SORE FEET? COMMON INJURIES & PHYSIO TREATMENTS TO HELP
Foot injuries are amongst the more common ones we see at the clinic. Our feet contain lots of little bones, tendons and muscles which are all treated differently with foot physiotherapy management. With foot physio, accurate diagnosis is important to ensure appropriate management and successfully overcoming the injury. As foot physiotherapists in Melbourne, here are the 3 most common foot injuries that we see:
1. Plantar Fasciitis or Fasciopathy
This is a very common problem characterised by heel pain and is due to excessive pressure against the inner part of the heel where the plantar fascia starts from. It is particularly worse on initial walking after a long period of rest and also after a long period of standing, walking or running.
Reasons differ for every individual, however most people with this problem have a combination of the following factors which may be contributing to their problem:
Excessive standing, walking or running
Excessive increase in exercise load
Suboptimal footwear - usually too firm
Suboptimal foot mechanics
Suboptimal hip mechanics
Suboptimal calf strength
Poor running technique
Reducing the time spent on your feet and wearing shoes with a softer sole are good measures to reduce the pain in the short term. However, muscular and leg biomechanical deficits will need to be addressed in order to promote healthy movement of the leg and reduced pressure upon the heel, given that it is not practical to spend all our time sitting.
For example, hip muscle weakness can result in suboptimal leg alignment during walking, thereby causing the foot to roll inwards excessively and place greater pressure through the inner side of the heel, as shown by the blue arrow:
Foot physio for Plantar Fasciitis
Physiotherapy is important in relieving the heel pain and preventing the recurrence of the problem. Initially, physiotherapy measures may include taping of the foot in order to reduce the pressure on the heel during walking, and shockwave therapy (if needed) to reduce the inflammation at the painful site. Strengthening of weak and relevant calf and hip muscles will also begin early on during management.
As the pain settles, it is important to note that the absence of pain does not mean absence of the problem, as the calf and hip muscles will need to continue getting stronger through advanced exercises.
What about a running assessment?
A running assessment may also be helpful, as excessive heel strike during running can also increase pressure on the plantar fascia. Optimising your running technique in combination with a thorough strengthening program will help to prevent future recurrence of plantar fasciitis.
2. Peroneal Tendinopathy
The peroneal tendons are a pair of tendons running along the outer side of the ankle and connecting to the outer side of the foot. Like any other tendon problem, if they are too weak compared with the demands placed on them with physical activity, the tendon can become painful and limit the ability to walk properly. Pain due to peroneal tendinopathy can be anywhere on the outside of the ankle to the foot along the area shaded red:
Diagnosis by a foot physiotherapist
Successful foot physio management for this injury typically depends on accurate diagnosis, as bone stress injuries can occur to bones near the tendon. The tendon will typically be weak on strength testing compared with the other non-painful side. The pain will tend to improve with movement and walking or running, as if it needs to be “warmed up” to feel better. Typically, people mention the first few steps of the day in the morning to be one of the worst times of the day for their pain. However once there has been too much walking or running beyond which the tendon can handle, it will become painful once again.
Compared with a Peroneal tendinopathy, a bone stress injury will typically be not too bad with initial walking in the morning, but get worse throughout the day as more pressure has been placed through the foot. Physiotherapy management of bone stress injuries and tendon injuries are very different, and at times an X-ray or MRI may be required to help determine the cause of the pain.
Absolutely. Initially taping is very helpful to reduce the pressure on the tendon. With taping most people have reduced pain with walking or running immediately. Although that is great in the short-term, the tendon will ultimately need to be strengthened through an exercise program in order to properly fix the problem. As the tendons help the main calf muscles during movement, calf raises are an important part of exercise rehabilitation and can be progressed to jumping and landing drills once able to without bringing on the symptoms.
3. Bone stress injuries
It is possible to sustain a stress injury to any bone in the body, and particularly the bones of the foot as they must tolerate a lot of force coming from the rest of the body and coming back up from the ground with landing during running and sport. A bone stress injury refers to 1 of 2 issues:
a. Stress reactions, which are painful overuse injuries for which there is X-ray or CT scan evidence showing a “hot spot” on a bone without there being a fracture. The following is a very clear example of a stress reaction:
b. Stress fractures, which are considered the end-stage progression of a stress reaction where the bone has become weak enough to break and show a fracture line on imaging:
Foot physio to fix a Bone Stress Injury
Physiotherapy cannot directly fix such injuries, however it has an important role in diagnosing the problem as these injuries should not be missed, especially as long-standing stress fractures can progress to the point of non-union where the bone can no longer heal. If a bone stress injury is suspected, a Physiotherapist may refer directly for an X-ray, or request a G.P. to refer a patient for a CT scan as Physiotherapists cannot refer directly for these. Even if a Physiotherapist believes a patient only has a small chance of a bone stress injury, imaging should be organised to make sure.
Management of a foot bone stress injury should involve a Sports Doctor, who may recommend a period of using crutches to avoid bearing weight through the foot, or allow a patient to walk on their injured foot with the use of a moon boot. This reduces the pressure on the bone to allow healing.
Generally speaking, a period of 6 weeks may be required for a stress reaction to fully heal before sport, and 12 weeks for a stress fracture.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!