For treatment of foot or heal pain to be successful, accurate diagnosis is vital. There are lots of generic or ‘umbrella’ terms applied to pain in this area. We use a series of targeted questions coupled with a highly detailed examination to assess underlying causes for your pain. There is no ‘one size fits all’ solution to foot pain, you must be assessed as an individual and your body movements must be understood to provide accurate long term relief.
“I have recently invested in a pair of insoles from Ian at Norfolk Biomechanics Clinic after suffering from several years of foot and lower leg pain. This was brought around due to many years of sport including rugby and road running and suffering injuries and breaks. I have had one set of insoles off the shelf before, but these purpose made insoles and Ian’s direction and exercise have been the biggest improvement I have seen in years.”
Grant Houlden Former manager Next Generation Gym and east county rugby union second row.
Bunions and other toe deformities
The movements in your toes are the last in a long sequence of events, that allow you to stand, walk and run. Toe deformities are often connected to a postural problem elsewhere in your body, and are an early indicator to poor Biomechanics.
Bunions (Hallux Abducto-Valgus)
This condition is when your 1st Metatarsal (the long bone leading up to your big toe joint) is forced to deviate towards your other foot. It is often caused because of poor Biomechanics and unstable foot function, and leads to uneven pull between the muscles in your foot and your big toe (Hallux). This uneven action causes your big toe to pull towards your other toes, over time this abnormal position causes wear and tear to the joints and arthritis.
People suffering from Rheumatoid Arthritis are at much greater risk of developing bunions, you are also at risk if you run for long periods of time or wear poor fitting shoes. Evidence also indicates that this risk is progressive and will increase as you grow older.
By identifying the cause of your underlying poor biomechanics or unstable foot movements the progression of your bunion can be reduced by more than 70% and your pain greatly reduced or eliminated altogether.
Other conditions such as Hallux rigidus (bony restriction of big toe functions) or limitus (soft tissue restriction) are often diagnosed as a bunion. Again specific diagnosis and investigation to find the underlying cause are key to treatment.
Hammer Toes and other lesser toe deformities.
The muscles that control your toes are divided into those that originate in the calf and lower leg and those that originate in the foot. Lesser toe deformities are commonly caused by these muscles being used in the wrong way. If the muscles in your foot are weak or your foot is unstable due to poor biomechanics anywhere in your posture or gait, the function of your toes will be impaired and over time the toe position becomes fixed and possibly arthritic.
If your foot, ankle or general gait Biomechanics are not working properly the controlling toe muscles that originate in your lower leg can be recruited to help. This pulls the toes out of position and again over time the position becomes fixed and arthritic. The earlier this can be identified and treated the better. The key to treatment is to identify the underlying poor posture or biomechanics and using foot scanning pinpoint the precise time at which the muscle is used. By re-timing the events of the foot and ankle, proper function can be restored.
For more information about how you get injured and how to recover from injury see the science bit.
Metatarsalgia
Metatarsalgia is an ‘umbrella’ term use to describe pain in the front part of your foot. To provide treatment a specific diagnosis is required and the underlying cause identified. Common ‘metatarsalgia conditions include;
Capsulitis and/or Sinovitis
The joints that connect your toes with the rest of your foot (Metatarsal Phalangeal joint) is held in place and supported by a complex joint capsule. This capsule is lined with a membrane producing synovial fluid that lubricates the joint. If this structure is repetitively overloaded it causes inflammation in the joint capsule and the feeling of “walking on a pebble”. This condition is often related to Bunions or other toe deformities causing increased load on the joint, but may be related to poor Biomechanics anywhere in your posture or gait.
This condition may progress if left untreated causing rupture of the capsule and toe deformity. Depending on the cause of the pain and how long it has been there your Biomechanics can be improved and your load redistributed away from your poor joint.
Neuritis and Neuroma
Irritation or damage to the nerves that run between your metatarsals and into your toes can cause them to become inflamed (neuritis). If this persists the cells around your nerve that help the nerve signal transmission enlarge and become less effective (Morton’s Neuroma). These conditions give rise to the feeling of burning or numbness in the ball of your foot and your toes.
This can be secondary to some of the other conditions mentioned on this page or primary due to poor foot Biomechanics or badly fitting shoes. The underlying cause of the condition must be found and eliminated, it is unlikely to go away on its own.
Other Metatarsalgia conditions include;
Sesamoiditits – the inflammation of the little bones that sit under your big toe joint and help it to work more efficiently.
Fractures – these can occur in any of the metatarsals in your foot or to the sesamoids.
For more information about how you get injured and how to recover from injury see the science bit.
Plantar fasciitis and heel pain syndromes
Plantar fasciitis is when the tough band of fascia, which gives shape and stability to the long arch of your foot, degenerates with the appearance of micro tears. It is not an inflammatory condition so anti-inflammatory drugs and steroid injections have little effect. The term plantar fasciitis is often used as an ‘umbrella’ term for pain in the heel or even pain in the foot or ankle. There are a lot of soft tissue structures that attach into your heel and lay under your arch. If any of these become inflamed you will suffer pain on rising from rest thatpasses after a period of walking then returns towards the end of the day, sited as the symptoms of plantar fasciitis.
Plantar Fascitis is an ‘umbrella’ term given to the following:
Heel spur
This is a bony protrusion from your heel bone caused by repeated overloading of the plantar fascia and other structures, leading to a prolonged cycle of damage and repair. However approximately 10% of the general population have a heel spur which is not giving them pain. Therefore your heel spur may not be the cause of your pain. Individual biomechanical assessment is required to find out what is causing your pain.
Fat pad problems
There is a thick pad of fat under your heel which has a good blood supply so that every time your heel hits the ground it has a good cushion. With age, and other conditions, this pad can become thin and its blood supply reduced. This leaves the structures beneath open to damage. The fat pad itself may also become inflamed.
Policeman’s heel
As well as your fat pad you also have a Synovial bursa (fluid filled cushion) under your heel bone. As a result of fat pad thinning or biomechanical problems this can become inflamed.
Nerve problems
There are several nerves and their offshoots that run under or around your heel. Your heel pain could come from damage to the nerve under your heel or even from a problem with your back or sciatic nerve.
Muscle problems
Several other muscles insert into your heel or run passed it so an inflammation of one of these may give you heel pain.
One or more of these conditions may be playing a part in your heel pain. Accurate diagnosis and assessment of your bodies Biomechanics is essential to the treatment of your heel pain.
For more information about how you get injured and how to recover from injury see the science bit.
Flat and high arched feet
If you have flat or high arched feet you have a Biomechanical problem. This may be as a result of the way your foot has developed, or the movements of your legs, hips or back. Conditions such as bunions and toe deformities also impact on your Biomechanics, and can change the shape of your foot leading to knee or back pain.
A true flat foot is when the bones of your arch touch the ground when walking and standing. In most cases this is as a result of prolonged inward rolling of the arch and heel (pronation).
Most people with flat feet simply pronate too much causing their arch to lower. Pronation is a good thing. It is your body’s natural shock absorption. If you over pronate your arch lowers and your heel bone roles out, this changes the interaction between your joints and overloads your soft tissue structures. This is poor Biomechanics and can come from anywhere in your gait or posture.
High arches usually occur because your gait, posture or muscle structure does not allow you to pronate enough. This reduces your shock absorption, naturally your foot will adapt to compensate for this and cause changes to your Biomechanics.
Simply applying a foot arch support is not sufficient and depending on the underlying cause of your under pronation can make things much worse. Finding the root cause of your poor Biomechanics and bringing the movements of your foot and leg back into synchronisation will see improvement. If under or over pronating feet and not correctly supported you may suffer with arthritic related pain in your feet, toe deformities, heel pain, shin and calf pain, knee pain or hip and back problems.
See the experience of a patient suffering with arch pain.
For more information about how you get injured and how to recover from injury see the science bit.
