Foot Pain

The foot is made up of 26 bones, 33 joints, 107 ligaments, 19 muscles AND provides the suport for the entire human body and all of its weightbearing requirements! It is nothing short of a musculoskeletal miracle!

At Resonance we are passionate about foot health, foot function and the management of foot pathology and injury. We will continue to expand this resource over time however if you have an particular area of interest, complete the contact form below and we will see how we can help.

 

Fungal nail infection (onychomycosis)

What is it:

10% of the adult population will come across a fungal nail infection at some point of their life. A fungal nail infection is when a strain of microscopic fungus invades in and around the toenail, altering the appearance of the nail. They grow and survive by eating the keratin present in your nails. They also thrive in moist, dark and warm environment which makes feet that spend a large amount of times in socks and shoes the ideal host.

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Causes/risk factors:

Fungal spores spread through air and direct contact. For the infection to occur the fungus must encounter the nail. Certain people are more susceptible to a fungal infection such as:

  • Increased age
  • Males
  • Poor circulation
  • Compromised immune system
  • Microtrauma to the nail eg: tight footwear
  • Those who wear bare feet in public areas such as pools and gyms.
  • Poor hygiene such as not changing shoes and socks regularly and not washing and drying in between toes.

 

What does it look like?

  • Yellow/white/brown appearance
  • Crumbling edges
  • Brittle
  • Thickened nail
  • The distal part of the nail separates from the nail bed

 

Self-management:

  • Wear shoes in public areas
  • Changing socks daily
  • Washing and drying in between the toes daily
  • Purchase a topical antifungal lacquer to paint onto the affected nails

 

Podiatry treatment:

  • Cut and file down the affected nail
  • Advise topical antifungal lacquers
  • Advise if oral medication could be beneficial

 

Callus

What is it:

A callus (hyperkaeratosis) is when there is thickening and hardening of the skin as a response to high areas of friction and pressure.

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What does it look like?

  • Yellow colour
  • The skin is thick and hard
  • Pain with pushing
  • Commonly found on the bottom of the foot under the heel or forefoot

 

Causes/risk factors:

Callus are formed when there is an increase of pressure and friction. This can be caused by:

  • Narrow/tight shoes
  • Biomechanical abnormalities eg: prominent bones, excessive supination or pronation.
  • Common in athletes as sport can require a lot of running, jumping, change of direction etc. This can cause extra frictional stress on the feet.
  • Structural deformities exposing the foot to high areas of pressure

 

Self-management:

  • Moisturise feet every day to soften the hard skin
  • Use pumice to smooth out the hard skin
  • Wear cushioning and supportive footwear

 

Podiatry treatment:

  • Debride the callus
  • Off load with padding
  • Orthotic to off load and redistribute plantar pressure
  • Footwear assessment and advice

 

Corns

What is it:

Corns are an area of hard skin that can contain a deep central mass or nucleus. They form as a response to pressure and always occur over a bony prominence such as a joint. There are five different types of corns, the two most common being hard and soft corns.

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Hard corns

What does it look like?

  • Hardening of skin, generally resembling the shape of a circle
  • Pain with pressure
  • Digital deformities may be present (claw toes, bunions)
  • Redness from friction

 

Causes/risk factors:
Corns are formed when there is an increase of pressure. This can be caused by:

  • Digital deformities (claw toes, bunions)
  • Narrow and shallow shoes
  • Elderly with fragile skin
  • Biomechanical abnormalities leading to abnormal high pressure

 

Self-management:

  • Wear shoes that are wide and deep to prevent friction
  • Purchase protective covering such as silicone sleeves from the pharmacy
  • DO NOT use corn pads, they can destroy healthy tissue and can cause further problems

 

Podiatry treatment:

  • Debride the corn
  • Silicone sleeves to protect the affected area
  • Footwear assessment and advice
  • Orthotic therapy to distribute the pressure

 

Soft corn

 

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Soft corns appear in between toes due to high amount of friction and tend to be soft due to a high H2O content in between toes.

What does it look like?

  • Found In between toes
  • Can have a macerated appearance
  • Pain with pressure

 

Causes/risk factors:

Corns are formed when there is an increase of pressure and friction. This can be caused by:

  • Digital deformities
  • Bunions

 

Self-management:

  • Wash and dry thoroughly in between toes
  • Avoid wearing cotton socks to prevent increase of moisture between toes
  • DO NOT use corn pads, they can destroy healthy tissue and can cause further problems

 

Podiatry treatment:

  • Debride the corn
  • Toe separators to reduce friction
  • Footwear advice and assessment

 

Athletes foot (Tinea Pedis)

What is it:

Athlete’s foot is a common skin problem caused by a fungal infection.  The fungus invades the superficial layer of the skin, and the infection remains limited to this layer. It generally effects the skin on the sole of the foot and in between the toes. The fungal infection usually begins as scaly and itchy. Over time it may cause breaks in the skin and start to cause discomfort.

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What does it look like:

  • Can be found in between toes or on the sole of the foot
  • Flakey skin
  • Redness of the skin
  • Moist peeling of irritable skin between toes
  • Clusters of blisters
  • An itchy or painful sensation

 

 

Causes/risk factors:

  • Fungal infections thrive in warm, moist and dark environments therefore it is very common to contract the fungal infection in communal areas such as the floors of public showers, changing rooms and swimming pools.
  • Wearing occlusive shoes and socks for a long period of time.
  • Sweaty feet
  • Poor immune system
  • Poor foot hygiene eg: not cleaning or drying in between toes.

 

Treatment:

  • Using an anti-fungal cream, gel or powder to fight off the infection.
  • Your GP can prescribe you with an antifungal tablet
  • Wash socks, towels, bedding and bathmats as they can contain fungal spores. Wash at over 60 degrees to ensure they are killed. Additionally, you can add tree oil or canasta washing powder.
  • Washing and drying feet and in between toes daily

 

Prevention:

  • Airing out feet if you are prone to having excessive sweat
  • Changing socks regularly
  • Keeping shoes dry
  • Wash and dry in between toes daily
  • Wear shoes in public areas eg: jandals while at the swimming pool
  • Wear ventilated shoes that allow your feet to breathe

 

Verruca

What is it?

Verrucae pedis is a very common skin condition amongst both children and adults and is caused by the the human papilloma virus. To contract the virus there needs to be a break in the skin, once the virus enters the body a benign mass is formed which then protrudes above the skin.

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What does it look like?

  • Hard rough growth
  • Yellowish colour with or without small black/red dots which are superficial capillaries.
  • Pain with squeezing
  • Can present as one or multiple on the sole of the foot
  • Can be symptomatic or non-symptomatic

 

Causes/risk factors: 

  • Verruca’s are spread by skin to skin contact or by contact with the skin shed from another verruca containing the virus. This means that they are often picked up by walking around in bare feet in public areas such as swimming pool and changing rooms.
  • Poor immune system making it harder for the body to fight off a foreign invader.

 

Podiatry treatment:

  • Debriding the verruca and applying a special agent that helps kill the virus
  • Advice on how to safely treat the verruca at home
  • Surgery to remove the verruca
  • Be cautious about over the counter treatments as they can sometimes damage skin, especially if you have diabetes or poor circulation.

 

Prevention:

  • Wearing shoes in public areas
  • Avoid contact with other verruca’s and warts from both yourself and other people.
  • Washing and drying feet daily

 

Calcaneal apophysitis AKA Severs disease.

What is it:

Severs disease is a common condition in children where there is irritation at the growth plate in the calcaneus (heel). A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. During this process, the growth plates expand and unite, which is how bones grow.

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Severs is thought to be a result of both:

  • A traction injury where the achillies tendon (tendon that attaches to the back of the heel) and the plantar fascia (fascia that attaches underneath the heel) pull in opposite directions irritating the growth plate.
  • High impact forces going directly through the growth plate.

 

Causes/risk factors:

  • Occur in children 8-14 years
  • Physical overuse
  • Poor training practice (poor warm ups and cools downs)
  • Playing sport on hard surfaces
  • Growth spurts
  • Pronation
  • Tight gastrocnemius (calf muscles)
  • Increased BMI
  • Poor footwear (lack of, or negative heel height).

 

Signs & symptoms:

  • Present with dull ache or sharp acute painin the heel
  • Absence of swelling or warmth
  • Limping and hobbling at the end of sport
  • Pain with increased activity
  • Pain settles with rest
  • Absence of night pain

 

Self-management:

  • Calf stretches
  • Icing
  • Anti-inflammatory rub through the plantar fascia, calcaneus and achillies tendon
  • Physical activity modification
  • Include a good warm up and cool down routine before and after sport

 

Podiatry treatment:

  • Footwear advice to help reduce the amount of impact going through the growth plate.
    -Strong shank through the middle of the shoe
    -Effective cushioning in the rear foot
    -10mm pitch height
  • Heel raises to shift load away from the heel
  • Orthotic therapy

 

Pain from calcaneal apophysitis may last weeks to months and may come back if the child returns to sports or strenuous activities too soon, but will completely resolve when the growth plate is no longer active.

 

Heel pain

What is it:

Plantar fasciopathy (often known as plantar fasciitis) is one of the most common foot conditions that a podiatrist sees. The plantar fascia is a fibrous band the originates the bottom of the heel and spans out across the bottom of the foot and inserts into the toes. The function of the plantar fascia is to support the arch both statically and functionally. Plantar fasciopathy is an overuse injury caused by repetitive stress on the plantar fascia. Over time this stress causes small microscopic tears in the plantar fascia resulting everyday pain and discomfort.

 

 

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Causes/risk factors:

  • The foot excessively rolls inwards when walking (excessive pronation)
  • A flat foot or a foot with a very high arch.
  • Tight calf muscles
  • High impact activities eg: soccer, tennis, netball.
  • Walking/standing on hard surfaces for long periods of time
  • Change in activity eg: increased running distance
  • Increased BMI
  • Poor footwear

Signs & symptoms:

  • Heel pain is often worst in the morning immediately after rising from bed, or after sitting for long periods.
  • Pain can stay localised to the heel or radiate throughout the arch along the plantar fascial band.
  • There is often no mechanism of injury, but instead an insidious onset.
  • The pain can be described as a dull ache or feel as if there is a stone or bruise under the heel.
  • Pain with increase of activity
  • Pain at the end of the day

Self-management:

  • Massage under the heel and along the plantar fascial band with a tennis ball, anti-flame or frozen water bottle.
  • Stretching calf muscles
  • Activity modification
  • Appropriate footwear

Podiatry treatment:

  • Footwear assessment and advice
  • Rehabilitation foot exercises
  • Strapping tape to stabilise and to rest foot structures
  • Customized orthotic therapy

 

Ingrown toe nail (onychocryptosis)

Minolta DSC

What is it?

An ingrown toe nail is where one or both edges of your nail penetrate the surrounding skin. Initially the nail may push up against the surrounding skin causing tenderness. However, once the nail enters the skin it becomes at risk of infection. Ingrown toe nails can become very painful and frustrating.

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Causes/risk factors:

  • Poor cutting technique
  • Pulling or picking nails
  • Microtrauma from shoes that are too narrow or small for your feet
  • Injury to the nail
  • The natural shape of the nail can naturally curve inwards predisposing the nail to becoming ingrown.
  • Fungal infections can thicken and widen the nail plate

 

What does it look like?

  • Tenderness
  • Redness
  • Swelling
  • Painful to touch, this can range from mild-severe.
  • Fluid/pus can be leaking out the affected side of the nail if infection is present
  • Difficulty wearing shoes or something as light as a sheet touching the nail in bed.

 

Self-management:

  • Daily warm salt water baths to prevent/help treat and infection
  • Apply an antiseptic cream to the affected area
  • See GP if infection persists for some antibiotics
  • Wear wide fitting shoes to prevent micro trauma
  • Do not pick or pull nails
  • Cut nails to the shape of the toe and do not dig down the sides.

 

Podiatry treatment:

  • Footwear advice and assessment
  • Can demonstrate proper cutting technique as prevention
  • Conservatively remove the piece of nail that has penetrated the skin
  • Preform a surgical procedure to permanently remove the offending nail spike and prevent it from growing back.

 

Ankle sprain

What is it?

Ankle sprains are acute, painful injuries that most likely occur on the outside part of the ankle. Movements such as jumping, pivoting, changing direction and tripping can cause the ligaments on the outside of the ankle to stretch beyond their normal range resulting in a teared ligament.

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Causes/risk factors:

  • Sports that require change of direction
  • Running or walking on uneven surfaces
  • Previous ankle sprains
  • Feet that are hypermobile
  • People who have high arches can often have naturally inward turned heels predisposing them to rolling outwards.
  • Wearing shoes that do not have good support

Signs & symptoms:

  • Bruising and swelling around the ankle
  • Ankle pain, this can be mild to severe
  • Difficult to put weight on the ankle
  • Stiffness and reduced function through the ankle
  • Weakness or instability in the ankle

Self-management:

Within the first 72 hours of sustaining and ankle injury it is important to:

  • R- rest the foot
  • I- ice every 20 min every 2-3 hours
  • C- compression – using a compression bandage
  • E- elevate the foot

Podiatry management:

  • Footwear assessment and advice.
  • Strapping
  • Orthotic therapy to improve stability and function
  • Ankle braces
  • Strengthening exercises

 

Achilles tendinopathy

What is it?

The achilles tendon is a thick, fibrous band that is the thickest tendon in the body. It is located at the back of your leg near the heel and connects the calf muscles (gastrocnemius, soleus and plantaris) to the heel bone (calcaneus). The achilles tendon is designed to withstand a reasonable amount of stress however, when there is an excessive amount of strain and load on the tendon it can cause the tendon fibres to become damaged and sustain microscopic tears, resulting in everyday pain and discomfort.

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There are two types of achilles tendinopathy:

Mid portion: This is the most common form of achilles tendinopathy, located above the heel bone (calcaneus). Fibres in the lower one third of the tendon have started to degenerate, thicken and swell.

Insertional: This type of achilles tendinopathy is when there is degeneration of the fibres of the Achilles tendon directly at its insertion into the heel bone.

Causes/risk factors:

Achilles tendinopathy is not typically caused by a specific injury. It commonly results from repetitive stress to the tendon.

  • Increase in training intensity
  • Sports that require a lot of jumping (dancing, basketball, netball)
  • Training on hard or sloped surfaces
  • Poor flexibility in calf muscles and hamstrings
  • High arched or pronated foot
  • Abnormal foot biomechanics that put extra strain on calf muscles and achilles
  • Unsupportive footwear

Signs & symptoms:

  • Pain and stiffness in the achilles tendon when getting out of bed in the morning
  • Pain exacerbated with running, especially uphill or on hard surfaces
  • Pain worsens with activity
  • Severe pain the following day after exercising
  • Thickening and swelling of the achilles tendon

Self-management:

  • Stop any high impact activities (eg: running up hills) or activities that initially triggered the pain
  • Icing regularly
  • Wear cushioned and supportive footwear
  • Prolonged complete rest can make the injury worse therefore It is important to restart low impact activity one the pain begins to reduce.

Podiatry treatment:

  • Heel lifts to offload strain on achilles tendon
  • Stretching and strengthening program
  • Footwear advice
  • Orthotic therapy to correct any biomechanical abnormalities that may be contributing to the pain.
  • Return to sport exercise program to ensure that you are returning to sport efficiently to prevent re-injuring.

 

 

Neuroma

What is it?

In the foot, there are nerves that run in between the metatarsals and toes called our digital nerves. A neuroma is when there is thickening of the nerve tissue. This can result in compression and impingement of the digital nerves on surrounding structures, causing nerve like symptoms such as burning, tingling and numbness.

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Causes/risk factors:

  • Narrow shoes
  • High heels
  • Reduced range of motion in the ankle joint
  • Trauma
  • Increase pressure through the forefoot when walking
  • Obesity

 

Signs & symptoms:

  • Burning, tingling, numbness that may or may not radiate.
  • Pain is typically present between 3rd and 4th toes
  • Feels like wrinkled sock
  • Pain worsens in footwear and decreases in bare feet
  • A neuroma typically presents on only one foot

 

Self-management:

  • Wearing footwear that are wide in the forefoot and do not have a high heel to prevent compression of the digital nerves
  • Tight calf muscles can restrict the amount of movement in the ankle, this can lead to increased forefoot pressure. Stretching calf muscles can help increase ankle range of motion leading to reduced forefoot pressure.

Podiatry treatment:

  • Footwear advice specific to your foot type and function
  • Adding a unique felt pad into footwear to help spread the metatarsals to prevent compression on the digital nerves
  • Orthotic therapy to offload and prevent compression of the digital nerves
  • Referral to orthopaedic surgeon if required

 

Bunions

What is it?

Bunions are often described as a bump on the side of the big toe. The bump is caused by malalignment of the big toe joint where the long bone in the foot that connects to the big toe (metatarsal) moves out towards the opposite foot, and the big toe moves in towards the little toes on the same foot. Bunions typically worsen over time and become more prominent which may lead to increased stiffness and pain.

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Common causes/risk factors:

  • Hereditary
  • Regularly wearing high heels
  • Poor footwear
  • Increasing age
  • Arthritic conditions
  • Flat or feet the pronate
  • History of trauma to the big toe

 

Signs & symptoms:

  • The most common sign is a bump forming on the side of the big toe and the big toe moving towards the little toe.
  • Redness
  • Swelling
  • Pain when moving the big toe

 

Self-management:

  • Avoiding high heel and narrow shoes. Instead wearing a shoe that is wide and deep to give the bunion enough room.
  • Icing can help to reduce inflammation and pain

 

Podiatry treatment:

  • Mobilisation techniques to maintain movement in the big toe joint
  • Padding to redistribute pressure from the bunion and reduce pain.
  • Footwear advice
  • Strengthening exercises
  • Orthotic therapy to improve foot function and slow down changes at the big toe joint.
  • Orthopaedic referral for surgical management if required

 

Plantar plate injury

What is it?

The plantar plate is an extension of the plantar fascia, it runs from the top of each metatarsal and attaches into the bottom of each toe. The plantar plate provides support to each toe and prevents it from hyper-extending, helps absorb shock and assists other structures in the foot such as the plantar fascia. Plantar plate injuries typically result in a partial tear or complete rupture and can result in pain under the affected toe which is commonly the second.

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Causes/risk factors:

Plantar plate injuries occur when the plantar plate is over loaded. This can be from:

  • Trauma, such as missing a step when walking up stairs
  • Having a 2nd toe that is longer than the first therefore predisposed to more load
  • High impact activity such as running
  • Biomechanical abnormalities that put increase strain of the forefoot (ball of the foot)

 

Signs & symptoms:

  • Pain/tenderness of the affected toe ‘like walking on a stone’
  • Swelling at the bottom of the foot
  • Pain worsens in bare feet and improves when wearing supportive shoes
  • Affected toe has lifted off the ground slightly when weight baring
  • The affect toe has separated from one of its neighboring toes creating a ‘V’ shape between the toes.

 

Self-management:

  • Wear supportive and cushioning shoes to support the affected toe. Avoid wearing high heels as it creates more load in the forefoot.
  • Icing the affected to settle the inflammation

 

Podiatry treatment:

  • Use felt padding to offload the affected toe
  • Footwear advice and assessment
  • Strapping of the toes
  • Orthotic therapy to offload the affected digit and correct any biomechanical abnormalities.

 

Pronation

Pronation is a normal motion that a foot goes through when walking and running. It can be described as the foot rolling inwards. Pronation is an important movement as it allows the joints in the foot to unlock and unwind so that the foot can shock absorb. Although pronation is a natural motion, excessive pronation can lead to problems.  Excessive pronation can affect the function and stability of the foot leading to straining muscles, tendons, ligaments and joints in the feet and legs.

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Examples of conditions related to excessive pronation:

  • Plantar heel pain
  • Posterior tibial tendon dysfunction
  • Achilles tendinopathy
  • Medial tibial stress syndrome (shin splints)
  • Knee pain

 

Supination

Supination is the opposite motion to pronation. Supination is the when the foot rolls outwards. Like pronation, supination is a normal motion the foot goes through while walking and running. Supination is important as it put the foot in a rigid position so that the foot is stable during the toe off phase in walking and running. Excessive supination however, can lead to problems. Excessive supination means that the foot is in a rigid position therefore it is unable to absorb shock. This can lead to irritation and strain of the structures in the foot and leg.

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Examples of conditions related to excessive supination:

 

  • Lateral ankle instability
  • Plantar heel pain
  • Achilles tendinopathy
  • Knee pain
  • Peroneal tendinopathy