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.
Treatment of Achilles tendinopathy commonly involves loading based exercises. This basically means exercises for the affected muscle/tendon unit with the aim that it improves strength and endurance and reduces the symptoms. Read a recent article in the British Journal of Sports Medicine around treatment.
Please don’t expect things to improve overnight though. It can take time for the tendon and muscles to adapt and improve. You may also find heel raises are useful to reduce the stress on the Achilles tendon while you are doing the rehabilitation, however, if they are uncomfortable, causing an increase in pain or other any other issues, then please remove them.
The video below demonstrates a range exercises that might help in the initial stages. There are 7 exercises in total. Numbers 1-4 relate more to problems with the Achilles Tendon, however, you may find the others useful too.
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.
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 review 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
What is a Pressure Ulcer?
Site currently under construction. Information to follow
Practice Based Learning in Podiatry
The Podiatry Service offers an innovative and soundly governed Practice Based Learning (PrBL) programme. We utilize a blended learning provision which is centred on a Peer Assisted Learning (PAL) model. We aim to engage students in a programme of meaningful clinical thinking with the objective of maximising their capabilities and confidence within clinical decision making whilst delivering optimal person centred care.
Over the course of an academic year, we offer in excess of one thousand placement weeks. Placements are offered to both institutes in Scotland offering entry qualifications into Podiatry. There are currently two institutions offering Podiatry, Glasgow Caledonian University (GCU) and Queen Margaret University . Various options of study are available depending upon eligibility criteria being met.
As the primary PrBL provider for the GCU Podiatry programme, we host Level 1 to Level 4 students at the Department of Podiatry, Queen Elizabeth University Hospital (QEUH) throughout Trimester A and Trimester B which acts as our placement hub. Block placements occur during Trimester A, B and C within the single service seperate from our placement hub.
Additionally, as the need for PrBL placements for all AHP professions increase, we aim to explore new and innovative methods of offering cross-profession PrBL opportunities through both face-to-face and digital platforms.
The Podiatry Service works collaboratively with its academic colleagues ensuring alignment to learning outcomes with quality underpinning every placement hour.
We are keen to hear the voice of the student and their experience at the end of each placement. Using a student-based audit enables an understanding of what worked and what didn’t to inform changes to the PrBL programme.
Are you thinking about studying Podiatry and want to find out more? Consider joining our ‘Get Ready For’ programme.
Return to Practice in Podiatry
The Podiatry service offers an excellent opportunity for podiatrists who wish to return to podiatry practice and require to re-register with the Health and Care Professionals Council (HCPC). Our fully funded learning programme will support you in your return to practice. Candidates who successfully achieve registration will be eligible to apply for Band 5 posts within NHS Boards.
We offer a structured development opportunity to support and consolidate knowledge, skills and competence in supportive learning environments. Your individual learning and support framework will have full mentorship from our team of practice educators and practice development.
In this post you will:
Have the opportunity to provide podiatric care in a variety of clinical environments. You will be supported by your mentor using various supervisory methods.
Provide a high level of both palliative and corrective care as outlined in the agreed management plan.
Liaise with or referring to other Health Care Professionals (HCPs) or Agencies as appropriate.
Plan and organise own workload to ensure effective caseload management of a diverse range of patients
Knowledge, Experience and Qualifications
You must hold a BSc (Hons) Podiatry or Diploma in Podiatry and will be required to complete a period of supervised practice. The length of supervised practice will be detailed by the HCPC Returning to Practice Requirements. You will demonstrate the ability to work as part of a team. Evidence of prioritisation, planning and organisation of workload are essential.
Roles and Responsibilities
You will create a portfolio to showcase your learning and development.
Adapt your learning needs through reflective practice and feedback to develop professional knowledge and skills.
Read and understand the HCPC Standards of Proficiency.
We offer this opportunity on a fixed term basis and will accommodate the return to practice requirement of the applicant. There is flexibility across whole and part time working.
For initial discussion please contact Julie Braidwood on Julie.Braidwood@nhs.scot or Pamela Price on Pamela.Price@nhs.scot
The PREPARE Project
What is PREPARE?
The Pre Registration Podiatry: Accessible Recruitment & Employment (PREPARE) Project is an innovative approach to growing our workforce by enabling people into the profession of Podiatry. The service employs PREPARE trainees on an annex 21 basis to undertake a BSc (Hons) in Podiatry. PREPARE Trainees receive full employee benefits as per Agenda for Change terms and conditions.
How does PREPARE work?
The Podiatry Service has an agreement with Glasgow Caledonian University (GCU) which has condensed the teaching timetable to three full days, instead of spreading it over five days. This is in line with student feedback across the institution and would benefit the student experience. There is no change to programme or module learning outcomes. PREPARE Trainees have dedicated time to engage within the academic content up to 3 days per week with the remaining 2 days being specified by service led duties. Trainees engage in service-led duties 5 days per week during non term time.
Why is PREPARE needed?
Through widening access to those who are not able to leave full time employment to access adult learning opportunities we believe this novel approach to meeting the workforce challenges stands to safeguard frontline Podiatry services in NHSGGC for the intermediate and long term future. Investment in ‘Earn to Learn’ schemes enhance graduate capability by providing integration across service delivery which enables extensive clinical exposure, whilst undertaking graduate level study.
Continuation of employment to a Band 5 Podiatrist is subject to successful completion of the BSc (Hons) Podiatry and Health & Care Profession Council (HCPC) registration. For the Health Board, these graduates will have extensive clinical experience, alongside a detailed knowledge of policies and procedures. The Podiatry service will employ PREPARE to 4 trainees per academic year from 2023 to 2027.
What Next?
Are you thinking about studying Podiatry and want to find out more? Consider joining our ‘Get Ready For’ programme.
Hear from a PREPARE Trainee and their experience in the video below.
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
Good footcare is important no matter what age you are. Well cared for feet can improve your comfort, mobility, confidence, independence and have an impact on your overall quality of life.
The video below is a useful way to learn how to manage your own footcare.
Looking after your feet
Do you need help to care for your own feet or would like to know more about how to help a relative or friend with their footcare?
Please click on this link to take you to NHS Inform where you will find lots of information and advice on personal footcare and footwear.
Local support for footcare
There are a small number of voluntary groups and charities that provide nail cutting services in local community settings. Details of these will be added here very soon
Watch this interview with Bridie (aged 87). This is her experience of the attending a workshop on ‘how to look after your feet’ and some of the things she learned.
Here are some really useful diabetes resources to help you look after your feet made by health professionals from across the UK. There may be small differences in the care or services you receive in NHSGGC.
If you have any questions or concerns please get in touch with your podiatrist or healthcare professional. Details on how to contact are on the main page
The videos below have been produced to help those with diabetes look after their feet. A kind thank you to our colleagues in NHS Torbay & South Devon Podiatry for permission to share these videos. You can also click on this link to My diabetes My way for lots more helpful information about how to look after your feet
Diabetes: Low Risk
Diabetes: Moderate Risk
Diabetes: High Risk
Diabetes: Care of your foot ulcer
Toe IT – Control IT plus
Below is the link to a video by podiatry in Greater Glasgow & Clyde which will help to raise awareness of diabetes and the development of foot complications, to discuss a preventative approach to diabetes foot care and for you to know how and when to refer to podiatry.
The podiatry foot protection service is involved in the assessment, treatment and management of foot wounds. Foot wounds may be slow to heal for a number of reasons. The key areas that are focused on are:
Blood supply to the lower limb
Pressure at the wound site
Infection
Other medical conditions such as diabetes, inflammatory arthritis or renal disease which may make it harder for your body to heal
We aim to help you to improve these factors as much as possible to give your wound the best chance of healing. The podiatry team work closely with a variety of services to offer multidisciplinary care where appropriate. We have strong links with diabetes, vascular, orthopaedic, orthotics, infectious diseases and rheumatology clinics
Rehabilitation while wearing an offloading boot or shoe.
While wearing an offloading boot or shoe, there is a risk that the muscles of the foot and ankle get weaker. There is also a risk to the other foot as you may be overloading it to try and compensate. It is important therefore that you continue to make sure the muscles of the foot and ankle remain strong while wearing and offloading boot or shoe. The leaflet below gives some advice and some gentle exercises for you to try. Ask your podiatrist about them to make sure that are safe for you to do.
There are a lot of musculoskeletal (MSK) problems/injuries that can be associated with the foot, ankle and lower limb and it would be impossible to list them all.
We have highlighted some of the most common problems and created resources which you might find helpful in sections below.
A painful flat foot will often involve a muscle called tibialis posterior. This can be called several names including posterior tibial tendon dysfunction (PTTD) and it can be the result of a sudden change in activity levels, or it could be a gradual increase in discomfort due to increased demand on the muscle. The main purpose of this muscle is to help stabilise the arch of the foot and, more often than not, it happens because the muscle/tendon is not strong enough to cope with the demand that is being placed on it. The picture below shows the area where the muscle sits on the inside of the leg (shown by the red dotted line) while the tendon is shown by the purple line. Its main insertion point is being pointed out, however it has multiple insertions so the pain may spread around the arch of the foot.
You might notice some swelling or pain around the inside of your ankle bone and into the arch of your foot. A reasonably reliable way of telling if this muscle is involved, is to try multiple heel raises on the unaffected leg – and then seeing if you can do the same on the affected leg without any discomfort. An observational study by Herbert – Losier et al in 2017 studied over 500 healthy active people and found the following norms for male and female groups. Please remember though that this is just a guide but it is really useful for you to gauge your ability.
How many single leg heel raises can you do?
20-29yrs: Males 37, Females 30.
30-39yrs: Males 32, Females 27
40-49yrs: Males 28, Females 24
50-59yrs: Males 23, Females 21
60-69yrs: Males 19, Females 16
70-79yrs: Males 14, Females 16
80-89yrs: Males 10, Females 13
What causes a painful flat foot?
Spending long periods standing or walking, especially a sudden increase in these activities is often the reason we see problems around this area. Also, if you are overweight, this will increase the stress through the muscle and tendon. Footwear is important, as is the strength and flexibility of certain muscles.
Exercises and information
The videos below will give you advice on how to manage this problem and some exercises that may be useful in strengthening the muscle to help it cope better with the demand that you are placing on it.
There are 7 exercises in total. The video relating to tibialis posterior is number 7 but you may find the others useful too.
Don’t expect things to improve overnight though. It takes time for muscles and joints to adapt and get stronger.
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. Click on the link below for some examples of more advanced exercises. There are 5 exercises in total.Numbers 4 and 5 are the ones that relate more to tibialis posterior.
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.
The leaflets below provide some added information, however, if you feel you would liketo talk to a podiatrist about your options, please phone 0141 347 8909 for more advice and support.
