Foot & Toes Pain

Extensor retinacular irritation

The extensor retinacular is a piece of tough tissue that keeps the tendons running smoothly and in the normal alignment when we pull up our foot and walk. This tissue can become inflamed and irritated with overuse activity, trauma such as twisting the ankle or after blunt trauma to the top of the foot. Pain is commonly felt over the top of the foot around the ankle joint and can spread down the foot towards the toes. The pain is commonly mechanical in nature and occurs with activity such as walking or rising onto your toes.

Physiotherapy can be useful for careful identification of the structure at fault. We can then use specific soft tissue release methods, mobilisations and occasionally ultrasound to reduce the symptoms. We will also look at the cause of the problem and work to correct any abnormalities with walking, foot position, movement control and balance to ensure it does not reoccur.

Fractured metatarsal bone (bones in middle of foot connected to toes)

This injury commonly occurs with impact activity in sports people, after a particularly awkward fall or in the elderly if bone density is not good. Pain normally starts suddenly after the aggravating activity and can progress to a severity where weight bearing and walking becomes very difficult. If this injury is due to a repetitive impact activity such as running then symptoms may build up slower but become very severe if the activity is not stopped.

Physiotherapy treatment can be very successful. You will be advised on appropriate ‘active rest’ strategies to maintain fitness without over-loading the healing fracture. Your physiotherapist will be able to guide you with weaning from an aircast boot or support, if it has been prescribed by a foot and ankle consultant. We can ensure that full movement of the surrounding joints is regained as well as foot strength and normal walking/running. We are ideally placed to guide with return to high level sporting activity with sport specific training and rehabilitation.

Extensor tendinopathy

There are a number of muscles that run down the front of the lower leg and over the top of the foot and bend the foot and toes upwards called the extensor muscles. Sometimes the tendons of these muscles can become painful due to overuse.

Physiotherapy can help reduce any inflammation and pain and then take you through a progressive exercise programme and address any causes that may be leading to these muscles being overused.

Osteoarthritis

Pain around the front of the ankle joint can commonly be due to osteoarthritis (OA) of the talus, the main bone supporting weight in the foot and ankle when we move our foot with walking, stair climbing or squatting down. This pain commonly appears gradually, can be worse with changes in weather, is nagging and aching in nature and can be accompanied by swelling. This condition is due to wearing of the cartilage and joint surfaces within the ankle

There is good evidence that physiotherapy to strengthen the ankle stabilising muscles and improve balance can be beneficial for ankle OA. This is thought to take pressure off of the joint surfaces and reduce loading and therefore the pain experienced. Taping techniques, acupuncture , advice on shoewear/insoles and mobilisations can also be used successfully to treat the movement restrictions and pain of OA.

Referred pain

Pain can be referred into the top of the foot from the lumbar spine and spinal nerves. This occurs because irritation and compression of these nerves causes pain in the associated area that they supply and the brain gets confused by the signals, sending pain to the area served by the nerve. This pain is commonly burning in nature, diffuse and can be accompanied by pins and needles or numbness in the area.

Your physiotherapist will be able to exclude any local structures as the cause of your pain and will assess the nerve health and mobility. If this diagnosis is reached then successful treatment can include specialist nerve mobility exercises, release of the tissues affecting the normal nerve movement and treat the low back if appropriate to ease your symptoms.

Avascular necrosis of the talus

The top of the talus bone is shaped like a dome and connects the bottom of your leg to make the ankle joint. Avascular necrosis is serious and successful treatment requires early identification and treatment. A good assessment with a physiotherapist will be able to identify if you have high risk factors for this condition and we can then provide appropriate advice and recommend a top Singapore foot and ankle consultant to review you. Avascular necrosis is death of part of the joint surface due to loss of blood supply.

Treatment will include advice and management of the symptoms with acupuncture, supports and taping. We will guide you through stretches and strengthening regimes to build support around your ankle and also mobilisations to regain any lost movement.

Corns/calluses

If there is a continuous pressure on an area on the top of the foot it can lead to a build up of skin and direct pressure applied can often be painful. Often in this case the removal of the excess skin by a chiropodist should be done.

Physiotherapy can help by looking at if your walking pattern could be changed to stop excessive pressure on that area and advise on better footwear.

Rheumatoid Arthritis

Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. Affected joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

• Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
• Wheelchair assessments
• Splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related.

Complex Regional Pain Syndrome

This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The foot can be affected by this syndrome and the symptoms can extend up the leg. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. ‘The sympathetic nervous system’ has been shown to be involved which controls blood flow and skin temperature.

Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top Singapore pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety

Plantar fascia pain

This condition is irritation of the tissue under the foot, commonly under the heel or inner arch of the foot. This pain can be worse in the mornings and associated with stiffness when first walking. The pain is commonly achy in nature and can become burning. Common causes include unaccustomed exercise, rapid changes in exercise level or changes to footwear.

Physiotherapy can reduce symptoms by assessing and treating any biomechanical issues, altering loading through the tissue by improving strength, movement control and posture. Specialised exercises can be prescribed to improve balance and control, known to be very important for reducing load through the plantar fascia. Techniques such as taping, orthotics, soft tissue massage and acupuncture can also be used to relieve pain.

Osteoarthritis

Osteoarthritis is ‘wear and tear’ of the joint surfaces with wearing away of the cartilage than lines the joints. It can affect any of the joints within the foot or joints between the end of the foot and beginning of the toes. It can cause pain and feeling of stiffness within the joints it affects and in some cases swelling or redness.

Physiotherapy can help this condition by working on strengthening the muscles within the foot and toes and teaching stability proprioceptive exercises to help improve stability around the affected joint. Manual treatment with massage of tight surrounding tissues and working on the stiff joints themselves can help the condition. They can advise on more comfortable footwear and how to reduce inflammation. Acupuncture can be another form of pain relief.

Morton’s neuroma

This condition is caused by irritation or entrapment of the small nerves between the toe bones. The nerve can become painful causing burning pain or numbness it the area. This most commonly occurs between the 3rd and 4th metatarsals (foot bones). This condition can be due to tight fitting shoes, or poor walking/running pattern but can also be bought on by unknown cause.

Your physiotherapist can assess if this is the cause of your foot pain, advise you on appropriate footwear for your condition, and use taping to offload the tissue or acupuncture to relieve the pain. Sometimes appropriate stretches and strengthening exercises to improve your biomechanics can offer relief of symptoms. If they feel a medical review is required we can recommend top Singapore foot and ankle consultants to you.

Metatarsalgia (synovitis of the MTP joints)

This condition refers to pain in the long toe bones of the foot. It is commonly caused by hallux valgus or hallux rigidus of the big toe (explained above). Change to the positioning and joint movement of the big toe has a knock on effect on the movement and positioning of the other toes. This can lead to inflammation and pain over the joints, most commonly the 2nd and 3rd toes are affected. Sometimes this leads to noticeable alteration to the position of the toes if left untreated.

Physiotherapy can offer pain-relieving modalities such as acupuncture and taping techniques plus guidance on appropriate footwear and pacing of activities. We can also offer advice on strengthening exercises if the biomechanics have been altered significantly and this can sometimes have a positive effect on the pain from metatarsalgia. If your physiotherapist feels you need to a medical review we can recommend a top Singapore foot and ankle consultant to you.

Fractures

Fractures can occur in the long bones (metatarsals) of the foot with overuse activity, trauma or high impact or to the small bones within each toe. Pain from fractures of the ankle and heel can also sometimes refer into the sole of the foot. Sometimes these fractures can occur with osteoporosis if the bones are weakened. This type of pain can be severe and persistent if not identified and treated early. Stress fractures can also occur to bones within the foot over time.

Your physiotherapist will be able to fully assess your risk of fracture after injury and advise you on the appropriate treatment options in line with best practice. If a fracture is suspected they will recommend a review with a top Singapore foot and ankle consultant who may recommend you have a plastercast, supportive boot or shoe to support the fracture site while it is healing. With time you may have a limitation of movement and stiffness due to this. Physiotherapists can utilise mobilisation, massage and specialist stretching techniques to regain your full movement and return to full function after this injury. We will progress your individual exercise programme with you, ensuring the rehabilitation is fully tailored to your individual needs and sports.

Referred pain

Pain can be referred into the base of the foot from the lumbar spine and spinal nerves. This occurs because irritation and compression of these nerves causes pain in the associated area that they supply and the brain gets confused by the signals, sending pain to the area served by the nerve. This pain is commonly burning in nature, diffuse and can be accompanied by pins and needles or numbness in the area.

Your physiotherapist will be able to exclude any local structures as the cause of your pain and will assess the nerve health and mobility. If this diagnosis is reached then successful treatment can include specialist nerve mobility exercises, release of the tissues affecting the normal nerve movement and treat the low back if appropriate to ease your symptoms.

Corns/calluses

If there is a continuous pressure on an area on the bottom of the foot it can lead to a build up of skin and direct pressure applied can often be painful. Often in this case the removal of the excess skin by a chiropodist should be done.

Physiotherapy can help by looking at if your walking pattern could be changed to stop excessive pressure on that area and advise on better footwear.

Rheumatoid Arthritis

Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. Affected joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment that includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

• Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
• Wheelchair assessments
• splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top Singapore pain consultants to help you.

Complex Regional Pain Syndrome

This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The foot can be affected by this syndrome and the symptoms can extend up the leg. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. ‘The sympathetic nervous system’ has been shown to be involved which controls blood flow and skin temperature.

Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top Singapore pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety

Plantar fascia pain

This condition is irritation of the tissue under the foot, commonly under the heel or inner arch of the foot. This pain can be worse in the mornings and associated with stiffness when first walking. The pain is commonly achy in nature and is brought on by unaccustomed exercise, rapid changes in exercise level or changes to footwear.

Physiotherapy can reduce symptoms by assessing and treating any biomechanical issues, altering loading through the tissue by improving strength, movement control and posture. Specialised exercises can be prescribed to improve balance and control, known to be very important for reducing load through the plantar fascia. Techniques such as taping, orthotics, soft tissue massage and acupuncture can also be used to relieve pain.

Tibialis posterior tendinopathy

This condition involves degenerative change to the tibialis posterior tendon. The tendon connects the tibialis posterior muscle which is a deep calf muscle to bones on the inside of the foot. This causes pain along the inner shin and inner arch of the foot. If severe, the tendon can become deficient and the inner arch can fail leading to flat foot deformity and changes to walking.

Physiotherapy can be useful at all stages of the condition. Early identification means we can alter the risk factors for rupture by using orthotics, strengthening and control exercises. Physiotherapy can provide pain relief by using acupuncture, soft tissue release techniques and taping. We will commonly provide a rehabilitation programme that will utilise eccentric strengthening exercises to gradually load the tendon and encourage regeneration of the injured tendon.

Navicular stress fracture

A stress fracture to the navicular bone which is on the inside of your foot can result from sports that involving repetitive landing on the foot. The pain normally is a dull ache and starts gradually and improves with rest.

A medical referral will be required if this is suspected but physiotherapy can help maintain ankle/foot and leg movement and strength whilst healing. We can recommend a top Singapore ankle and foot consultant if suspected.

Referred pain

Pain can be referred into the inner arch of the foot from the lumbar spine and spinal nerves. This occurs because irritation and compression of these nerves causes pain in the associated area that they supply and the brain gets confused by the signals, sending pain to the area served by the nerve. This pain is commonly burning in nature, diffuse and can be accompanied by pins and needles or numbness in the area.

Your physiotherapist will be able to exclude any local structures as the cause of your pain and will assess the nerve health and mobility. If this diagnosis is reached then successful treatment can include specialist nerve mobility exercises, release of the tissues affecting the normal nerve movement and treat the low back if appropriate to ease your symptoms.

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis can occur in any joint in the body and is a the process of ‘wear and tear’ where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become painful and stiff. The joints sometimes can also become swollen and hot. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

• Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
• Wheelchair assessments
• Splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top Singapore pain consultants who can help you.

Complex Regional Pain Syndrome

This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The foot can be affected by this syndrome. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. ‘The sympathetic nervous system’ has been shown to be involved which controls blood flow and skin temperature.

Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top Singapore pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety