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Patient – Osteomalacia

Summary

  • Heel pain caused by a weakness in the bone structure, leading to fractures.

 

How did I get this?

  • Deficiencies in Vitamin D, Phosphate, and Calcium.
  • Osteomalacia may be associated with Coeliac Disease, Liver and Kidney problems.

 

What can I do about it?

  • Rest
  • Dietary advice and supplements

 

What help can I get for this?

  • Xrays or scans may identify fractures.
  • A Podiatrist will provide splinting or immobilisation, footwear advice and strengthening exercises.
  • Your doctor may advise blood tests and medication, along with referral for dietary advice.

 

When will it get better?

  • Appropriate dietary supplements will help strengthen bones.
  • Fractures may take 3 months to stabilise.

Patient – Lateral Plantar (Baxter) Nerve entrapment

Summary

  • Heel pain that often shoots under the outside of the heel and travels up the leg

 

How did I get this?

  • The nerve under your heel becomes pinched by a muscle connecting your big toe and your heel bone.
  • You may have a low arch foot type, or the area could be irritated by footwear.

 

What can I do about it?

  • Wear supportive cushioning footwear.
  • Avoid going barefoot.
  • Modify your activity to stop doing the things that cause pain.
  • Short term use of pain killers can give relief.

 

What help can I get for this?

  • A Podiatrist will provide padding, cushioning or orthotics to reduce load in the painful area.
  • Xrays or scans may identify bony lumps or soft tissue abnormalities.
  • If other treatment is not successful surgery may be required to release tissue around the nerve.

 

When will it get better?

  • Activity modification plus appropriate footwear and orthotics should see an improvement in 6-8 weeks.

Patient – Heel Fat Pad Atrophy

Summary

  • Damage or wasting of the fat pad under your heel makes it painful to stand or walk.
  • Loss of fat pad can put more pressure on nerves and bloodvessels.

 

How did I get this?

  • Often associated with ageing, but may also be associated with diabetes, rheumatoid arthritis, peripheral vascular disease, trauma and long term corticosteroid use

 

What can I do about it?

  • Wear supportive cushioning footwear.
  • Avoid going barefoot.
  • Short term use of pain killers can relieve the pain.

 

What help can I get for this?

  • A Podiatrist will provide padding, cushioning or offloading pads, and advise appropriate footwear.
  • Xrays or scans may identify bony lumps or soft tissue abnormalities.

 

When will it get better?

  • A bruised fat pad should recover in 4-6 weeks with appropriate cushioning and footwear.
  • Wasting (atrophy) of the fat pad will require constant protection from footwear and padding

Patient – Neoplasm Bone Tumour

Summary

  • Bone tumours in the foot account for less than 2% of all bone tumours, and approximately 80% are benign. They can become painful if they cause enlargement of the bone or fractures.

 

How did I get this?

  • Previous breast, bladder, lung, kidney or colorectal cancer most frequently metastasize to the foot.
  • Most heel bone tumours are discovered on xray for other unrelated conditions.

 

What can I do about it?

  • Rest or non-weightbearing activity may help in preventing fractures.

 

What help can I get for this?

  • Your doctor will arrange scans and specialist treatment.
  • Your podiatrist may be able to assist with cam walker immobilisation.

 

When will it get better?

  • Benign tumours may require surgical excision and a period of recovery for bone strengthening.
  • Malignant tumours will need advice from an oncologist and orthopaedic specialist

Synovitis

Summary

  • Inflammation of the tissues that line the joints, often under the ball of the foot. It causes redness, swelling, warmth, and pain on weightbearing or with joint motion.

How did I get this?

  • Pressure overload on the toes due to an associated deformity, wearing inappropriate footwear such as high heels or isufficient width, and arthritis.

What can I do about it?

  • Wear good fitting shoes.
  • Avoid high heels.
  • Wear a protective pad.
  • Hot or cold packs may help.
  • See a podiatrist.

What help can I get for this?

  • A podiatrist may provide padding to reduce pressure on the area, footwear advice, orthotics, strapping.
  • Your doctor may administer a cortisone injection in the injured area.
  • A surgeon to correct the associated deformity which is causing the synovitis.

When will it get better?

  • The earlier the diagnosis and treatment, the better and sooner the outcome will be. If left untreated synovitis could result in rupture and permanent deformity.

Sinus Tarsi Syndrome

Summary

  • The sinus tarsi is a small cavity located on the outside of the ankle. This cavity contains numerous anatomical structures including ligaments and joint capsule. These structures may be injured following an ankle sprain or due to the repetitive strain associated with an excessively pronated (flat) foot. When this occurs, the condition is known as sinus tarsi syndrome. Patients with sinus tarsi syndrome typically experience pain over the outside of the ankle. There may also be swelling and tenderness in the region. Symptoms are typically worse in the morning and may present as pain and stiffness that slowly improves as the patient warms up. Symptoms may also be aggravated during walking or running especially on slopes or uneven surfaces.

How did I get this?

  • Sinus tarsi syndrome usually occurs following an ankle sprain or due to the repetitive strain associated with walking or running on an excessively flat foot.

What can I do about it?

  • Rest sufficiently from any activity that increases your pain.
  • Icing and short term anti-inflammatory medication (e.g. Ibuprofen) may help to significantly reduce inflammation.
  • Elevation of the affected foot to decrease inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe an ankle brace, appropriate footwear, and orthotics, along with strengthening exercises.
  • Your doctor may prescribe a steroid injection.

When will it get better?

  • Most patients with this condition heal well with an appropriate treatment program. This can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early treatment is vital to hasten recovery and ensure an optimal outcome.

Sesamoiditis Fact Sheet

Summary

  • The sesamoids are two baked bean sized bones in the tendons under your big toe joint.
  • They can become inflamed and even fracture causing pain particularly when wakling quickly or running.

How did I get this?

  • Sesamoidits is usually seen in people who have a sharp blow to the joint, or have a high arched foot with a prominent big toe joint. Dancers and people that wear high heels are more prone to this.

What can I do about it?

  • Wear flat cushioning footwear such as joggers. Ice the area.
  • Short term use of anti inflammatory drugs such as ibuprofen may relieve the symptoms.

What help can I get for this?

  • See a podiatrist for footwear advice, padding, strapping, and possible orthotics to relieve stress on the sesamoids.
  • Immobilisation in a cam walker may be necessary for severe cases.
  • If there is a fracture that does not respond to conservative treatment then surgery may be necessary.

When will it get better?

  • Conservative measures should see improvement over a few months.
  • Surgical intervention will require a longer recovery period.

Pump Bump

Summary

  • It is a condition where there is bony enlargement on the back of the heel due to irritation if rubs against the shoes. Symptoms include a noticeable bump on the back of the heel, pain in the area where the Achilles tendon attaches to the heel, swelling in the back of the heel, and redness near the inflamed tissue.

How did I get this?

  • Any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps can cause this irritation.

What can I do about it?

  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be taken to reduce the pain and inflammation.
  • Apply an ice pack to the inflamed area for reducing the inflammation.
  • Stretching exercises help relieve tension from the Achilles tendon. Heel lifts placed inside the shoe to decrease the pressure on the heel.
  • Heel pads placed inside the back of the shoe to cushion the heel may help reduce irritation when walking.
  • Shoe modification (Backless or soft backed shoes help avoid or minimize irritation).

What help can I get for this?

  • Podiatrist may prescribe orthotics to control the motion in the foot.
  • Foot and ankle surgeon if non-surgical treatment fails to provide adequate pain relief.

When will it get better?

  • Nonsurgical approach control symptoms if treated early but will not shrink the bony protrusion.
  • Surgical recovery time depends greatly on which procedure your surgeon performed.

Plantar Plate tear/rupture

Summary

  • The plantar plate is a thick ligament on the underside of your foot, running along the first joint of each toe. Its purpose is to act like a support cable and protect the toe joints from pressure and injury, and to prevent the joint from bending upward beyond the normal range of motion. Injury to the plantar plate results to mild to severe pain and swelling under the ball of the foot, extending toward the toes (most commonly the 2nd or 3rd). One or more of your toes may be splayed or clawed. You may also have a sensation of numbness or “burning pain” in your toes, or a feeling like you’re walking on the bones of your foot.

How did I get this?

  • Injury to the plantar plate is usually caused by overuse, such as from running; obesity, which puts too much body weight on the ligament; or wearing high heeled shoes too often which locks the forefoot into a flexed position and requires the plantar plate to carry all of your body weight.

What can I do about it?

  • Icing the injured area.
  • Short term anti inflammatory medications (e.g. ibuprofen) to reduce pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe strapping the toe into a downward position to align it in order to help healing, footwear modifications, orthotics.
  • Podiatrist prescribe special boot or shoe if your case is severe to keep weight completely off the ball of your foot.
  • Foot and ankle surgeon for surgical treatment when non-surgical measures fail to alleviate pain and begin to limit your lifestyle.

When will it get better?

  • Treatment for this acute condition can take time, with most patients pain free with 3-4 months. Initial symptoms improvement allows most people to return to activity within 1 month.

LISFRANC INJURY

Summary

  • Lisfranc injuries occur at the midfoot where a cluster of small bones forms an arch on top of the foot between the ankle and the toes.Lisfranc fracture-dislocations are swollen and painful with some bruising and inability to put any weight on the foot.

How did I get this?

  • Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.Commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

What can I do about it?

  • Refrain from putting weight on the foot.
  • Oral anti-inflammatory medications (ibuprofen) help reduce pain and inflammation.
  • Swelling is reduced by icing the affected area and keeping the foot elevated.

What help can I get for this?

  • Podiatrist will place the affected foot in a cam walker to keep it immobile, and crutches are used to avoid putting weight on the injured foot.
  • Orthopaedic foot surgeon for possible surgical treatment to realign the joints and return the broken (fractured) bone fragments to a normal position.

When will it get better?

  • The majority of the recovery occurs in the first 6 months, but it is often a year or more before patients reach their point of maximal improvement. If the surgical treatment fails or the joint damage from the injury leads to severe arthritis, then a fusion (arthrodesis) of the Lisfranc joints may be necessary. Despite the stiffness of a fused joint most patients with successful fusion of the midfoot joints have good function of the foot.