My leg gets numb!

After 30 min of playing football my left leg goes dead to my toes.  It’s fine normally and I know that my right leg is slightly shorter than the left one. I am not sure what to do or who to see.  Will a foot orthotic help?  

I think you are describing the symptoms of nerve entrapment and the associated loss in sensation – parasthesia.
Spine alignment It is really important that we quickly assess your leg length, as improper spine alignment will cause pressure on the nerves exiting the spine and create all sorts of nasty sensations …. that’s the first thing to rule out.  Id recommend you also investigate this with your GP as an MRI of your back will give great insight as to what is going on.  If you can’t arrange this yourself we can help arrange a private MRI.
Tight PiriformisThere may also be another explanation for your numbness, try searching on google for ‘piriformis syndrome‘, this causes painful muscular entrapment of the big nerve that supplies the back of your leg and can give you numb feet.  The pain is known as sciatica and it is thought that it typically affects about 50% of the population whose sciatic nerve is entwined through their piriformis muscle.  When the muscle is allowed to become too tight it causes pressure on the nerve.  As a keen footballer, it would be typical for your gluteus muscles and hamstrings to be really tight and trigger nerve pain after extreme bursts of activity.  Releasing your Piriformis and glut med muscles is likely to have a significant and quick effect on your leg pain.  Try glut med stretching after sport and observe any changes in your leg pain.
If it was just your toes that gets numb then it would be more likely to be ‘tarsal tunnel syndrome‘ (more interesting googling for you), affecting mainly your 1st 3 toes.  This is fairly straightforward to treat with foot orthotics and conditioning/flexibility exercises for your lower leg.
Mortons Neuroma If it were just affecting your smaller toes it could be a Mortons Neuroma or Mortons metatarsalgia which is a bruising of the delicate plumbing between your metatarsals (long fore-foot bones). This is often simply relieved by not wearing shoes or ditching slim fashion styles – football boots are pretty awful for this as they are so tight across the joints of your feet.  Chronic mortons Neuroma need prescription orthotic insoles, a really careful shoe choice, foot mobilisation to help control it.
Leg Length Discrepancy I will need to see you and treat your leg length and assess your foot posture very soon but the most important thing is to see a specialist soon regarding your spine alignment and the flexibility of your bum muscles.
Weak Buttocks – Its worth noting that having an unstable foot, knee and hip complex effectively shortens your leg by about 10-15mm, so your feeling of a short leg may just be the symptom of weakness in your buttocks (sorry) – again this is another reason why weak hip muscles can trigger pirifomis syndrome and peripheral sciatica.
Either way we need to fix this quickly
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Plantar-fasciitis (Heel Pain) What can you do?

This gallery contains 4 photos.

Plantar-fasciitis (P.F.) is a seriously annoying, long lasting painful condition of the big ligament that passes along the sole of your foot – It will typically persist unless the repeated daily cycle of day time trauma and night time healing … Continue reading

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My heel hurts, what is causing it?

Intermittent burning pain on the heel of my right foot. There’s no obvious trigger and it lasts a few minutes. The heel sometimes feels very tight, usually after I’ve been inactive for a while.

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

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.  Heel spurs are easy to find and identify in clinic and also easy to offload with adaptation to your existing insoles from your sports shoes.

Hauglands Deformity – This is a bony outgrowth observed at the back of your heel where it meets your achilles that causes irritation within shoes especially with a rigid heel counter (back of heel).  Typically golf. shoes and stiff walking or sport shoes are the worst offenders.  This condition is often related to poor foot alignment (plano-valgus foot posture – flat foot) but often affects individuals with an unstable high arch foot (Cavo-planus).  Within clinic, adaptations can be made to your shoes to accommodate for this deformity and prescribed orthotic insoles can help minimise foot instability that triggers the overwork of your foot.  Bone grows with pressure/impact so it is important to remove mechanical irritation from your shoes and make space for your heel deformity.

Plantar-fasciitis – See fuller answer on this one on other post. 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.

Severs Disease – Young adolescents 10-14 complaining of widespread heel pain typically after 15-20min of sport.  This is typically found in children undertaking a significant amount of sport but with  bones that are not quite strong enough to cope with the demands.  Regulating sport participation is vital, simple cushioned heel inserts or prescription orthotic insoles  can be very beneficial.  Regular dynamic stretching of legs and building stability and balance.  Try to stand and balance on one leg … Do you wobble?

Tibialis Posterior (Tib Post) Dysfunction – Individuals with unstable feet can often become aware of pain on the inside border of the heel just below and behind the inside ankle bone.  This is the tendon of the main muscle that acts as a spring to stabilise the collapse of your arch especially in jumping and sport.  If hyou have Flat-foot posture this means that the tendon of this muscle is under constant load but when impact and load exceeds its capacity the tendon becomes very bruised and tender and walking becomes very painful.  Your Tib post is supported by your buttocks and you can assess the function of your tib post by standing on one leg and observing how much your knee rotates and your foot collapses and lifts as your try to retain balance.  This is treated in clinic with initially, modifications to your current inlays in your shoes with hip exercise to support and offload your tib post and also with prescribed orthotic insoles to maximise the offloading to this tendon.  With correct treatment the pain quickly subsides and function restores, but with no treatment this eventually becomes much worse.

Peroneii Tendonitis – These are muscles on the outside of your leg that control the outwards rolling of your ankle and heel bone.  The tendon of these muscles passes close to the heel and when overloaded can become quite bruised and tender just to the outer side of your heel bone.  Strengthing, taping and local muscular release are extremely beneficial in addressing this tricky problem.  Oddly, this problem occurs frequently in individuals with flat feet whose feet collapse inwards (not outwards) resulting in the peroneii having nothing to do and becoming very lazy and ultimately weak.  Correcting Foot posture, giving firm stable foundations and building strength are essential in managing this.

Also, Individuals with extremely high arched feet will be aware that their feet typically roll outwards in an uncontrollable manner overstraining these same muscles.  Restricting and controlling this excessive movement is essential and is done using clnic tape and prescribed orthotic insoles designed to accommodate and correct the unique issues that a high arched foot brings but then building strength and balance on top of new foundations is vital.

Also try NSAIDS (non steroidal anti-inflammatiories), or Ice and heat, also make sure you  warm up carefully before activity and use well cushioned running shoes for normal activity. Avoid very low heeled shoes or barefoot walking.

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Perfectly Poised High Heel Masterclass

As seen on the BBC, ITV, Daily MailThe TimesThe SunThe Express and more.

High Heels are definitely here to stay, and, if we not careful, our nation’s girls and ladies will end up seriously hurting themselves, gradually building up a list of complications over time.

As a heel wearer, if you can change your mentality from treating your heels like your best friend but to that of your most respected enemy then you will immediately see a dramatic increase in the fluidity and control of your walk.  Learn to live in this way and your body will survive, but walk in heels like you are wearing a pair of flats and the results can be disastrous.

Using digital clinical video gait analysis we provide one to one tuition or group classes to help you improve your elegance, gait and poise. Compare the dramatic transformation to your posture and control after receiving instruction from our walking expert Martin Bell.

weak hip muscles

Effect of lazy right bum/hip muscles on walking in a pair of 4.5″ heels. Clip taken from video footage, showing the effect of high heel class training and education

The Great British Wobbly Bottom (GBWB)

A weak bum (Poor Gluteus muscle control), means that it is difficult for ladies to control their knees and feet properly especially when walking down a steep slope, even in flats!

When you put on a pair of high heeled shoes you force your body to walk down a steep slope all day long. This challenging environment encourages your legs and bum to fatigue much more quickly, making it difficult to remain elegant and poised.  Keep this up all day and your joints will suffer for it.

Wonky legs!

Girls with weak legs and poorly controlled bum muscles often complain of painful knees when walking down steep slopes or long flights of stairs.  This easily treatable condition is called ‘Lower Kinetic Chain Dysfunction’ but unfortunately it’s all too easy to take wobbly walking for granted and ignore the symptoms of this condition.

The symptoms of this are:

  • Turned out feet
  • Turned in knees and hips
  • Flat feet
  • Over extended knees (hyper-extended)
  • Sticky out bottom (increased lumbar lordosis)
  • Pain at front of knee
  • Back pain
  • Numb toes
  • Poor sporting performance
  • Premature fatigue

Typically girls with this condition will complain of a significant increase in their symptoms when walking downhill or descending steep stairs.

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Clarks ‘Wave’ shoes

Clarks have just released a brand new style of footwear to make walking that little bit easier. These follow on from the more hardcore research driven ‘MBT’, ‘Fit-flop’ fitness styles of footwear – see fitness footwear.  Thankfully all of these shoes bringing a welcome breath of new technology into the footwear market, but benefits are invariably far too hyped up and exaggerated beyond proportion.  NB Sketchers ‘shape uprange  of fitness shoes are cheaper copies of the original MBT patent and lack some of the rigidity of the original MBT design but are still a very comfortable shoe.

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!

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Morton’s Neuroma – nerve pain in my foot

“I suffer intermittently from a strong nerve pain in the middle toe of my left foot.  Do you think you could be of help to me in this.
Thank you”

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

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.

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.

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

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My skin’s falling off my feet!!

“I’ve started running on the treadmill at my gym recently and am finding that a lot of skin is peeling from the soles of my feet. This has now become pretty painful and is upsetting my exercise regime.
What can I do to stop this?”

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.

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I have a morton’s Neuroma what should I do?

“I have Morton’s Neuroma and need advice on how I can live with it  comfortably. I had  a cortisone injection in November, it relieved the acute pain but I still have noticeable discomfort.  Is there anything that can help minimise the pain?”

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.
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Love Running

Love Running is a brand new initiative that helps ordinary people do extraordinary things. It’s about engaging with our communities, making a difference to people’s lives, and doing ourselves some good while we’re at it.

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.

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My legs and back are sore, please help!

David wrote:
“I have orthotic insoles that were made for me about 3 years ago.  They are hard
orthotics.  I have now started getting knee pain, lower back pain,inner thigh
tightness and calf tightness.  What do I do?”

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

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