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FOOT PAIN AND COMMON PROBLEMS
Although traumatic injuries and strains may require casts or even surgery, most foot pain can be alleviated with simpler measures. These may include:
- Proper foot hygiene
- Wearing properly fitting shoes
- Cushions or pads in shoes for comfort
- Orthotics (specially designed inserts for shoes)
- Stretching exercises before and after an activity
- Physical therapy
- Medications
 Plantar Fasciitis
Plantar Fasciitis is an inflammation of the plantar fascia, a thick fibrous band of tissue in the bottom of the foot which runs from the heel to the base of the toes. When placed under too much stress, the plantar fascia stretches too far and tears, resulting in inflammation of the fascia and the surrounding tissues. The tears are soon covered with scar tissue, which is less flexible than the fascia and only aggravates the problem.
SYMPTOMS
Pain at the base of the heel
Pain is most severe in the mornings on getting out of bed, and at the beginning of a run
The pain may fade as you walk or change running stride, in an attempt to alleviate the pain, however, this will only provide temporary relief
CAUSES
- Stress, tension and pulling on the plantar fascia
- Inflexible calf muscles and tight Achilles tendons will place more stress onto the plantar fascia.
- Overpronation (feet rotate too far inward on impact)
- High arches and rigid feet
- Incorrect or worn shoes
- Overtraining
TREATMENT
- Stop running, especially in the case of severe pain. If pain is mild, then reduce training load and intensity
- Take a course (5 - 7 days) of non-steroidal anti-inflammatory drugs (ibuprofen/voltaren/cataflam/mobic) available from your general practitioner or pharmacist
- Apply ice to the plantar fascia - for 10 minutes every 2 hours, in order to reduce the inflammation. An effective way of icing is to fill a plastic 500 ml Coke bottle with water, and to freeze it. Apply the ice as instructed by rolling the bottle under the foot
- Self-massage, using arnica oil or an anti-inflammatory gel, to the plantar fascia
- Stretching of the gastrocnemius and soleus muscles – see our page on stretching
- Return to running gradually
- Full recovery is usually between six to eight weeks
- Visit your physiotherapist if the injury doesn't respond to self-treatment in 1-2 weeks
- You may need orthotics to prevent over-pronation.
- X-rays may need to be taken in moderate to severe cases to check for a heel spur.
- Orthopaedic surgeon - if injury does not respond to physiotherapy treatment, a cortisone injection, or surgery to release the plantar fascia may be indicated.
- Do alternative exercise such as swimming, pool running, cycling (in low gear) "spinning"
- Avoid any exercise that places strain onto the plantar fascia
PREVENTION
- Stretching of the gastrocnemius and soleus muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches two - three times per day.
- Stretching of the plantar fascia. Sit on the floor with one knee bent and the ankle flexed towards you. Pull the toes back towards the ankle. Hold for 30 seconds. Relax slowly. Repeat to opposite foot. Repeat 2 - 3 times per day.
- Strengthening of the muscles of the foot. Pick up marbles or golf balls with your toes. Pull a towel towards you with your toes. Grab some of the towel with your toes and pull, then release, grab, and pull some more
- To loosen the plantar fascia, place a golf ball under the foot, and roll the foot over the ball. Start with the ball at the base of the big toe, and roll the foot forwards over the ball, then back again. Move the ball to the base of toe and repeat. Repeat for each toe. Always exert enough pressure so that you feel a little tenderness.
- Correct shoes, specifically motion-control shoes and orthotics to correct overpronation
- Always apply ice to the area after running
- Gradually progress your training programme
- Incorporate rest into training programme
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Heel Spurs
A heel spur is a hook of bone that can form on the heel bone (calcaneus) and is associated with plantar fasciitis.
About 70 percent of patients with plantar fasciitis have a heel spur that can be seen on an X-ray. However, many patients without symptoms of pain can have a heel spur. The exact relationship between plantar fasciitis and heel spurs is not entirely understood. For more information see plantar fasciitis.
Who gets heel spurs?
Heel spurs are common in patients who have a history of foot pain caused by plantar fasciitis. In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.
Why did I get a heel spur?
The plantar fascia is a thick, ligamentous connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. That's why tremendous stress is placed on the plantar fascia.
Heel spurs form in some patients who have plantar fasciitis, and tend to occur in patients who have had the problem for a prolonged period of time. While about 70 percent of patients with plantar fasciitis have a heel spur, X-rays also show about 50 percent of patients with no symptoms of plantar fasciitis also have a heel spur.
TREATMENT
See Plantar fasciitis
Heel cups
Gel heel cups are great at alleviating symptoms of plantar fasciitis and heel pain. Different patients prefer different products in the treatment of plantar fasciitis, but overall, most patients find the heel cups provide padding directly over the area of most pain. By slightly elevating the hind-foot they also help minimise pressure on the plantar fascia. Be sure to wear them in all of your shoes (work and exercise).
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Achilles Tendonitis
 Achilles tendonitis is inflammation of the Achilles tendon. The Achilles is the large tendon connecting the two major calf muscles, gastrocnemius and soleus, to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that is tendonitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.
SYMPTOMS
- Dull or sharp pain anywhere along the back of the tendon, but usually close to the heel.
- Limited ankle flexibility
- Redness or heat over the painful area
- A nodule (a lumpy build-up of scar tissue) that can be felt on the tendon a cracking sound (scar tissue rubbing against tendon) with ankle movement.
CAUSES
- Tight or fatigued calf muscles, which transfer the burden of running to the Achilles.
- This can be due to poor stretching, rapidly increasing distance, or over-training excessive hill running or speed work, both of which stress the Achilles more than other types of running.
- Inflexible running shoes, which, in some cases, may force the Achilles to twist.
- Runners who overpronate (feet rotate too far inward on impact) are most susceptible to Achilles tendonitis
TREATMENT
- Stop running
- Take a course (5 - 7 days) of non-steroidal anti-inflammatory drugs(ibuprofen/voltaren/cataflam/mobic) available from your general practitioner or pharmacist
- Apply ice to the Achilles - for 10 minutes every 2 hours, in order to reduce the inflammation.
- Avoid weight-bearing activities and keep foot elevated where possible
- Self-massage - using arnica oil or anti-inflammatory gel. Rub in semi-circles in all directions away from the knotted tissue, three times a day
- Once the nodule is gone, stretch the calf muscle gently
- Do not start running until you can do heel raises and jumping exercises without pain
- Return to running gradually
- Full recovery is usually between six to eight weeks.
- If injury doesn't respond to self-treatment in two weeks, see a physiotherapist
PREVENTION
- Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles.
- Strengthening of foot and calf muscles (eg, heel raises)
- Correct shoes, specifically motion-control shoes and orthotics to correct overpronation
- Gradual progression of training program
- Avoid excessive hill training
- Incorporate rest into training program
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 Bunions
Bunions are a common problem that most people experience as a bony protuberance at the base of the big toe. A bunion, however, is more complicated than simply a bump on the foot.
When a patient has a bunion, the big toe angles in towards the other toes, a condition called hallux valgus. Bunions are most common in women, and the cause is almost always due to unsuitable footwear.
CAUSES
Tight fitting shoes are thought to be the cause of bunions in about 90% of patients.
Shoes such as high heels are particularly damaging to the toes. These shoes have a sloping foot piece and a narrow toe box. The slope causes the front of the foot to be pushed with force into the narrow toe box. The narrow toe box causes the toes to become squeezed together.
Depending on factors such as duration of wearing constraining footwear, skeletal maturity, and individual factors, the toes can become permanently adapted to the new position and lead to the formation of a bunion.
WHY PAIN?
- Once a bunion has formed, the mechanics of the feet and toes are altered. Tendons begin to pull the toe into an abnormal position, and the problem tends to progress over time.
- Pain over the bunion occurs as the big toe becomes more and more angulated (pointing towards the other toes), the base of the toe becomes more and more prominent, thus forming the bunion.
- The bunion forms in part because of the new angulation of the toe, and in part due to inflammatory changes over the bunion surface.
- As the inflammation worsens, people can experience pain with shoe wear and walking.
- Development of a hammer toe when the big toe eventually comes to lie over, or more commonly under, the second toe. This may cause further irritation while wearing shoes, and cause more pain. The second toe of patients who have bunions commonly forms a hammer toe.
PREVENTION OF BUNIONS
- Wear comfortable shoes
- Foot muscle strengthening exercises
- Think wide toe box
- Avoid high heels
- Make sure the shoe fits
- Pad the bunion
- Orthotics can help
- Take a shoe break
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Morton’s Neuroma
A Morton's Neuroma is a benign growth of the nerve sheath of a nerve that courses between the toes. This condition is an abnormal growth, but it is not a cancer that can become a dangerous condition. Rather, the Morton's neuroma can become a painful nuisance. Occasionally, people may also experience symptoms of shooting pains or tingling extending into the toe adjacent to the neuroma. Pain is usually most significant with more strenuous activity and when wearing shoes with a narrow toebox.
TREATMENT
- Conservative Initially in an effort to decrease pain in the area of the growth.
- Most patients find removing their shoes and massaging the feet is an effective means to reduce the pain they experience.
- Wearing appropriate footwear (with a wide toebox)
- Use of so-called metatarsal pad are also effective.
- About 25% of patients will experience complete resolution of their symptoms by taking these steps.
If footwear adaptation and some mild analgesic medications do not help the situation, then surgery may be needed. Surgery is done to remove the abnormal nerve. When the entire growth is removed, the pain is usually resolved. Patients will also notice a small area of numbness in the toe. Sensation in the numb area was provided by the affected nerve and when the Morton's neuroma is removed an area of numbness will result. It is important for patients to know, prior to undergoing surgery, that about 15-20% of the time the pain will not resolve entirely following the operation to remove the Morton's neuroma.
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