Podiatry referrals (foot & ankle)

Most foot and heel problems settle with combination of relative rest, avoiding the activity that caused it.
More specific measures include the following:

• Painkillers – simple over the counter painkillers may help ease pain
• Cold packs – an ice pack wrapped in a damp cloth may help ease pain
• Exercise – While removal of causative activity is often necessary it is important to stay active if possible. Regular exercise such as swimming and other non-weight-bearing exercises are best if your feet are painful and make it difficult to exercise. Visit the Arthritis Research UK website for specific exercises to help with foot pain.
• Footwear – Comfort and support should be the main consideration when choosing shoes. If you have a flattened arch that is likely to be causing or aggravating symptoms you may consider insoles to support the arch.
• Heel Pad – may help reduce impact on a painful heel
• Ankle support – an elasticated support my help symptoms and/or reduce swelling
• Weight management – If you are overweight, aiming to get yourself down to a healthy weight can help your condition. Adjusting your eating habits and simple measures such as portion control, will make a great difference. There are many sources of support to help you lose weight. The NHS Livewell website has a 12-week plan to lose weight.

Most foot and heel pain can be self-managed by following the advice above. However you should see your GP if:

• You can’t put weight through your foot
• Pain does not improve after a few weeks
• Pain gets worse despite self-management
• Area becomes red and hot e.g. signs of Gout or swelling

• Plantar fasciitis is a common cause of foot pain. The plantar fascia is the tough band which supports the arch of the foot, and runs from the heel to the bases of the toes, along the sole of the foot. Plantar fasciitis results in pain on weight bearing when getting out of bed in the morning. It is relatively easy to diagnose and can be self-managed although takes time to settle.
• Lateral ligament injury – another common injury, also known as ‘’rolling the ankle’’. This is easily done during activity, whether it be sport or twisting the ankle on an uneven surface. Pain is felt on the outside of the ankle. If you are able to walk on it (weight bear) after the injury self- management is usually successful. If you are unable to weight bear, you should seek advice to ensure you get correct treatment as an X-ray may be indicated. Without proper rehab this can be a persistent injury so please take time to look at the above link to ensure proper rehab and reduce risk of recurrent injury.
• Achilles tendinopathy – This commonly results from overuse of the Achilles tendon so is commonest in runners. It results in pain and stiffness, often worst first thing on getting out of bed.
  If you think the tendon has “snapped” – resulting in sudden, severe pain, and often associated with a loud snap or crack, you should seek urgent medical attention
• Morton’s neuroma, or Morton’s metatarsalgia. One of the nerves in the foot becomes thickened which irritates and compresses the nerve It results in pain at the base of the toes and ball of the foot. Sometimes feels like a pebble in the shoe. It may start as a tingling sensation between the toes.
• Bunion (hallux valgus)– This is a deformity in the bone at the base of the big toe, which causes the big toe to bend towards the other toes, resulting in a painful, swollen bony lump on the outside of the foot (the bunion). Often worsened by pressure from shoes.
• Tibialis Posterior Dysfunction – This condition causes pain on the inside of the ankle, behind the bony prominence (medial malleolus). It is more common in those over 50 or with flat feet. It causes pain in the affected area, usually with increase in weight bearing activity. It is important to treat it to reduce both symptoms and risk of tendon rupture which can occur if it is left untreated for a prolonged period.
• Gout– The big toe is the most commonly affected joint, although other joints may also be involved. Crystals form inside the joint, and cause often severe pain, swelling and redness often coming on quickly overnight. Initial management targets symptom relief, so try using painkillers such as ibuprofen, and cold packs. Other medications such as steroids are sometimes needed. To prevent future attacks, lifestyle modifications such as weight loss (if needed) help, as well as longer-term medications such as allopurinol prescribed by your GP. There is a link between gout and heart disease so it is important not to ignore it but seek medical advice.