PLANTAR FASCIITIS (HEEL/ARCH PAIN)
A very common foot complaint. The plantar fascia runs underneath the foot from the heel bone to the ball of the foot, along the arch. Pain is mostly felt at the heel but can also be painful through the arch whenever standing. It is often described as especially painful during the first step after getting out of bed in the morning. The plantar fascia acts to absorb the ground on landing and can get over-stressed in a number of ways. For example, wearing 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 can be diagnosed on x-ray. Treatment can include orthotics, rigid strapping, rock taping, dry needling, stretching regimes and changes to footwear.
The Achilles tendon is what connects the calf muscle to the back of the heel bone. This can become strained in both professional athletes and 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 the development of Achilles tendonitis. The degree of injury 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 PLANO-VALGUS FOOT POSTURE)
Flat feet refers to people who have a very low or no arch that runs length ways along the inside of the foot. Pes plano-valgus posture refers to the deviation and bulging of the joints on the inside of the ankle, where the bones of the feet meet the leg. This can cause the foot to turn out or appear ‘C-shaped’. People with flat feet can be more susceptible 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 common in young children as it is part of normal 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. 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 cause uneven wearing of the joint space which can cause arthritic changes and excessive bony growth to form that can add to the ‘lump’. This can also reduce the function of the big toe and lead to other issues. Pain can be due to reduced movement in the big toe joint causing the body to compensate or from rubbing against footwear. Bunions are progressive, more common in females, are hereditary 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 is common and can occur by accident (by standing in a pot-hole or walking on uneven ground) or during sport (when landing on an opponent's foot during basketball or when changing direction whilst playing tennis). A sprained ankle is often very painful and makes it difficult to put weight on the affected foot. This is due to the ligaments on the outside of the ankle being strained or in severe cases being completely torn. People with a high-arched foot sometimes walk more on the outside of the foot and are susceptible to repeated ankle inversion sprains. Treatment varies depending on severity and stage of injury- can include early rest/icing/compression, using crutches or a CAM walker (moon boot), strapping, footwear, strengthening regime and orthotics if it is a recurrent problem.
POSTERIOR TIBIAL TENDON DYSFUNCTION
The posterior tibial muscle runs from the inside of the lower third of the shin and attaches around highest point of the arch on the inside of the foot. 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 occurs around the inside of the ankle and foot. The other major sign is as the condition progresses, the arch will continue to lower and become flatter as well as the ankle rolling in. Treatment involves orthotics and strengthening of the affected muscle. Referral to a specialist may be 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 on the outside layer of the shin bone and/or small muscle tears where it attaches to the bone (mostly the posterior tibial 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 bone may be due to compression syndrome which is caused by excessive muscle swelling- both of these are far more serious and may require referral to a specialist. Treatments include footwear and orthotics, strapping, dry needling and activity modification.
KNEE PAIN (PATELLOFEMORAL PAIN SYNDROME)
Most often caused when the kneecap is not sitting 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 of gradual onset and felt at the front of the kneecap, within the joint itself or a generalised discomfort when squatting or going down stairs. Poor biomechanics such as rolling in/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. Treatment can involve rock taping, stretching/strengthening exercises and orthotics.
A Morton’s neuroma occurs 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 happen in people with very flexible feet, foot deformities such as bunions or in people 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.