foot or ankle pain

Why does my heel hurt?

Heel pain is sometimes placed under an umbrella of ‘policeman’s heel’, however as anyone with heel pain knows – it is not unique to any one single profession! Here are some common offenders that cause heel pain:

  • Plantar fasciitis – inflammation/degeneration of the long fibrous fascia under the arch of the foot, often where it inserts under the heel bone. Sometimes called plantar fasciosis.
  • Sub-calcaneal bursitis – a bursal sac beneath the heel bone which becomes painful and inflamed.
  • Sever’s Disease – a painful heel condition often experienced in the juvenile at the location of the apophyseal growth plate on the heel bone. Sometimes called a traction apophysitis.
  • Nerve-related pains – Nerves pass around the ankle joint and then pass near the heel. Pain can be due to local irritation or changes of these nerves, or even due to a problem further up the nerve.

The Footcare Centre follows evidence-based pathways in its assessment and treatment of heel pain.

What is plantar fasciitis and heel spurs

First let’s understand what the plantar fascia is.  The plantar fascia is a fibrous band of tissue anchoring from the heel all the way up along the arch into the toe joints. It is an extremely important structure involved in support and propulsion of the foot.

The plantar fascia commonly becomes inflamed and painful – a condition known as plantar fasciitis. This is often due to the repetitive strain, called micro-trauma, carried by this tissue over a period of time.

Long term the plantar fascia degenerates, thickens, weakens and can become calcified. This demonstrates that plantar fasciitis can be a degenerative condition of the plantar fascia – this we call plantar fasciosis.   Heel spurs are common and occur where calcification occurs at the insertion of the plantar fascia to the heel bone.

We do indeed treat this condition and tend to treat it multifariously.  Treatments include therapies such as ultrasound or laser therapy, taping techniques, injections (such as cortisone) or ESWT (shock-wave therapy).

A multi-factorial approach is key in that we not only treat the plantar fasciitis but also address external, environmental and internal factors such as footwear and activity as well as focusing on the bio mechanics of the foot and lower limb.

We aim to improve the way in which the foot structure and the plantar fascia tissue bears the strain placed upon it. Foot orthotics are specialized insoles that foot specialists/chiropodists often prescribe and are often a key component in the treatment of this condition.

Can you tell me about the Achilles tendon and Achilles tendinitis?

The Achilles Tendon or its covering, the paratenon, is a common source of damage, pain or inflammation.

The tendon itself with long term repetitive trauma can undergo a degenerative process called tendinosis and in some cases can rupture completely. The paratenon often becomes inflamed – a condition called paratenonitis.

There are many reasons for Achilles tendon problems including training regimes, tight calf muscles, or over-use. Hyper-pronation is sometimes a mechanism for injury, or can delay resolution, due to the ‘whipping’ motion placed on the tendon.

 Foot Specialist/Chiropodist assesses and treats the abnormal bio mechanical strain placed upon the tendon, and can utilize electrotherapy such as Ultrasound Therapy or Low Level Laser Therapy in treating Achilles tendon problems.

Troublesome Achilles tendon problems can respond well to Radial Extracorporeal Shock-wave Therapy.

Why does the ball of my foot (forefoot) hurt?

Pain on the ball of the foot is often referred to under the umbrella of metatarsalgia, which literally translates to “forefoot pain”. There are two main reasons for forefoot pain:

  • Pressure related – Walking on hard surfaces can sometimes cause pain and inflammation of the metatarsophalangeal joints. Factors that increase the risk of developing this condition are: bony feet, certain conditions like rheumatoid arthritis and diabetes, barefoot walking, heeled footwear and overtraining. Pain is typically felt on the ball of the foot with standing and walking, and does not radiate to the toes or toward the ankle.
  • Compression related – There are nerves that pass between each of the bones of the forefoot to supply sensation to the toes. Sometimes these nerves get inflamed (neuritis) or develop an enlargement (neuroma), which gets irritated by the bones. Symptoms typically involve some or all of the following: shooting pain toward the toes or ankle, burning, numbing, pins and needles, pain worse in footwear. Causes include tight fitting footwear, heeled footwear, depressed transverse arch.

Do I have a bunion?

The only real way to know if your big toe joint is developing a bunion or some other big toe or joint problem is to get it checked out.

A bunion – called Hallux Abductovalgus – is the common name for a protruding big toe joint on the side of the foot which can cause difficulty finding shoes of sufficient width and can cause pain and rubbing.   There often is a tendency for bunions to run in families.

A bunion is caused by a displacement of the first metatarsal bone (the long bone in the arch) and its connecting toe bone (called the phalanx). This displacement is oftentimes made worse by poor footwear including fashion shoes, court shoes or pointed shoes.

Abnormal foot posture is also sometimes an underlying factor therefore your chiropodist foot specialist may sometimes suggest correcting foot position or posture using orthoses (special insoles) as an adjunct to improving styles of footwear.

We may also be able to offer help with respect to footwear for difficult to fit feet.

What is gout?

Gout is a metabolic disorder and results in the formation of Uric Acid crystals within joints. It is often larger joints that are affected, therefore in the foot the big toe joint, ankle joint and midfoot are often seen as most affected.

A flare up of gout is usually extremely painful and the affected joint will often be red and swollen. Gout can often create deposits called ‘Tophus’ – whereby a chalky white substance can be seen. In treating gout, foot specialists can help by protecting and padding affected joints, and providing wound-care to areas where tophus has led to the skin breaking down.

Medications include anti-inflammatories or longer-term medication to prevent gout. Recurrent bouts of gout may cause arthritic change within a joint which your chiropodist may sometimes help manage through special orthoses (orthotic insoles) or footwear.

What does a mortons neuroma feel like?

Tingling, numbness, pain or the feeling of ‘walking on a pebble or marble’ are all common ways people describe the feeling of a mortons neuroma.

This happens because there are nerves in feet which run up towards the toes, which finally branch off to give sensation into the toes themselves. At the level where the smaller toes meet the foot (at the level of the intermetatarsal ligament) these nerves are vulnerable to thickening or impingement. This can occur between the 3rd and 4th toes, but also between the 2nd and 3rd toes. This thickening/impingment is called a mortons neuroma.

Neuroma pain is believed to be related to mechanical irritation to the nerve where the neuroma is located and different methods can be used to reduce symptoms and treat neuromas including the prescription of custom orthotics to offload the mechanical irritation or pressure on the nerve. If you are suffering with pain in the ball of your foot (metatarsalgia) or toes then speak to a foot specialist/chiropodist for advice.

What causes big toe joint pain?

Pain is not normal, so always ensure your big toe joint is checked out by your chiropodist! Causes of big toe joint pain include gout, osteochondrosis, sesamoiditis and arthritis.

A common change to a big toe joint is the condition Hallux Limitus. Rather than moving within a complete range of motion (like a hinge) the big toe joint flexibility can become restricted.  Slow, degenerative changes to the big toe hinge joint contribute to this change. This is called a Hallux Limitus.

Hallux Limitus can be painful, and can be exacerbated by heeled shoes or activities requiring the bending of the big toe such as walking, bowling or golf. Hallux Rigidus is where the big toe hinge joint becomes more rigid and more immobile.

Foot specialists/chiropodists can assess your big toe joint pain and will be able to develop a treatment plan that is right for you.

Often orthotics can help improve symptoms or the functioning of the big toe joint.