them for short periods (a few days) and follow dosing instructions. If you cannot take these, plain pain relievers (like acetaminophen) may help with discomfort.
Weight management: Extra body weight puts more stress on your feet. Losing weight (if needed) or avoiding weight gain can reduce heel strain. Obesity is a known risk factor for plantar fasciitis, so even modest weight loss can help recovery and prevent recurrence.

Supportive Devices

In addition to exercises, certain devices can offload stress from the foot:

Shoe inserts (arch supports/orthotics): These are inserts placed inside your shoes to provide extra arch support and cushioning. Over-the-counter arch supports can help most people. In stubborn cases, a doctor or podiatrist might prescribe custom molded orthotics. By lifting and cushioning the heel/arch, orthotics reduce strain on the plantar fascia.
Heel cups or pads: Soft gel or foam pads placed under the heel (inside the shoe) can cushion the heel bone. They slightly elevate and soften heel contact, which may ease pain when walking or standing.
Night splints: A brace that holds your ankle at a right angle overnight keeps the plantar fascia gently stretched while you sleep. This can reduce the common morning pain. Night splints can be uncomfortable at first, but many people find that after a few nights they wear off and get relief.
Walking boot or brace: In severe cases, a removable walking boot (similar to a cast) can immobilize the foot for a short time. This is usually only for a few weeks when pain is very intense. Crutches or a cane may be used briefly if needed.
Athletic tape or kinesiology tape: Taping the arch and heel with special medical tape can give temporary support during the day. A therapist can show you a taping technique to lift the arch and reduce stress on the fascia.

Medical Treatments

Non-Surgical Options

If home care isn’t enough after several weeks, doctors offer various non-surgical treatments:

Corticosteroid injections: An injection of steroid medicine (such as cortisone) into the heel can sharply reduce pain by damping inflammation. Relief may last weeks to months, but effects often fade. These injections are used sparingly because repeated shots can weaken or even rupture the plantar fascia. Some guidelines note that steroid shots give only short-term benefit.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Doctors may recommend taking NSAIDs (ibuprofen, naproxen, aspirin) for short periods to manage pain and swelling. These are the same pills used for arthritis or headaches. Use them as directed and avoid long-term use without medical advice.
Platelet-Rich Plasma (PRP) therapy: PRP involves drawing a bit of the patient’s blood, concentrating its growth factors, and injecting it into the painful area. The idea is to stimulate healing. PRP is still considered experimental: it can be expensive and research shows mixed results. Some people have relief, but it’s not guaranteed.
Shock Wave Therapy (ESWT/EPAT): This procedure uses focused sound waves to stimulate healing in the fascia. It is done by a specialist in an office. Some studies and reviews report that about 60% of patients get pain relief. Mayo Clinic notes it is usually tried only when other treatments have failed. Results can be inconsistent: some people benefit, others do not.
Ultrasound (Ultrasonic) therapy: Not the diagnostic ultrasound, but a treatment where a probe delivers high-frequency sound waves to the tissue. A newer technique uses ultrasound guidance to insert a tiny probe into the fascia and break up scar tissue. This is a minor surgical procedure (often in-office) and not widely available.
Other injections: Some providers try injecting other substances (like platelet-rich or stem-cell concentrates, or dry needle injections of botulinum toxin) to ease pain. These are less common and still being studied. Generally, any injection carries a risk of pain or infection.

In all non-surgical treatments, doctors emphasise continued stretching and exercises. No injection or therapy is a quick fix without also keeping up home rehab and using good shoes.

Surgical Options

Surgery is a last resort. Fewer than 10% of patients need surgery, usually only after 6–12 months of severe, unrelenting pain that did not improve with the above treatments. Types of surgery include:

Gastrocnemius recession: Tight calf muscles can pull on the plantar fascia. In this procedure, one of the calf muscles (gastrocnemius) is lengthened to relieve tension on the foot. It is done through a small incision and usually done if calf tightness is part of the problem.
Partial plantar fascia release: The surgeon makes one or more cuts (releases) in the plantar fascia to relieve pressure. Often this is a “partial” release (only cutting about 50% of the width) to reduce tension but leave some ligament intact. The surgeon may remove a bone spur at the same time if one is present.
Endoscopic vs open surgery: Both the above can be done as open surgery (larger incision) or endoscopically (small incisions with a camera). Endoscopic surgery may have a faster recovery, but it can carry a slightly higher risk of nerve irritation.

Risks and recovery: As with any surgery, there are risks. The most common complications are injury to nearby nerves (causing numbness or tingling) and incomplete relief of pain. Cutting the fascia also slightly weakens the arch, so some people may notice arch flattening. Recovery usually involves wearing a protective boot or cast for 1–2 weeks and using crutches until you can bear weight. Full recovery can take several weeks to months. Because surgery is not guaranteed to fix the pain and can introduce new issues, surgeons only recommend it when every nonsurgical avenue has been exhausted.

Alternative Therapies

Some people explore complementary treatments as add-ons. These should not replace standard care, but may provide extra relief:

Laser therapy (LightForce® XLi and similar high-intensity lasers): Laser therapy uses focused light to reduce inflammation and promote healing. The LightForce® XLi is an example of a class IV therapy laser, which delivers higher power than low-level lasers. These high-powered lasers penetrate deep into tissue, targeting inflamed areas like the plantar fascia to reduce pain, improve circulation, and stimulate cell repair. Treatments are typically brief (about 5–10 minutes), and painless. A course of multiple sessions may be recommended. Patients often report gradual relief over time, although results can vary. Laser therapy is non-invasive.
Massage and manual therapies: Professional deep-tissue massage of the calf and foot can loosen tight muscles and fascia. Techniques like myofascial release or Graston/IASTM are used by some therapists. These may be worth trying if they fit your comfort and cost constraints.
Topical treatments and taping: Some people find relief using over-the-counter pain-relief creams or gels, particularly those with menthol or anti-inflammatory ingredients. Supportive taping (like kinesiology tape) can also help reduce strain on the fascia during the day.

Because alternative therapies have varying levels of evidence, it’s important to discuss them with your healthcare provider to ensure they safely complement your treatment plan.

Prevention Tips

Preventing plantar fasciitis is easier than curing it. Once you recover, these habits can help avoid future flare-ups:

Wear good shoes: Always use well-cushioned, supportive footwear, especially for exercise. Avoid high heels, flip-flops, or thin-soled casual shoes that offer no arch support. Rotate between a few pairs of athletic shoes and replace them every 6–9 months (or sooner if the soles are worn).
Stretch regularly: Do calf and foot stretches daily, particularly before and after exercise. Keeping muscles flexible reduces strain. Even on rest days, a quick morning stretch and evening calf stretch can help.
Maintain a healthy weight: Extra pounds increase heel stress. If you are overweight, losing even 5–10% of body weight can significantly decrease foot load.
Gradual training: When increasing exercise or standing time, do it gradually. For example, add only 10% per week to your running mileage. Avoid sudden spikes in activity level. If your job involves long standing, try to take breaks and sit down when possible.
Cross-train: Mix in low-impact activities (swimming, cycling, elliptical) with running or sports. This reduces repetitive stress on the heels.
Foot care: Avoid walking barefoot on hard floors at home. Consider using flat supportive slippers or house shoes. Over time, walking barefoot can contribute to strain.
Proper warm-up: Always warm up and do gentle stretches before vigorous exercise or sports. Cold muscles are more prone to strain.

By combining these prevention tips with proper treatment, most people manage plantar fasciitis effectively. Nearly all cases resolve with consistent care within 6–12 months. Patience and adherence to the plan are key. If pain persists or worsens despite all measures, seek professional medical advice for advanced therapies or evaluation.

Supportive Shoes for Plantar Fasciitis in South Africa

Supportive footwear for plantar fasciitis typically features good arch support, cushioned heels, and stable midsoles. Below is a list of recommended options available in South Africa:

Men's Shoes

Low-Cost

AEROSOFT Orthotic Flip-Flops (Thong Sandals)
Price: R399
Type: Casual sandal
Features: Orthotic footbed, arch contour, cushioned heel
View

Adidas Runfalcon 5 (Unisex)
Price: R1,099
Type: Running Shoe
Features: Cushioned midsole, supportive fit, removable insole for custom orthotics
View

Under Armour Charged Assert 10
Price: R899–R1,199
Type: Running Shoe
Features: Molded midsole with EVA cushioning, durable leather overlays, stable heel cup
View

Mid-Range

Merrell Hydro Next Gen Moc 1TRL
Price: ~R1,999
Type: Casual/Water Shoe
Features: FloatMax™ foam, contoured heel, quick-dry design
View

Brooks Ghost 15 (Road Running Shoe)
Price: R1,899 (sale)
Type: Running shoe
Features: DNA LOFT v2 midsole, crash pad, neutral support
View

Brooks Adrenaline GTS 23
Price: R1,899 (sale)
Type: Stability running shoe
Features: GuideRails support, DNA LOFT cushioning, orthotic-friendly
View

Premium

HOKA Clifton 9 (Running Shoe)
Price: R3,250 (R2,800 on sale)
Type: Road running
Features: High cushion EVA, rocker geometry, orthotic-friendly
View

HOKA Bondi 9 (Running Shoe)
Price: R3,900
Type: Max-cushion trainer
Features: EVA midsole, removable insole, heel support
View

Brooks Adrenaline GTS 24
Price: R3,299
Type: Stability trainer
Features: GuideRails, DNA LOFT v2, arch support
View

Women's Shoes

Low-Cost

AEROSOFT Orthotic Flip-Flops
Price: R399
Type: Casual thong sandal
Features: Arch contour, soft footbed, orthotic-friendly
View

Adidas Runfalcon 5 (Unisex)
Price: R1,099
Type: Running Shoe
Features: Cushioned midsole, supportive fit, removable insole for custom orthotics
View

Under Armour Charged Assert 10
Price: R899–R1,199
Type: Running Shoe
Features: Molded midsole with EVA cushioning, durable leather overlays, stable heel cup
View

Mid-Range

Merrell Hydro Next Gen Moc

Price: ~R1,999
Type: Casual water-friendly
Features: FloatMax™ foam, deep heel cup, contoured design
View

Brooks Ghost 16 (Road Running Shoe)
Price: R2,049 (sale)
Type: Road running
Features: DNA LOFT v3 midsole, arch support, heel cushioning
View

Altra Torin 7
Price: R2,999
Type: Cushioned neutral trainer
Features: EGO™ MAX foam midsole, foot-shaped toe box, zero drop for even pressure distribution
View

Premium

HOKA Bondi 9 (Running Shoe)
Price: R3,900
Type: Max-cushion runner
Features: EVA midsole, wide stable base, orthotic-friendly
View

Brooks Adrenaline GTS 24

Price: R3,299
Type: Stability shoe
Features: GuideRails tech, arch contour, heel cradle
View

HOKA Clifton 9 (Running Shoe)
Price: R3,250 (R2,800 on sale)
Type: Lightweight trainer
Features: EVA foam, neutral support, orthotic compatible
View

Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA), previously called “degenerative joint disease,” affects the entire joint—not just cartilage, but also bone, synovium (joint lining), ligaments, and muscles around the joint. It develops when joint tissues fail to repair after stress, leading to pain, stiffness, swelling, and reduced movement.

Types of Osteoarthritis

Primary OA

Age-related wear-and-tear with no specific cause.
Often affects weight-bearing joints such as knees, hips, spine, and hands

Subtypes of primary OA include:

Generalised/Nodal – multiple joints with bony enlargements (common in fingers).
Erosive OA – a rarer, more inflammatory variant affecting finger joints

Secondary OA

Resulting from a specific trigger:

Joint injury or fracture
Congenital joint issues (e.g., hip dysplasia)
Metabolic disorders (e.g., hemochromatosis)
Inflammatory conditions or infections
Post-traumatic OA (following injuries) is a major form of secondary OA.

How OA Affects the Body

Cartilage becomes frayed, causing bone-to-bone contact.
Bone reacts by forming osteophytes (spurs) and thickening.
Inflammation occurs via cytokines in the synovium
Pain is typically mechanical: worse with activity, relieved by rest, and morning stiffness usually under 30 minutes

Grading Osteoarthritis

Radiographic grading systems are used to assess disease severity. These are particularly useful for surgeons.

Kellgren–Lawrence (KL) Grading – Knees & Hips

Grade 0: No signs of OA.
Grade 1: Doubtful narrowing; possible small osteophytes.
Grade 2: Definite osteophytes; possible/visible joint space narrowing.
Grade 3: Moderate osteophytes, definite joint space narrowing, sclerosis (bone hardening), mild bone deformity.
Grade 4: Large osteophytes, severe narrowing, sclerosis, marked deformity

Hip – Tönnis Classification

Grade 0: No OA.
Grade 1 (Mild): Minor sclerosis and slight joint space loss.
Grade 2 (Moderate): Cysts, moderate space loss, mild deformity.
Grade 3 (Severe): Cysts, severe space loss or obliteration, deformity .

Other Joint Systems

Knee: IKDC (A–D) and Ahlbäck (I–V) systems assess joint space and deformity
Shoulder: Samilson–Prieto grading based on bone spurs size and sclerosis

Knee Bracing in Osteoarthritis: A Short-Term Fix, Not a Long-Term Solution

Wearing a knee guard (brace or support) for Grade 2 knee osteoarthritis can sometimes help, especially during flare-ups or physical activity — but long-term or unnecessary use can be problematic. Here’s why:

Muscle Weakness

Braces reduce the load on muscles (especially quadriceps and hamstrings).
Over time, this can lead to muscle atrophy, which worsens joint instability and pain.
Strong muscles are critical to offloading the knee joint — particularly the quads.

Joint Stiffness