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Talking runners & foot injuries with Mr Francesc Malagelada

Mr Malagelada - Home Physio Group

Mr Francesc Malagelada is a fellowship trained orthopaedic surgeon specialising exclusively in the treatment of foot & ankle conditions.

He is a consultant at The Royal London Hospital, the largest Trauma Center in the UK, where he also contributes in advanced research, holding a PhD on minimally invasive surgery of the foot.

Clinical Director, Hily Perpinyal interviews Mr Francesc Malagelada.

Clinical Director, Hily Perpinyal talks to him about his career as a professional fighter and discusses his physical injuries, recoveries and all things related to overcoming major hip surgery.

He is a consultant at The Royal London Hospital, the largest Trauma Center in the UK, where he also contributes in advanced research, holding a PhD on minimally invasive surgery of the foot.

Clinical Director, Hily Perpinyal interviews Mr Francesc Malagelada.

Q.     What are the most common running injuries that you come across?

As a foot and ankle surgeon, the top of the list goes to ankle sprains. They are particularly common in runners and athletes. Ankle sprains have been listed as the most frequently diagnosed lower limb injury during sports practice in the UK. They are highly prevalent but they normally go on to heal well with the correct treatment. Ankle sprains however can be overlooked and in actual fact sometimes present with much more severe injuries when left untreated. In addition to sprains, tendinitis and stress fractures can also be quite common in runners.

Q.    What are the predisposing risk factors for running injuries?

A good level of training and lower limb conditioning is possibly the most important factor assuming one is in good general health. So weekend warriors are unfortunately at higher risk of injury. The ankle is such a complex jigsaw puzzle of joints and intricate biomechanics that requires appropriate attention and some tender love and care, especially for those that have higher demands like runners or sportsmen and women. 

We also know that having had an ankle sprain in the past puts one at risk of developing further injuries unless the sprain is treated properly. Those that are double jointed or are hypermobile can also be more prone to sustaining injuries.

Finally, the other joints of the lower limb can indirectly contribute to ankle performance, and so muscle imbalances that come from higher up like the hip, knee or shin can negatively impact the ankle.

Q.     What can be done to prevent running injuries?

As a general advice, good running shoes are a must! A running style assessment is also a fantastic way to address almost unnoticeable running patterns that can eventually predispose to injuries. 

Once an injury has already occurred, prevention of future injuries is important. We know that people are at higher risk of recurring injuries following the initial one. Being pain free does not mean that you are fully recovered! Rehabilitation following an injury is highly important and should not be avoided. It involves working on muscle strengthening, coordination and balance. A good sports physiotherapist guiding this treatment will be a key factor towards a full and speedy recovery.

Q.    If a foot or ankle injury is sustained, how long should one wait before getting medical attention? 

Quite often pain levels will determine the severity of an injury. But pain is very subjective in the way it is experienced by different individuals and therefore it is not always helpful to determine what injuries warrant urgent attention.

Complex injuries, those that may require early surgery, such as fractures and tendon ruptures, have a small window of opportunity to heal well. A delay in medical attention of 2 or 3 weeks may affect outcomes negatively, and so as long as one seeks help promptly, it is all within safe limits. In those less severe injuries a much wider margin exists before a delay in treatment carries any significant consequences.

In general terms, the sooner a treatment plan has been put in place the better and faster the recovery. So seeking attention early is never a bad idea for appropriate healing and for peace of mind.
 

Q.     Tendinitis is quite common from running and can develop in different parts of the foot. We know physiotherapy can often help relieve symptoms, however, are there any other treatment options available should the pain become persistent e.g. steroids or surgery?

I would stay away from steroids and surgery as much as possible in cases of tendinopathy in runners. It is known that steroids may damage the tendon further and predispose to ruptures making the cure worse than the disease. There are a few exceptions when steroid injections around tendons can be indicated. As for surgery, it is reserved as the last resort after all other non-operative methods have failed to improve symptoms. 

Scientific evidence states that physiotherapy is the number one treatment option, with also convincing support for Extra-corporeal Shock Wave – a form of non-invasive treatment that promotes healing. Stem cells are also a promising therapy and are currently under investigation to pin down what conditions can be addressed successfully.

A special thank you to Mr Malagelada for taking the time to give us a great insight into runners & foot injuries.

For more information about Mr Malagelada please visit: https://www.lips.org.uk/consultants/mr-francesc-malagelada/

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