Forefoot Pain

Morton’s Neuroma

Morton’s neuroma: is an thickening of the nerve that runs between the toes (the “interdigital nerve”)which may be the result of chronic impingement (“pinching”) of the nerve. The most common site for a neuroma to develop tends to be between the 3rd and 4th toes and creates numbness or tingling in the toes.

Often one of the easier ways to determine if pain in the front of the foot is as a result of a Morton’s neuroma is to ask whether the pain is better or worse when wearing footwear. Often, in cases of Morton’s neuroma, the affected person feels much better when footwear (typically tight fitting) is removed. In these cases, the compression of the nerve caused by squeezing the foot into a tight shoe makes the pain much worse.

 

Sesamoiditis

Inflammation of the sesamoid bones and surrounding structures beneath the ball of the big toe.  This condition creates a sharp pain or burning and is made worse with excessive bending of the big toe joint and wearing unsupportive shoes, especially high heels.

Hallux valgus

 

 

Hallux valgus: is an angulation of the big toe toward other toes that often results in a bunion. (Bunion: prominent bump on the first joint of the big toe.)

Often referred to as a bunion, hallux valgus is a deformity at the major joint of the big toe, otherwise known as the 1st metatarsal phalangeal joint. This condition comes about when the end of the big toe angles towards the smaller toes. Such an abnormal angle causes the joint to enlarge. This enlargement (the bunion) can be red and swollen, is often painful and may stiffen over time. The most common symptoms associated with bunions include:

  • Pain at the 1st toe joint.
  • Pain under the 2nd toe joint.
  • Stiffness of the first toe joint in more advanced cases.
  • Inflammation of the first toe joint.
  • bunionette bunion on the little toe

 

Metatarsalgia

Metatarsalgia is the general term used to describe forefoot pain in the area of the metatarsal bones. The pain usually occurs at the ball of the foot, otherwise known as the metatarsal phalangeal joints. 
The most common symptoms associated with metatarsalgia include:

  • Tenderness and / or burning at the ball of the foot.
  • Sensation of walking on a pebble.
  • Sharp or shooting pain.
  • Painful callous under a metatarsal head.

The most common causes of metatarsalgia include:

  • Overuse caused by prolonged standing or walking.
  • Quick ‘start and stop’ sports.
  • Diseases such as arthritis, diabetes, osteoporosis and other bone/joint diseases.
  • Higher heels or pointed toed shoes.

Heel Pain 

Plantar Fasciitis

Plantar Fasciitis is one of the most common heel problems seen by Canadian Certified Pedorthists, plantar fasciitis is the inflammation and irritation of the plantar fascia (a thick fibrous tissue that extends from the heel to the toes and supports the arch). Poor foot posture or excessive ankle motion during walking can strain the plantar fascia resulting in small tears and increased tension where the fascia attaches to the calcaneus (heel).

Symptoms:

  • Pain and swelling (inflammation) at the beginning of the arch or bottom of the heel
  • Often the pain is worse with the first few steps when getting out of bed or after sitting

 

Severs Disease

Severs Disease is pain in the back of the heel where the Achilles Tendon inserts into the bone.  It is often caused from playing sports or anything that involves a lot of repetitive heel movement. It can be associated with starting a new sport, or the start of a new season. Children who are going through adolescence are also at greater risk of getting it because the heel bone contains a growth plate that is softer during growth and is susceptible to overuse. Flat shoes, especially cleats, increase the strain on the Achilles Tendon and create increase tension on the heel bone often causing Severs Disease. It occurs more commonly in children who over-pronate, and involves both heels in more than half of patients.
Treatment may consist of one or more of the following:

  • Elevating the heel
  • Stretching hamstring and calf muscles 2–3 times daily
  • Using R.I.C.E. (Rest, Ice, Compression, Elevation)
  • Foot orthotics
  • Medication
  • Physical therapy
  • Icing daily (morning)
  • Heating therapy
  • Open back shoe are best and avoid high heel shoe

 

Achilles Tendonitis & Achilles Tendonopathy

These are injuries to the Achilles tendon just above the heel on the back of the leg. This condition may be due to abnormal or excessive strain on the tendon from poor shock absorption or excessive foot pronation.  The achilles tendon joins the calf muscles to the heel bone. This tendon allows the calf muscles to move the ankle when walking, running and jumping. With repeated strain, micro-tears as well as degeneration may occur as a result in the tendon.

Symptoms:

  • Pain, swelling, and possible nodule formation along the Achilles tendon or where it is attached to the back of the calcaneus (heel)
  • Stiffness may be present after sitting or resting
  • Pain with flexing the ankle

Calcaneal Stress Fracture

Calcaneal stress fracture of the heel is usually a result of some sort of trauma but can also result from increased activity done improperly.
Symptoms:

  • Total avoidance of weight-bearing will be seen in an individual with a stress fracture of the calcaneus (heel) due to severe pain in the bone.

 

Knee Pain

Patellofemoral Pain Syndrome (PFPS)

Patellofemoral Pain Syndrome (PFPS) is often described as a gradual onset of pain in the front of the knee cap. The pain is caused by improper tracking and abnormal movement of the knee cap over the bone below.
The most common symptoms associated with Patellofemoral Pain Syndrome include:

  • Pain with walking up or down stairs.
  • Discomfort with prolonged sitting.

 

Iliotibial band friction syndrome (ITBFS)

Iliotibial band friction syndrome (ITBFS) is pain along the outside of the thigh that can radiate from the hip to the knee.  The pain is due to overuse or mechanical strain of the Iliotibial band and requires specific rehab exercise and adjustments to the mechanics of the hip, knee and foot.

Shin Pain (shin splints)

The term shin splints refers to a painful condition that develops where the muscles located on the shin and in the calf muscles attach to the shin bone (tibia). They actively control 1 to 5 times your body weight, an average of 10,000 times per day.
The most common symptoms associated with shin splints include:

  • Burning and aching along the shin bone.
  • Pain is sharp and constant when muscles are used.
  • Most symptoms increase with accumulating activity.

The most common causes of shin splints include:

  • Over pronation - flat feet, fallen arches and weak ankles strain these muscle.
  • Unsupportive footwear - common with gel pads or air bag soles.
  • Participation in high impact sports and “too much, too soon” training.

Tibialis Posterior Tendonitis

Inflammation of the tibialis posterior tendon. The tibialis posterior tendon runs along the inside of the ankle and shin. The tendon functions to control the arch of your foot while walking. Because it is used so much when waking, then tendon undergoes a great deal of stress. For this reason, the tendon is vulnerable to injury.

The most common symptoms of Tibialis Posters Dysfunction include:

  • Collapsed arch.
  • Pain along the inside of the ankle.
  • Tendon is tender to touch.
  • Pain with walking.

The most common causes of Tibialis Posters Dysfunction include:

  • More common in females.
  • Overpronation (feet rolling in and flattening).
  • Overweight.
  • Previous injury to the area.
  • A shortened leg ( genetic or due to surgery).

 

Other Conditions or Complications Due To:

  • leg length discrepancy
  • osteoarthritis and rheumatoid arthritis
  • diabetes
  • neuropathy
  • peripheral vascular disease
  • chronic ankle sprains