Common reasons for referral to the London Podiatry Clinic

1. Pain in the foot and/or ankle

This may be general and difficult to place, or it may be at a particular site or during a certain movement.

Possible reasons may include: arthritic change, a response to injury or trauma, nerve entrapment, a systemic cause e.g rheumatoid arthritis or diabetes, soft tissue inflammation or an unstable foot and/or ankle perhaps due to an underlying biomechanical problem .

Management: The cause of the pain would require diagnosis and then treatment options would be explained to and a treatment plan agreed

2. Deformity

A change in the position of one of more toes is a common occurrence e.g a bunion or hammer toe. This may hurt at the joint or when a shoe rubs against the bony prominence

Possible reasons may include: arthritic change (often associated with age), footwear, muscle imbalance, an unstable foot, a systemic arthritic problem or the result of an injury

Management: Often a toe may be straightened by surgery, allowing correction of the deformity. However, surgery is not always appropriate and sometimes an orthotic and/or a change in footwear may be viable alternatives.

3. Heel Pain

This may be under the heel or at the back of the heel

Possible reasons may include: Plantar fasciitis (damage to a ligamentous band attaching to the bottom of the heel), a bony bump at the back of the heel (a ‘pump bump’ or Haglund’s bump), inflammation of the Achilles tendon, referred pain e.g from impingement of the sciatic nerve, or a nerve problem e.g local nerve entrapment or neural tension (tightness in a bundle of nerve fibres).

Management: Dependent on the cause, can range from local cushioning and physiotherapy to steroid injections and surgery.

4. Sports injuries

Many sports place considerable stresses on the foot and ankle and these are common sites of injury. Trauma may cause soft tissue inflammation (tears in tendons, muscles and ligaments), stress fractures and also joint problems.

Some people have a foot or ankle ‘type’ that may predispose them to a greater incidence or severity of injuries.. An unstable foot and/or ankle, a tight muscle group, or a functional characteristic during standing or walking will lead to increased stress and can lead to an overuse or acute injury.

Management: Dependent on the cause. Common techniques used in sports injuries include strapping, external supports, physiotherapy, orthoses, advice e.g training, footwear, anti-inflammatory therapies (ice and medication) and in certain cases surgery.

5. Flat feet

This can be a concern for children and their parents, as well as adults. Usually, this is perceived to be a flatter than normal arch on the inside of the foot. This can be a normal finding and is very commonly observed in children, requiring no more than reassurance. In a small number of cases, the foot can assume a position in which the joints, tendons and muscles are under an abnormal degree of stress, causing pain in the foot which can radiate into the leg.

Management: The flat foot is often managed by supportive footwear with or without orthoses (inserts) inside the shoe. Exercises may also help. Surgery is reserved for those with very severe malalignment, sometimes due to a torn tendon, and who don’t respond to conservative care. In these cases the alignment and stability of the foot is restored with a combination of bone and soft tissue techniques.

6. Diabetic problems

All forms of diabetes may lead to damage to the circulation and to the nerves. This is particularly common in the extremities of the body. The foot is a vulnerable area because it is enclosed in a shoe and it can be difficult to see and check regularly. If some sensation is lost in the foot because of nerve damage, pain may not alert the person that damage has occurred. Problems such as broken areas of skin around the foot can easily arise, but can be difficult to heal. Prevention is therefore very important and following the appropriate advice is vital.

Management: This will involve regular check-ups to ensure good foot health. Prompt treatment for any foot problems is also important. Prevention of possible long-term problems may also be appropriate, with the use of modified footwear, orthoses and surgery to correct deformity. In cases where severe infection or lack of circulation are present then salvage surgery might be required to re-establish the circulation or restrict the spread of infection.

7. Rheumatological problems

Joint problems are very common in the foot because of the impact incurred during walking and other activities. Wear and tear occurs in the foot as the skeleton ages, but may also be the result of sudden or repeated trauma e.g a heavy object dropped on the foot or a repeated stress e.g going on points. Age-related wear and tear in the ankle is rare, although may be secondary to injury.

The foot and ankle are sites which may be affected by some systemic conditions, such as rheumatoid arthritis or gout. A swollen painful joint(s) which has appeared without a history of injury should always be investigated further. This is likely to require blood tests, as well as examination and imaging of the joint(s). A positive family history can also be relevant.

8. Acute injuries

There are many ways to injure the foot and ankle. These range from ankle strains/sprains and fractures to stepping on a foreign body e.g a needle or nail, a hair, or a splinter. Sports injuries are also often acute i.e require immediate attention.

Management: Dependant on the cause. Initially this will typically follow the standard ‘RICE’ process i.e rest, ice, compression and elevation.