Physiotherapists in Rugby treat many different conditions including the issues profiled below.

Hammer toes

Hammer toes are a common deformity of the foot and often associated with more profound changes in the foot such as pes cavus where the inside foot arch is exaggerated. The small intrinsic foot muscles, which allow the toes to be kept straight as they grip the ground, weaken and the extensor muscles then pull the near part of the toe upwards. This makes the near joints of the toes bend up leading to a clawing of the toes. The extensor tendons can then shorten, leading to a permanent deformity where the person cannot get the toes flat down onto the ground any more.

There are a series of consequences from this deformity. The toes curl up and thereby take up much more room at the end of the shoe, causing the tops of the joints to suffer pressure against the shoe and develop sore areas or calluses. A more spacious toe box in the shoes can relieve this. The metatarsal heads suffer increased pressure from weight bearing and also develop calluses under the ball of the foot where the loading is greatest. In time these changes can lead to foot pain and require stretches or surgical correction.

Intervertebral Discs and Ageing

Ageing starts early in the discs and proceeds through life. Initially a loss of proteoglycan occurs, and as these chemicals attract and hold water into the centre of the discs, a degree of loss of hydration steadily occurs. The collagenous tissues lose some of their suppleness and resistance, becoming more brittle and more likely to suffer injury. As the discs have no central blood supply and rely on nutrition and oxygen diffusing in, a limitation of this process will accelerate the degenerative process going on in the disc centres. The tops and bottoms of the vertebrae, the endplates, are cartilage but can become calcified, further reducing supplies to the nucleus inside.

The outer part of the disc, the annulus, has layers of collagen material and these thicken and can develop defects. Overall the central disc material becomes drier, fibrosed and stiffer with a smaller volume as it loses water, throwing compressive forces onto the back of the disc annulus. The annulus becomes both stiffer and weaker with age, the increased stiffness perhaps offset by the increase in defects in the disc wall with time. Studies of discs have shown that they do not generally decrease in height with age.