Common Conditions

Foot Conditions

Helping you put your best foot forward


forefoot conditions

Your forefoot is a very complex area of the foot. It is made up of 26 bones and many small muscles, ligaments, tendons and other soft tissue structures, such as nerves and blood vessels. As a result, numerous conditions can affect the forefoot and lead to debilitating pain. Due to its complexity, it is very important that you see a practitioner with in-depth knowledge of the foot to make an accurate diagnosis. A poor diagnosis often results in poor treatment outcomes. At Podiatry Illawarra diagnosis is carefully made by first taking a thorough history of your complaint. A comprehensive knowledge of the forefoot anatomy and the numerous conditions affecting the forefoot, is vital to be able to perform detailed examinations of the area of complaint.

Morton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton’s neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock. Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb. This condition can be diagnosed by our podiatrists, an ultrasound may also be required (we can refer you for the ultrasound) to confirm the presence of a neuroma. The treatment normally consists of footwear advice and off the shelf insoles insoles.

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe. The movement of the big toe angles in toward the other toes. The growing enlargement or protuberance then causes irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists. Wearing shoes that are too tight may accelerate the development of bunions however they are linked to genetics, normally because of a malfunctioning foot structure. Foot injuries, flat feet, and pronated feet can contribute to their formation. Bunions can also lead to secondary problems, such as hammertoe, bursitis or arthritis. Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The bigger the bunion gets, the more it hurts to walk. Because they are bone deformities, bunions do not resolve by themselves. Our objective is minimum invasive treatment initially as this is less hazardous and the patient is less likely to suffer side effects and complications of more invasive methods. Our podiatrist’s will remove the corns and calluses gently with a scalpel and can advise on the best form of treatments available which may also include protective padding or orthotics. In severe cases where these conservative methods have failed referral to a specialist surgeon may become necessary.

A Tailor’s bunion is similar to a bunion, the main difference being that it occurs on the outside of the foot presenting as an enlargement of the joint at the base of the little toe. Common symptoms will include pain, swelling and redness over and around the enlargement of the joint. This inflammatory response is due to irritation of the soft tissues overlying the joint. Wearing shoes that are too narrow or pointed in the toe box is the primary cause of this. The underlying causes of a tailor’s bunion may include the structure and function of the bones that make up the joint. Changes to the alignment of the long metatarsal bone and smaller toe bones will often result in a protrusion of the joint. This protrusion is easily aggravated when a shoe rubs against it. Continued wearing of narrow or tight fitting shoes may actually speed up the development of the bunion. Treatment will initially involve measures to decrease the pain and inflammation. Primarily with pressure deflection and the correct footwear. Orthotics or customised insoles may also be prescribed to help protect the joint and correct any structural alignment issues. If pain and dysfunction continues after persisting with the conservative treatments mentioned above, consultation with an orthopaedic surgeon would be considered.

The plantar plate is a thick, fibrous structure at the base of each joint in the ball of the foot. The fibrous band stabilizes the toe, preventing elevation and rotation. When a tear of the plantar plate occurs it causes instability, deviation of the toe and results in pain and inflammation around the joint. This condition is most common in the 2nd metatarsal phalangeal joint and is a result of faulty foot mechanics, hypermobility of the 1st ray and chronic 2nd metatarsal overload. The chronic overload causes repetitive microtrauma to the joint and surrounding tissues, especially the plantar plate. Traumatic injuries can cause plantar plate tears, but they are not as common as chronic, repetitive stress as a result of abnormal foot mechanics. Conservative treatment with splints and footwear advice will normally resolve the problem.

Hammer Toe /Mallet Toe/Claw Toe. These terms are used to describe deformities that sometimes develop in the lesser or smaller toes. They are common in people with bunions or people who have very flat feet or feet with very high arches. A hammer toe is when the intermediate joint of the little toes are bent right over and eventually the joint becomes completely rigid. A mallet toe affects the distal (end) joint at the end of the toes, if both joints are curled over they are called ‘claw toes’. All these deformities can cause corns and calluses where the prominent joints rub against the shoes or the ground. In severe cases extreme pressure can cause the affected areas to ulcerate. Initially we treat this condition conservatively as this is less invasive and the patient is less likely to suffer side effects and complications than more invasive methods. We will remove the corns and calluses gently with a scalpel and discuss with you treatments that you may benefit from in the future. Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. ‘Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.

This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment. Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff. Treatment ranges from footwear modification to orthotics.

midfoot conditions

The midfoot is primarily made up of your foot’s arch, which consists of a series of many small complex joints. The arch is considered the bridge which connects the ball of your foot and your heel, the two areas which bear most of your body’s weight when standing and walking.

Healthy function of the midfoot is very important as its flexibility allows for the foot to adapt to uneven ground, and therefore helping you to maintain balance. Because the midfoot is the high-point of the foot, the joints in this area are subject to problems if the arch falls, flattens or collapses. A foot with a collapsed arch is considered an unstable foot and this can result in excessive stress on the joints and soft tissue (i.e. plantar fascia) of the midfoot, with subsequent pain.

Flatfeet is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.

Other characteristics shared by most types of flatfoot include:

“Toe drift,” in which the toes and front part of the foot point outwardThe heel tilts toward the outside and the ankle appears to turn inA tight Achilles tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worseBunions and hammertoes may develop as a result of a flatfoot.

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed. The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing. Depending on the symptoms caused by the flat feet, the treatment regime may involve stretching, muscle strengthening, footwear advice and/or insoles/orthotics.

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot. PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.

Diagram of posterior tibial tendon - Podiatry Illawarra

A Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

Like flat feet this condition can be symptomless, but if pain occurs such as calluses on the soles of feet, ankle instability or hammer/clawed toes the orthotics will help.

Stress fractures of the lower extremities account for 95% of all stress fractures in athletes. In the foot the most common sites are the metatarsals (forefoot) whilst in the lower leg it is in the lower third of the tibia.

They are also common in the metatarsals of older patients who may have a degree of osteoporosis

Stress fractures are overuse injuries and result from fatigue failure within the bone, although surrounding muscles actually fatigue first. The muscles are unable to absorb added shock and this is then transferred to the bone leading to a tiny crack.

Symptoms are usually gradual in onset but progress to more intense localised pain with swelling. Pain is usually most severe during exercise but may also be present at rest.

Poor lower leg mechanics (flat feet), poor footwear, poor training and diet insufficiencies can all be factors which cause stress fractures.

Rearfoot conditions

Numerous conditions can cause pain and discomfort in the rearfoot, but by far the most common rearfoot pain is heel pain. There are a number of conditions that may result in pain in the region of your heel, with plantar fasciitis being the most common. Due to the large range of conditions that may cause rearfoot and heel pain, it is vital an accurate diagnosis is made in order to achieve the best outcomes from treatment.

At Podiatry Illawarra, Anthony has undertaken extensive training and education in order to perform comprehensive assessments of the rear foot, allowing us to establish a clear and accurate diagnosis. A clear diagnosis allows us to develop effective treatment plans tailored specifically to you, an approach proven to be highly successful.

Many conditions can cause serious discomfort or pain in the rearfoot. By far the most common complaint is heel pain which can be attributed to a number of conditions.

Plantar Fasciitis is the most common cause of heel pain seen by Podiatrists. Most people who suffer from this condition experience severe pain in the heel of the foot when taking their first few steps out of bed in the morning or after prolonged sitting. The pain classically occurs again after lunch, and after exercise. Some people feel a sharp/stabbing pain, whilst others feel a dull ache.

If plantar fasciitis is not treated appropriately it may become a chronic condition and will prevent you from walking. It may also contribute to developing symptoms in your feet, knees, hip and back due to the changes in the way in which you walk to accommodate the condition.

The good news is that Plantar Fasciitis can be treated relatively easily and results of treatment can be felt quickly. A thorough medical history, assessment of the symptoms, analysis of foot function and footwear will confirm diagnosis.

The treatment regime normally consists of a combination of stretches, ice, rest, footwear and insoles.

Achilles tendonitis pain is often felt in the lower third of the Achilles tendon, approximately 5cm from its insertion into the heel. Pain can also occur at the tendon’s attachment site to the heel. Achilles tendonitis can be either acute or chronic. Symptoms are aggravated by activity and relieved by rest.

It is caused by overuse or excessive strain on the achilles tendon and accounts for an estimated 11% of all running injuries. Poor foot mechanics and excess pronation is often a factor that goes unnoticed. Achilles tendonitis is often now referred to as achilles tendinopathy. This is because it is thought to be due to tendon fibre degeneration rather than inflammation.

Treatment outcomes are best if treated early. The tendon has a poor blood supply meaning that healing is often slow so don’t let this problem progress into the chronic form.

Sever’s disease is a common cause of heel pain, particularly in the young and physically active. During puberty the calcaneus (heel bone) consists of two areas of bone known as ossification centres. These two areas are divided by an area of cartilage known as the calcaneal apophysitis.

The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus. As a child grows the calcaneus grow faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in tensile load can cause inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever’s Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever’s disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.

Treatment can include rest, ice, insoles, stretches.

Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following: Anti-inflammatory drugs, ice, stretches, heel lifts, shoe modification, rest, orthotics.