Common Podiatry Conditions

Ill fitting footwear- High heels, shoes with pointed toes and  flimsy/ thin soled shoes (ballet pumps)

• Bunion or a fused or arthritic 1^st toe joint -As this will Increase the pressure on the 2^nd metatarsal joint.
• Flat arches/excessively pronating feet- As this affects the functioning of the 1^st toe joint it classically leads to an increase in the pressure on the 2^nd metatarsal joint.
• Tight Calf muscles- Tight/ inflexible calf muscles reduce ankle joint bending potential which increases the pressure on the forefoot.
• Change in running form from heel striking to forefoot striking

Treatment.

• Change to shoes with a lower heel, no greater that 1.5 inches and a thick sole underneath the forefoot to reduce excessive bending of the toes joints
• If the foot is excessively pronated (rolling in the way) and the arch flattens when you stand we recommend foot orthotics with a metatarsal pad to reduce the pressure on the metatarsal head/heads and to improve function of the big toe joint.
• A specific taping technique to reduce the ability of the toe to bend excessively. We recommend the use of a rigid sports tape which can be easily applied at home daily.
• In the presence of tight calf muscles, a calf stretching program is provided to increase the ability of the ankle joint to bend, thus reducing the pressures on the balls of the feet.
• Low level laser therapy to reduce the inflammation and improve the healing of the damaged tissue.

Pain on inside of ankle joint and side of arch- Medical term- Adult acquired flatfoot(AAFF)

What is AAFF

Adult acquired flatfoot is a condition that involves the soft tissues of the arch and inside ankle joint.

When subjected to repetitive, excessive load the tendon and ligaments become damaged and their ability to support and maintain the arch and hindfoot is compromised. The result is pain around the course of the tendon and visible deviation (pronation) of the foot with gross collapse of the arch structure.

Symptoms

• Pain underneath the inside ankle bone (medial malleolus)
• Pain on the inside margins of the arch
• Pain with an increase in weightbearing and sporting activity.
• Difficulty or pain when attempting heel raising (going onto tiptoes)
• Possible swelling and heat around the inside ankle joint.
• Decreased movement of the joints at the back of the foot.

Causes

• Although damage to the tendon (posterior tibial) and surrounding ligaments can occur with a single episode of trauma (accident/sporting incident) it is usually the result of repetitive overload. This means that the strain on the tendon is greater than it can manage and this results in damage to the tendon.
• Weak calf muscles
• Hypermobile joints
• Flat footed condition
• Poor supporting shoes
• A sudden increase in sporting activity (i.e training for marathon) from being relatively inactive.

Treatment

• Supporting the ankle area and the arch is paramount in the  early management of this condition.
• We recommend supportive footwear such as trainers and lacing shoes or hillwalking boots
• Foot orthotics with corrective wedging on the inside of the orthotic. These can be either modified, prefabricated orthotics or custom made orthotics.
• Strength and balance exercises to improve muscle function and hindfoot stability.
• If these measures fail to address the symptoms sufficiently we recommend a custom made ankle brace. The Ritchie brace offers a superior level of support to the arch and ankle joint complex. Sometimes if the deformity is excessive, this measure is necessary to alleviate the symptoms.

Pain at the back of the heel-medical term- Achilles tendinopathy

What is achilles tendinopathy

The achilles tendon is the structure that passes into the back of your heel bone. It is the union of the calf musculature into the heel bone. When the tendon becomes overloaded it is prone to injury and tendon damage. This can either be where the tendon inserts directly into the heel bone (insertional) or slightly higher up the tendon (mid portion) With this, inflammation and degenerative change occurs within the tendon with the result being pain and reduced function.

Symptoms

• Pain at the back of your heel when walking, seldomly at rest.
• Pain usually worse when you weightbear 1^st thing in the morning or after a period of inactivity
• Pain usually worse after climbing stairs or hills and when running.
• Pain/discomfort when performing single leg heel raise.
• May be evident thickening to the tendon compared to the non affected limb.

Causes

• Sudden increase in activity i.e increasing running distance or speed too quickly
• Going from daily use of heeled shoes to flats or barefoot.
• Tight calf and hamstrings
• If pain on the inside of the tendon (nearer to inside of ankle) and your foot pronates (rolls in) excessively this can increase the strain on the tendon.
• A change in running shoe from high pitch to low pitch.
• Poor circulation/poor blood flow to this area of the foot.
• Increased age = more prevalent to injury.

Treatment

• In the early phase of the injury
• Reduction in the aggravating factor. If running causes pain, Significantly reduce or discontinue running until symptoms subside.
• If climbing the stairs at work all day causes discomfort reduce or eliminate this until such time as the pain has eased.
• Slow integration back into activity is always recommended. i.e walk/ run intervals to begin with if running your sport.
• Isometric calf exercises work very well in reducing pain in the early phase of injury to the achilles.
• Heel raises (both legs then progressing to single leg) help also and should only be performed on the flat and not off a step at this stage of the injury.
• Calf stretching is not advocated for this stage of the injury.
• Foot orthotics and heel raises can be used to reduce the tension forces applied to the achilles in the presence of excessively pronated/flat arched feet.
• Running shoes with a higher heel to toe drop ration.
• Low level laser therapy to improve the healing rate of the injury.
• If the injury presents in a chronic state (more than 6 months of symptoms) we advocate the use of shockwave therapy and an exercise program consisting of progressive loading. These are strengthening exercises which aim to change how the tendon deals with the load that it is subjected to, ultimately so that its capacity to perform its role increases i.e increased milage etc
• Biomechanical factors must be investigated also so we conduct gait and pressure analysis to look for a potential mechanical cause of the injury.

Pain in the heel of the foot -Medical term -Plantar fasciitis

What is plantar fasciitis

The plantar fascia is a band of connective tissue that connect the forefoot to the heel bone.

Its primary function is to support the medial arch of the foot. Damage to the fascia occurs when the structure becomes overloaded.

Acutely this leads to an inflammatory process setting up in the tissue and then progressively a change to the tissue (degeneration) if the load isn’t modified.

It is a painful condition characterised by 1^st step pain on the inside of the heel.

Symptoms

• Pain on weightbearing on the inner aspect of the heel.
• Pain is worse with 1^st step pain. (rising 1^st thing in the morning) and after a prolonged period of inactivity.
• The pain generally reduces throughout the course of the day but increases towards the end of the day or when performing sporting activities involving impact.
• Applying pressure to the heel bone when the toes and ankle are bend backwards can elicit the painful symptom.

Causes

• The cause of plantar fasciitis is overload/overuse of the tissue. This can be due to the following factors
• An increase in bodyweight
• An increase in weightbearing activity
• The introduction of an impact based sport
• Excessively pronated feet with flattening of the medial arch of the foot.
• Flat, non supportive footwear (ballet pumps are a prime example)
• Tight calf muscles

Treatment

• The treatment of plantar fasciitis depends on the duration of the condition:
• If it is an acute injury to the fascia (relatively new injury) we advise the following:
• A stretching and strengthening protocol
• Sports taping or foot orthotics to support the arch and reduce the strain on the plantar fascia
• Deep tissue or tool assisted massage for the plantar fascia and the calf muscle when tight.
• Acupuncture and trigger point therapy with either Low level laser therapy or dry needling (acupuncture) to improve healing rates
• If the injury is chronic (over 6 months duration) and unresponsive to 1^st line approach we use shockwave therapy to initiated a healing response and increase blood supply to the area.
• We couple the shockwave therapy with an exercise protocol and shoe advice.

Outer ankle sprain Medical term: inversion injury/Lateral ligament sprain

What is an inversion ankle injury?

This describes damage to the ligaments on the outer side of the ankle joint classically due to “going over” your ankle. This can happen when wearing high heeled shoes, walking or running on uneven surfaces, coming off a kerb or a tackle/impact related episode in sport etc.

The lateral ligaments provide stability to the ankle joint and prevent excessive motion taking place at the joint. If they are subjected to a rapid, uncontrolled outer wards force they stand a reasonable chance of becoming sprained or worse still, torn.

Symptoms

• The outside ankle joint area will usually present with swelling and often bruising
• Moving the foot inwards (towards the middle line of the body) will likely produce pain
• Pain will occur mainly on weightbearing and less so at rest.
• There will be reduced range of motion in the ankle joint and reduced muscle power.
• If there is pain when you press on the ankle bone itself and you are unable to weight bear on the affected foot you will require to have an x-ray taken to rule out a fracture of your ankle bone.

Treatment

• The immediate application of ice is necessary to reduce the swelling and pain. This should be performed 5x a day for the first 48hrs. Each icing session should last approximately 20minutes and the ice should not come into direct contact with the skin, thought the thin plastic membrane of a bag of frozen peas etc is fine.
• The area should be rested and weight bearing restricted. The application of an ankle sleeve can be used to compress the site and a sturdy supportive shoe should be worn. If weightbearing is not possible due to pain and the area has been x-rayed and is negative for a fracture, you can use crutches in the short term or an aircast boot (cam walker) to minimise movement at the joint.
• After 48hrs basic range of motion exercises should commence. New research suggests that an early return to movement and light weightbearing is important to healing, repair and recovery of the damaged tissue.
• Over the forthcoming weeks the exercise program will increase to include balance exercises, resistance exercises and weighted exercises. This is important to increase movement at the joint, strengthen the muscles surrounding the joint and improve balance (proprioception)
• Gentle joint mobilisations and low level laser therapy can also help with the healing rate and provide symptom reduction.
• If your foot is very supinated (high arched) this may predispose you to injury. An ankle brace or foot orthotic with outside wedging can help to reduce your likelihood of a recurrent ankle sprain.

Disclaimer: The conditions/injuries explained above are common conditions that affect the foot and lower limb, it should not be perceived that you are suffering with these aforementioned conditions unless you have been assessed and diagnosed by a medically trained practitioner. All the staff at the Shand practice undergo extensive training in the field of musculoskeletal medicine and are therefore best suited to diagnose and treat your condition.

Please seek the advice of a healthcare practitioner rather than self diagnosing and self treating. This can cause more harm than good.

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“Central location with on street parking outside. Great service and flexible appointments. I have been to the practice for various injuries and pains such as ‘shin splints’ and plantar plate issues. Treatment included; massage, acupuncture, review on how I was running (treadmill) and I was also given exercises to do at home and lots information and tips to stop the problem reoccurring. I would like to thank Scott as it never has! A family run business who care about their clients and the results.”

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