Foot Problems

Of course our aim is to reduce your pain but firstly we must establish the causative factors; tight calf muscles, a stiff, immobile ankle joint and poor lower limb control (weak gluteal muscles) must all be addressed in addition to local treatment to reduce symptoms.

Local treatment can include mobilisation of stiff joints, flexibility and strengthening exercises and provision of a night splint to improve your symptoms.

The dreaded Plantar fasciitis; characterised by first step pain in the centre, inside or back of the calcaneus (heel bone). Most common on getting out of bed in the morning and often can take up to 30 minutes to settle. It can also occur when you stand up after prolonged sitting. It may or may not be accompanied by a calcaneal spur on X-ray. It is caused by repeated micro trauma to the plantar fascia which runs from the calcaneus to the toes e.g. in bed at night our feet are relaxed and the fascia shortens.

As soon as we stand out of bed we put a load (our body weight) on the fascia. In normal circumstances, this has no ill effects but if the fascia is traumatised the immediate loading can cause micro-trauma thus precipitating the inflammatory cycle again.

Why does it occur in the first place? A stiff ankle/foot perhaps from an old ligament sprain, rapid weight gain or a sudden increase in exercise levels are all common causes of this problem.

Not confined to the “Older foot” unfortunately. As described above the foot is a mobile adaptor: however, if the arch profile drops significantly the toes must “get out of the way”. The big toe encroaches on the second toe, leading to extra bone being laid down at the base of the big toe. This thickening affects the ability of the big toe to bend as you “push-off” when walking resulting in pain and inflammation.

Physiotherapy will aim to improve the biomechanical position of the foot by addressing any flexibility or strength issues. In this case, orthotics is often necessary to improve the foot position.

Not as common in presentation these days as they were in the previous running boom of the 1980’s. Usually refers to pain at the front of the shin associated with running or fast walking. The muscles that control your foot hitting the ground are attached to the tibia (shin-bone). If they are loaded excessively they can become painful and inflamed.

Careful examination of the walking and running gait will reveal where the lack of control exists; sometimes it’s poor control of the femur (thigh bone) at heel-strike that needs to be addressed (those glutes again). Orthotics is of benefit but addressing the control issues is key to long-term solutions

As we age all our tissues thin. Our fat pads (cushioning) diminish in thickness. Our muscles lose tone and the shock absorbing structures are just not as efficient. This can result in “tender” feet. This foot problem can benefit greatly from accommodative orthotics made of a high shock absorbing material.

Orthotics are corrective devices that are placed in your footwear to:

• Provide shock absorbency and support the painful tissues
• Correct alignment issues where appropriate

We have a large range of off-the-shelf insoles in stock and custom insoles are usually ready two to three weeks after making the casts/moulds. We prefer to use the casting technique to capture the foot in its neutral or correct position. Your chartered physiotherapist will recommend what shell strength is required.

In Ballsbridge Physiotherapy Clinic, we endeavour to provide our patients with the most effective device which isn’t necessarily the most expensive one. Often an off the shelf device will correct the problem and the patient can then decide at a later date if they want to invest in the more expensive long-tern device such as the customised orthotic. For the past 13 years we have used Podiatry Products Limited, an orthotic laboratory based in Cork for the provision of our customised devices. During that time we have built up a strong relationship with the company which provides our patients with an excellent service.