PLANTAR FASCIITIS (HEEL/ARCH PAIN)
Plantar fasciits is a very common foot complaint. The plantar fascia runs underneath the foot from the heel bone to the ball of the foot, under the middle and along the inside arch. Pain is mostly felt at the heel but can also be painful through the arch, this is often described as especially painful on the first step after getting out of bed in the morning. The plantar fascia acts to absorb the ground on landing and also provide propulsion when pushing off through your toes and can get over-stressed in a number of ways. Such as poor footwear, high levels of activity/exercise, being overweight, older age or in people with lower arches/flat feet. People may also have a heel spur, which is an indicator for experiencing heel pain, and this can be diagnosed on x-ray. Treatment can include orthotics, rigid strapping, rock taping, dry needling, stretching regimes, and changes to footwear and activities.
The Achilles tendon is what connects the calf muscle to the back of the heel bone. This can become strained in anyone, from professional athletes and to weekend warriors, and may become swollen and painful especially when trying to 'push-off' when walking/running. Poor foot and leg alignment, tight calf muscles and improper footwear can all contribute to pain in the Achilles tendon. The severity of the problem can range from a minor strain to full tear which can often require surgery. Treatment of Achilles tendonitis can involve stretching and strengthening of the calf muscle, heel raises and orthotics- if it is due to any biomechanical abnormalities.
FLAT FEET (PES PLANUS)
Flat feet refers to people who have a very low or no arch that runs length ways along the inside of the foot. Pes planus posture refers to the collapsing of the inside arch and inside of the ankle, In severe cases, this can cause the front of the foot to turn out and the outside border of the foot to appear ‘C-shaped’. People with flat feet can be more prone to overuse injuries such as plantar fasciitis and Achilles tendonitis due to abnormal biomechanics, however, research has not found that people with flat feet are more likely to be injured than those people without. Low arches are actually common in babies and young children as part of their usual development but most kids should form their normal arch by around six years of age. Treatment can involve the use of orthotics, strengthening exercises and footwear recommendations.
BUNIONS (HALLUX ABDUCTO-VALGUS)
A bunion is sometimes simply referred to as a ‘lump’ on the inside of the big toe joint- this is partly correct but is slightly more complex than this. The ‘lump’ is mostly caused when the big toe is crooked and deviates towards the little toes, this deviation causes the big toe joint to protrude out and appear larger. As the big toe is no longer aligned, this can cause uneven wearing within the joint space which can cause arthritic changes and excessive bony growth to form that can again add to the ‘lump’ appearing larger. Bunions can reduce the function of the big toe and lead to other issues, such as reduced movement in the joint causing the body to compensate or from the bunion rubbing against shoes. Bunions have a high link to the family history of the deformity, are progressive, more common in females, people with flexible or flat feet and can also be caused by wearing pointed or high-heeled shoes. Treatment includes footwear advice, orthotics and strapping.
INVERSION ANKLE INJURY (ROLLED/SPRAINED ANKLE)
A sprained ankle can occur by seemingly harmless incident twisting on uneven ground or whilst playing sport landing awkwardly after jumping or when changing direction. A sprained ankle is usually very painful and makes it difficult to put weight on the foot. This is due to the ligaments on the outside of the ankle being strained or in severe cases being completely torn. People with high-arched feet sometimes walk more on the outside of the foot and are more likely to have recurrent ankle inversion sprains. Treatment varies depending on how severe the injury is but can include early rest/icing/compression, using crutches or a CAM walker (moon boot), rigid strapping, footwear advice, muscle strengthening, and orthotics if it is an ongoing problem.
TIBIALIS POSTERIOR TENDON DYSFUNCTION
The ‘tib post’ muscle runs from the inside of the shin, around the inner ankle and attaches to the middle/highest point of the arch. This is a major supporting muscle of the foot and if this muscle is no longer able to support the foot properly it can cause the arch to collapse. In adults, this is often termed ‘adult acquired flat foot’. Initially, pain and swelling usually occur around the inside of the ankle and foot and as this progresses the arch will continue to lower and flatten as well as the ankle rolling in. Treatment involves orthotics and strengthening of the affected muscle with a referral to a specialist being required in severe cases.
SHIN SPLINTS (MEDIAL TIBIAL STRESS SYNDROME)
The exact cause of shin splints is still not fully understood, however the most likely caused by inflammation of the shin bone and small muscle tears where it attaches to the bone (mostly the ‘tib post’ muscle). Pain is mostly felt along the inside border of the lower shin and is often caused by a sudden increase in activity, high impact sports or exercising on hard surfaces. Other causes of pain in the shin bone include stress fracture or pain on the outer side of the shin may be due to compression syndrome which is caused by excessive muscle swelling- both of these are serious and may require referral to a specialist. Treatments include footwear and orthotics, strapping, dry needling and changes to activity.
KNEE PAIN (PATELLOFEMORAL PAIN SYNDROME)
Most often caused when the kneecap is not resting or moving properly in the groove of the thigh bone at the knee joint causing it to rub against one side of the groove. Pain is often gradual and felt at the front of the kneecap, within the joint itself or a generalised discomfort when squatting or going downstairs. Poor biomechanics such as flat feet or imbalance of the quadriceps muscle are two of the main causes. It is common in sports that involve jumping, running or squatting and treatment can involve rock taping, stretching/strengthening exercises, and orthotics.
A Morton’s neuroma occurs generally between the 3rd and 4th toes where two nerve branches join- between the other toes there is only one nerve branch- which can cause compression and irritation of the nerve. It can occur in people with very flexible feet, foot deformities such as bunions or in people who wear pointed or tight-fitting shoes. This compression of the nerve branch can lead to a burning pain, numbness/tingling or the feeling as if standing on something inside the shoe or sock. Pain usually comes on gradually and can be diagnosed on clinical assessment with a conclusive diagnosis by ultrasound/MRI. Treatment options include changes to footwear, temporary padding and strapping or orthotics designed to offload the specific area. In certain cases, steroid injections or surgery are required.