Foot Pain

Painful heel

Heel pain can be caused by many different pathologies. The most common symptom of pain is caused by plantar fasciitis. This is a condition in which the plantar fascia (a tendon like structure on the bottom of the foot) becomes inflamed due to strain or trauma. The plantar fascia attaches to the bottom of the heel bone (calcaneus) and fans out to the toes. When the fascia is strained due to sudden or repetitive stress, the fibers attached to the bone tear, causing inflammation. This causes pain at the heel of the foot especially in the morning when the fascia is contracted. This condition can also be associated with a heel spur which is an excess of bone growth outside the normal anatomy. Your chiropodist may treat you with many different modalities, depending on the severity and length of the condition. Orthotic therapy is a proven modality in controlling and curing pain and inflammation associated with plantar fasciitis.

It is important to be evaluated for heel pain by your chiropodist because there may be other underlying conditions that are causing heel pain, i.e. stress fracture, bone tumor, or nerve entrapment.

Metatarsalgia/pain at the ball of the foot

There are many pathologies associated with foot pain in the areas under the toes. There is a fat pad that is present underneath the ball of the foot that dissipates as we mature in age causing the bones to be more prominent. When this happens, the bone has less fat to act as a shock absorber, subsequently causing abnormal pressure at the heads of the metatarsals (ball of foot). THis can lead to painful callus and corns and inflammation at the metatarsal phalangeal joints. High heeled shoes tend to cause increased pressure concentration on the heads of the metatarsals. Simple footwear modifications and orthotic therapy can help disperse these pressures and make ambulation more comfortable.

Big toe (hallux) pain

Pain in the joint of the big toe (hallux) can be caused by various biomechanical abnormalities or arthropathies such as hallux valgus, gout, rheumatoid arthritis etc. A physical examination from you chiropodist will reveal the problem and appropriate treatment will be administered.

Orthotics

Orthotics take various forms and are constructed of various materials. All have the ultimate goal of improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain. There are three broad categories of orthotics: those that primarily attempt to change foot function, those that are mainly protective or accommodative in nature, and those that combine functional control and accommodation.

Orthotics

A prescription custom foot orthotic is an in-shoe brace which is designed to correct abnormal foot and lower extremity function. In correcting abnormal foot and lower extremity function, the prescription foot orthotic reduces the strain on injured structures in the foot and lower extremity, allowing them to heal and become non-painful. In addition, a custom foot orthotic helps prevent future problems by reducing abnormal or pathological forces acting on the foot and lower extremity.

While orthotics can be made by several different processes, the preferred way is to cast a plaster mold of the patient’s foot and send it to a laboratory with a prescription. At the lab, technicians pour plaster into the mold, and when it hardens, it exactly reproduces the bottom of the individual’s foot. Once a reproduction of the individual’s foot is made, the technicians then use the chiropodist’s prescription to custom-make a device to met the patient’s specific needs.

Chiropodists prescribe two main types of prescription custom foot orthotics for their patiens, accommodative orthotics and functional orthotics. Both types are used to correct foot function of the patient, so that the pain in their foot or lower extremity will improve. However, accommodative and functional orthotics are generally made using different materials and may not look or feel the same. Both types of prescription foot orthotics are nearly always prescribed as a pair to allow more normal function of both feet.

Skin Disorders

Plantar warts

A plantar wart is a small wart caused by the human papilloma virus (HPV). It is a small lesion that appears on the sole of the foot and typically resembles a cauliflower. A plantar wart may have small black specks within it that ooze blood when the surface is cut of shaved; these are abnormal capillaries.

Corns / heloma durum

Corns are usually hard and circular, with a polished or translucent center, like a kernel of corn. They may become painfully inflamed in response to persistent, excessive pressure or friction.

Callus

A callus is an especially toughened area of skin which has become relatively thick and hard as a response to repeated conact or pressure.

Foot Deformities

Bunions

A bunion (hallux valgus) is a sometimes painful structural deformity of the bones and the joint between the foot and big toe. A bunion is an enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint). The big toe may turn in toward the secone toe (displacement), and the tissues surrounding the joint may be swollen and tender. Treatment is either conservative (i.e. orthotic therapy) in order to stop the progression or surgical if symptomatic.

Hammertoe

A hammer toe is a deformity of the second, third, or fourth toe, causing it to be permanently bent at the proximal interphalangeal joint, resembling a hammer.

Hallux Limitus

When the big toe (hallux) loses range of motion it is called Hallux limitus. This may cause pain in the joint and can lead to painful calluses, bunions, and arthritis. Treatment includes orthotic therapy and footwear.

Flat foot/Pes Planus

Flat feet, also called pes planus or fallen arches, is a condition in which the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground. In some individuals (an estimated 20-30% of the general population) the arch simply never develops in one foot (unilaterally) or both feet (bilaterally).

Nail Disorders

Fungal nails

Thickened, discoloured nails can be problematic not only cosmetically, but physically.  Superficial fungal infections appear on top of the nail as a white or yellow chalk like substance.  This can be easily treated in the office with minor sanding and topical treatment.  Unfortunately, other fungal infections are not as easily treated.  Trauma and maturity can cause nails to become thickened, brittle, and easily susceptible to fungus.  Fungus also adds to the thickness of the nail as well as debris and discolouration.  This can become painful due to the stiffness of the nail.  The surrounding skin can also become infected and cause further pathology.  A discussion of your medical history with your chiropodist will allow appropriate selection of medications to help treat the fungus.

Subungual hematoma

Traumatic injuries to the nail and nail bed may present as a black or blue discolouration under the nail.  If you have sustained an injury similar to the one described, it is necessary to have your foot examined.  Although the hematoma often will spontaneously resolve, there may be a fracture associated with it which may reveal a more complicatd problem requiring additional treatment from your chiropodist.

Ingrown nail/onychocryptosis

Offending nail borders can cut into the nail folds on either side of the nail causing discomfort in footwear.  A simple procedure (partial or total nail avulsion) can permanently remove a typical “ingrown nail”.

Paronychia

When an “ingrown nail” is present for an extended period of time or is poorly cut, an infection can occur.  In this instance, your chiropodist can remove the offending nail border and depending on the extent of the infection may prescribe the appropriate medication and management.

Heel Pain

Achilles Tendonitis

The Achilles tendon is the large tendon connecting the two major calf muscles to the heel bone. This is one of the more common sites of overuse injury seen in athletes. Achilles tendonitis is inflammation in the large tendon that is attached to the heel bone (calcaneus). It results in specific, localized pain in the back of the heel, which is aggravated by physical activity, especially running. Inflammation in the bursae (“bursitis”) adjacent to the tendon can cause similar symptoms. Injuries to other nearby tendons may also occur. Treatment often includes custom made orthotics, supportive footwear, laser therapy, and stretching.

Heel Spur

Heel spur is technically a bone formation at the bottom of the heel where the plantar fascia attaches to the heel bone. If this finding is present with pain overlying the area of the spur, the patient is said to have “heel spur syndrome”. Since the plantar fascia connects to the heel, it is clear why “plantar fasciitis” and “heel spur” are often used interchangeably.

Spending a great deal of time on your feet can increase the likelihood of developing these conditions. Being overweight can aggravate the condition. Overstressing the area by walking, running, or jumping, especially on hard surfaces, and activities such as aerobics, stair-climbing, hiking, volleyball, basketball, and tennis, often can lead to plantar fasciitis. A heel spur is present (on x-ray) inonly about half of all patients.

Plantar Fasciitis

Plantar fasciitis and heel spur are terms that refer to conditions that are associated with pain and inflammation of the heel, bottom of the foot, and arch. Many healthcare professionals use the terms interchangeably but they are not technically the same. These conditions may or may not co-exist.

“Plantar” means bottom of the foot. Fascia is a band or sheet of fibrous tissue that lies beneath the skin and separates muscles or other structures from the surrounding tissue.

The plantar fascia is found on the sole of the foot and passess from the heel bone (calcaneus) to the bases of the toes. It is a band that helps support the arch of the foot. If you pull your big toe and foot up toward your head, you will feel this band tighten. The plantar fascia must withstand a great amount of tension. It often withstands two to four times the body’s weight during activity or exercise. Plantar fasciitis is inflammation at the attachment of the fascia at or around the heel and arch. Treatment often includes custom made orthotics, laser therapy, and stretching.

Diabetic Foot Care

More than 2 million Canadians have diabetes. By the end of the decade this number is expected to rise to 3 million. How does foot care fit into the picture? Because of neuropathy (loss of sensory nerve fibers in the feet), people with diabetes are less likely to feel a foot injury, such as a blister or cut. Unnoticed and untreated, even small foot injuries can quickly become infected, potentially leading to serious complications that can lead to amputation. A comprehensive foot care program can reduce complications of diabetes by 45-85%! Although the program sounds complicated, it is not. Simple tasks such as checking your feet daily, drying between the toes, wearing socks, wearing the appropriate footwear, and having routine nail care and callus reduction performed by your chiropodist will reduce future complications. A simple blood test can inform your doctor if you are diabetic or pre-diabetic and can help set a guideline for blood sugar management.

Pediatrics

Development

Many parents are concerned when they see their children with flat feet, in-toeing gait (pigeon toed) and out-toeing gait. Orthotic therapy is often used to help correct certain ailments and deformities and help your child walk more efficiently. A complete physical examination with the chiropodist will help determine the treatment.

Heel Pain

Children between the ages of 8 and 14 are susceptible to injury of the epiphyseal (growth) plate. This is the plate which is responsible for bone growth.  When our bodies reach skeletal maturity, in our late teens, the plates seal and the bone stops growing lengthwise. Before the plates seal, and if there is repetitive stress applied to the tendon attached to the bone of an “open” plate, the pediatric patient will have symptoms of apophysitis or inflammation of the growth plate in the heel. Treatment includes orthotic therapy, footwear modifications, stretching, physical therapy, and rest. If a child is experiencing pain, physical activity should be discontinued until the examination.

Foot FAQ

WHAT IS PLANTAR FASCIITIS / HEEL PAIN?
WHAT IS A FUNGAL NAIL?
WHAT IS ATHLETE’S FOOT?
WHAT IS A HAMMER TOE?
WHAT ARE PLANTAR WARTS?
WHAT IS A NEUROMA?

WHAT IS PLANTAR FASCIITIS / HEEL PAIN?
Definition:
Plantar fasciitis is an inflammation of the long band of connective tissue running from the heel to the ball of the foot. Heel spur syndrome is a bony overgrowth on the heel bone. The bottom of the foot, heel and arch can become very painful. Often, the first few steps in the morning are the most difficult.

Causes:
Stretching the long band of tissue that connects the heel and the ball of the foot, muscle imbalance, bone deformity, high arches, low arches, poor alignment of the joints of the foot, obesity, trauma, tight muscles on the back of the leg.

What might a chiropodist do?
Perform a physical examination, recommend taping, recommend stretching exercises, prescribe orthotic devices, administer injections.

WHAT IS A FUNGAL NAIL?
Definition:
Nail Fungus is a chronic infection of the nail that leads to nail discoloration, nail thickening, scaling, and/or detachment of the nail plate from the nail bed. Cosmetically, it may be a concern but the problems go much deeper as many patients with fungal nails experience pain, discomfort, and psychological distress.

What might a chiropodist do?
When a fungal nail is diagnosed it should be treated with appropriate drug regimens along with debridement and reduction of the thickness in order to achieve a cure.

WHAT IS ATHLETE’S FOOT?
Definition:
Athlete’s foot is a common infection of the skin characterized by itching, scaling, redness, and the formation of small vesicles. It can affect both the bottom of the foot and between the toes. When not treated it has the potential to spread to the toenails.
Causes
It is usually contracted in dressing rooms, locker rooms, hotel showers, and public swimming areas. People who work in boots or wear shoes for long periods of time are also vulnerable because the humid environment can increase the risk of fungal growth.
What might a chiropodist do?
Prescribe topical anti-fungal medication and advice on proper foot hygiene.

WHAT IS A HAMMER TOE?
Definition:
A hammer toe is a lesser toe contraction deformity, resulting in a boney prominence on top of the toes of the feet.

Causes
Hammer toe can be caused by improper, ill-fitting shoes, high heel shoes, trauma or heredity.
What might a chiropodist do?
A chiropodist will perform a physical examination, give footwear advice, recommend padding and/or offloading the area, and prescribe orthotics.

WHAT ARE PLANTAR WARTS?
Definition:
Plantar warts are manifestations on the plantar surface or sole of the foot. They are caused by a virus, which enter the skin through small or invisible cuts and abrasions. Children are often more susceptible to warts than adults.

Problems
Most warts are generally harmless. However they do have a tendency to spread and can be very resistant to treatment. Mostly they are painless lesions grayish or brown in color with pinpoints of black. They can often be mistaken for corns or calluses – which is why it is important to consult a chiropodist for a correct diagnosis and treatment.

Sources Of Virus
Plantar warts are often contracted by walking barefoot in communal bathing facilities or on dirty moist surfaces where the virus tends to thrive. The causative virus thrives in warm, moist environments, making infection a common occurrence. If left untreated, warts can grow quite large and spread into clusters which can become painful when on the weight bearing surfaces of the foot. Self treatment is generally not advisable.

What might chiropodist do?
Removal of warts with caustics or cryotherapy.

WHAT IS A NEUROMA?
Definition:
A neuroma is a painful condition caused by a swollen, inflamed nerve bundle between the 3rd and 4th toes which results in pain and numbness in the ball of the foot and toes..

Causes:
Improper or ill-fitting shoes, high heeled shoes, repeated trauma to the area (ie: running with poorly fitted shoes).

What might a chiropodist do?
A physical examination, padding and taping, footwear advice, custom made orthotics, administer cortisone injections.