Duration:
It used to just be the tightness and has happened for the last two or three years but the last year or so has been more the the burning pain

History:
I thought originally this was Achilles tendinitis from running but I stretch well and even when I’m not running it is no better.  I often go months without running but it doesn’t make a difference.

“Sorry to hear about the aching in your heel

Hopefully you will be able to work out what is happening from the information below. Is the pain at the top of the heel bone (at the insertion of your achilles) or is it under the heel bone? Which side of the heel is the most painful?

Typical problems are:

Heel spur (small overgrowth of bone on bottom of heel) – This normally creates sharp hot searing pain on weight bearing especially during excessive heel contact.  Sometimes you can actually feel a hard object in the centre of your heel (not dissimilar to the princess and the pea).  Treatment is orthotics, careful choice of footwear, minimise barefoot activity and spur removal surgery when it is really bad.  Request an X ray of your heel from your GP to rule this condition out.

Plantar-fasciitis – inflamed fascia/ligament connecting your heel to your toes. This typically becomes inflamed on the inside border at the base of your heel giving initially sharp pain especially after rest periods, normally easing with a little activity and typically increases to a deep aching/burning pain with increased activity.  The condition is classically triggered by tight calves and  too much exuberance during walking/running with insufficient fitness or warm up.  It is a typical holiday condition – girls jumping into flip flops from high heeled office shoes and then doing much more walking than normal giving an unwelcome persistent pain than  for them bizarrely resolves when they put their high heeled shoes back on but returns when they use their flip flops.  Treatment is stretching, deep tissue massage, orthotics, careful choice of footwear and minimising barefoot activity for as long as required until the pain gradually subsides.

Inflamed fat pad – fat pad syndrome is akin to deeply bruising your heel after jumping and landing hard on your heel.  Often it is impossible to weight bear on you heel at all. Treatment is rest, taping and sometimes orthotics to support the fat pad and reduce the stress on it. This condition typically self resolves with proper rest but the above treatments make it resolve more quickly.

Also try NSAIDS (non steroidal anti-inflammatiories) and use well cushioned running shoes for normal activity. Avoid very low heeled shoes or barefoot walking. “

Named ‘Wave‘ shoes they claim to reduce the load over your toes, increasing comfort and ease of Gait.  Most of this is actually quite true.. the discretely designed fore-foot rocker will be a delight for anyone with painful feet especially at the joints and toes.  Good news as well that the pre-moulded insole inside the footwear can easily be removed to allow custom orthotic insoles to be fitted.  At a much more reasonable price (£50-70 ) than MBT’s, and without all the marketing twaddle these are a really good option to consider.

These are not fussy shoes for looking good at the gym, but reasonably appealing shoes suitable for everyday working environments.

At last someone has been listening!

Untreated this condition will rarely resolve itself within 9 months – Sometimes lasting for years.

I have tried to list the main options for you to consider.  Basically you need to do as many of these things as often and as regularly as possible – bear in mind that if you do nothing it’s  not likely to go away by itself. (see below)

Understanding Plantar-fasciitis

Orthotic Insoles
Wear insoles – always – as it aids the control of the movement of your feet through the day, protecting your feet from the excessive twisting and stretching movement on the insertion of the plantar-fascia at the heel bone.  An incorporated slight heel raise also benefits by further reducing the tension of your calves.

Stretching
Stretch your legs, especially your calves and hamstrings every morning before walking and regularly through the day (to try to get some extra length in your calves and Achilles) – While we sleep our muscles and ligaments shorten and the foot is pulled into a relaxed posture with the toes pointing down – this period of rest allows the body to try to heal the affected area and it does this by laying down scar tissue that, is put under too much tension when we force our feet into a 90 degree position as we haul ourselves out of bed in the morning thus causing the newly formed scar tissue to tear/rip away causing extreme pain.  This pain lasts for only the first few steps and soon subsides as we continue to walk.  Passive stretching prepares our muscles and the fascia for the onslaught ahead.  Contact your P.T. for advice about dynamic stretching to maximise the effect of  your stretches.

See Grange Physio’s exercises for walk through stretching guides.

Massage
Book yourself in for a deep tissue sports massage twice a week initially to help reduce the stiffness and rigidity in your legs and feet.  Tightness in muscles and the resulting reductions in ranges of movement in your joints transfers huge tension to the plantar-fascia compounding the problem.  A good massage will hurt and find muscles you thought you never had.  We look after our cars better than we look after our bodies – keep up a regular monthly massage to keep supple.

Don’t forget to drink lots of water after your massage.

Therapeutic Ultrasound

High frequency vibrations focused on the affected area helps by gently breaking down the scar tissue that untreated can delay healing.

Contact you Physiotherapist for advice on this treatment.

Shoes
Avoid very flat low heeled shoes and traditional flip-flops as the low heel forces the achilles and plantar-fascia to be put under increased tension.  Avoid walking barefoot – always wear supportive slippers around the house.  Wear day shoes with a slightly more than average heel height to reduce the tension in your achilles.  Try fit – flops (girls) or MBT shoes for improved cushioning at heel and smooth roll over the toes.

Look for soles with cushioned heels as hard soles create jarring and heel pain.  Fit-flops  or MBT shoes or clark’s ‘wave’ shoes all  incorporate fore-foot rockers easing the load on your foot during gait.

Acupuncture
This is another extremely beneficial treatment to release the tension affecting calf muscles and reduce inflammation in the plantarfascia.  Effects can be accentuated through the use of electro-needling to increase the stimulation to affected or intended area. (Ben Tolson professional acupuncture)

Night time stretches
There are a variety of devices that you can wear to keep your feet in a stretched position through the night.  Unfortunately they generally look and feel like snowboarding boots and their bulk and rigidity are rarely appreciated by sleeping partners. (below left) These retain cheaply £30-50 but are pretty nasty to wear and impossible to walk with if you get up to go to the loo in the night.

Footworks clinic stock a vastly superior front fitting night splint (above right) which gives significant improvements to comfort.  A well padded contoured aluminum shell  works perfectly to maintain your foot in a stretched toes up position keeping tension on the plantar-fascia forcing it to heal with your foot in a functional position either when seated or whilst sleeping through the night.

Night splints are great because they give almost immediate relief to the sharp ‘getting moving pain’ that is characteristic of this condition.  These top of the range splints currently sell online for £91 but are available in clinic for £60

Contact me directly if you think that this may benefit you.

Exercise
Don’t bother exercising unless you have warmed up and stretched really well before hand.  Swimming is Ok as you swim with your toes pointing down, but take care stepping out of the pool – take time to sit on the side and do a few passive stretches before walking.

Remember to stretch after exercise.

Other options:
Cortizone injection to reduce the acute inflammation (really painful injection but normally takes pain away for 3-4 months)

Rest
If you can afford to lie on your back and let the kids do all your work then your feet will heal beautifully in about 8 weeks and you will forget how horrendously painful this awful condition is!

This sounds like a Morton’s Neuroma.

Classically this is an extremely severe shooting nerve pain stimulated by squeezing up from the base of your foot in the space between between the 2nd and 3rd or 3rd and 4th toes quite close to the ball of your foot.  Often causing numbness and tingling in the affected toes.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage. The nerve gets squeezed by the adjacent bones during walking, creating astonishing levels of pain and is, unfortunately, quite common.

In the clinic, a positive indication to a Morton’s Neuroma is that I have to scrape you off the ceiling after squeezing your foot in this way!

What Causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities – bunions, hammer toes or v.flat feet are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma. (see below)

causes of pain for mortons neuroma

Treatment
1st option
Icepack to reduce swelling and inflammation  -  avoid narrow fronted shoes  -  change your activity to stop the over-loading at your toes, chose shoes with a well shaped fore-foot rocker to reduce the load and stress over your toes – Clark’s wave, MBT, Fit-flop.

2nd
Orthotics -  often highly successful
Insoles to spread the transverse arch (across ball of foot) creating as much space as possible between the bones of your foot where the restriction or crimping has occurred and reduce the mechanical trigger.
Improving the bio-mechanics of your gait keeps your foot in the best position during walking -controlling the trigger and allowing the nerve inflammation to subside
Ensure shoes are wide at the fore-foot and do not squeeze and restrict the ball of your foot.  It may be worth having shoes stretched slightly to give more space – NB trainers/running shoes are normally very wide over the forepart but do vary significantly with each manufacturer.

3rd
cortizone injection to reduce swelling and inflammation

This can work very well to reduce the acute inflammation but the effects are often short lived and the pain will often recur after 3 months or so.

4th – and normally the very last option!
Surgery to chop out a chronically damaged nerve

Although this can work very well in obvious cases, it is not the best option as this problem can often recur in an adjacent toe.   Care must be taken

hope this helps

There are basically 2 reasons for this but normally it’s a combination  of both.

Fungal infection- athletes foot loves warm sweaty environments  causing softening of the skin and peeling. This is typically more
irritating than annoying and easily treated with non prescription  creams.

Skin shear- normally causes hard skin or blisters and is not normally  problematic but can, when severe or combined with a moist environment   result in large slabs of skin separating from the bottom surface  of the foot normally at the heel or under the ball of the foot,  especially the big toe. This can be seriously painful as the exposed skin/tissue is extremely raw.

Skin shear and hard skin / callus development is a sign that foot  movement is excessive and that the foot pressures are unusual.  Good fitted Orthotic insoles will resolve this.

Check shoe fit, look for skin peeling between the toes.  Change socks  regularly to keep feet dry.

Contact me if you would like an appt to discuss  further.

A Morton’s Neuroma is a really irritating problem that typically causes extremely severe pain in the web space between either the 2nd and 3rd or 3rd and 4th toes.

The Neuroma or enlarged nerve becomes compressed during walking giving rise to surprisingly high levels of localised pain.  The Jury is still out in determining the cause of nerve inflammation, but flat-foot posture or wearing higher heeled shoes can exacerbate this problem by decreasing the space between the bones or metatarsals and squeezing on the nerve.

Resolving this issue is complex and needs to be tackled on many fronts.

• Shoes – avoid higher heeled shoes or ones with thin bendy soles that do not protect the feet.
• Insoles do help by correcting any unwanted deviations of the foot that may cause  compaction of the fore-foot and by elevating the transverse arch (across your forefoot from side to side) allowing the bones of your foot to spread apart and bring a gasp of relief to the troubled nerve.
• as Expected – Rest and relief to allow the nerve inflammation to reduce.

February 27th, 10am-12pm. Launch Seminar
We’ll be going through everything here – instructions on how to train, how to get the most out of Love Running and how to do your sponsorship. Plus, we’ll be giving out the special packs and goodie bags.

May 1st – 3rd. The Noise
This is our weekend of community action. We’ll be doing everything from community clear ups to family fun days. A chance to get as involved as you want, with hundreds of other volunteers.

May 9th. The Bristol 10k Race
We’ll make our presence felt with wacky costumes, loads of support and a general fun-loving attitude.

May 16th and 23rd. The Runners Ball & Prize Giving
Prizes, celebrities, music, food, dancing, Djs, surprises and plenty of shenanigans and japes. All in the best possible taste.

Reply:
Sounds nasty!

What you describe sounds postural as opposed to muscular.  Ie muscular problems you can normally stretch out or get physio to improve specific muscle group function.  Postural variances tend to be caused by joint mal-alignment and includes multiple joints as you describe, but unfortunately you frequently see a blend of both situations.

There are probably only 2 options to consider

1.Your feet have changed (worsened) and your insoles do not fit you or give you the same support they once did.

2.You don’t actually need insoles and they are proving counter productive and are affecting other parts of your body

I suspect by the description of your symptoms that it is the former.
Typically, excessive flattening of the foot (pronation)  causes internal rotation of the knee which in turn internally rotates the hip causing an anterior tilt of the pelvis, obviously more dramatic if both feet do the same thing.

Rigid orthoses can cause quite a severe change to your gait and posture.  They work in the same way as softer ones but apply a much greater correction to your feet.  It may be worth sourcing some semi-rigid ones that work dynamically with your feet, providing a more balanced gait by not restricting the natural movement of your feet.

NB – calf tightness is an occupational hazard of growing older, keep up hamstring, gastroc and soleus stretches before and after activity to keep tightness at bay.

Hope this helps