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The function of the foot is to support a person’s body weight and act as a lever to propel the body forwards during walking and running. It is this motion which sometimes leads to conditions from, but not limited to, weight bearing activities.
The condition diagnosed will dictate the treatment available to you, which is why a professional diagnosis is essential to that you can begin your treatment straight away, whether that is rest, physiotherapy, the use of an orthosis, surgery or a combination of some or all of them.
Drop Foot - Drop foot is the inability to lift the ankle and toes upwards when walking. This is caused by weakness or nerve damage to the muscles in the front of the leg which creates the upwards movement of the foot. Drop foot may be a temporary condition caused by injury or nerve damage; or it may be caused by a neurological condition and can be lifelong.
Heel Pain - Heel pain is a very generic term and can cover a multitude of conditions including plantar fasciitis, stress fractures and bursitis and highlights the importance of a professional diagnosis since treatment methods will differ from condition to condition and patient to patient.
Plantar Fasciitis - The plantar fascia is effectively a shock absorber for the foot, tough bundle of tissue which resides at the bottom of the foot and is stretched every time we walk. When this tissue becomes inflamed following overuse it is known as plantar fasciitis and can be quite painful and have an impact on walking.
Diagnosis is essential in being able to determine an effective treatment programme and whilst the majority of cases can be diagnosed following an examination by a doctor it may require an x-ray to clarify.
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Despite the condition suggesting otherwise the root cause of drop foot doesn’t reside within the foot but stems from either neurological conditions (brain injuries) or damage to the peroneal nerve (which sits behind the knee and is a branch of the sciatic nerve).
The peroneal nerve runs from behind the lateral side of the knee and runs down the fibula to the foot. It consists of two branches in the deep and superficial and is responsible for providing feeling (sensation) to the front and side parts of the leg and the foot. They also work to enable dorsi flexion (lifting the toes and ankle upwards).
There are a number of conditions that can cause drop foot syndrome, either temporarily or permanently, including:
If we take a slightly more detailed look at some of the main causes of the condition.
Nerve damage in the knee: One of the main sources of problems associated with drop foot is where there is damage to the peroneal nerve. As this is located behind the knee and runs alongside the fibula any knee injury can result in damage, which is why some people may not link the two conditions. If you were to break or fracture your leg then you may run the risk of the damaged bone compromising the nerve, another reason why immobilisation and immediate medical attention should be sought in order to prevent further damage being caused. Likewise a bad sprain or twist of the knee joint can impact on the nerve adversely. Following a sprain there will be an inherent weakness in the joint and an increase in the likelihood of it happening again, which is why it is important to work on strengthening exercises and even to utilise a knee support for greater protection to avoid further sprains which could cause further damage to the peroneal nerve.
Muscular Dystrophy: A group of generative conditions, muscular dystrophy leads to the gradual weakness of a muscle. It can affect any muscle in the body and in serious cases can compromise breathing which could be life threatening. From a drop foot perspective the muscles in the leg become weaker so that the patient no longer has the strength to lift their leg / feet when walking and is something more common in elderly patients.
Strokes: Not all cases of drop foot relate to peroneal nerve damage but can result from trauma to the brain such as a stroke (or even trauma associated with the spinal code which can occur as a result of an accident). A stroke can be extremely serious (requiring immediate medical attention) and occurs where the brain is affected by a compromised blood supply.
The biggest sign of drop foot is your inability to lift your foot when walking and follow the normal gait cycle.
The below video shows the gait of a healthy individual and any deviation from this is a cause for concern.
The condition itself is not painful but the repercussions from failing to manage it could be. If you feel that you are having difficulty lifting your feet when mobile or find yourself catching your toe when walking then this is something you should seek to address.
Trips and falls are common with drop foot sufferers which can lead to further complications from bruising to broken bones and even head injuries, another reason why diagnosis and treatment is important to minimise the risk to yourself. It is worth noting that trips and falls are just as common at home as they are outside due to the number of obstacles which may be in your path from room to room.
A doctor or clinician should be able to diagnose the appearance of drop foot through a physical examination. Your gait will be analysed and your leg muscles will also be assessed to check whether there is any degradation (muscular dystrophy).
If the initial examination is not conclusive there are a number of other tests which can be undertaken, either through analysis of the peroneal nerve via an x-ray or ultrasound scan or even performing a nerve conduction test to check the response of each nerve, which in turn will identify the main source of the problem.
Complete recovery will depend on the root cause of the condition.
If the root cause is a knee injury then there is a greater chance of regaining movement (control) in the foot compared to if the condition follows a brain injury which is more neurologically based. A doctor or clinician will be able to work with you on identifying the best treatment options available to you and typically a combination of some or all of these may offer the best possible results.
In the majority of cases drop foot cannot be prevented, especially where the root cause is a neurological condition. If this is the reason for the condition then it is important to work on the exercises provided by your physiotherapy to help offer you a greater control over your mobility and at the same time using an AFO.
If there is a family history of muscle degenerative conditions then you may want to look at the same type of exercises as those currently suffering from drop foot to build up the muscles in a bid to counteract the degradation.
It is also important to understand the early signs of the condition setting in so that you are able to address it quickly.
If you have any questions regarding drop foot or any other foot problems then we would recommend speaking with your doctor or clinician.
Physiotherapy: One of the main causes of drop is muscle weakness, therefore a physiotherapist can work with you on strengthening the knee and the foot to help build up muscle which in turn will give you greater control when active. Speak with your physiotherapy before starting any exercise programme (to make sure it is suitable for you) but there is a wealth of information online on the best exercises for the management of drop foot. Knee exercises can work to offer greater control of the foot by strengthening the thighs, hamstrings and calf’s.
The following exercises are designed for Achilles tendonitis but can equally be applied for the management of drop foot by working on strengthening the muscles and ligaments in the foot region through extended range of motion actions.
Electrical Stimulation Device: This can help in some, but not all, cases of drop foot syndrome and can assist users in walking more confidently and with less effort. Electrodes are placed next to the relevant nerves and over the muscle, either externally or implanted under the skin. These will then be connected via leads to a small portable, battery operated stimulator. Triggered by a sensor worn in the shoe, an electrical impulse will stimulate the nerves to contract the muscles and lift the foot up each time it is lifted off the ground. In the case of implanted electrodes, the electrodes can be activated with radio-frequency. The electrical stimulation device can be a temporary measure or one that’s used over a number of years. For treatment of this kind, a referral can be made through a GP or consultant.
Ankle Foot Orthosis (AFO): This is a special brace or foot support worn on the lower part of the leg and ankle to stabilise and control the ankle. AFOs can significantly improve walking ability by offering stability and enhancing confidence.
There are two types of AFO:
It is normally advisable to try the different options available on the market to find the right option for you as whilst a Prolite might be perfect for one person the Foot-Up may be more suited to someone else. It is the same with most supports in that whilst they are designed to undertake a specific function it is personal preference as to which one you feel most comfortable with.
Surgery: For those with drop foot syndrome as a result of permanent paralysis, surgery may be an option. This could involve the removal of a tendon from the stronger leg to the weakened muscle, which will help the sufferer to lift their foot up more easily. Very occasionally, it may be necessary to completely fuse the affected ankle joint.
There are a number of different types of breaks of the toe bone with some severe fractures requiring a visit to your local accident and emergency department. Where the bone has broken away at an angle a reduction may be required in order to move the bone back into its original place and can be achieved via a local anaesthetic, albeit not entirely pleasant.
In more serious cases a broken toe may require surgery to realign the bone under a general anaesthetic using pins and screws to fix the toe back in place. If you have broken your big toe then it may even require a cast and for you to use crutches to avoid applying weight on it.
A broken toe can be very painful and make it difficult to apply weight to your foot and even put on your shoes, but it is a surprisingly common injury. It can be sustained from dropping something on your foot or through impact damage like stubbing your toe on an item of furniture.
In the immediate aftermath of hurting your toe it will be extremely painful and is likely to become very inflamed very quickly. In severe breaks the toe may even stick out at an angle which will be a clear indicator of the damage sustained.
It is important to note that the majority of broken toes can be managed at home and do not require medical assistance as the toe will heal naturally.
In the majority of cases your toe will heal naturally, but it can take up to six weeks before you are back to normal.
In the immediate aftermath of the injury you should elevate the foot above the heart to help reduce swelling as well as applying ice which can help manage any pain. Once the initial pain and swelling has subsided you should strap your broken toe to the toe next to it so that it acts as a splint. You should also try and refrain from applying weight to your foot but when you do, wear footwear which are sturdy and avoid placing too much pressure on the affected toe.
If you are unsure as to the extent of the damage then an x-ray at hospital will confirm this.
In the vast majority of cases you will not need to see a doctor or visit the hospital but there are occasions where medical attention should be sought.
You should see a doctor if the pain fails to subside as you may need more powerful painkillers which can help, likewise if the swelling fails to subside after a few days then anti-inflammatories may be required.
A visit to the hospital may only be required where there is suspected nerve damage and you experience a tingling sensation in your toes as the condition may need to be investigated further, likewise if you suspect you have severely damaged your toe.
Pain in your feet, and in particular, your heels can be incredibly debilitating, especially if it prevents you from walking properly.
If you suffer from heel pain, you are not alone, as it’s a very common condition. You might find that it builds up, and you will often notice that it’s only prevalent in one foot.
Heel pain can be very frustrating and inconvenient when active. The root cause of heel pain can be from a variety of conditions, of which plantar fasciitis is probably one of the most common and accounts for about four in five cases. Other conditions contributing to heel pain include stress fractures, bursitis and tarsal tunnel syndrome.
Plantar Fasciitis: The condition plantar fasciitis is used to describe damage to the plantar fascia, which is the thick band of tissue connecting the heel and the foot. When this becomes either damaged or thickened then a patient will typically experience pain and discomfort in the heel region. The condition can be brought on from either a sudden injury or from gradual wear and tear which is more common amongst the over forty demographic. A sudden injury can occur when active, where damage to the heel is caused as a result of running and even dancing and is more common amongst the younger demographic.
There can be an increased risk of plantar fasciitis for those who are overweight, have a job requiring long periods of standing up or from wearing flat shoes. These elements can contribute to the degradation of the plantar fascia leading to problems in later life, which is why it is always important to look after yourself, stay fit and wear appropriate footwear.
Stress Fracture: Typically as a result of impact damage a stress fracture occurs where there is damage sustained to the heel bone. This can occur as a result of landing awkwardly or from a height or from an impact such as a football challenge. This can be very painful and may require surgery to remedy the problem leaving you immobile for a greater period of time.
Fat Pad Atrophy: Beneath the heel there is a layer of fat referred to as the fat pad. Heel pain occurs where this layer begins to wear away and reduce the amount of cushioning in the heel, thereby causing pain. This condition is gradual and typically experienced by wearers of high heel shoes, where too much pressure has been placed on the fat pad in the first instance.
Bursitis: A bursa is a small fluid-filled sac which reside under the skin between bones and tendons throughout the body. Bursitis occurs where these sacs become inflamed, thereby restricting movement of the joint and causing the patient pain. The condition itself can be experienced in any joint throughout the body, with the heel and elbow the more common places.
Tarsal Tunnel Syndrome: Tarsal tunnel syndrome is a nerve damage related condition. The nerves from the sole of your foot are connected to the ankle joint through a small tunnel referred to as the tarsal tunnel, with any damage sustained to this tunnel leading to compression of the nerves which can be the root cause of pain experienced by the patient. The nerves within the foot cover a large area, therefore the pain can be centred at any point from the sole of the foot to the heel to around the ankle joint.
Sever's Disease: Sever’s disease is typically a children’s condition as a result of a combination of growth spurts and sports activities which stretch and tighten the tendons within the hamstring and calf. A stretching calf muscle pulls on the Achilles tendon which in turn pulls on the growth plate on the back of the heel, thereby causing the patient pain.
Peripheral Neuropathy: Where a patient complains of numbness or a tingling sensation within the foot it could be a sign of peripheral neuropathy or nerve damage and you may be referred to a specialist for it to be investigated before an official diagnosis is given.
Bone Infection: The symptoms of a bone infection is a high temperature in the actual foot, seeing temperatures of 38 degrees and above and typically considered as a fever. Osteomyelitis, as it is referred to medically, is typically caused from bacteria resulting in a high temperature, pain in the actual bone and swelling and inflammation of the affected area.
Arthritis: If your complaint of heel pain is through stiffness and swelling of the heel area then the root cause of the issue could be arthritis. You may be sent for further tests including an X-ray before this is determined, from which there are a variety of treatment options available to help manage the condition and enhance your levels of activity. People with pain in their heel normally get better within a year and only 5% of people with the condition will require surgery. Pain can be relieved and recovery aided by a combination of different treatments such as analgesics and stretches.
This type of pain is usually at its worst first thing in the morning or if you’ve been sitting or lying down for a long time, and you might find that being mobile helps to lessen the pain. You could also try a foot support, so it isn’t too painful to put your weight onto the affected foot.
Pressures over time on our feet and heels can cause a thickening of the plantar fascia; this is the name of the tissue band which is underneath your feet. It’s extremely tough and flexible but can develop tears or damage, either over the years or as the result of a sudden injury.
If you’re suffering from heel pain, you can visit your doctor or foot specialist, known as a podiatrist, who will examine your feet and try to ascertain the root cause of your problem.
Heel pain is uncomfortable, to say the least, but that’s not to say you have to live with it. You can help to relieve your pain and aid recovery by following a few simple tips:
Usually your heel pain will disappear, although around 5% of cases will need surgery.
As well as following the above advice for relieving your pain, there are some things you can do to help yourself in preventing it from occurring in the first place. It’s always a good idea to stay at a healthy weight for your height, so a balanced diet and plenty of regular exercise will work wonders (this applies to your overall health and not just your feet). It’s also very important to make sure you are wearing the right type of shoes or other footwear, avoiding high heels and shoes without any heels, and opting for choices with plenty of support and cushioning.
Footwear is an important factor in giving you healthy feet as the wrong footwear for the wrong occasion can cause injury and heel pain. You would never go hiking wearing a pair of flip flops, likewise you would never go running in a pair of hiking boots which is why it is important to select footwear designed for your specific task.
Women’s footwear is something which will always be highlighted where heel pain is concerned and whilst the use of high heels sparingly can have little impact on your feet, constant use can lead to problems and heel pain from a number of conditions. The condition can be worsened from continual walking or standing when wearing high heels.
Sports shoes are designed to offer protection of the foot and cushioning, which is essential when running on hard surfaces. It is recommended however that you should replace your shoes every 500 miles to ensure that they continue to give you to right level of protection. The majority of sports shops will assess your running style to offer you the right style of shoe to ensure you are fully protected which can help to minimise the risk of injury.
A common foot injury is tibialis posterior pain. This condition can result in acquired flat foot and cause subsequent pain. The tendon can rupture, partially tear or become inflamed. The inside of the ankle can become quite painful.
Although the condition can be triggered by a direct trauma to the tibialis posterior tendon, such as a kick, it more frequently occurs over time with overuse and insufficient foot support. Foot pain is especially common in people who over pronate (where the foot rolls inwards) as this puts extra strain on the tendon.
It is really important that the tibialis posterior tendon functions correctly as it plays an essential role in providing arch support to the foot. If ignored, problems with the tibialis posterior tendon can progress into a full rupture, which will then require surgery to repair. Therefore pain or discomfort in the foot or heel area should never be ignored and treatment should be commenced as soon as possible.
A significant issue arising from untreated problems with the tibialis posterior is foot pain, fallen arches and acquired flat foot. This condition can lead to mobility problems, particularly in older people.
Tibialis Posterior Dysfunction can occur when commencing a new programme of exercise. It can also develop when increasing the intensity or frequency of an activity. Therefore, care should be taken to plan a programme which includes rest breaks and gradual steps up in intensity.
Foot pain is felt on movement, especially when the foot is pushed downwards or the sole of the foot is flexed inwards.
The tibialis posterior tendon is attached to the navicular bone, located approximately where laces are tied. As well as the tendon itself, this area can also become extremely sore to touch. The area behind the inside ankle bone can become swollen and painful and will often make a distinctive 'creaking' noise when the ankle is moved.
Unfortunately, because tibialis posterior tendon issues often occur as a result of abnormal mechanics of the lower leg, a physiotherapy assessment is usually required. Over pronation, or more rarely, a dysfunction of the ligaments supporting the inner foot, can cause overstrain of the tibialis posterior tendon. If this is the case, the sufferer can benefit from wearing a foot support or brace to reduce the stress on the tendon and increase mobility.
A strengthening programme may be recommended which, when carried out under the supervision of a physiotherapist can enable a safe and gradual return to previous activities.
Tibialis posterior dysfunction can be treated with PRICE in the early stages.
It may be necessary to take Non-Steroidal Anti Inflammatory drugs (NSAIDs) or apply an anti-inflammatory gel to relieve pain and discomfort.
Very occasionally, where the condition is longstanding, an injection of local anaesthetic and corticosteroid, followed by a period of immobilisation, can reduce symptoms.
The plantar fascia is a tough and fibrous bundle of tissue stretching from the heel of the foot to the toes.
It is the principal support for the arch of the foot and is stretched every time we take a step, acting as a type of shock absorber for the sole of the foot. When the tissue of the plantar fascia becomes inflamed it is known as plantar fasciitis.
One of the first symptoms of plantar fasciitis is foot pain, usually experienced towards the heel at the base of the foot, although it can make itself apparent throughout the length of the tissue bundle. The use of appropriate foot support is recommended as soon as possible in order to stretch and realign the plantar fascia. Wearing a good quality support for the arch of the foot is important as it keeps the foot correctly aligned and can prevent further damage to the structures of the sole of the foot.
There is not always an obvious reason for the pain, but it is usually due to overstretching of the plantar fascia or other damage causing minute tears to the ligament-like structure. These tears cause the plantar fascia to become inflamed and thickened, which causes pain and difficulty in walking. People who spend a lot of time on their feet are more at risk, as are those carrying excess weight, which can cause additional strain on the structures of the foot.
A doctor or podiatrist will usually confirm the diagnosis after examination of the foot, but in some cases an x-ray or scan may be required to pinpoint the inflammation with great accuracy. Although the condition tends to clear up on its own after a period of rest and appropriate support, there are ways of relieving the foot pain and speeding up recovery.
Acute cases of foot pain can be relieved through paracetamol and non-steroidal anti-inflammatory medicines (NSAIDs). An adequate period of rest is usually recommended along with an appropriate foot support, which provides cushioning for the inflamed areas and exerts gentle pressure on the foot to stretch the tissue.
Severe pain in the foot can be relieved through the application of ice packs, but make sure to avoid placing ice directly on the skin. Cushioned insoles can help to provide additional shock absorption and minimise pain. Gentle stretches which pull the toes upwards towards the body encourage the plantar fascia to stretch out and can help to speed healing and recovery.
Foot pain associated with plantar fasciitis can last for up to a year, although most people experience relief sooner provided that they abide by the recommendations of their medical practitioner or sports physiotherapist. Wearing a high-quality foot support can speed healing as it encourages the fibrous tissue to align correctly and repair itself, although in extremely severe cases surgical intervention may be required.
The human foot has five metatarsal bones and about 30% of foot injuries are metatarsal fractures. Over the last few years, a number or prominent athletes have had metatarsal fractures, and this has made it a well-known injury.
A metatarsal fracture or broken foot can happen as a result of overuse, excessive rotation force or through direct trauma.
There are two common types of metatarsal fracture:
The patient will need an x-ray to confirm if there is a fracture, where it is and if the bones are still aligned.
Treatment for a metatarsal fracture is dependent upon its location and the type of fracture.
For acute metatarsal fractures, as long as the bones have remained properly aligned, the foot will be immobilised in a cast. Often a removable cast is used. Weight bearing will be restricted for about 6 to 8 weeks.
However, research suggests that a fifth of metatarsal stress fractures do not heal as quickly or easily. In some circumstances therefore, it may be necessary for the bone to be fixed surgically. The foot may need to be immobilised in a special shoe or cast for several weeks while the fracture heals. It may take some six to twelve weeks until previous activities can be resumed without foot pain.
Pain medication, such as non-steroidal anti-inflammatory (NSAIDs) or paracetamol may be prescribed to minimise foot pain following a metatarsal injury. Ice therapy and elevating the affected foot can also be helpful to reduce pain and swelling.
Physiotherapy may be required to get the foot and ankle moving again after a metatarsal injury, especially for those who have had their foot immobilised in a non-removable cast. Activity levels should be built up slowly to prevent further injury. It may be necessary to wear a foot support until strength and stability has been regained.
Wearing a foot support can minimise the chances of sustaining an injury to the metatarsal bones, especially for those with foot pain or people taking part in sporting activities.
There are several ways you can reduce the risk of a metatarsal injury:
Never ignore foot pain and seek medical advice as soon as possible. Finally, wear a foot support, especially when participating in high impact activities or contact sports.
The Achilles tendon connects the calf muscles to the heel. It is the largest tendon in the body and can withstand large forces. However due to the amount of activity encountered by the tendon it is one of the most common ankle injuries resulting from overuse injuries. The low blood supply to the tendon also means that recovery can be slow.
Achilles Paratendinopathy is the inflammation or damage of the membrane surrounding the Achilles tendon. This can be a chronic condition, caused by overuse, and will be painful during exercise but not necessarily at times of rest. Alternatively the injury can be caused instantly if too much strain is placed on the tendon.
Achilles Tendinopathy is damage to the fibres of the tendon. Again this is often referred to as Achilles tendonitis. Ankle injuries of this nature are usually caused from long term stress to the tendon, the damage may be increased if there is a sudden rise in activity, or the person has tight calf muscles; placing more stress on the Achilles. The damage can occur in the middle portion of the tendon, usually in younger, more active people. Injury can also occur where the tendon connects with the heel, this can occur at any time whether the patient is active or not. Additional bone growth at the heel (bone spurs) can rub and damage the tendon.
Achilles Paratendinopathy will result in pain and swelling at the point of the damage. This condition will often be referred to as Achilles tendinitis.
Symptoms of Achilles tendonitis include pain along the Achilles, pain during and/or following exercise, thickening of the tendon and swelling which increases during activity.
In the event of such an injury it is advisable to seek medical advice. To check the extent of any damage an ultra sound may be required from which a decision can be made on the most appropriate form of treatment.
When pain occurs in the tendon it is important to rest, either completely or by switching to low impact exercise such as swimming or cycling. This will give the tendon chance to heal and stop any further fibre damage. Using ice on the tendon should help with pain and inflammation. As will anti-inflammatory medication, although this will not reduce the thickening of the tendon which is caused by damage.
Physiotherapists will be able to inform people with Achilles pain on how to carry out simple stretches and strengthening exercises which should ease the stress on the tendon. Shoe inserts can help to lift the heel and relieve some of the strain placed on the tendon. A walker boot may also be prescribed to rest the tendon if severe pain is being suffered or an ankle support worn during recovery for added stability and protection.
Foot pain can be a serious problem for those affected, but there are a number of options available in terms of supports and braces to help limit its impact on daily life.
Our specialist team are on hand to provide further information or answer your questions and queries on foot injuries. Getting in touch is simple, either call us on 0845 006 40 40, email us, chat to us online using our Live Chat function or fill in our contact form and we will get back to you.