Are my feet healthy?
This is a question I am often asked by patients and is also something I think about a lot myself. Our feet (and the rest of our body of course) carry us through life – we are swept off them, stand on our own two, sit at them, drag them and land on them all being well! With this in mind; foot health can be an indicator of our overall health and is something worth monitoring.
My aim here is to pass on straight forward information and some practical tests you can do at home to help you understand why you might be experiencing foot pain. Please note that this blog is not a replacement for assessment and treatment by a registered healthcare practitioner.
If any of these tests indicate that you may be suffering from one of the conditions described here, then I would recommend seeing your osteopath so that they can confirm and diagnose what is going on and either treat it themselves or send you to the right specialist who can help you.
I’ve divided these tests up into three sections, so you can focus on the part of the foot which is most relevant to you. Each section relates to a different part of the foot; the heel (rearfoot), middle (midfoot) and the front (forefoot). The diagram below shows each of the 3 sections.
The heel also known as the hindfoot:
Aching or pain on the back of the heel can indicate Achilles tendon strain. Pressing and gently squeezing the tendon as shown in the picture would feel tender and bruised if there is Achilles tendinopathy present.
Stiffness in the heel joint (also known as the sub talar joint)
Stiffness and reduced movement in the joints of the ankle can, over time lead to strain and problems in the feet and higher up into the leg. By taking hold of the ankle with one hand and stabilising the leg with the other as shown in the photo below you can test and feel how much movement you have in this joint.
There is not a great deal of movement at the sub talar joint, but there should be some noticeable movement. If you are in any doubt then get your osteopath to check it for you.
Calcaneal fat pad inflammation/atrophy
On the sole of the heel we have a thin pad of fat which helps to cushion the force as we step on our heel. Lots of walking on hard surfaces especially in shoes which are not very cushioned can cause irritation and pain in this fat pad. An indication of this specific problem is tenderness when pressure is applied to centre of the base of the heel. To test this yourself – use your thumb to apply a firm pressure to your heel as shown in the picture.
The plantar fascia is a tough fibrous band of tissue on the sole of the foot rather like the white gristle you see around a steak. This tissue supports the arch of the foot and helps with shock absorption when we are on our feet. If the plantar fascia is inflamed or strained then it can generate pain in the sole of the foot. This pain is often most severe where the plantar fascia attaches to the bones of the foot. To test this on yourself – press firmly with your thumb into the sole of your foot as shown in the picture.
The middle of the foot also known as the midfoot:
The cuboid is a bone of the midfoot which lies on the outside of the foot.
In some people the cuboid bone can become slightly out of place which causes pain over and around the bone and is called cuboid syndrome. Causes include foot or ankle injury as well as gradual build up over time through regular minor strain.
If you have pain when pressing in the area shown in this picture, you may have cuboid syndrome.
The front of the foot also known as the forefoot:
The outer toes
If you have pain in the ball of the foot which is not related to your big toe joint and which is not causing pins and needles in your toes then a likely cause is metatarsalgia. This is irritation of the heads of the long bones in the feet and will typically be worse when you apply pressure to the balls of the feet when walking or running. Inserting a metatarsalgia support into your shoe to reduce the pressure can often resolve this problem by giving the metatarsals a chance to heal (this can be bought from any high street chemist). If you try a metatarsalgia support and your foot pain does not get any better then a fracture of the metatarsal should be considered.
If you have pain in the ball of the foot which is accompanied by pins and needles in one or more of the outer toes then a likely cause could be Morton’s neuroma. A neuroma is a thickening of a nerve. Once thickened it is then easier for the neuroma to be irritated as there is relatively less space around it. Narrow or tight-fitting shoes around the toes will typically make the pain and pins and needles worse if Morton’s neuroma is present. If you think this is the case with your foot pain then a podiatrist should be consulted to start appropriate treatment and rehabilitation.
The big toe
Pain around the big toe joint is common and can have a number of causes. A common cause is hallux limitus or hallux rigidus, literally meaning limited movement of the big toe joint. You should be able to bend your big toe back to almost a right angle. If you can’t then you may have hallux limitus.
A less common cause of pain near to the big toe joint is Sesamoiditis. This is pain in the small bones underneath and slightly behind the big toe joint ( the sesamoid bones). The pain here can be due to irritation of the bones but also fracture of them. As such, a fracture should always be ruled out by x-ray. In the case of sesamoiditis or sesamoid fracture, pain will be worse when walking and especially when running. It may feel like you are walking on stones or that there is something under the big toe joint in your shoe.
I hope you’ve found this information useful. Please don’t hesitate to drop us a line if you have further questions or require assistance.