Podiatry

There can be many causes of pain under the heel, but probably the most common one is irritation to the plantar fascia – sometimes called plantar fasciitis. The plantar fascia is a band of thick tissue which runs from your heel bone to your toes. If you bend your big toe back, you should see it become prominent on the sole of your foot. It helps to supports the arch of your foot but if it gets overloaded it can become thickened and cause discomfort under your heel. You can see the inside band of the plantar fascia in the picture below with the thumb pressing on the common site of pain.

Symptoms of Plantar Fasciitis

A classic symptom of plantar fasciitis is pain on the first steps after getting up from a period of sitting, or first thing in the morning when getting out of bed – again, usually in that area being pressed above. Sometimes it eases of a little when actually walking, only to come back again when you stop for a rest.

Please watch the video below for more information on pain in the sole of the heel and how to manage it.

Don’t expect things to improve overnight though. It takes time for muscles and joints to adapt and get stronger.

Please note: If you do not see any sign of improvement after 6 to 8 weeks of following the advice and exercises please phone 0141 347 8909 for more advice and support.

“If exercise were a pill, it would be one of the most cost-effective drugs ever invented”

Dr. Nick Cavill

Physical activity

Evidence shows that the people of Scotland need to be more active with 73% of children and 40% of adults not achieving recommended activity levels. Walking improves health. There was good evidence for the health benefits of walking – as the infographic below demonstrates. As well as having significant physical health benefits such as improving heart, lung and joint health, there are also major improvements in mental health as well as the social aspect. It is a simple, cheap and effective way to maintain a healthy BMI and a improve quality of life. 

Physical activity guidelines

Additional resources

Benefits of physical activity

The video ‘23 and a half hours – What is the single best thing we can do for our health’ by Mike Evans. It is an excellent way of demonstrating that 30 minutes per day of activity can have a profound positive effect on our health.

Strength and conditioning

There is good evidence to suggest that strength training is useful in reducing injuries – in some cases it is reported to reduce sports injuries to less than one third and overuse injuries by half. This doesn’t necessarily mean joining a gym and doing weights. Simple exercises performed safely, and in the comfort of your own home can be just as good.

There is also good evidence to support exercise and resistance training for managing cardiovascular disease risk factors and peripheral arterial disease (PAD). PAD is when there is reduced muscle blood supply to the lower limb which can cause muscle weakness, cramp or discomfort in the lower limb.

Due to this, some people believe the pain induced by it can be harmful. This might lead to increased sedentary behaviour, reduced aerobic capacity or cardiorespiratory fitness, and reduced muscle strength and endurance, all impairing walking ability further and ultimately reducing quality of life. If you want to speak to someone before beginning exercise, please contact on the number below. Visit the Physical Activity, Strengthening & Falls Prevention page for further information.

Recent research also shows strong evidence of strength training having a positive effect on musculoskeletal disorders as regards employees who work in physically demanding jobs.

Sarcopenia

Sarcopenia is a condition characterized by loss of skeletal muscle mass and function. Its development may be associated with conditions that are not exclusively seen in older persons, although it is primarily a disease of the elderly. Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability and mortality. It is highly correlated with frailty and risk of falls in eldery (see falls below). Risk factors for sarcopenia include age, gender and level of physical activity. 

There is an established link between inactivity and losses of muscle mass and strength, this suggests that physical activity should be a protective factor for the prevention but also the management of sarcopenia. 

Please speak to your GP or any of the Allied Health professionals that you may have an appointment with – for example Podiatrist, Physiotherapist, Occupational therapist – for more information and advice if required.

Risk of falls

Falls are a common, but often overlooked, cause of injury. Around 1 in 3 adults over 65 who live at home will have at least one fall a year, and about half of these will have more frequent falls. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. Exercise reduces the number of falls over time by around one quarter (23% reduction) which means if there were 850 falls in 1000 people followed over 1 year, exercise would result in 195 fewer falls. Read the Cochrane Review on Exercise for preventing falls in older people living in the community. 

This study that provides evidence foot and ankle problems are important risk factors for falls in older people – particularly reduced ankle flexibility, hallux valgus deformity, decreased tactile sensitivity and decreased toe plantarflexor strength, and doing some simple exercises to address these modifiable risk factors may be beneficial in reducing falls. 

The video below demonstrates some exercises you may find useful.

Please note: If you want to speak with someone for more advice and support regarding exercises please phone 0141 347 8909.

An ankle sprain, or going over on your ankle, is one of the most common musculoskeletal injuries. It can result in damage to the ligaments on the outside of the ankle.

It usually occurs when the ankle is turned in and pointed down with the forefoot taking the weight. Ligaments are strong tissues around joints which attach bones together to provide support and approximately 75% of ankle injuries involve the ligaments shown in green in the picture below, with the peroneal muscles (muscles on the outside of the leg) being represented by the red dotted line and the tendon(s) in purple.

Generally speaking, ankle sprains usually heal well, and most people will be able to get back to normal activities within 6 to 8 weeks. It is important however to make sure that the muscles and ligaments are strong enough to allow you to go back to full activity.

One of the biggest risk factors to an ankle sprain is a previous ankle sprain that has not had the appropriate rehabilitation. Read more.

Symptoms of ankle sprain

You may see some bruising and swelling in the early stages along with the pain, and find it difficult to walk normally. An xray is not always required unless there is tenderness in the bone at the outside of the ankle or foot or, you cannot walk for 4 steps.

Exercises and support

In the early stages, there is good evidence for anti-inflammatory medication and early movement – for instance in a seated or lying position, draw circles with your foot in both directions as often as you can and within your pain limits. Also, including balance and strengthening exercises is effective at increasing the movement at the ankle as well as preventing further injury.

The videos below demonstrate exercises that should help. Don’t expect things to improve overnight. It can take time for the ligaments and muscles to adapt and improve.

Please Note:  If you do not see any sign of improvement after 6 – 8 weeks of following the advice and exercises, please phone 0141 347 8909 for more advice and support.

The ankle joint is formed by the lower end of the tibia (shin bone) and the talus (ankle bone).

Symptoms of ankle arthritis?

In normal joints there is a layer of tough slippery material called cartilage, which acts as a shock absorber and allows smooth gliding motion. In osteoarthritis the cartilage thins out and becomes rough. When this happens the tissues in your joint work harder in a process of wear and repair.

Often extra bits of bones form which, together with scarring of the joint lining, are responsible for joint stiffness. 

Pain and stiffness are the two main symptoms of ankle arthritis.

Causes of ankle arthritis?

Most cases of ankle arthritis are secondary to injury, for example, occurring years after an ankle fracture or even several severe sprains. It can also be caused by rheumatic conditions such as rheumatoid arthritis or gout which can lead to damage and destruction of joints.

In some cases of ankle osteoarthritis there is no known cause (other than genetic). In this situation, other joints may be affected such as your hands, knees, or hips, and there may be a family history of similar issues.

We are more prone to develop osteoarthritis over time and it is more common in people over 40. Being overweight is also an important factor in causing osteoarthritis in weight bearing joints.

What tests are there?

In the majority of cases of ankle osteoarthritis you do not need an x-ray or any other tests to confirm what is wrong, unless your problem is severe enough that we may consider surgery.

What can you do to help your ankle osteoarthritis?

There are many non-surgical treatments that can help:

• Diet: Losing weight will reduce the strain on your ankles
• Medication: Painkillers such as paracetamol can reduce the pain. Follow the advice from your community pharmacist or other healthcare professional about taking medication. It is important to take medication regularly
• Ice packs: Ice packs can also help with pain
• Exercise: Exercise helps build the strength of the muscles, which can take the strain off the joint and you can choose from many non-impact activities such as swimming or cycling
• Footwear: Supportive boots, shoes or insoles may help
• Walking aids: A walking stick or cane can be very helpful.

What else can be done?

Most patients with ankle arthritis respond to non-surgical treatments where these have been tried and failed then there may be other options. If your pain does not start improving after a period of 3 months of following the advice above, please phone 0141 347 8909 to see a healthcare professional who can assess your foot.

Some patients may be referred on for a surgical opinion.

Types of Surgery

One option or the other may be better for certain people depending on a number of reasons.

Both operations mean you would need to spend several week in a plaster cast and/ or boot and would require most people to be off from work in a physical job for around 4-6 months.

Where can I find more information?

Versus Arthritis 

Offers a selection of self-help booklets, which can be downloaded on the Internet.

Visit: www.versusarthritis.org

British Orthopaedic Foot & Ankle Society (BOFAS) 

Offers a selection of patient leaflets and list of all surgeons carrying out specialist ankle surgery across the UK.

Visit: www.bofas.org.uk

The Achilles tendon is the biggest and strongest tendon in the human body. Achilles tendinopathy is a condition that can cause pain, swelling, stiffness and weakness of the Achilles tendon. It is a very common injury reported in runners, however, it is not exclusive to this population as people who have a more sedentary lifestyle will also suffer from it.

Symptoms of Achilles Tendinopathy

Pain generally tends to be worse in the morning, or during and after exercise. Some swelling and/or pain can occur around the tendon and calf area – most often in the areas shown below. The tendon may be very tender to touch and you may have increased discomfort wearing shoes that press against it.

The blue coloured area is the insertion point of the the tendon into the heel bone and the green coloured area is roughly the tendon itself with the yellow area the musculotendinous junction

Causes of Achilles Tendinopathy

The reasons for developing Achilles tendinopathy are varied but there are some common factors that seem to be important. The research consistently shows that reduced strength and endurance in the calf muscles is a major factor in developing Achilles tendinopathy. Also, being overweight will add more stress to the already struggling tendon. Footwear choice is important as the wrong shoes may aggravate the problem.

Research papers for further reading

Please watch the video below for more information on pain at the back of the heel and how to manage it.

More advanced/progressive loading exercises

As the initial exercises become easier and less painful, it is important to progress and make the rehabilitation more challenging in order to improve the strength and endurance of the muscle/tendon unit. This progression is vital to ensure that the muscles and tendon are capable of coping with whatever activity you want to return to. The video below shows 5 videos that will take you through this progression.

Please make sure that you are comfortable and ready before making the step up to more challenging rehabilitation, and if in doubt, stay with the current plan until you are.

Please note: If you do not see any sign of improvement after 6 – 8 weeks of following the advice and exercises, please phone 0141 347 8909 for more advice and support.

Information leaflet

Podiatrists are allied health professionals (AHP) who are trained to prevent, diagnose, treat and rehabilitate conditions affecting the feet and lower limbs. They provide assessment, management and foot health education to patients-enabling self care where appropriate

Will I receive podiatry?

A podiatry assessment will be provided to assess foot health needs

We aim to provide rapid access for any non-healing would -called and ulcer- in the foot and ankle.

Our service follows the Scottish Government Personal footcare Guidelines (2003), which mean we do not provide personal footcare such as simple toenail cutting or routine skin care. More information on Personal Footcare can be found here

Can I receive a home visit?

The NHS GG&C podiatry service provides home visits -also known as domiciliary visits- to patients who are totally bed bound or chair bound. We encourage all our patients to attend their community clinics as treatment is safer and more appropriate clinical environment. Appointments can be made on days and times that are convenient to you.

If you have had an acute episode of illness and are clinically too unwell to travel to a clinic, then please make your GP or health care professional aware so we can arrange a temporary home visit for you.

Please note: All new home visit requests must come through your GP or appropriate health care professional. All new patients will receive a telephone or video consultation in the first instance to ensure you are triaged to the appropriate place.

You are not eligible to receive a home visit if:

• You attend any other NHS appointments – for example, GP, hospital, dental – with or without assistance.
• You attend hairdressers, shops, post office etc.
• You visit friends or family.

Prior to a home visit

You will be notified on the day of your visit by telephone. We will ask you if there are any special arrangements – such as a key box number- in order to gain access to your home. To help support the podiatrist please ensure:

• You wear socks or pop socks where possible instead of tights
• There is good lighting and adequate space to help provide care
• Your home is smoke free
• All pets are in a cage or in another room
• Your feet are clean and dry

During your visit

The podiatrist will update your medical history and medication. We will assess your foot and lower limb care needs and discuss an appropriate management plan. Treatment will be provided if required.

Following your visit

If assessed suitable for a clinic appointment, details on how to arrange this will be given. Similarly, if a return domiciliary visit is required, then this will be discussed and agreed.

Contact information

North GGC Hub telephone – 0141 531 6261

South GGC Hub telephone – 01475 501 206

Podiatry patient consultations are delivered in a range of ways including
telephone, video and face to face. You will be asked for more information at
your first telephone call to best support your needs.  Please note, this
may not include face to face attendance.

Podiatry does not provide personal footcare. Please refer to the
personal footcare resource page for help.

Telephone

0800 592 087 OR 0141 347 8909

Monday to Friday 8.00am – 8.00pm Saturday 9.00am – 1.00pm

E-mail

E-mail: AHP.Appointments@ggc.scot.nhs.uk