Foot or Ankle Pain
Forefoot pain can be a stress fracture of the bone. A stress fracture is a small crack or severe bone bruise in the foot or ankle. Stress fractures, unlike an acute fracture, is brought on by overuse. The bones in the body are constantly being replenished with bone stock, but if you have been much more active than usual a stress fracture may occur. This happens as a result of the body not having time to rebuild the bone.
Stress fractures are more common in sports people and athletes, and more common in women than men. If you have increased your training volume, training intensity or changed running or training surface you may get a stress fracture. Wearing shoes that reduce the foot’s ability to absorb stress can cause a stress fracture.
Other causes of stress fractures can be a less than optimal bone stock. This can occur if you have had or have health issues, have spent very little time weight bearing or have a poor nutritional intake.
You may have a stress fracture of the foot or ankle if you:
- Experience pain when weight bearing
- If there is swelling of the foot or ankle
- You see a bruise on your foot or ankle
Stress fractures are usually caused by repetitive stress on the foot or ankle that it is not used to. Increasing your training volume too quickly or starting a new sport without giving your body time to get used to the new activity your bones and muscles haven’t got time to increase in strength to gradually adapt to the new activity. Your bodies weight bearing bones are especially vulnerable to stress fractures as they absorb repetitive forces from running, walking and sports.
If you are getting pain in the foot, it’s not advised to try to walk through the pain. A stress fracture that is ignored can lead to an complete fracture. See your podiatrist who can ultrasound scan your foot or ankle for stress fractures. An ultrasound scan is usually more accurate than an x-ray for stress fractures as an x-ray will not show a stress fracture until a few weeks have gone by. An x-ray can sometimes be requested in particular circumstances.
Treating bone injuries depends on the severity, the bone that’s injured and your overall health. You should in all cases stop any high impact exercise to let the bone heal: See the podiatrist.
The most common areas for stress fractures are the metatarsals, the heel bone and the tibia and fibula.
Preventing stress fractures
If you are starting a new sport or starting running, we recommend a strengthening program. You can alternatively try some cross training as this can have some effect on increasing your bone and muscle strength.
In particular novice runners are advised to see the podiatrist for a running analysis where some minor adjustments can be made to reduce the risk of a stress fracture or soft tissue injury. A podiatrist can also give you a strengthening program.
Start your new activities slowly. This will give your body time to adapt. Don’t train every day if you haven’t been active for a while even if you start to see improvements early on.
Mix up your activities so your body gets trained in different ways. This will reduce the risk of overtraining certain parts of your body.
If you get pain and swelling, stop your activity for a few days and if you get the same pain recurring when you train again, see the podiatrist.
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Ankle Sprains are very common. They occur when you roll, twist or turn the ankle in an awkward way. This might lead to a tear or stretch the soft tissue bands that hold the foot and ankle bones together. These soft tissue bands are ligaments and they help stabilise the foot and ankle.
Self treatments might be indicated in very mild sprains. With more serious injury especially if you were unable to weight bear immediately afterwards or you are limping warrants a medical examination from a podiatrist or medical doctor. This is to assess the amount of ligament and soft tissue damage, but also any movement and balance deficits you may have suffered with your injury. In addition how the structural injury can lead to stability issues.
Signs and Symptoms
- Pain – more when weight bearing on the injured foot
- Bruising (not always)
- Restricted Range of Motion
- Instability of the Ankle
- Popping sound or sensation at the time of injury
When To See a Podiatrist
If your pain is severe and doesn’t go away within the next couple of days you should come in for an evaluation. As well as ligament damage you may have a fracture. These can be a straight forward fracture of the bone or an avulsion fracture. An avulsion fracture is where the ligament has torn off a piece of bone, and neither of these are uncommon in ankle sprains.
Call us If you are unsure
Causes of ankle sprains
- A fall that causes your ankle to twist
- Landing awkwardly on your foot after jumping or turning
- Someone stepping on or landing on your foot while you are moving
- Walking on or exercising on uneven surfaces
Other factors that contribute to ankle sprains
- Participating in sports activities any activity that involves jumping, cutting and quick changes of direction can result in an ankle sprain
- Uneven surfaces walking or running on uneven surfaces may cause an ankle sprain. This is especially important if your not used to moving on these surfaces
- Prior Ankle Injury previous injury is a risk factor. In particular if you haven’t properly rehab’ed the ankle first time around
- Poor Physical Condition poor strength and flexibility can increase the risk of an ankle sprain
- Inappropriate Shoes shoes that aren’t made for the activity you are undertaking can lead to instability and ankle sprain. The best example is a high heeled shoe on cobbled roads
Not treating an ankle sprain properly after injury can lead to:
- Chronic pain
- Chronic Ankle Instability
- Arthritis of the Ankle Joint
How to prevent ankle sprains
- Warm up before exercise or play sports
- Wear ankle support or brace on a weak or previously injured ankle
- Try to wear high heeled shoes as little as possible
- Practice stability training, such as balance exercises
- Maintain good conditioning and muscle strength
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Ankle Injury, Diagnosis and Treatment
During the examination the podiatrist will examine your foot, ankle and lower leg. The Podiatrist will touch the areas that are most sensitive to find what structures are injured. The podiatrist will also move your foot and ankle in different positions to find out movement deficits and where pain is coming from.
If the pain is severe we may offer you an ultrasound scan in the clinic.
- An Ultrasound uses sound waves to create real time images. These images can show how badly you have injured your ligaments and if you have fractured your ankle or foot.
Treating your injured ankle depends on the severity of the injury. Treatment is aimed at
- Reducing swelling
- Improving Range of Motion
- Improving tissue healing
- Addressing strength, balance and movement deficits
Treatments can be:
- Foot and ankle mobilisation
- Stretches and strengthening exercises
- Shockwave treatment for tissue healing
- Splints – Braces – Ankle supports
There are many causes of knee pain and one of the most common is patellar tendinopathy ‘runners knee’ or ‘jumpers knee’. More men than women are affected and its most common in athletes, runners and people involved in high impact sports where jumping and changing direction occurs frequently. ‘Jumpers knee’ is most frequent in people in their twenties to thirties, but it can affect all ages.
Pain comes on due to overload of the patella tendon or a trauma such as a fall. It’s rare to have pain when resting and the pain is associated with weight bearing and during activity. There may be swelling at the front of the knee, but more often there isn’t.
The Patella Tendon
The patella tendon sits below the knee cap and can be seen here.
How is patella tendinopathy diagnosed?
The podiatrist will examine you and the clinical findings are backed up with imaging. This can include an ultrasound scan or an MRI study. You will also have a biomechanical assessement that will show any movement and strength deficits. These are recorded and worked into your treatment program.
Why Have I got Patella Tendon Pain?
Patella tendon pain can be brought on by previous injury. It can be caused by a deficit in muscle strength, endurance, reduced flexibility or aberrant movement patterns can all play a part in jumpers knee. Faulty training techniques and focusing on only one type of training can lead to overuse of the patella tendon.
Treatment depends on the presentation of the injury
- Activity modification
- Exercises to stretch and strengthen supporting structures
- Shockwave treatment
- Movement modification
- Foot wear
With good treatment the prognosis is good. Not treating a painful patella tendon can lead to tears, further pain and delayed healing. Contact the podiatrist or book a consultation for the right treatment.
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Big Toe Pain
Pain in the big toe can be many things. However, a very frequent cause of big toe pain is a restriction of upward motion of the first toe joint in walking. Your big toe joint will feel sore in shoes, sometimes without shoes and mostly painful when you are walking or running.
The pain can come on immediately upon weight bearing activities or afterwards there may be a dull, aching or sharp pain in the joint. Sometimes there is swelling or redness of the joint and in some patients’, there isn’t.
The medical term is hallux limitus and it can be caused by
- biomechanical factors
- autoimmune disease or systemic arthritis
Often you will have pain in both big toes at the same time. If you are seeing a bump on the top of the joint its most likely a pain that will get worse as it progresses – increasing joint stiffness and increased pain is the usual course.
Once the problem becomes more involved, gait compensations can occur.
- The first issue we will look at is changing your foot wear to something more supportive for your foot. A stiffer soled shoe is important to help reduce tension in the joint. A deeper toe box with an adjustable strap or lace across the midfoot will reduce any friction on the joint.
- If your foot and ankle have restrictions we will aim to reduce these restrictions with foot and ankle mobilisations
- A home exercise program to strengthen and improve the range of motion of your foot and ankle
- Foot orthotics to reduce the internal compression in the big toe joint thereby improve pain and mobility
- Shockwave treatment for cartilage repair and reduction of pain of the big toe joint
- Steroid injection
Other causes of big toe pain are
- Nerve entrapment
- Ingrown nail
- Sesamoiditis (small circular bones under the big toe joint)
- Restricted blood supply
- Muscle cramps
- OCD (piece of bone or cartilage that has broken off and is in the joint)
The type of treatment you will be advised on depends on your age, activity levels and how restricted the big toe joint has become. The main aim of treatment is to reduce the pain and improve your quality of life so you can enjoy your favourite activities again.
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Heel Pain in Children
Children between the age of 8 and 12 years old years old are vulnerable to heel pain. The pain is located at the back of the heel bone and is called Severs disease. This is by and large a self-limiting swelling of the growth plate of the heel bone. The injury should improve within six weeks if the right treatment is given.
Pain usually comes on during or after activity. It may stop the child doing sports activities and can cause a limp when progressing to become more painful. There can be a palpable lump at the back of the heel and usually there is no visible inflammation. Certain shoes can make the condition worse.
Boys are more affected than girls and usually have the condition between the age of 8 and 12 years of age, whilst girls are more affected between the age of 10 and 12 years of age.
The Cause of the Problem
In children the heel bone is composed of two parts. These two parts are separated by cartilage. As the cartilage grows the edges of each side ‘ossifies’ and becomes bone thereby allowing the bone to grow over time.
When your child is very active and has a growth spurt, the soft tissue grows quicker than bone and extra force is put on the heel bone. This can result in an overuse injury where the achilles tendon attaches to the back of the heel. The heel growth plate swells and is painful. The swelling is sometimes seen seen at the back of the heel.
You may find that your child stops enjoying running or jumping sports and doesn’t enjoy being active.
The area marked in red is where the pain most often is located
Treatment is aimed at reducing and modifying activity levels, stretching and strengthening exercises, heel lifts and orthotics.
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Getting the right shoes for your child
Shoes are possibly the most important ‘clothing’ you buy for your child. A child can wear clothes that are too small or large, be uncomfortable but not get long term problems from them. However not wearing the right shoes can cause long term and even permanent damage to your child’s feet. Gait compensation as a result of foot pain and deformity can lead to painful knees, hips and lower backs. No wonder there are so many teenagers and young adults with painful knees and backs!
Therefore, getting the right shoes for your children is a responsibility that should be a high priority for all parents. Many parents rush to the shop, especially just before school start, and are shopping for the cheapest shoes. This is not advisable as sturdy, good quality shoes are oftentimes a little dearer. Following is a guide for parents when getting shoes for their children and also how to maintain good foot health.
- Have their feet measured by a qualified fitter. Make sure both feet are measured for size and width. One foot maybe different from the other. Buy shoes for the larger foot
- A fitting gauge is just a guide – all gauges vary in calibration – and also all shoes vary in sizes. There is no standardisation and therefore a fitter that is qualified is so important to get the right shoe for the shape of the foot
- Assessment should be made standing as the foot spreads when weight is applied
- Buy foot wear from natural materials – cotton, leather etc. These materials allow the foot to breath and mould to the shape of the foot
- Adjustable – lace, strap or Velcro fastener – across the midfoot. This allows better fit and for thicker/thinner hosiery and more room if the feet get hot and swollen
Don’t Forget to:
- not rely on the question ‘do they feel comfortable?’ for very young children. Toe and foot distortion can occur without feeling pain and cramping
- Check for fit – Childrens shoes should be professionally checked for correct fit every 3-6 weeks for infants (0-3 years), 6-8 weeks (3-4 years) and every 10-12 weeks thereafter. A qualified shoe fitter will not sell you shoes if the current ones are a good fit. Don’t be afraid to get a fitting; as they will be happy to measure and give advice accordingly. Never take advice from a shop that asks your child’s shoe size and takes your word for it without checking themselves
- Wearing new shoes can lead to blisters. Make sure they wear their shoes with socks. Their school shoes should be worn for short periods indoors before wearing them all day at school
- The shoes should bend at the big toe joint. This is important for good foot function
- Sturdy supportive sole and upper – including the heel counter
- Check your child’s sock drawer regularly and discard outgrown or misshapen socks. Check for seams that can create a knot that rubs on your child’s toes. Socks that are too small can restrict growth and circulation
- A fingers breadth of space to the longest toe of the foot
- The right shoe for the right occasion. Trainers for sport, school shoes for school, mountains shoes for hill walking and wellies for wet weather!
We are happy to see your children for an assessment. Please contact us below or
call 0203 6022640
When searching for a shoe shop with a qualified fitter go to:
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Can be pain in the toes, the toe joints or as a result of the nail units impinging on the sulcus of the toes. This are of pain can also be pain in the ball of the foot and is then called metatarsalgia. The pain can be aching, stabbing, electric ‘like’, radiating, a dull pain or bruise ‘like’ pain.
Forefoot pain is often caused by a poor choice shoe. Shoes that are:
- Wide at the toe box
- Deep enough to allow your toes to move around
- Have an adjustable strap or lace across the mid-foot to stop the foot sliding forward
- Have a firm and cushioning sole
High-heeled shoes are probably the worst type of shoes to wear if you have forefoot pain as they transfer all your body weight towards the forefoot. If you have to wear a high heeled shoe, wear one with an adjustable strap across the mid-foot. Gel pads for the forefoot can also help to alleviate pain in the ball of the foot.
Even the Tudors knew to wear sensible shoes as we can see here, an example from the recovered Mary Rose Warship. The front of the shoes are square, to accommodate the shape of the foot. Getting shoes quite as roomy as these can be difficult, but there are brands on the market that accommodate the foot to a large extent. We can discuss this when you arrive in clinic.
Can be either a soft tissue pain or a bony or osseous pain.
- An irritated nerve, otherwise called a Morton’s neuroma
- A torn or damaged plantar plate
- Flexor or extensor tendinopathy
- Distal plantar fasciitis
- Intermetatarsal bursitis
- Vascular malformation
- Stress fracture
- Plantar metatarsal pad bruising
- Foreign body
- Osteoarthritis of the metatarsal joints
- Systemic inflammatory arthritis
- Poor foot wear as mentioned earlier
- The type of foot you have; foot posture – high or low arches
- Standing for prolonged periods
- Overtraining or training on hard surfaces alone
- Moving from a ‘normal’ running strike pattern to a forefoot striking pattern
- An accident or injury during sports
- Jumping or cutting movement in sports
- Getting older as the plantar fat pad reduces with age and provides less cushioning
- Painful verrucae or corns
At Lewisham Foot Health we treat forefoot pain by assessing the cause first. This may include a biomechanical assessment with gait analysis, and an orthopaedic assessment with ultrasound scanning to check for soft and bony tissue disease.
- Foot wear modification
- Activity modification
- Orthotics or insoles
- Foot and ankle mobilisations
- Exercise prescription and home exercises
- Shockwave treatment
- Steroid injections
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Plantar fasciitis or Heel pain
Plantar fasciitis is a very common problem. So common in fact that many patient come in saying they know one or more people who have the same 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.
What is Heel Pain – in actual fact!
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 you may get pain where the circle is shown. You can also get pain along the mid-substance of the fascia – more towards the arch of the foot.
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.
What else can your heel pain be?
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 and stretching exercises. You can take NSAIDS for short term pain relief. See below:
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.
Toe Extension and Arch Massage
See us at the clinic and we can offer you a definitive diagnosis
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
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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
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