Toe Pain

Claw toes can develop in many people as they age. It is caused by a muscle imbalance. The long muscles that originate from the lower leg overpower the smaller muscles within the foot. This muscle imbalance leads to the clawing effect of the toes. Claw toes typically involve all four lesser toes, and rarely involve the great toe. The term ‘hammer toe’ (although a slightly different condition) can be used interchangeably with the term claw toes.

Claw toes can create multiple problems for patients. These include:

  • Rubbing on the top of the toes from shoes
  • Rubbing on the tip of the toes as they jam into the sole of the shoes
  • Pain under the “ball of the foot” due to partial displacement of the metatarsophalangeal joints

The treatment will vary slightly depending on the exact symptoms, but may include:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

One of the most common sites for arthritis is at the base of the great toe in the metatarsophalangeal joint. This joint is regularly flexed with each step we take. A bony spur on the top of the bone may develop, making the joint stiff and painful when walking. This is called Hallux Rigidus.

The symptoms of Hallux Rigidus include:

  • Pain in the joint when walking, particularly during push off
  • Swelling around the joint area
  • A bump on the top of the foot
  • Severe stiffness in the great toe, particularly when bending upwards

With Hallux Rigidus, patients may require:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

 

A bunion is clinically known as hallux valgus. A bunion occurs when the joint at the base of the big toe becomes enlarged, sore and swollen, and often angles toward your second toe. Bunions are mostly genetic, but can be particularly prominent in females due to narrow tight high-healed shoes.

A bunion develops as the metatarsal (long bone) of the great toe elevates and rotates. This causes excessive pressure through the 2nd metatarsal head and often presents with pain and callousing under the 2nd metatarsal head and within the big toe joint itself.

There is no conservative management that can correct the bunion or position of the great toe. The aim of conservative management is to reduce pain levels. This can be achieved by using:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

Midfoot Pain

There are many bones and joints in the midfoot area. It is not uncommon that people develop midfoot arthritis in these joints. The pain experienced is commonly worse when walking, standing or laying in bed at night. This pain can be extremely debilitating and make everyday function very difficult.

With each step the joints of the midfoot collapse slightly and flex as you push off during gait. To counteract this, common treatment includes:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

Medial Arch Pain

The tibialis posterior runs down the medial (inside) and posterior (back) of the ankle. The tibialis posterior tendon functions to stop the ankle from rolling inwards and the medial arch collapsing. This tendon can either completely rupture or develop tears along the length of it (tendonitis/dysfunction).

Symptoms of Tibailis posterior dysfunction/tendonitis or rupture include:

  • Severe pes planus (flat foot deformity)
  • Pain on the medial (inside) of the ankle
  • Swelling on the medial side of the ankle
  • Pain on the lateral (outside) of the ankle
  • Inability or difficulty doing a single leg calf raise

There are many different orthotic treatments available depending on the grade of deformity. These include:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

Flat feet or pes planus is a very common condition associated with medial arch collapse. The symptoms of flat feet include:

  • Physical signs of medial arch collapse
  • Pain along the tibialis posterior tendon which runs down the inside (medial side) of the leg and ankle
  • Pain on the outside of the ankle where the heel bone (calcaneus) and the fibula compress together
  • Knee pain, particularly on the inside (medial side) of the knee joint

Some common causes of flat feet include:

  • Injury to the tibialis posterior tendon.
  • Arthritis in the foot and ankle destroys the cartilage between the joints and the ligaments that support these joints. This can cause the joints to shift and develop a flat foot deformity
  • Injury to the bones or ligaments in the midfoot area (lisfranc injury) can result in a flat foot deformity
  • Diabetics with peripheral neuropathy can develop a charcot foot. The bones and ligaments in a charcot foot are basically destroyed and almost crumble. This can result in a severe flat foot and often unusual deformities which puts them in a high risk category for developing ulcers

The most common treatment for a flat foot is:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

Heel Pain

Plantar fasciitis is the most common cause of heel pain. The plantar fascia is a thick band of tissue which runs along the sole of the foot. The plantar fascia creates the medial arch of the foot. When sitting, the plantar fascia is shortened and the medial arch is high. When we stand, the plantar fascia stretches, allowing the medial arch to collapse slightly.

When someone has plantar fasciitis, they have a very tight plantar fascia. During standing, instead of the plantar fascia stretching to allow the arch to collapse, it has to tear along the length of the fascia and pull away from where it inserts into the heel bone. This causes pain, particularly first thing in the morning or when standing up after sitting for a period of time. As a result of the pulling in the heel bone, a heel spur can develop however is not always present in patients with plantar fasciitis. Plantar fasciitis is also exacerbated by tightness in the calf muscle and Achilles tendon.

Symptoms of plantar fasciitis include:

  • Pain in the heel area, particularly first thing in the morning
  • Tenderness along the sole of the foot
  • Pain when palpating the heel area
  • Calf cramps and tightness

Depending on the specific symptoms and the biomechanics of the foot and ankle, plantar fasciitis can be treated with:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

Forefoot Pain

Morton’s Neuroma presents as pain in the ball of the foot, commonly between the 3rd and 4th metatarsal heads. There are many nerves which pass from the foot to the toes. The major nerve is called the plantar digital nerve. A neuroma is a thickening of the tissue which surrounds this nerve.  A Mortons Neuroma is a neuroma in the plantar digital nerve. Symptoms which develop include:

  • Burning pain in the ball of the foot which may radiate to the toes
  • Numbness or strange sensation in the toes
  • Pain which worsens when wearing tight footwear

Morton’s Neuroma can be clearly identified by doing the squeeze test. This compresses the painful nerve and simulates the pain that is felt.

Morton’s Neuroma can commonly be treated using:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.

Metatarsalgia is characterised by pain in the forefoot area, under the ball of the foot. The most common area for pain is under the 2nd and 3rd metatarsal heads. This could be due to the wearing of the fat pads underneath the metatarsal heads or due to synovitis (inflammation) in the joints of the forefoot. People sometimes describe the feeling as walking on a stone or a rolled up sock. Factors that may predispose patients to the development of Metatarsalgia include:

  • A bunion deformity
  • Arthritis of the great toe
  • Ligament instability of the midfoot
  • An extremely tight calf muscle
  • Claw toes

Treatment for this condition may include:

To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.