Mr Liam Stapleton BSc PGc PGdip FFPM RCPS(Glas) FRCPodM
Common Conditions
Heel pain, plantar fasciitis:
This can manifest as heel pain, or pain in the arch. It is important not only to treat the pain but also the cause. The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the
foot, attaching at the bottom of the heel bone and extending to the forefoot. When the plantar fascia is excessively stretched, this can cause plantar fasciitis, which can also lead to heel pain, arch pain, and heel spurs.
Often it is important to use an Ultrasound scanner to assess the severity and rule out partial tears. This can be treated with a combination of simple exercises and stretches, injection therapy, wave therapy Shock, and/or Orthotics and insoles, which help to solve the cause, not just treat symptoms.
Big toe arthritis (1st MTP degeneration):
One of the most common foot conditions seen; is pain & poor function in the great toe is one of the biggest causes of other problems both in the foot and lower limb. This is a commonly seen condition in both the
sporting population, and the older general population.
It is now better understood just important this joint is in being able to walk and run. Symptoms include reduced movement, pain during walking and running, and sometimes pain at rest.
Surgery is the very last resort, so we use corticosteroid injections along with Ostenil injections to repair the cartilage damage, and orthoses to make better use of the reduced movement range.
Achilles tendinitis (tendinopathy):
One of the most difficult conditions to treat can be separated between insertional and mid-portion tendinopathy, with many subcategories.
These distinctions are very important, as they are treated very differently. An ultrasound scan is used to help distinguish the type and track progress.
In the early stages, specific exercises and relative rest may be enough to reverse symptoms. In progressive
tendinopathy other interventions like injections and Shock wave therapy may be necessary.
Morton's neuroma:
A Morton's Neuroma is essentially a nerve compression or 'trapped nerve' between the metatarsal heads.
Symptoms include burning pain walking, pins and needles, and numbness.
There are different causes, including footwear and arthritis. Your podiatrist will get to the root cause, and from there help you decide how best to treat.
Treatment options include changes, orthoses, corticosteroid injections, and surgery in the worst
cases.
Ingrowing toenail surgery:
This is known as a Partial Nail Avulsion. This is a simple surgical procedure, performed under local anesthetic to permanently remove the ingrown section of the nail, reshaping the offending side, to prevent reoccurrence.
This is considered a particular specialty of our senior Podiatrist.
This procedure is pain-free and takes about one hour. You will need to have the toe dressed and kept dry for at least a week, and because of the anesthetic, you should arrange transport as you may be unable to drive home You will also need at least one follow-up appointment.
Ankle Joint Arthritis:
This is a surprisingly common occurrence following a severe ankle sprain or repeated minor ankle sprains. Treating early is very important. One of the most difficult joints to treat surgically, but one of the most debilitating when in pain and with loss of function.
It has recently been proven that early-onset osteoarthritis follows even relatively minor lateral ankle sprains if not treated well at the time. It is important during your examination to understand how much range of motion you have and how much pain you are in when walking. We use a combination of corticosteroid and Ostenil injections to manage the deterioration and pain and may use a heel lift or orthotic if needed.
'Shin splints' (MTSS):
Commonly known as Shin splints, this is common in individuals with 'Mr biomechanics, but a full assessment of the cause can give full relief. MTSS or Medial Tibial Stress Syndrome is often known by
most people by the term •Shin Splints'. This is now thought of as an outdated term.
Common in runners, and often in people beginning training after a layoff. This can be caused by pmr footwear, biomechanics problems, or running gait flaws.
Symptoms of pain along the shin bone, often in the first 10 mins of beginning a run, will often ease the further you go Eventually the pain may well not ease as the condition remains untreated.
Full MSK assessment is needed, along with gait analysis. Gait retraining may be necessary, changes in footwear, orthoses prescribed, and/or strengthening work with a physio to overcome biomechanic weaknesses.
Knee Arthritis:
Common in older age groups, and in athletes where there have been meniscal tears. More and more can be done to prevent often unsuccessful knee replacement surgery.
Osteoarthritis of the knee is one of the most common musculoskeletal problems faced in the UK. Often the result of 'wear & tear' as we age, however, early onset can be the result of sporting injury.
As result with total knee replacements inactive patients often proving unsatisfactory, every care should be taken to avoid this inevitable conclusion. Early treatment is key, in tackling the risk factors, but pain
management and mobility maintenance should be maximized until such time surgical replacement is needed.
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This has been proven possible to extend the life of an affected Knee by years and possibly negate the need for replacement at all. Treatment includes a combination of Physiotherapy, with
Corticosteroid or Ostenil injections and exercise.
Jumper's knee
(Patella tendinopathy):
Similar in some ways to Achilles Tendinopathy, this is a very common cause of knee pain.
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Patella Tendinopathy, and similarly Quadriceps Tendinopathy, is a painful overuse condition of the tendon. this can be at the insertion, where the tendon attaches to the bone, or mid-portion, which will change the treatment protocol.
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combination of injection therapy, and physiotherapy exercises to progressively load the tendon are needed.
Sesamoiditis:
Localized pain under the big toe, can be caused by numerous faults. Early treatment will prevent stress fracture, or worse.
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There are two sesamoid bone under the first metatarsal on each foot. These can easily become inflammed and cause pain. Inflammation is often caused by mechanical overload of the area, this can be because of footshape, biomechanics of an individuals gait, footwear, sporting activity, or other pathology like osteoarthritis or functional hallux limitus. Treatment options depend upon an assessment of the cause but include Orthotics, change of footwear, and injection therapy. It is important to have treatment as if left untreated, this can lead to a stress fracture, and possibly even necrosis, possibly resulting in surgical excission and should be avoided if possible.
Tibialis Posterior Tendon Dysfunction:
Often the result of overuse, or through trauma. This causes pain and loss of function of the foot and a possibly noticeable reduction in arch height.
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Tibialis Posterior is a musculotendonous structure responsible for maintaining foot stability and plays an important role in every step when walking or running. Injury can be caused by a single incident or a gradual onset. There are many factors that can cause injury, so they will be assessed and this determines the treatment. Often an Ultrasound scan is needed to assess how badly the injury is, and to rule out tears or rupture.
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Treatment will require exercises, possibly Orthotics, and Physiotherapy, but in certain cases, a brace or immobilisation in a boot may be needed for a period of time.
Tarsal Tunnel Syndrome:
A nerve compression of the tibial nerve behind the medial ankle bone. Giving pain along the inside and bottom of the foot.
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Tarsal tunnel syndrome is caused by a nerve compression of the tibial nerve, just behind the medial ankle bone. This narrow passage, called the Tarsal tunnel, is also home to tendons and blood vessels, which can at times pinch the nerve. Symptoms include pain along the side, and sole of the foot, sometimes including the toes. However, numbness, 'pins & needles', tingling, burning or cold feeling, or electric shock feeling are also reported.
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Diagnosis requires the exact cause to be found, this will probably require an ultrasound scan.
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Treatment options include, injection therapy, orthotics, stretching and strengthen exercises, an ankle brace in rare cases. If conservative treatment fails then surgery is an option.
Bursitis:
There are many bursae all over the body, and many in the feet. When they become inflamed they can cause significant pain and internal compression to the corresponding area.
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A bursa is a pocket of fluid naturally occurring all over the body, offering protection to structures moving over one another. When there is trauma or increased tissue stress, they can become inflamed. This can result in the area becoming painful, swollen, and red, and possibly leaving the area feeling stiff.
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As long as the bursa is not infected, NSAIDs, corticosteroids, and/or functional offloading of the area reducing tissue stress should cure bursitis.
