This is a question I am often asked by patients.

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 do note that this blog is not a replacement for assessment and treatment by a registered osteopath.

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 heel also known as the hindfoot:

Achilles tendinopathy

Aching or pain on the back of the heel can indicate Achilles tendon strain.  Pressing and gently squeezing the tendon 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 you can test and feel how much movement you have in this joint.

There is typically very little movement at the sub talar joint.  Therefore, when you test your own joint you are really just trying to feel the difference between no movement at all and slight movement.

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.  

Plantar fasciitis/ heel spur

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 just in front of the heel pad.

If the plantar fascia has been under strain for a long time then bone can begin to form along the line of pull resulting in a heel spur.  – NOT SURE HOW MUCH TO GO INTO THIS?

The middle of the foot also known as the midfoot:

Cuboid syndrome

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.  A fracture of the cuboid and surrounding bones would need to be ruled out before a diagnosis of cuboid syndrome was decided.

If you are experiencing pain in the area of the cuboid, one way to test the positioning and health of the bone is to apply pressure over the bone from above and below and gently move the bone up and down.  In a healthy, unaffected bone there should be no pain when doing this small movement.

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 on the metatarsals can often resolve this problem by giving the metatarsals a chance to heal.  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.  Movement at this joint should be tested whilst stood on the foot and with no weight on the foot.  

With weight on the foot, ask a friend to gently lift up the big toe.

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. If the diagnosis is sesamoiditis then a full recovery is achievable through manual and physical therapy.

I hope you’ve found this introduction to foot health interesting and helpful. Please don’t hesitate to get in touch if you have further questions.

The content of this blog post is copyright of Holly Elliott registered osteopath GOsC 9607 15a Clayton Road, Jesmond, Newcastle upon Tyne, NE2 4RP.