Plantar Fasciitis

Plantar Fasciitis is a very common foot complaint with pain felt underneath the heel and/or through the arch. The plantar fascia runs underneath the foot from the heel bone to the ball of the foot.

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 to provide propulsion when pushing off through your toes and can get over-stressed in a number of ways.

Contributing factors are poor footwear, high levels of activity or exercise, being overweight, older age or in people with lower arches or flat feet. Some people may also have a heel spur, which is an indicator for experiencing heel pain and this can be diagnosed on x-ray. Treatment options include orthotics, rigid strapping, rock taping, dry needling, stretching regimes and making changes to footwear and activities.

Achilles Tendonitis:

The Achilles tendon connects the calf muscle to the back of the heel bone. This tendon can become strained in anyone, from professional athletes to weekend warriors. Can become swollen and painful, especially when trying to ‘push off’ when walking or running.

Poor foot and leg alignment, tight calf muscles and improper footwear can all contribute to pain in the Achilles tendon.

Depending on the severity of the problem, treatment can involve stretching and strengthening of the calf muscle, heel raises and/or orthotics if it is due to any biomechanical abnormalities. If there is a full rupture of the Achilles tendon this will often require surgery.

Flat Feet

Flat feet refers to people who have very low, or no arch that runs lengthways along the inside of the foot. Pes Planus posture (flat feet) 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 normal development but most kids should form their normal arch by around six years of age. Treatment can involved the use of orthotics, strengthening exercises and footwear recommendations

Bunions:

A bunion is sometimes simply referred to as a lump on the inside of the big toe joint. Whilst partly correct, it is slightly more complex. The ‘lump’, or hallux abducto-valgus, is mostly caused when the big toe is crooked and deviates towards the little toes, this deviation causes the big toe joint to protrude 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 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 or from the bunion rubbing against shoes. Bunions are progressive and have a strong link to family history, are 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 changes, orthotics and strapping.

Sprained Ankle

A sprained or rolled ankle can occur by a seemingly harmless incident, such as twisting on uneven ground/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 through the foot. This is because the ligaments on the outside of the ankle have been strained or in severe cases been 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/rehab exercises and orthotics if it is an ongoing problem.

Tib Post Tendon Dysfunction

The ‘tib post’ muscle runs from the inside of the shin, around the inner ankle bone 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, Tibialis Posterior Tendon Dysfunction is often referred to as; adult acquired flat foot’.

Initially, pain and swelling 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 tib post muscle. A referral to a specialist may be required in severe cases.

Shin Splints:

The exact cause of shin splints, or medial tibial stress syndrome, is still not fully understood however, they are most likely caused by inflammation of the shin bone and small muscle tears where the shin attaches to the bone (mostly the ‘tib post’ muscle as mentioned above).

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 fractures or pain on the outer side of the shin which may be due to compression syndrome caused by excessive muscle swelling- both of these are serious and may require a referral to a specialist.

Treatments for shin splints include footwear and orthotics, strapping, dry needling and changes to activity

Knee Pain

Knee pain or patellofemoral pain syndrome is 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
as generalised discomfort when squatting or walking downstairs.

 

Poor biomechanics such as flat feet or imbalance of the quadriceps muscles
are two of the main causes. Knee pain is common in sports that involve
jumping, running or squatting and treatment can involve Rock-taping, stretching
or strengthening exercises and/or orthotics.

Morton's Neuroma:

This is a common cause of pain in the ball of the foot, however, there are many other causes of forefoot pain. 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 will usually occur in people with very flexible feet, foot deformities such as bunions or in people who wear tight fitting shoes.

This compression of the nerve branch can lead to a burning pain, numbness or tingling, or the feeling as if standing on something inside the shoe is swollen. 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.

Sever's Disease

Sever’s disease is most common in growing, active kids with pain felt at the back of the heel bone. This is a condition that can be classified as “growing pain”, as it is common during period of rapid growth in children. Growing pains does not mean it can’t be treated.

It is most common in children aged 8 to 14 and can be brought on due to poor foot biomechanics or alignment. The pain is caused by tension and micro trauma of the Achilles tendon where it attaches to the growth plate on the heel bone.

Treatment for Sever’s can involve stretching and strengthening of the calf muscle, orthotics, heel raises, footwear change and activity modification.