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Plantar Fasciitis and heel spurs, Bruised Heel, Blisters, broken toes, bunions, metatarsal fracture, mortons neuroma, metatarsalgia, heel pain, pain in the big toe bunions pain in the ball of the foot, pain in between the toes.

Plantar Fasciitis: Heel Pain Heel Spurs (pronounced plan-tar fashy-eye-tiss)
The  plantar fascia is a piece of connective tissue that runs from the heel bone (calcaneus) to the base of the toes, on the sloe of your foot. It function is to support the arch of the foot by acting as a bowstring. It connects the ball of the foot to the heel. It also acts as part of the shock-absorbing mechanism of the foot and stabilizes the foot when your toe lifts off.

Signs and symptoms
Symptoms usually develop gradually on a few days or even a few weeks, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot

  • Sharp pain at the bottom of your heel, almost like walking on glass.
  • Mild swelling within your foot and around your heel
  • The pain, tends to be worse with the first few steps in the morning, going up stairs or standing on tiptoes
  • Pain after long periods of standing or getting up from sitting
  • Pain during but more commonly after exercise

Stretching is an important treatment. Standing calf stretches are particularly important. If the pain is bad in the morning the foot can be stretched up by putting a towel under the forefoot and pulling up with the hands. For severe cases that won  t respond to treatment a night splint to hold the foot up in a partly stretched position can also be useful.
Stretching exercises are individual to each patient depending on your muscles and your foot type. It is important to be supervised by a physiotherapist in order to ensure you are doing the exercises effectively.

Deep massage along the plantar fascia may be useful and can be done by the sufferer once shown how by a therapist.

Ice can reduce both pain and inflammation, used from 10 to 20 minutes as an ice pack. Use care with ice and ensure your skin is protected. Do not put a freezing pack directly on your skin as this can cause frost-bite like damage.

Taping can be used by a therapist or trainer to attempt to route some of the forces through the sole along a different line.

Advice on activity modification is important as the condition may not completely resolve. Patients may need to consider alternative methods of keeping up their aerobic fitness and strength if weight-bearing activity is too painful.

Orthotics may also be useful to restore more normal foot mechanics in cases where this has been disturbed. Orthotics are best prescribed by your physiotherapist. At Wicklow Physiotherapy Clinic we have a special interest in foot pain and are specialist in assessing and treating disorders related to the feet. We find the over the counter gel heel cups to be of little help in managing the plantar fasciitis effectively.

Pain in the Big Toe: Bunions/ Hallux Valgus
The term bunion refers to a swelling on the side of the big toe joint, a condition which The term bunion refers to a swelling on the side of the big toe joint, a condition which occurs when the big toe leans too much into the second toe. The medical term for this condition is hallux valgus..

As the swelling is prominent, this area is prone to rubbing from shoes, causing inflammation (redness) and pain.

Not all bunions are painful and some people can have large bunions without experiencing significant pain. However the deviating big toe can cause pressure on the second toe, resulting in the second toe becoming a hammer toe. In some cases, the first two toes will cross over, making it hard to walk.

Bunion causes
According to some reports up to 33 per cent of people will develop bunions at some stage in their lives, although the real incidence is probably lower than this. The reason why bunions develop is genetic and the majority of people with bunions have a family history of the condition.

If an individual is prone to developing a bunion, tight footwear is likely to cause the big toe to deform. This is almost certainly the reason why the condition is much more common in females than males. High heeled, pointed toe shoes are not the primary cause of the problem, but such footwear can accelerate the condition.
Other causes of bunions include injury, arthritis and muscle imbalance.

Bunion treatment
Around half of all bunion sufferers do not need surgery. The goal of non-surgical treatment is to relieve pressure on the foot and to prevent the development of pressure sores and ulcers. At Wicklow Physiotherapy Clinic we are experienced in dealing with foot problems and bunions area very common complaint that patients present to the clinic with.
In some cases, comfortable, well-fitted shoes are sufficient to alleviate pain. We can advise you on what brands are likely to fit best and also have several suppliers we deal with who offer quality specialist shoes that can help relieve your pain.

It is also very important to address any abnormalities in biomechanics. At Wicklow physiotherapy Clinic your physiotherapist will carry out a full biomechanical assessment to determine which orthotics will best suit your problem.

Arthritis in the Big Toe: Hallux Limitus, Hallux Rigidus
Hallux rigidus is the medical name for arthritis that occurs at the base of the big toe. The joint at the base of the big toe is called the first metatarsophalangeal joint, or MTP joint. This is the junction of the long bone of the forefoot, and the small bone of the big toe. Because of the mechanics of our feet, this joint is especially prone to developing arthritis. In fact, hallux rigidus, or big toe arthritis, is the most common site of arthritis in the foot.

Symptoms of Hallux Rigidus
The most common symptom, and the most common reason to seek medical attention for this problem, is pain around the base of the big toe. This pain is accentuated with activity, especially running or jumping. Wearing firm-soled shoes that prevent motion at the base of the big toe will help relieve symptoms. Other common symptoms include swelling at the base of the big toe, a lump next to this joint due to bone spur formation, and calluses from the abnormal shape of the toe.

The diagnosis of hallux rigidus is made by testing the mobility of the MTP joint, usually comparing it to the opposite foot to see how much motion is lost at the joint. X-rays can be performed to determine how much of the joint cartilage has worn away, and to see if bone spurs have formed in this area. Determining the extent of the arthritis will help guide treatment.

Treatment of Hallux Rigidus
The most common treatments for hallux rigidus include:

• Wearing Stiff-Soled Shoes
Stiff-soled shoes limit motion at the base of the big toe. Inserts can be made for shoes that can help support your existing footwear. Alternatively, when buying shoes, look for types with a less-flexible sole that will prevent the arthritic joint from bending.

• Adding a Rocker Bottom to Shoes
A rocker-bottom is a curved sole that can be added to your footwear. The rock-bottom, much like the bottom of a rocking-chair, helps the foot smoothly transition from the heel to the toe while walking. This modification also limits the movement of the arthritic toe joint.

• Orthotics: An insole for the shoe to help correct any biomechanical problems

• Anti-Inflammatory Medications
These medications will help to decrease pain and swelling at areas of inflammation.

Mortons Neuroma:
Morton’s neuroma is a condition characterized by localized swelling of the nerve and soft tissue located between two of the long bones of the foot (metatarsals  €“ figure 1), which can result in pain, pins and needles, or numbness in the forefoot or toes. The pain is most commonly felt between the third and fourth toes but can also occur in the area between the second and third toes.

The foot comprises of many small bones, 5 of which are the long bones known as the metatarsals which are situated beside each other (figure 1). Between these bones are nerves (known as the interdigital nerves) which supply the toes.

It is not entirely understood why an interdigital neuroma forms. Most likely, it results from repeated injury to the nerve in this area. Many theories have been put forth as to the cause of the chronic injury, but none has been proven.

The most common cause of pain is thought to be irritation on the nerve. The chronic nerve irritation is believed to cause the nerve to scar and thicken, creating the neuroma. Many foot surgeons feel that the problem may arise because the metatarsal bones squeeze in on the nerve, and the ligament that joins the two bones irritates, or entraps, the nerve. Entrapment of the nerve is thought to lead to the chronic irritation and pain.
The neuroma usually causes pain in the ball of the foot when weight is placed on the foot. Many people with this condition report feeling a painful catching sensation while walking, and many report sharp pains that radiate out to the two toes where the nerve ends. You may feel swelling between the toes or a sensation similar to having a rock in your shoe. This can feel like electric shocks, similar to hitting the funny bone on your elbow.

Diagnosis of mortons neuroma is made from taking a detailed history and examining the foot and lower leg. Once a diagnosis is made the physiotherapists at Wicklow Physiotherapy Clinic have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

When you begin physiotherapy at Wicklow Physiotherapy Clinic, our treatment of an interdigital neuroma usually begins with evaluating your shoes and recommending changes in your foot wear. The physiotherapist may suggest firm-soled shoes that have a wide forefoot, or toe box. The added space in this part of the shoe keeps the metatarsals from getting squeezed inside the shoe. We may also place a special metatarsal pad within your shoe under the ball of your foot. The pad is designed to spread the metatarsals apart and take pressure off the neuroma.

These simple changes to your footwear may allow you to resume normal walking immediately. But we recommend that you cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside.

In addition to changing the shoes that you wear, your physiotherapist may also apply direct treatments to the painful area to help control pain and swelling. Examples include ultrasound, moist heat, and soft-tissue massage.

Patients with a Morton’s neuroma should perform pain-free flexibility, strengthening and balance exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as balance, soft tissue flexibility and strength are quickly lost with inactivity. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they can be commenced.

In the final stages of rehabilitation, a gradual return to activity or sport can occur as guided by the treating physiotherapist provided there is no increase in symptoms. The use of orthotics, correct footwear or metatarsal padding during this phase of rehabilitation, and, as an ongoing form of injury prevention, may be indicated.

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Wicklow Primary Healthcare Centre, Knockrobin, Wicklow, A67 K5C7, Ireland

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