Sole Focus! Understanding Seven Conditions Affecting the Bottom of the Foot
Foot pain is particularly prevalent among older adults, with one in three people over 65 years-old experiencing this problem. Individuals suffering from foot pain face significant physical disability, difficulty with daily activities, and an increased risk of falling. For those suffering from rheumatoid arthritis (RA), these conditions occur at nearly double the rate compared to the general population.
COMMON CAUSES OF FOOT PAIN
Poor footwear choices.
Foot injuries due to car accidents, falls or high-impact sports.
Health conditions such as rheumatoid arthritis, gout or osteoarthritis.
Specific body structures like Plantar Fasciitis or Morton's neuroma.
CONDITIONS AFFECTING THE BOTTOM OF THE FOOT
1. Plantar Fasciitis
Plantar Fascitiis is the most common cause of heel pain, significantly impacting around 10% of runners and accounting for 11-15% of all foot conditions. It arises from repetitive strain that causes micro-tears in the plantar fascia, a thick band of connective tissue that supports the arch of the foot. Individuals with Plantar Fasciitis often experience heel pain, particularly with the first few steps in the morning or after prolonged periods of rest.
Other symptoms include heel tenderness, limited dorsiflexion (the ability to bend the foot upward), and sometimes a noticeable limp. Treatment options range from self-help measures, such as using insoles, plantar fascia taping or self-massage tools such as a tennis ball, foam roller, massage gun or socks. Physiotherapy consists of foot exercises, stretches for tight plantar fascia and gait analysis. More advanced treatments include acupuncture, shockwave therapy and, in severe cases, steroid or platelet-rich plasma (PRP) injections. Surgery is considered as a last resort when other treatments have failed to provide relief. (The below photo shows Plantar Fascia Taping.)
Above image shows Plantar Fascia Taping, a technique using tape (with varying strengths) to relieve pressure and pain on the foot. Exercises are usually advised by the physiotherapist.
2. Plantar Fascia Tear
A Plantar Fascia tear can range from minor tears to full ruptures, significantly affecting foot function. This condition typically presents with sharp pain, swelling and bruising underfoot, making walking and standing particularly painful. Treatment varies, depending on the severity of the tear. Severe tears often require immobilisation with a walker boot, followed by a period of rest and physiotherapy to aid recovery. For milder tears, rest and physiotherapy are usually sufficient to restore function and alleviate pain. Conservative treatment is highly successful and rarely any form of surgery is required for a Plantar Fascia Tear.
3. Fat Pad Atrophy
Fat Pad Atrophy involves the thinning of the specialised adipose structure over the calcaneum or fat pad, resulting in decreased cushioning during locomotion. This condition is characterised by bruise-like pain on the heel and a burning sensation when walking, especially on hard surfaces or when barefoot. Treatment focuses on modifying activities to reduce impact. Insoles and cushioned trainers may provide additional support. Physiotherapy consists of stretching and strengthening exercises, gait analysis and, in some cases, surgical fat grafting may be considered.
4. Baxter's Nerve Entrapment
This condition occurs when the Baxter's nerve (Inferior Calcaneal Nerve) is compressed, leading to inflammation. Tight-fitting shoes, ill-fitting custom orthotics or compression from some of the smaller foot muscles in the foot (or a bone spur on the heel) can compress or pinch the nerve and cause sharp heel pain, numbness in the heel or foot and moderate muscle atrophy in the foot. Heel pain from Baxter's Nerve Entrapment can be similar to Plantar Fasciitis. However, while Plantar Fasciitis pain normally improves with gentle activity, the symptoms of Baxter's Nerve Entrapment normally worsen. Treatment focuses on reducing inflammation through various means, such as wearing wide-fitting cushioned shoes, Kinesiology tape (strategically placed around the heel to offload pain from the 'entrapped' Baxter's nerve) custom insoles and performing specific exercises – which have been shown to be a highly effective form of pain relief. In more severe cases, corticosteroid injections may be necessary, and nerve release surgery may be considered to alleviate symptoms.
Shockwave Therapy - a popular treatment used to treat Plantar Fasciitis on the sole of the foot.
Suvarna Mohture, based at Activ's Totley clinic, is one of our experienced Physiotherapists, specialising in Acupuncture, Shockwave, manual therapy antenatal and postnatal women’s health, back & neck pain and osteoarthiritis.
If you would like to book an appointment with her, please call our friendly team on 0114 235 2727.
