Foot

At Walker and Hall we know through personal experience how any condition affecting the foot can have an enormous effect on every aspect of your life e.g., from standing and walking, to commuting to sports and leisure activities.

The most common types of foot pain we treat are

Plantar fasciitis
Fractured heel bone – calcaneal fracture
Morton’s neuroma
Stress fractures
Referred pain

If your condition is not listed above please contact us

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please see below:

Plantar Fasciitis (also known as Heel Pain, Heel Spurs, Painful Heel Syndrome)

This is a condition characterised by damage and inflammation to the plantar fascia on the sole of the foot and it is the most common cause of heel pain we treat at Walker and Hall.

We know through experience that it responds well to the appropriate physiotherapy treatment.

Anatomy

The plantar fascia is the thick sheet of connective tissue (fascia) which supports the inner arch on the bottom (plantar aspect) of the foot. It runs from the heel bone (calcaneum) forwards to the base of the toes (heads of the metatarsals).

During walking or running, tension is placed through the plantar fascia. When this tension is excessive – often due to poor foot biomechanics such as flat feet, or if it is too repetitive or forceful, then damage to the plantar fascia can occur. This damage is accompanied by inflammation and degeneration and it normally occurs at the attachment of the plantar fascia to the heel bone.

Occasionally, a heel spur may develop in association with plantar fasciitis.

Causes of plantar fasciitis

  • Repetitive or prolonged activities – it is common in any activity that places strain on the plantar fascia e.g., running, dancing and gymnastics. It may also occur with excessive walking – especially up hills or on uneven surfaces and with older people who tend to spend more time on their feet. It frequently occurs in association with calf muscle tightness, inappropriate footwear and biomechanical abnormalities e.g., excess pronation (flat feet) or supination (high arches)
  • Trauma – it may occur suddenly due to a high force going through the plantar fascia beyond what it can stand e.g., a sudden acceleration or a forceful jump

There are a number of factors which can predispose you to plantar fasciitis and these include

  • poor foot posture – especially flat feet
  • foot or ankle stiffness
  • muscle tightness – particularly in the calf
  • inappropriate or excessive training
  • being overweight
  • poor biomechanics
  • inappropriate footwear
  • inadequate warm up
  • muscle weakness
  • leg length differences
  • poor proprioception or balance
  • poor core stability

Signs and symptoms of plantar fasciitis

  • Pain and stiffness – mainly felt underneath the heel and along the inner aspect of the foot. In less severe cases you may only experience an ache or stiffness in the plantar fascia or heel that increases with rest, especially at night or on waking first thing in the morning. Activities which place stress on the plantar fascia may include standing, walking or running excessively – especially up hills, on uneven surfaces and in poor footwear, jumping, hopping and general weight bearing activity. The pain may also warm up with activity in the initial stages of injury. As the condition progresses you may experience symptoms that increase during sport or activity, affecting performance.
  • Walking with a limp – mainly seen in severe cases and you may even be unable to bear weight on the affected leg

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the plantar fasciitis. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for plantar fasciitis are

  • R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and Elevation (providing this is comfortable)
  • Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, gentle ankle and heel joint mobilising techniques and soft tissue massage to reduce pain and muscle spasm
  • Advice with regards to the use of heel padding, heel wedge or heel cup
  • Advice with regards to the use of crutches
  • Arch support taping
  • Footwear assessment and biomechanical correction e.g., the use of orthotics
  • Home exercise programme – a graduated flexibility (particularly of the calf muscles), strength and balance to ensure an optimal outcome
  • Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Fractured heel bone – (also known as Heel Fracture, Calcaneal Fracture, Fractured Calcaneus, Broken Calcaneus)

This is a condition characterised by a break in the heel bone of the foot, known as the calcaneus.

It is a condition we treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.

Anatomy

The heel bone (calcaneum) is located at the back of the foot and is responsible for transferring weight from the ankle to the ground during standing, walking and running activities. It is located below one of the ankle bones (talus) and with this bone it forms the subtalar joint. It also forms joints with several other bones in the foot including the navicular and cuboid.

During certain activities, such as landing on the heel bone from a height or when rolling an ankle, stress is placed on the calcaneum. When this stress is traumatic, and beyond what the bone can withstand, a break in the calcaneum may occur. This condition is known as a calcaneus fracture.

Because of the large forces required to break the calcaneus bone, this condition often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Calcaneus fractures can vary in location, severity and type including stress fracture, displaced fracture, un-displaced fracture, comminuted fracture etc.

Causes of a calcaneus fracture

  • Trauma – this is the main cause of a calcaneal fracture and is usually the result of a large traumatic force being applied to the heel e.g., landing on the heel bone from a height – such as falling off ladders or a roof
  • Overuse – often associated with a recent increase in running / training and may cause a stress fracture of the calcaneum
  • In association with other ankle / foot injuries – because of the large forces required to break the calcaneal bone, this condition may occur in association with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg

Signs and symptoms of a calcaneus fracture

  • Pain – usually experienced as a sudden onset of sharp, intense heel pain at the time of injury. It often causes you to limp or attempt to walk without placing weight on the heel. In severe cases you may be unable to weight bear at all. It is usually felt in the heel region although may spread to the sides and occasionally to the front of the ankle. The pain may settle quickly with rest leaving you with an ache in the heel that is particularly noticeable at night or on waking. The pain may increase during certain movements of the foot or ankle, when standing or walking – especially on uneven surfaces, when placing weight through the heel, putting shoes on or when attempting to stand or walk
  • Swelling and bruising
  • Pins, needles and or numbness in the ankle, foot or toes

How Walker and Hall can help you

Treatment for a calcaneal fracture depends whether the fracture is undisplaced i.e., where the two ends of the bone remain in contact or displaced i.e., where the two ends of the bone are separated from each other.

For a displaced fracture, treatment involves re-alignment of the bone by careful manipulation under anaesthetic, followed by surgical internal fixation to stabilize the fracture e.g. use of screws. This is followed by the use of a plaster cast or similar and the use of crutches for a number of weeks.

For an undisplaced fracture treatment involves immobilisation in a plaster cast or similar and the use of crutches.

With either type of fracture once the immobilisation has been removed, a thorough musculoskeletal examination will be required following which a treatment plan devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a fractured calcaneum are

  • Advice with regards to the use of crutches
  • Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, and soft tissue massage to reduce pain and muscle spasm
  • Joint mobilising techniques including muscle tension techniques
  • Home exercise programme – a graduated flexibility, strength and balance to ensure an optimal outcome
  • Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Morton’s Neuroma (also known as Morton’s Metatarsalgia, Morton’s Neuralgia, Plantar Neuroma)

This is a condition characterised by localized swelling of the nerve and soft tissue located between two of the long bones of the foot (metatarsals).

It is a condition we treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.

Anatomy

The foot comprises many small bones, five of which are long bones called the metatarsals and are situated side by side running from the middle of the foot to the toes. Between these bones are nerves, the interdigital nerves, which supply sensation and muscle power to the toes.

During certain activities, particularly weight-bearing activities e.g., walking and running, a compressive force is sometimes placed on the interdigital nerves and the surrounding soft tissue between the metatarsal bones – this can often happen when you are wearing tight fitting shoes or if you have flat feet. If this force is repetitive and beyond what the nerve and soft tissue can stand, swelling of the nerve and soft tissues may occur. This can result in pain, tenderness, pins and needles or numbness in the forefoot or toes. When this happens it is known as a Morton’s neuroma.

This type of neuroma most commonly occurs between the 3rd and 4th metatarsal bones and is more common in women than men. It may occasionally affect both feet at the same time.

Causes of a Morton’s neuroma

  • Repetitive weight bearing activity – this is the most common cause of the neuroma and includes activities such as walking and running, particularly when combined with tight fitting shoes or excessive pronation of the feet i.e., flat-feet
  • Forefoot instability – an unstable forefoot allows excessive movement between the metatarsal bones
  • Trauma, foot deformities and the presence of a ganglion or inflamed bursa – all these conditions may increase compressive forces on the nerve

There are a number of factors which can predispose you to a Morton’s neuroma and these include:

  • inappropriate footwear – particularly tight shoes or high heels
  • poor foot posture – flat feet
  • forefoot instability
  • poor flexibility – particularly of the ankle joint, the subtalar joint or the calf muscles
  • inappropriate or excessive training or activity
  • inadequate recovery periods from training or activity
  • poor biomechanics
  • certain foot deformities
  • local trauma
  • the presence of a ganglion or inflamed bursa in the area
  • poor proprioception or balance

Signs and symptoms of a Morton’s neuroma

  • Pain – usually experienced as a sharp, shooting and or burning pain and felt at the base of the forefoot or toes. It may radiate into the two affected toes and occasionally into the foot. The pain is usually increased by forefoot weight bearing activities – such as running, with narrow-fitting footwear, or with high heeled shoes
  • Swelling – may be seen and felt at the site of injury
  • Pins, needles and numbness – may be felt in the forefoot and or toes

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the Morton’s neuroma. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for Morton’s neuroma are

  • Footwear advice – including the use of orthotics and metatarsal padding
  • Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, and soft tissue massage to the calf and plantar fascia to reduce pain and muscle spasm
  • Joint mobilising techniques – to the ankle, subtalar joint, midfoot and forefoot
  • Foot taping techniques
  • Neural stretches
  • Home exercise programme – a graduated flexibility (particularly of the calf muscles), strength and balance to ensure an optimal outcome
  • Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Stress Fracture of the Foot (also known as Foot Stress Fractures)

This is a condition characterised by an incomplete crack in one of the foot bones.

It is a condition we treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.

Anatomy

The foot comprises many small bones. Seven are located in the rear foot and are collectively known as the tarsals, five are located in the middle of the foot and are known as the metatarsals and the toes comprise several small bones known as the phalanges. Each bone within the foot forms a joint with the adjacent bones.

The bones of the foot provide attachment points for the many muscles of the lower leg and foot and when these muscles contract, a pulling force is exerted on the respective bone. In addition, weight bearing activity places stress on the bones of the foot. When these forces are excessive or too repetitive, and beyond what the bones of the foot can stand, bony damage will gradually occur. This may initially result in a bony stress reaction, but with continued damage it may progress to a stress fracture of the foot.

Cause of a stress fracture of the foot

  • Excessive weight bearing over time – activities such as distance running, sprinting, jumping and dancing can all cause a stress fracture of the foot
  • An increase in activity or change in training conditions – such as surface, footwear or technique changes
  • Trauma – landing on a hard surface from height

There are a number of factors which can predispose you to a stress fracture and some of these include:

  • inappropriate or excessive training – particularly on hard or uneven surfaces
  • poor foot posture – especially flat feet or high arches
  • poor biomechanics
  • muscle weakness – particularly of the gluteals, quadriceps, calf and core stabilisers
  • muscle fatigue
  • poor balance
  • poor flexibility – particularly of the calf muscles
  • joint stiffness – particularly of the ankle, heel or foot
  • inappropriate footwear
  • poor running technique
  • inadequate diet
  • leg length discrepancies
  • being overweight
  • menstrual disturbances

Signs and symptoms of a stress fracture of the foot

  • Pain – usually experienced as a localized pain in the foot, toes or ankle that increases with impact activity – such as running, jumping and sprinting, and may decrease with rest. It may radiate to other areas of the foot that are not specifically involved in the injury. In severe cases, walking or standing may be enough to aggravate symptoms. Other symptoms may include night ache or pain on firmly touching the affected bone.
  • Limp – noticeable as the symptoms worsen and may lead to having to stop the activity altogether

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the stress fracture. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a stress fracture are

  • Footwear advice – including the use of orthotics
  • Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, and soft tissue massage to the calf and foot to reduce pain and muscle spasm
  • Joint mobilising techniques – to the ankle, subtalar joint, midfoot and forefoot
  • Foot taping techniques
  • Neural stretches
  • Home exercise programme – a graduated flexibility, strength and balance to ensure an optimal outcome
  • Advice with regard to a graduated return to active sport depending upon the improvement achieved during treatment
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Referred Pain

Not all pain experienced in the foot is necessarily coming from the foot. Occasionally pain felt in the foot can be referred or caused by a problem in another area of the body such as the back or spine. This is called referred pain.

What is Referred Pain?

Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.

What structures can refer pain into the foot?

The following structures have the ability to refer pain into the foot

  • The lumbar and sacral spines (from the 4th Lumbar vertebra to the 2nd sacral vertebra – L4 to S2). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a foot problem.
  • The hip joint
  • The knee joint
  • The ankle joint
  • The muscles of the hip and pelvis area
  • The muscles of the thigh
  • The muscles of the lower leg

How can Walker and Hall help you distinguish between a foot problem and referred pain?

At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for your foot symptoms.

It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.

You will be involved in all stages of your treatment given every opportunity to ask questions.