Plantar fasciitis or Heel pain
Plantar fasciitis is a very common problem. Many patients decide to self-treat for six months to a year sometimes before seeking professional help. These self-treatments are often very poor and often do not lead to resolution of symptoms.
First things first, when having heel pain, plantar fasciitis is just one of many causes of heel pain. The many structures in and around the heel can be the cause of the heel pain. There is also a condition called radiculopathy where there is referred pain from nerves in the lower back. Having said that, the most common cause of heel pain is plantar fasciitis. The plantar fascia is a band of connective tissue that starts at the heel bone and attaches into the toes via the plantar plates:
When the plantar fascia gets overstrained microtears and inflammation will form. There is also a mechanism of degeneration of the diseased tissue. Over time the inflammatory process will stop and be replaced by scar tissue. Often the pain will continue.
The cause of your heel pain
Causes of plantar fasciitis can be your foot type, low or high arch profile, overtraining, putting on weight, prolonged standing, poor foot wear or foot wear not suitable for you and injuries of the foot and ankle.
Some other problems that could be your heel pain are Achilles tendinopathy, subcutaneous bursitis, heel bone fracture, peroneal tendinopathy, tarsal tunnel syndrome (nerve entrapment), posterior tibial tendinopathy, heel pad bruising and tumours to mention a few.
For plantar fasciitis home treatments can include taping the foot (low dye taping) and stretching exercises. You can take NSAIDS for short term pain relief.
Standing Calf Stretch
- Stand placing hands on wall for support. Place your feet pointing straight ahead, with the involved foot in back of the other. The back leg should have a straight knee and front leg a bent knee. Shift forward, keeping back leg heel on the ground, so that you feel a stretch in the calf muscle of the back leg.
- Hold 45 seconds, 2-3 times. Repeat 4-6 times per day.
Toe Extension and Arch Massage
- Sit with involved leg crossed over uninvolved leg. Grasp toes with one hand and bend the toes and ankle upwards as far as possible to stretch the arch and calf muscle. With the other hand, perform deep massage along the arch of your foot.
- Hold 10 seconds. Repeat for 2-3 minutes. Repeat 2-4 sessions per day.
These exercises can in some cases solve the problem entirely. You can try these exercises at home for a few weeks. If they are not solving your problem you should consider booking in to see us at the foot clinic. We can then offer you a proper foot and ankle assessment with a detailed treatment program.
We can offer
- Insoles or orthotics. These are arch supports especially made for you (we also do ready made devices)
- Exercise prescription tailored for you
- Steroid injections for quick pain relief
- Shockwave treatment. You can read about this here: Heel pain treatment
Exercise induced leg pain is usually what we call ‘shin splints’ or medial tibial stress syndrome. Other types of leg pain can be chronic compartment syndrome and calf muscle tears.
Shin splints accounts for more than 70% of leg injuries in runners in particular. The usual symptoms are
- Pain that starts when you begin running – often disappears during the run
- Worse pain after exercise
- Next morning pain
The most usual sight of pain is at the distal 2/3 on the inside of the tibia or leg bone.
Causes of shin splints can be
- Muscle weakness
- Non supportive shoes
- Foot and ankle posture and function
- Overtraining – improper training
- Hard surface running – only
Running through shin splints is not a good idea. Continuing to run with this type injury can lead to stress fractures developing. An ultrasound, MRI or bone scan can help diagnose the source of your leg pain.
Further causes for your leg pain can be muscle imbalances, partial tears of the leg muscles, leg length difference or compartment syndrome. There are also other causes such as vascular malformations – normally seen at the back of the knee with ultrasound.
Treatments – First Line
The first step in treatment is reducing your pain level. This is done by RICE
- A 50-90% drop in activity levels
- ICE – after training 10-15 min reduces inflammation and pain
- Compression – ACE wraps can reduce pain and help you to heal the leg
- Elevation – reducing inflammation can help the leg to heal
The podiatrist is happy to see you at any stage of your leg pain problem. The podiatrist can assess the function of your foot, ankle and lower limbs in walking and walking.
At Lewisham Foot Health we can treat your leg pain with
- Gait and Run Re- Education
- Foot and Ankle Mobilisation
- Foot Wear Education
- Stretches and Strengthening Programs
- Orthotics (arch supports)
- Shockwave (ESWT) treatment
Book an appointment
Shockwave therapy has been used in continental Europe successfully for several decades. International studies have shown more than 80% success rates in chronic pain patients. It is now becoming recognised in the UK and is therefore used more and more for elite athletes. Most premier league football clubs have access to shockwave treatment. Injuries and pain are healed quicker, confidence restored and you can get back to your favourite activities again, pain free. See your podiatrist for heel pain.
As podiatrists or foot and leg specialists, we specialise in treating pain of the lower limbs: hip to toe. To have shockwave you will need an initial consultation with us to assess if you are suitable to have this treatment.
Shockwave therapy is non-invasive, has minimal side effects (sometimes tender, can be reduced with ice, bruising – rare) and heals the injured tissue.
For example, we treat heel pain (plantar fasciitis), chronic pain from ankle sprains, general ankle pain, achilles tendinopathy, shin pain, patellar pain (knee), hip pain (trochanteric bursitis), insertional hamstring tendinopathy, pseudoarthropathy (fractures that aren’t healing).
Some areas we can treat
Shockwave for heel pain
In most cases you will need three treatments for optimal results. Sometimes you may need more depending on how quickly you are improving. You will notice immediate improvement in pain and dysfunction, and symptoms continue to improve up to three months after your last treatment.
What is shockwave therapy and how does it work?
The shockwaves are produced in the handpiece of the latest machines from EMS medical a swiss company with the Swiss Dolorclast and the Swiss Piezoclast shockwave machines. The shockwaves are applied to the injured tissue.
Shockwaves increase blood flow, increase cellular turn over (bone and soft tissue cells), and reduce sensitivity and pain. Shockwaves also reduce the friction in tendons and break down calcifications that have built up in tendons and ligaments. Shockwave therapy is also ideal for delayed onset muscle soreness (DOMS) and muscle tissue with knots and restrictions. Further applications are the metatarsal fractures that simply don’t heal – shockwave is very useful for initiating the healing response in bone healing.
The podiatrist will discuss with you at your consultation if you are suitable to have shockwave therapy. You will also be given other treatment options if deemed complementary or essential to your recovery.
More areas for treatment below
We look forward to seeing you at the clinic for a consultation! Please feel free to contact us if you have any questions, or book an appointment with us online. A podiatry appointment if the pain has been less than six month and a biomechanical assessment if the pain has been more than six months.
What you wear on your feet every day can be the main reason for your foot problems. Poor foot wear, shoes that are too narrow, unsupportive shallow or ill fitting shoes can give you corns and calluses on your feet, cause your nails to split and thicken or become ingrown.
Your podiatrist can assess your current foot wear for you, and the following information will guide you to getting better shoes for your foot health.
- An adjustable strap or lace across the mid foot stops your foot sliding around in the shoe.
- Foot wear that is supportive at the heel and through the sole of the shoe providing support throughout your the weight bearing contact with the ground.
- A deep toe box so your toes have enough space to move.
Choosing the right foot wear is dependent on your foot shape, your foot type and what activity you are wearing your shoes for. Wearing the right type of foot wear can improve your foot function, reduce foot pain and make your walks and activities comfortable and pain free.
Personalising your foot wear is part of what we do. Whether it be for running, tennis or hiking in the mountains. Getting the right sport shoe can help you achieve your goals without injury. Whether it is a barefoot running technique your aspiring toward or a more traditional running style we can help you choose the right foot wear and advice you on transitioning if thats what you are planning.
Heel to toe drop, thickness of the insole, a neutral shoe, the material type of the sole, the quality and properties of the upper and sole all play a part in how your shoes will affect your foot and lower limb function.
Some shoes have been made for running on roads, some have been made for running on trails and forest and fell.
Some running shoes can reduce stresses and strains of particular body segments and increase them in others. This means that if you have pain during running or sport, changing your foot wear can reduce strains in certain areas. Choosing the right shoes or trainers is part of what we do at Lewisham Foot Health.
Choosing the right foot wear
Childrens flat feet
Young children have flat feet. In fact development of the foot arch takes in some cases ten years to develop. I often get concerned parents who have looked at their children’s gait and foot posture and have wondered if their children’s feet are normal. In most cases they are. However there are some feet that don’t develop an arch and although this may not cause problems later in life, it can be difficult to know.
Who to treat?
There are some clues however for parents: if your child avoids running or other high intensity activities. If they prefer to be sedentary, or complain about growing pains this can be a sign that they would benefit from arch supports. The ‘growing pains’ may be difficult to discern for your children. They may say they have pain in their feet or legs, but when you ask where exactly the pain is, they can’t tell you. They may want to be carried a lot and feel tired or have achy feet. In other words your child may not be complaining of pain directly. Sometimes they can’t tell you where the pain is. And sometimes it is more specific. In one study adolescents with flat feet were twice as likely to suffer with knee and lower back pain.
Sometimes you or your partner may have foot, ankle or knee problems due to flat feet. This can be a sign that your children may grow to have the same problem. You may notice that your child’s feet turn out, or turn in when they walk. They may be unstable when they walk or you might notice that their feet ‘don’t seem quite right’ or may not be able to keep up with their peers. It’s in these cases it could be worth seeing a podiatrist for the right opinion or treatment.
Orthotics may help with your child’s foot and ankle posture. Improving this can help with your child’s overall posture. Orthotics fit into the shoe and change the way pressure is distributed through the foot. Orthotics also change the forces that work through the foot and improve gait and posture. This means that orthotics have an effect on the entire lower limb including the knee, pelvis and lower back.
There are two types: over the counter and custom devices. The ‘over the counter’ devices are ready made and will last a year or so. They can be a good alternative for certain foot types. Wearing these does depend on the severity of flat foot. Custom orthotics on the other hand are custom made to the foot. A cast of the foot is taken with plaster of paris. This cast is sent to the orthotics laboratory with a definitive prescription for that particular foot. As well as providing a better fit, the prescription is tailored for optimal functioning for that particular pair of feet.
Good Foot Wear
When wearing orthotics, good foot wear will improve your child’s foot and ankle stability. Important points to bear in mind are
- A deep and supportive heel counter: this will support the heel and provide a safe guide for heel contact when walking.
- A supportive sole, not easily bendable and ‘twistable’. The bending should occur below the big toe joint.
- A strap or lace across the mid foot to help hold the shoe onto the foot. A lace will also, being adjustable, customize the shoe to the foot.
- A wide enough toe box. Little feet need lots of space to grow into. Little toes are malleable and can easily become deformed over time in the wrong shoes.
Please come in for a Podiatry assessment for your child. We will be happy to answer any questions you may have about your child’s feet and posture.
Yagerman SE, Cross MB, Positano R, Doyle SM. Evaluation and treatment of symptomatic pes planus.Curr Opin Pediatr. 2011;23(1):60–7.
Fabry G. Clinical practice. Static, axial, and rotational deformities of the lower extremities in children. Eur J Pediatr. 2010;169(5):529–34
Yagerman SE, Cross MB, Positano R, Doyle SM. Evaluation and treatment of symptomatic pes planus.Curr Opin Pediatr. 2011;23(1):60–7
Harris EJ, Vanore JV, Thomas JL, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg.2004;43(6):341–73
Foot pain treatment
Treating foot pain is tailored to the type of pain and where in the foot or ankle the pain is. At Lewisham Foot Health we will diagnose the foot structure that is painful and the cause of your pain. You will be asked a full history of the pain, when the pain comes on, for how long have you had pain, when the structure gets painful, when is it at its worst. What type of pain is it and when is it slightly better. You will be asked about any medication and other relevant medical history.
Foot pain can be can be caused by many factors: In some cases it is due to ‘wear and tear’. As we get older, we may get heavier and a little weaker. Our posture may start to worsen. This can cause undue stress on the joints, tendons and muscles. When you try to improve your posture it simply makes the pain worse. At Lewisham Foot Health we specialize in making adjustments to your posture so you can get back to the exercises you once enjoyed.
Sometimes foot and ankle pain comes from repetitive strain, for example working long hours on your feet. Other times pain can be due to an uneven training load. At Lewisham Foot Health we look at not only assessing your foot and ankle, but your entire body. We will assess how you walk, and how your feet, knee and hips work together. The range and quality of motion will be checked from your foot and ankle to your knee and hips. The painful structures will be assessed as well as the surrounding support structures for strength and movement. This will give us the right information on your strengths and weaknesses and allow us to work toward an effective treatment plan.
The treatment plan will look at your your foot posture, your body posture, your current strength and flexibility as well as your foot wear. The treatment plan will include strength and movement work, we may give you orthotics, and foot mobilisation to reduce pain and improve function. The exercise plan is included with your biomechanical assessment if you choose to book one of these.
Finding the physiological cause of your pain is the aim of your consultation. Once this has been identified we will put together a treatment plan: that suits you and that you can enjoy.
Lewisham Foot Health uses a combination of strengthening exercises, stretches, taping, foot mobilisation, myofascial release, gait modification, arch supports and change in foot wear as our tools to reduce pain and improve foot function.
Taping for foot pain
Lewisham Foot Health
An orthotic, insole, or arch support is a device made to fit your foot. The orthotic goes into your shoe. It is a support device that changes your pressure distribution under your foot, to improve foot function. Orthotics can also change your joint alignment and speed up or slow down various parts of your walking or running cycle. An orthotic support is usually made of a polypropylene type material, a very durable material that lasts many years. They can also be made of carbon fibre, but also more compressible materials. Choosing the right material depends on what sort of use the orthotic is for and the type of foot in question. The orthotic is custom made right down to the type of top cover.
An orthotic can support your foot to improve both comfort and function in your everyday life. It may surprise you to learn that the way your foot and ankle works translates all the way up your body to affect your back ! Changing your foot and ankle can therefore improve your quality of life in many ways. Going for walks without the discomfort you used to have, feeling less tired and simply not being in pain. Playing your favourite sport without having to stop because your ankle hurts for example.
Most people seen for evaluation for orthotics have pain in the foot, ankle, knee, hip and sometimes the lower back. They may also have issues with their posture or the way they walk or run. Sometimes the issue has been on going for years, sometimes only a few weeks or months. Orthotics are suited to all ages, enquire with your Podiatrist for more information.
After careful assessment of your bodies’ movement pattern and range of motion of your joints and muscles, a custom mould of your foot is taken and sent to the orthotics lab for accurate evaluation. An arch support is then made to tailor your personal needs. Although an orthotic is made to fit you, your body may take up to three or four weeks to adjust to them.
A fitting appointment is booked when the orthotics are back from the lab.
A six week review is normally booked at this point.
In addition to getting a long lasting pair of orthotics, you will get a tailored exercise program to improve the movement and function of your body.
Please make your enquiries with the Podiatrist at Lewisham Foot Health
Tel 0203 6022640 for more information. or book online here:
Verrucas can be painful and unsightly. Verrucas are caused by the Human Papiloma Virus. They can spread by direct contact or through shared towels or walking barefoot in changing rooms and swimming pools.
Verrucas can be very resistant to over the counter treatments, and despite what you may have been told by your GP some verrucas can survive for years.
Verrucas in children
verrucas in children can cause a concern for parents thinking that they will spread to other family members or that they are unsightly and will lead to stigma by other children. These are valid concerns. However most verrucas disappear by themselves in children within nine months. They do not therefore need treatment in most cases. Having said that if you have been trying to self treat, but the verruca(s) are still painful get a consultation with the podiatrist and we will see what type of treatment will best suits your child.
We are now offering needling for verrucas. Your podiatrist will give you a local anaesthetic so your foot is numb. A small needle is then used to lance the verruca multiple times. It is totally pain free. The appointment is an hour. You will usually be seen for a follow up at one week. You will need to arrange a lift home as you cannot drive or walk home.
Most patients state this treatment is much better than they first thought, and in more than sixty percent of patients the verruca will resolve with one treatment (Longhurst and Bristow, 2013).
‘If you have verrucas on both feet you may only need to treat one foot, as this is an immune boosting treatment. Multiple lesions do not all need to be treated’. As just stated the treatment works by initialising your immune system.
There are other treatments available. These are either freezing the verrucas (cryotherapy) or applying salicylic acid. You will normally need a few treatments for these to work. The number of treatments depends on the length of time you’ve had your verruca, the size of the verruca and your general health. Your bodies’ ability to mount an immune response will also play a part in the success of your treatments. The downside with salicylic acid is you need to keep your foot dry between treatments. You will usually have one treatment a week.
You can book a chiropody appointment for a diagnostic check up here
BOOK ONLINE: CLICK HERE
In most cases leg pain is caused by overuse, too much sport with not enough rest, exercising the wrong way or poor biomechanics. ‘Poor biomechanics’ means your body is not moving in the best possible way. This can be brought about by a previous sports injury , a traumatic incident , or long term decline in posture leading to weakness and joint and muscle restrictions. Some people are also hypermobile, meaning their ligaments are softer than normal. This can cause the foot and ankle to move more than average causing bending moments of the leg, leading to inflammation and pain along the medial (inside) of your shin bone. Normally you will be feel a dull ache along the inside of your leg, especially when you are active.
Pain in the leg, leg pain, can be brought on by a reduced blood flow to the leg, and is termed ‘ischemic pain’. This is a much rarer condition. Pain is brought on by the cells needing oxygen that is in short supply. This is most often the case in elderly and heavy smokers. Very rarely you may have a faulty blood vessel most commonly at the back of the knee. You may need a scan at the hospital for this type leg pain.
At Lewisham Foot Health we will assess your posture and function, and diagnose the type of leg pain that you have. We will look at your current training and activity level, and give you an exercise programme to get your foot ankle, hips and legs working in an optimal way thereby reducing exercise induced leg pain. Please inquire for more information on getting a biomechanical assessment so you can stay on your feet without pain.
Forefoot pain can be very painful and impact on your enjoyment of your activities. Most forefoot pain happens when you are weight bearing, standing up or walking/running. Even so, sometimes the pain can come on when you are sitting or lying in bed. It can start as a result of an injury or can come on with an insidious onset due to a number of different issues:
The pain can be coming from the tendons, the muscle, nerve or the bone or a combination of all four.
Poor foot wear, foot type or foot mechanics, tight or restricted foot and ankle movement, poor training methods, increase or a sudden change in training methods. There can also be calluses or verrucas under your foot that cause pain. Sometimes a nerve can swell in the foot and cause irritation, called a Morton’s neuroma. The toes can be out of place creating too much pressure under the foot, or the padding under your foot can become displaced or reduced with age. Forefoot pain can also be the result of a fracture. This can be a stress fracture from over training; or if you have just started training; or you have changed your training methods.
We will assess, diagnose and treat your forefoot pain at Lewisham Foot Health and provide you with a treatment plan. This might involve foot mobilisation, foot exercises, taping, orthotics, change of foot wear or change of activity levels. We may even give you a cast walker if you have a fracture. We aim to reduce your foot pain so you can get back to the activities you enjoy, whether its walking in the park or playing football.