Foot & ankle pain

Up to 50% of people with diabetic neuropathy have no symptoms at all. Others may experience symptoms that don’t seem serious but develop slowly over months and years. It is very important for people with diabetes to undertake regular medical checks to look for early signs of this condition. Some of the signs of diabetic neuropathy may include one or more of the following:

• Numbness or reduced feeling in the feet.
• Tightness or burning, shooting, stabbing pains in the feet, hands or other body parts.
• A reduced or increased sensitivity to light, touch or temperature.
• Weakness and loss of balance and coordination.
• Extreme sweating on the torso, face or neck at night or when eating certain foods (spicy foods or cheese for example).
• Problems emptying the bladder properly or sensing when the bladder is full.
• Pain in and around the eyes, double vision and trouble moving an eye.

The high blood sugar levels common in people with diabetes can cause damage to blood vessels that supply oxygen and nutrients to the nerves in our feet. This can cause damage to the skin and the subsequent sensation, therefore making the feet more susceptible to damage. The following risk factors have also been shown to contribute to a diabetic person’s likelihood of developing diabetic neuropathy:

• Obesity.
• Smoking.
• Being older than 40 years of age.
• Extended periods of poor blood sugar level control.
• The chances of developing this condition increase the longer a person has diabetes.
• Hypertension.
• Heart disease.

To establish if diabetic neuropathy may be present, a podiatrist would typically ask questions about your symptoms and health history. A physical examination would be conducted checking the sensation in your feet, the circulation, looking at the skin of the feet thoroughly and checking the tendon reflexes. It may be necessary for you to schedule a doctor’s appointment for more extensive testing based on the results.

There is no cure for diabetic neuropathy, but controlling your diabetes properly and consistently is the best form of treatment. It is important to always keep your blood sugar levels within your target range to reduce symptoms.

It is also important to properly care for your feet. Diabetic neuropathy can cause the loss of feeling and sensation in the feet, increasing the risk of getting an unnoticed cut or scratch on your foot that can develop into a sore or ulcer, leading to the chance of serious infection.

Other treatments that may help to manage symptoms include:

• Regular exercise.
• Weight reduction.
• Enjoy a healthy and balanced diet.
• Quit smoking.
• Control your blood pressure.
• Limit or avoid alcohol consumption.

Dan Everson Podiatry would recommend the following steps to help prevent diabetic neuropathy:

• Never walk barefoot.
• Check your feet daily for redness, swelling, cuts, bruises, sores, ingrown toenails, splinters and blisters using a mirror or ask a friend or family member to check for you.
• Schedule 12 monthly check ups with your podiatrist. Have them check for any corns or callouses on your feet. If you find a corn or callous prior to a checkup, do not use over the counter corn pads or razor blades.
• Wash your feet daily and ensure they are completely dry, paying particular attention to washing and drying the soles of your feet and in between the toes.
• Cut your toenails straight across with good quality nail clippers. File the nails afterwards.
• Moisturise your feet daily but do not apply lotion in between the toes.
• Wear seamless socks or stockings that are not too tight or restrictive.
• Ask your podiatrist about the best type of footwear and orthotic devices for your particular needs.
• Keep your feet away from direct heat from heaters, hot water bottles, scalding hot showers or baths and electric blankets.
• Exercise regularly but carefully to prevent injuring your feet.

Diabetic Angiopathy is a serious disease of the blood vessels and is a common complication of chronic diabetes. It involves the decaying of the blood vessels and capillary tubes. There are two forms of Diabetic Angiopathy – micro-angiopathy which impacts the heart vessels and lower body limbs and macro-angiopathy which affects the eyes and kidneys. The triggers for diabetic angiopathy are the hormonal and metabolic disorders which stem from diabetes. Other risk factors include high blood pressure, smoking and regular alcohol consumption.

Symptoms of this condition include fatigue after exercise, and pain in the thighs and hips. This is followed by more acute pain in the feet when a person is lying down, which subsides during standing. At the condition’s most severe stage, the foot can become covered in ulcers and affected by gangrene. Diabetic patients should be checked regularly for diabetic angiopathy, and should immediately see their podiatrist if they suspect they have symptoms.

A person with a bunion may notice pain around the area and difficulty and increased pain when walking or running. The big toe will start to angle inwards towards your other toes – this can affect the second toe and cause it to become displaced also.

The area may become inflamed, swollen and painful to touch, with a lump of thickened and inflamed skin often appearing around the affected joint. Over time the foot may become too wide to fit into regular footwear. Arthritis of the big toe may also develop as a result.

Although it can be difficult to determine the exact cause of a bunion, it is thought certain hereditary foot types contribute to a large number of cases. These foot types have a faulty mechanical structure or characteristic making the person more likely to develop a bunion.

Other contributing factors include conditions affecting the joints such as osteoarthritis and rheumatoid arthritis.

Dan Everson Podiatry can diagnose a bunion through a physical examination of the foot.

There are several ways Dan Everson Podiatry would typically recommend, alone or in combination, to treat a bunion:

• Wearing appropriate and well-fitted footwear is essential to avoid further aggravating the condition. Roomy shoes will help to avoid rubbing of the bunion when you walk or run. Closed shoes, high heels and pointed shoes should be avoided.
• Following diagnosis, Dan Everson Podiatry may prescribe Kinetic Orthotics to insert into your footwear to help straighten the affected toes and treat other contributing factors. This is a range recommended by Dan Everson Podiatry, and is designed using patent-protected technology that optimises the way force is transferred as you move.
• Placing padding over the bunion will help to cushion it and prevent further rubbing and reduce impact to the area.
• Applying ice to the affected area during rest periods.
• Using pain-relief medication.

If you think you may be at risk of developing bunions, Dan Everson Podiatry would recommend seeing your podiatrist for advice on what kind of footwear is appropriate for you.

The main symptom experienced by people with Morton’s neuroma is a clicking feeling in the forefoot, followed by a sharp and burning pain or sensation of pins, numbness or needles extending to the end of their toes.

These symptoms typically become worse over time, and can be heightened through wearing narrow fitting shoes or extended periods of standing or walking. People with Morton’s neuroma can limp from the pain or feel forced to stop walking altogether.

Morton’s neuroma is most often brought about when the toes are squeezed together too often and for too long through activities such as wearing high heels or tight shoes.

Other contributing factors to Morton’s neuroma are:

• Being overweight.
• The ageing process that can weaken the pads that protect the feet.
• High impact exercises on hard surfaces that force the feet to absorb more impact from movement than they should.
• Abnormal foot movements used to ease the symptoms of bunions, hammertoes and flat feet.
• Having a stiff ankle or Achilles tendon.

A podiatrist can diagnose a case of Morton’s neuroma through history taking and an investigation of your symptoms. Your feet will also be examined and a hands on examination will take place where your podiatrist will try to bring about your symptoms. You may also be encouraged to perform certain movements to help your podiatrist assess your foot alignment and function.

A blood test, foot X-ray, bone scan, ultrasound or MRI scans are sometimes required to firmly establish the cause of the pain.

It is imperative to treat this condition immediately as the pain can spread to the rest of the foot and legs, eventually impacting a person’s ability to move freely.

Dan Everson Podiatry will recommend a treatment option based on the nature and severity of your condition. This may include:

• Rest and modifying your lifestyle to avoid unnecessary pressure on the feet while the area heals. This can involve using crutches and avoiding high impact exercises.
• Applying ice to the affected area for 15 minutes two or three times a day.
• Massaging the area.
• Anti-inflammatory drugs.
• Kinetic Orthotics are recommended by Dan Everson Podiatry to help ensure correct movement of the metatarsal bones to reduce compression on the nerves. Kinetic Orthotics are designed using patent-protected technology that optimises the way force is transferred as you move.

Dan Everson Podiatry recommends the following activities to help prevent Morton’s neuroma.

• Warming up thoroughly before intense exercise.
• Stretching and strengthening the feet through exercises prescribed by your podiatrist.
• Ensure your weight sits within a healthy range to avoid stress on the feet.
• Avoid lacing the forefoot part of your shoes too tightly.

A person with a metatarsal stress fracture will often experience a progressive pain in the front foot that gets worse when undergoing activities which bear weight on the foot such as walking and running. Swelling and tenderness around the area is often also experienced, with a sharp pain felt when pressure is applied to the metatarsal

The most common causes of this condition are:

• Excessive weight bearing activities such as running, sprinting, jumping or dancing.
• A second toe being longer than the first.
• Poor quality footwear that doesn’t provide enough support.
• Landing on a hard surface from a height.
• The foot being stepped on or kicked, or having something dropped onto it.
• Not allocating enough rest time between activities or suddenly increasing the intensity of their exercise programs.
• When the foot rolls inwards excessively during walking or running, which results in the lower leg also turning inwards.
• When the metatarsal bones weaken due to conditions such as osteoporosis.
• When nerve sensation in the feet is weakened due to neurological issues such as diabetes.
• Tightness in the calf muscles.

Dan Everson Podiatry can diagnose a metatarsal stress fracture through an examination of the area in conjunction with a bone scan that will provide a precise image of the fracture and can confirm the injury in very early stages. X-rays may be recommended for severe cases or at a later stage of the injury. MRI scanning is occasionally used to diagnose this injury.

First and foremost, people with metatarsal stress fractures must ensure they rest the area as much as possible. Your podiatrist will guide you as to the degree of rest required, depending on the nature and severity of your fracture. Below is a selection of other treatments Dan Everson Podiatry would recommend for this condition:

• Stick to low impact activities such as swimming, bike riding or running in the water during the healing process.
• Crutches to avoid weight bearing on the affected foot.
• Anti-inflammatory medications.
• A cast or brace for severe cases where a fracture or displacement is likely.
• Protective footwear with more supportive soles to relief stress to the area.
• Surgery is rare but occasionally needed where a screw is inserted into the bone to help it heal.

When the rest period determined by your podiatrist has been completed and you have remained free of pain for a fortnight, you are able to consider a gradual return to a reduced movement exercise program. Keep in mind the foot will be particularly vulnerable for the first four weeks while it repairs itself.

Dan Everson Podiatry recommends the following activities to help prevent metatarsal stress fractures.

• Custom orthotics can help prevent this condition through reducing the strain on the metatarsal bones. Dan Everson Podiatry recommends its range of Kinetic Orthotics, which is designed using patent-protected technology that optimises the way force is transferred as you move.
• Wear a supportive shoe at all times with appropriate arch support.
• Athletes should speak with their podiatrist about whether any modifications to their training program are needed.

People with sesamoiditis often experience a dull pain in the ball of the foot, right underneath the big toe joint. This pain typically does not improve without treatment and can heighten to a sharp throbbing sensation. The sensations can come and go and usually become worse when wearing certain kinds of shoes or during particular movements.

Other common signs of sesamoiditis include:

• Swelling, bruising and pain in the ball of the feet and surrounding area.
• An inability to move the big toe freely.
• Limping or walking differently compared to usual in order to compensate for the discomfort experienced. This can in turn result in pain to people’s knees, hips, lower back and other parts of the foot.

The major causes of sesamoiditis are:

• A sudden increase in activity levels or change of exercise type that places more pressure on the balls of the feet.
• Bony feet with a lack of padding to protect the sesamoid bones.
• Feet with high arches can transfer pressure to the balls of the feet during certain movements.
• Flat feet.
• Wearing high heels.
• When the big toe is suddenly pulled upwards.
• Footwear with narrow toe boxes and toe springs.

Dan Everson Podiatry is able to diagnose cases of sesamoiditis through history taking, a physical examination of the area and a Biomechanical Assessment to study your style of movement. An X-ray may also be recommended.

Dan Everson Podiatry would typically suggest one or more of the following treatment methods:

• A period of rest.
• Anti-inflammatory medication.
• Applying ice to the area after exercise or movement that causes pain.
• Your podiatrist may advise you to wear a different style of shoe that can take pressure off the area and allow the toes room to spread.
• Avoiding wearing high heels while the area heals.
• Strapping or taping the big toe during the healing process.
• Your podiatrist may recommend you wear a cushioning pad under the area for extra support.
• A short removable leg fracture brace or cast may be advised for serious cases.
• Certain exercises can support the recovery process.
• Surgery may be considered in some cases. Dan Everson Podiatry can advise you on the best approach.

Dan Everson Podiatry recommends the following activities to help prevent sesamoiditis:

• Kinetic Orthotics may help prevent this condition by cushioning the sesamoid bones if you have some of the risk factors. This is a range recommended by Dan Everson Podiatry, and is designed using patent-protected technology that optimises the way force is transferred as you move.
• The correct form of footwear that allow the feet enough room to move and do not cramp the toes.
• Replacing athletic shoes at least every six months.

The tendon of people with posterior tibial tendonitis typically provides less stability and support for the arch of the foot. This can result in:

• Pain experienced on the inside of the foot and ankle.
• People feeling unsteady on their feet, experiencing muscle weakness or difficulty rising onto their toes on the side that is affected.
• Pain which gets worse with movement or long periods of standing.
• Pain experienced on the outside of the ankle. This occurs as a result of the heel bone repositioning itself and placing pressure on the outside ankle bone.

More serious cases can result in a flattening of the inside arch of the foot resulting in flatfoot, and toes ‘splaying’ outwards.

The most common causes of posterior tibial tendonitis are:

• Continued wearing of poorly fitting or unsupportive shoes.
• Trauma or injury to the ankle joint.
• Poor foot posture, with too much pressure placed on the ankle joint.
• Overuse of the tendon by athletes or physically active people.

A podiatrist can diagnose a case of posterior tibial tendonitis through a physical exam of the foot and ankle area and an investigation of your symptoms. You may be asked to walk to help your podiatrist assess your range of motion and flexibility.

Your podiatrist may also recommend an X-ray, MRI, CT scan or ultrasound as part of the diagnostic process.

Dan Everson Podiatry will recommend a treatment option based on the nature and severity of your injury. These may include:

• Rest and modifying your lifestyle to reduce or stop painful activities. Changing to low impact exercise is usually recommended.
• Ice therapy to the affected area three or four times a day to reduce swelling.
• Strength and conditioning work.
• Stabilisation (strapping, splitting, casting) may be recommended to allow the area to rest and recover.
• Surgery may be needed in some cases, which requires referral from a doctor to an orthopaedic surgeon.
• Anti-inflammatory medication.
• Orthotics may be prescribed to help treat this condition and prevent a recurrence. Dan Everson recommends its range of Kinetic Orthotics, which is designed using patent-protected technology that optimises the way force is transferred as you move.

Dan Everson Podiatry recommends the following activities to help prevent posterior tibial tendonitis.

• Wear supportive shoes and customised orthotics to reduce stress on the tendon.
• Perform stretches daily that strengthen the calf and posterior tibial tendon.
• Balance work on a balance board or Bosu ball can alleviate stress to the tendon.

The condition develops gradually and results in pain and stiffness to the area that gets worse over time. People with osteoarthritis will usually find it difficult to walk, bear weight or bend the joint without pain. Bone spurs can also develop as a result of osteoarthritis.

The below are common causes of osteoarthritis:

• Obesity and a family history of the condition.
• An injury can lead to osteoarthritis in 15 percent of cases – such as kicking or jamming the big toe, dropping something on the midfoot, or a fracture of the ankle. This is called post-traumatic arthritis.
• Atypical foot mechanics – flat feet or high arches which cause strain on the joints.

Dan Everson Podiatry can diagnose osteoarthritis through history taking, a physical examination of the foot and ankle and a biomechanical assessment to study your range of movement, look for swelling in the joint and pain experienced through movement. An X-ray, MRI or CT scan may also be recommended to evaluate the stage of the illness.

Dan Everson Podiatry would typically suggest one or more of the following treatment methods:

• Anti-inflammatory medication.
• Kinetic Orthotics may be prescribed to help the foot move more freely or for cushioning support to provide pain reduction. This is a range designed by Dan Everson Podiatry, and is designed using patent-protected technology that optimises the way force is transferred as you move.
• Weight loss may be recommended for overweight patients.
• Shoe modification.
• A foot brace to protect the foot from movement and support the joint can reduce pain during walking and help prevent alignment problems.
• A cast to restrict movement while the inflammation reduces.
• Your podiatrist can recommend certain exercises to strengthen and stabilise the area, and minimise risk of injury.
• Surgery may be recommended in some cases with osteoarthritis has progressed to an advanced stage or when other forms of treatment have not improved the condition.

Dan Everson Podiatry recommends the following activities to help prevent developing osteoarthritis in the foot and ankle.

• Control your weight to lessen strain on the joints.
• Avoid foot and ankle injuries by wearing appropriate shoes, avoid hard surfaces when exercising and land with the knees bent to improve shock absorption.
• Treat any joint injuries as quickly as possible.

Symptoms are most often experienced in the toes and forefeet first, then in the back of the feet, and then the ankles.

The symptoms most often associated with rheumatoid arthritis are:

• Deformities of the feet.
• Pain, swelling and stiffness of several joints in both feet. This typically manifests in pain in the joint, sole or ball of the foot.
• Development of corns or bunions on the feet.
• Toes that curl and stiffen.
• Bones that shift, causing the foot’s arch to collapse, resulting in flat feet.
• Fever, fatigue and appetite loss of appetite.
• Softening of the bone resulting in stress fractures and bone collapse.
• Difficulties walking up inclines and stairs.

The causes of rheumatoid arthritis are presently unknown.

Dan Everson Podiatry can assess for rheumatoid arthritis through history taking, a physical examination of the foot and ankle and a biomechanical assessment to study your range of movement, look for swelling in the joint and pain experienced through movement. An X-ray, MRI or CT scan may also be recommended to evaluate the stage of the disease. A blood test through the doctor and consultation with a rheumatologist may also be required to diagnosis and manage in condition, in conjunction with podiatric care.

Dan Everson Podiatry would typically suggest one or more of the following treatment methods:

• Anti-inflammatory, pain relief and prescription medication which can help slow the spread of the condition.
• Rest and applying ice to the area.
• Kinetic Orthotics may be prescribed to help the foot move more freely or provide pain reduction. This is a range designed by Dan Everson Podiatry, and is designed using patent-protected technology that optimises the way force is transferred as you move.
• Shoe modification – deep toe boxes or soft arch supports with a firm heel can be helpful.
• Canes and crutches may be advised for severe cases.
• A cast to restrict movement while the inflammation reduces.
• Your podiatrist can recommend certain exercises to improve your range of movement.
• Surgery may be recommended in some cases. The most common procedure performed for rheumatoid arthritis is the fusion of the affected joints.

There is no known way to prevent rheumatoid arthritis, as the causes are presently unknown. There are several ways to reduce your risk of major joint damage after a diagnosis of this condition:

• Consult with your doctor as soon as you have any symptoms in order to be properly diagnosed, so you can be managed by your podiatrist appropriately.
• Speak with your podiatrist about a program of gentle stretches and strength movements to reduce pain and strengthen the bones.
• Rest from exercise during the periods you are experiencing the most pain.
• Avoid smoking.