Conditions Treated
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Achilles Tendonitis
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A condition affecting the achilles tendon and characterised by progressive pain and swelling of the same. Painful in the morning usually or more so if the day before involved increased activity or participation in sports. May improve following a short period of activity or a warm up with stretching.
This condition left untreated carries the risk of achilles tendon rupture. Most cases are caused by poor foot and lower limb mechanics, tight and or poor muscle balance.
Mechanical therapy plays an important role in the management of this condition if surgery is to be avoided.
Treatment of Achilles Tendonitis. This involves the use of orthoses to address any poor foot function and posterior leg night splints. This combined with appropriate exercises and physiotherapy will provide impressive results.
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Arch Pain - Strain
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Arch Pain (often referred to as Arch Strain) is an inflammation and/or burning sensation at the arch of the foot.
There are many different factors that can cause Arch Pain. A structural imbalance or an injury to the foot can often be the direct cause. However, most frequently the cause is a condition called Plantar Fascitis.
The Plantar Fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Plantar Fascitis is caused by excessive stretching of the Plantar Fascia usually due to overpronation (flat feet).
The inflammation caused by the Plantar Fascia being stretched away from the heel leads to pain in the heel and arch areas. The pain is often extreme in the morning when an individual first gets out of bed or after a prolonged period of rest.
If this condition is left untreated and strain on the longitudinal arch continues a bony protrusion may develop known as a Heel Spur. It is important to treat the condition promptly before it worsens.
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Athlete's Foot
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Athlete's Foot is a fungal infection. So called because it is common in athletes or those taking part in sports on a regular basis. It is normally caught in changing rooms or showers because the fungus likes a moist environment. When it infects the skin it is much easier to treat than when it infects the nails. Symptoms involve dry flaky skin which is very itchy especially in between the toe spaces. The condition can be uncomfortable and sometimes painful. Most people seek professional help because it is cosmetically unsightly. The condition can result in permanent deformity of the nails if left untreated.
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Bunions and Overlapping Toes
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Bunions referred to in the medical community as Hallux Valgus are one of the most common forefoot problems. A Bunion is a prominent bump on the inside of the foot around the big toe joint, this bump is actually a bone protruding towards the inside of the foot. With continued movement of the big toe towards the smaller toes, the big toe may rest under or over the second toe. This causes a forefoot condition called OVERLAPPING TOES. Some of the symptoms of Bunions include inflammation, swelling and soreness on the side surface of the big toe joint. The discomfort may cause difficulty in walking.
Another type of Bunion which some individuals experience is called a Tailor's Bunion, also known as a Bunionette. This forms on the outside of the foot at the joint of the little toe. It is a smaller bump that forms due to the little toe moving inwards towards the big toe.
Bunions are experienced mostly by women. The deformity can develop from an abnormality in foot function or arthritis and may be aggravated by wearing improper fitting footwear. Tight narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe leading to the formation of a Bunion. Women who have Bunions normally wear dress shoes that are too small for their feet, their toes are squeezed together in their shoes causing the first Metatarsal bone to protrude on the side of the foot. Finding suitable attractive footwear is a challenge.
Treatment of Bunions. This includes the use of foot orthoses, deflective padding and improvement in footwear. Some cases may require surgery to correct the deformity.
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Callouses • Corns
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A Callous is a build up of dead skin cells that harden and thicken over an area of the foot. They may be found on the ball of the foot, the heel and under or between the toes. Calluses form to protect the foot against excessive pressure and friction.
A Corn is an accumulation of dead skin cells on the foot forming thick hardened areas on the top, bottom, sides, tips or between the toes. They contain a cone-shaped core whose point can press on a nerve causing pain.
Callouses and Corns develop due to excessive pressure at a specific area of the foot. Some common causes are high heeled dress shoes, and shoes that are too small causing abnormalities in the gait cycle (walking motion), bony prominences, and the loss of the fat pad on the bottom of the feet, toe deformities such as claw/hammer toes and poor foot function such as flat or high arched feet.
Treatment includes regular chiropody in the form of footcare, improved footwear, toe splints to correct position and deflect pressure, foot orthoses or pads. Some cases may also benefit from minor surgery to correct the cause ie: toe deformities
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Claw Toes • Hammer Toes • Mallet Toes
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Many disorders can affect the joints in the toes causing pain and preventing the foot from functioning as it should.
A Claw or Hammer toe is contracted at the end joints in the toes by ligaments and tendons that have tightened causing the toe joints to curl downwards. Claw or Hammer toes may occur in any toe except the big toe. There is often discomfort at the top part of the toes that is rubbing against the shoe and at the end of the toes that is pressed against the bottom of the shoe. Sometimes a Callous or Corn forms and are the cause of the pain.
Claw or Hammer toes can be either flexible or rigid. A flexible toe has the ability to move and can be straightened manually. A rigid toe does not have the same ability to move, is very limited and can be extremely painful.
A Mallet toe occurs when the joint at the end of the toe cannot straighten. Constant rubbing of the Mallet toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe causing pressure and discomfort.
Mallet, Claw or Hammer toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight, this results in the joints curling downwards. Mallet toe may also occur if there is a muscle imbalance, however it is more common to see it affecting an excessively long toe. Arthritis can also lead to many forefoot deformities including Claw, Hammer or Mallet toes.
Treatment and prevention of Claw/Hammer/Mallet Toes. These toe deformities affect many people most of whom are unaware as they do not give rise to pain. Under certain circumstances they will give rise to pain and therefore treatment is indicated. Use of tight ill fitting footwear is one example and also the reason why these conditions cause problems more in women than men. This may give rise to pressure, blisters, calluses or corns. Treatment may include padding and strapping, improving footwear, corrective toe splints, foot orthoses or surgery to straighten the toes.
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Metatarsalgia • Forefoot Pain
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Metatarsalgia / Forefoot pain is a general term used to denote a painful foot condition in the Metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball of the foot). This is a common foot disorder affecting the bones and joints at the ball of the foot. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads or more isolated at the first metatarsal head (near the big toe). If it is under the big toe joint it may be due to inflammation of two small bones known as Sesamoids - in such a case the condition is known as SESAMOIDITIS. With this condition one or more of the Metatarsal heads become painful and/or inflamed usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent or chronic pain with this condition.
This condition may be a result of ill fitting footwear. In such cases improving shoe styles to lower heels and extra room will reduce symptons.
However it may also more often be a result of poor foot function which leads to overloading of the metatarsal area ie: dropped metatarsal arch in such cases the treatment of choice is the use of foot orthoses.
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Morton’s Neuroma
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Morton's Neuroma is a foot problem characterised by pain, swelling and/or an inflammation of a nerve usually at the ball of the foot between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning and even a lack of feeling in the affected area. Morton's Neuroma may also cause numbness, tingling or cramping in the forefoot.
Morton's Neuroma is a foot condition caused from an abnormal function of the foot that leads to bones squeezing a nerve usually between the 3rd and 4th Metatarsal heads, but also the 2nd and 3rd metatarsal heads. Symptoms of Morton's Neuroma often occur during or after you have been placing significant pressure on the forefoot area while walking, standing, jumping or sprinting. This condition can also be caused from footwear with pointed toes and/or high heels, constricting shoes can pinch a nerve between the metatarsal heads causing discomfort and extreme pain.
Treatment of Morton’s Neuroma. This involves the use of foot orthoses with appropriate padding to deflect pressure from the forefoot and nerve. Some cases may benefit from a local injection to reduce inflamation. Chronic (long term) or unresponsive cases may require minor surgery to deal with the affected part of the nerve.
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Over-Pronation
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Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person’s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, possibly causing severe discomfort and leading to other foot problems.
Over-pronation is seen in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding additional stress to other parts of the foot. Therefore over-pronation can often lead to a case of Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. People with flat feet often do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.
Treatment and Prevention. Over-Pronation can be treated with orthotics. These orthotics are designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improper fitting footwear can lead to additional problems of the foot.
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Posterior Tibial Tendonitis
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Posterior Tibial Tendonitis is a strain of the Posterior Tibial Tendon which runs along the inside of the ankle and the foot.
When there is Posterior Tibial Tendon dysfunction the tendon does not hold up the arch resulting in flat feet. This can lead to heel pain, arch pain, Plantar Fascitis and/or Heel Spurs.
With Posterior Tibial Tendonitis pain will be more severe upon weight bearing especially while walking or running.
Posterior Tibial Tendonitis occurs when the muscle is over used and the tendon (soft tissue) that connects the muscle to your bone is strained. Years of over-pronation (flat feet) can also lead to Posterior Tibial Tendon dysfunction. If you keep over using the muscle, damage to the tendon builds up and Tendonitis develops. At first the pain or swelling may come and go quickly but eventually the problem may become more permanent, eventually leading to foot collapse. A serious complication of this condition in that if left untreated the tendon may rupture leading to disability.
Early treatment of this condition is indicated to prevent serious problems. This includes the use of orthoses to support the foot and relieve tension on the tendon allowing the body to heal the area. In severe cases options include the use of plaster of Paris casts or orthopaedic walkers to immobilise the foot and ankle. In the case of tendon rupture surgical intervention is inevitable and post surgery most will require foot orthoses.
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Diabetes
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Diabetes Mellitus is a serious disease that can develop from the lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday functions. Insulin is a substance produced from the Pancreas gland that helps process the food we eat and turn into energy.
Diabetes is classified into 2 different types: Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often linked through heredity. Type 2, commonly referred to as adult onset diabetes, is characterised by elevated blood sugars, often by people who are overweight or have not attended to their diet properly.
There are often many complications associated with diabetes. Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs and feet. People with diabetes should pay special attention to their feet.
Foot problems encountered with Diabetes
Neuropathy
Diabetic foot conditions develop from a combination of causes including poor circulation and Neuropathy. Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat and cold. Diabetics suffering from Neuropathy can develop minor cuts, scrapes, blisters or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes and Charcot Feet.
It is very important for diabetics to take the necessary precautions to prevent all foot related injuries. Due to the consequences of Neuropathy daily observation of the feet is critical. When a diabetic patient takes the necessary preventive foot care measures it reduces the risks of serious foot conditions.
Poor Circulation
Diabetes often leads to peripheral vascular disease which inhibits a person's blood circulation. With this condition there is a narrowing of the arteries that leads to significantly decreased circulation in the lower part of the legs and the feet. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, therefore causing injuries to heal poorly. Poor circulation can also lead to swelling and dryness of the foot. Preventing foot complications is more critical for the diabetic patient since poor circulation impairs the healing process and can lead to ulcers, infection and other serious foot conditions.
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Heel Pain and Plantar Fascitis
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Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort. Foot mechanics play an important role in how the condition develops or improves.
There are three different categories of heel pain, the first is caused by an over-use repetitive stress which refers to a soreness resulting from too much impact on a specific area of the foot. This condition often referred to as 'bruised heel syndrome' can be caused from shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity, or bruising. Rest is often the best form of treatment for this.
Plantar Fascitis
A more common diagnosis of heel pain, is usually caused from a biomechanical problem such as over-pronation (flat feet). The Plantar Fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, from the heel through the mid foot and into the forefoot. Over-pronation can cause the Plantar Fascia to be excessively stretched and inflamed resulting in pain in the heel and arch areas of the foot. Often the pain will be most intense first thing in the morning or after a prolonged period of rest, the pain will gradually subside as the day progresses. Conservative treatment using triple therapy is very succesfull. This involves orthoses to support and rest the plantar fascia, paterior leg splints to be worn at night to apply a gentle stretch and stimulate healing. In difficult cases an injection to reduce inflamation will form the third part of the triple therapy. In rare cases surgery may be considered.
Heel pain in children under the age of approximately 13 may be due to Plantar Fascitis. However it may also be due to a condition known as Sever's Disease. This occurs in children who are very active in sports and who have regular and large growth spurts. Pain is usually present at all time from the outset and is evident all around the heel. The heel may also show signs of redness, some swelling and warmth. This condition is caused by an inflammation of the bone and cartilage. The use of orthoses and leg splints helps considerably and in severe cases applying a below knee plaster cast has been advocated.
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Heel Spurs
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The heel bone is the largest bone in the foot and absorbs the most amount of shock and pressure. A Heel Spur develops as an abnormal growth of the heel bone. Calcium deposits form when the Plantar Fascia pulls away from the heel area causing a bony protrusion or Heel Spur to develop. The Plantar Fascia is a broad band of fibrous tissue located along the bottom surface of the foot the runs from the heel to the forefoot. Heel spurs themselves are unlikely to be the cause of heel pain. However they are an important indicator that something abnormal is happening and in the presence of pain, requires further investigation and treatment.
Heel Spurs are usually secondary to Plantar Fascitis or repetitive low grade stress of the Plantar Fascia.
Treatment of the heel spur usually focuses on associated conditions such as plantar fascitis - please refer to ‘Heel Pain’ for more information.
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Ingrown Toenail
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An ingrown toenail occurs when a piece of nail edge grows into the skin causing a painful inflamed toe. It usually affects the big toenails and may be caused by improper pedicure, injury or because of an excessive curvature of the nail. It is easily treated by painlessly removing the section of the nail causing the problem.
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Knee Pain
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Anterior knee pain may be the result of poor foot mechanics. It can be present in people of any ages but is more common in young adults who have recently increased their sports activities at school or in adults who have recently joined a gym or sports in order to get fit. The condition may be caused by abnormal foot pronation. Pronation results in internal rotation of the leg and may cause a lateral movement of the patella (knee cap). This is referred to as ‘patella maltracking’. This causes a grating affect on the under-side of the knee cap and over a period of time leads to pain and disability. An increase of activity will aggravate the pain and a reduction of activity will improve the pain. Weakness of the medial (inner) part of the quadraceps muscle in the thigh may contribute to the problem. By controlling pronation with orthoses and balancing muscle strength with appropriate exercises results can be very impressive.
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Sports Injuries
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Most sports injuries affect the lower limb. Some of these are mentioned in the topics discussed in other parts of this site. Examples are, plantar fascitis, shin splints, knee pain etc. People with poor foot and lower limb mechanics are more prone to and more likely to suffer with sports related injuries because the forces are greater during sports and therefore instabilities are also multiplied. Biomechanics, gait analysis and mechanical therapy are now a recognised part of an effective treatment programme when dealing with sports injuries.
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Shin Splints
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Shin splints is a term used by many to describe a range of conditions affecting the front of the leg. Sometimes it may also affect the back of the leg when the posterior or lateral muscles are involved. There are essentially three types of condition that may affect the leg as follows;
Compartment syndrome - this is pain within the muscles at the front (anterior tibial), outer side (peroneal) or back (posterior tibial) of the leg. The pain is aggravated by activity and relieved by rest. It is normally described as a cramp in the muscle or a feeling of tiredness in the muscle. In fact that is exactly the case. The muscle gets tired due to overuse, becomes inflamed and painful. As it sits within a compartment it is unable to swell - this leads to an increase in pressure within the compartment and therefore pain. Continued activity leads to further damage and more pain. Runners are often affected by this and the primary cause is poor foot mechanics resulting from pronation – muscles have to work harder to stabilise the foot and therefore get tired. Other causes may be poor footwear, muscle damage or a trapped nerve syndrome in the lower back causing increased activity of muscle in the area.
Stress fracture of the tibia (shin bone) - here the pain is present within the shaft of the bone and an xray or bone scan may confirm diagnosis.
Tibial stress syndrome or periostitis - inflammation of the lining (periosteum) covering the tibia (leg bone). This may be due to stress resulting from abnormal muscle pull which itself may be the result of poor foot mechanics.
Treatment usually involves a detailed examination to identify the true cause of the pain. This may be followed by taping/strapping to provide stability or prescribing foot orthoses to control poor foot mechanics. A change in lifestyle, activity levels or training regime is also indicated. In severe or unresponsive cases surgery may be indicated
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Verrucae
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Verrucae are warts of the feet caused by a viral infection commonly found in swimming pools, changing rooms or communal areas. The infection can result in one Verruca, many Verrucae or a collection across a large area called Mosaic Verrucae.
They can be treated in a number of ways using topical chemicals, freezing or cautery.
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