MSK Podiatry

Physiotherapy move to improve image

 

A Podiatrist will assess and diagnose patients who have pain, lower limb or foot deformity or biomechanical abnormality which may significantly affect their mobility or ability to function or work.  This will determine the best treatment therapies and also the management and prevention of future injuries.  Treatment may include advice and reassurance, rehabilitation and strengthening exercises, orthoses and injection therapy related to the foot and ankle.

Podiatry service leaflet [pdf] 463KB

How to refer

A referral to the service is always through a Health Care Professional.  Please complete the appropriate referral form and send to the Podiatry email address, please note that we will only accept E-Referrals.

Please provide as much detail as possible on the referral form, this will help to assist on our triage process, and ensure patients are seen in the correct clinics and in a timely manner.

REFERRAL FOR PODIATRY ASSESSMENT [pdf] 114KB

For health professionals only please send your podiatry referrals to the relevant mailbox: WHCNHS.podiatrymsk@nhs.net  (Countywide MSK referrals)

What to expect when you attend

We will work with you to create a care plan that helps support you with your foot health.  You may wish to bring along a friend, family member or carer to your appointment.

 If you need an interpreter this can also be arranged for you in advance of the appointment, please let one our administration team aware.

At the appointment:

  • You will be asked to bring a list of medication and provide a brief medical history and information on your condition.  Podiatry Medical History & Medication [pdf] 78KB
  • We recommend that you wear appropriate clothing so that you can be examined effectively. You may want to wear loose fitting clothing such as shorts/tracksuit trousers and a t-shirt for musculoskeletal appointments.
  • Shoes and hosiery which can be easily removed and can accommodate orthoses in your shoes.
  • If you are under 18 years old we need you to bring an adult with you.  Even if you are over 18 years old you may wish to bring a friend or family member with you.
  • Please bring with you any x-ray or scans that you have and any clinical letters relating to your current problem.
  • We will work together to create a plan that helps you manage your Podiatry care.
  • A care plan will be discussed with you focusing on areas of greatest need. The agreed treatment plan may include:
  1. Short term one off treatment.
  2. On-going short term treatment
  3. Referral to another service
  4. Foot care and footwear advice
  5. Advice and Discharge
  •  Your care plan will be reviewed at every visit and you will be involved in making any changes to the agreed care plan, which may involve discharge from the service.
  • You will not routinely be seen by the same podiatrist.

Achilles Tendonopathy

What is it?

The achilles tendon is the largest and strongest tendon in the body. It is a cord that connects the muscles of the calf to the heel bone. When the tendon contracts it pulls the foot down and is very important in jumping, running and walking. 

The area may feel stiff in the morning and settle when you initially walk.  Pain occurs when you have walked or ran for a period of time and gets worse the more you walk or run. 

You may see a red lump and the tendon may feel tighter, warmer than the tendon on the opposite foot and tender to touch.

Achilles tendonopathy causes are not fully understood however there are many factors that can increase the risk of developing it:

  • Weak or tight calf muscles
  • Stiff ankle joints
  • Mental or physical health problems
  • Taking up a new physical activity or increasing the intensity in which they are performed for example running
  • Weight gain or being overweight

 

Treatment

The most effective treatment is to perform a training programme which strengthens the tendon by loading it and therefore allowing rapid healing.  A demonstration of this can be found by clicking on the link below or viewing the leaflet attached.  Please do not attempt these exercises if the pain is disabling or you are unable to bend your ankle

Reduce your physical activities and sports or switch to other exercise types where weight through the heel is reduced such as swimming and cycling

Wear non slip on supportive footwear with a slight heel such as trainers

Applying an ice pack or frozen peas to the area for  10 minutes on and 10 minutes off 2 to 3 times has been proven to provide some pain relief so feel free to apply this at painful times such as after exercising. 

Taking pain killers such as paracetamol and ibuprofen when needed. 

If you are unsure of how to perform your exercises, if symptoms do not settle after 12 weeks or indeed worsen in the meantime please see your doctor.

Achilles Tendonopathy Exercises Leaflet [pdf] 791KB

Forefoot Pain

Forefoot pain is pain that occurs on the balls of the feet and sometimes the toes.  It is sometimes known as metatarsalgia and can be extremely painful.  The forefoot is complex and pain could be caused by the joint, the nerves, the ligaments or the muscles.

Bunions

Also known as Hallux Abducto Valgus, a bunion is a change in the structural alignment of the bones in the foot, where the big toe angles toward the smaller toes. For more information click here

A change in the big toe position starts to crowd the smaller toes and it makes the foot wider which causes footwear fitting difficulties.

Treatments include;

  • Keep pressure off affected joint by wearing comfortable shoes which are wide, have a strapping device such as a lace or Velcro strap, have a low heel that fits well and has a deep toe box/forefoot part to allow enough room for your toes and joints.  
  • Remove any hard skin that has developed over the joint by filing it gently with a file and applying a moisturising cream to soften the skin.
  • Make changes in any activity that regularly stresses the foot.
  • Taking pain killers such as paracetamol and ibuprofen when needed.
  • The Podiatry department can intervene at Stages 1-2, later stages may require surgery. Surgery to straighten the toes is only endorsed by this NHS Trust, College of Podiatry and Royal College of Surgeons in the latter stages of the condition when there is extreme pain.

 

Neuroma

A neuroma is a swelling or thickening of a nerve which results in compression and irritation against other tissues between the metatarsal heads on the ball of the foot. For more information click here

Treatments include: 

  • Rest the foot
  • Keep pressure off the forefoot by wearing comfortable shoes which are wide, have a strapping device such as a lace or Velcro strap and a deep toe box/forefoot part to allow enough room for your toes and joints. Keep pressure off the forefoot by wearing comfortable shoes which are wide, have a strapping device such as a lace or Velcro strap and a deep toe box/forefoot part to allow enough room for your toes and joints.
  • Take anti-inflammatory medications such as ibuprofen when needed.
  • Wear a device known as an orthoses with a metatarsal dome in the shoe
  • If symptoms do not settle please visit your GP for further advice

Other conditions and treatments

Conditions:

Plantar Heel Pain (Plantar Fasciitis):  Plantar Fasciitis Leaflet [pdf] 972KB

Orthoses:  Foot Othosis [pdf] 61KB

Paediatrics (Childrens):  Podiatry Referral Guidance (Paediatrics) [pdf] 328KB

Sporty Feet:  Sporty feet leaflet [pdf] 836KB

 

Advice and Treatment: 

Advice on footwear:  Podiatry Footwear advice [pdf] 284KB

 

 

 

How to care for your feet

Lifestyle

Being physically inactive, overweight, smoking and suffering from long term conditions can increase the risk of developing musculoskeletal damage.  These lifestyle factors are also closely linked with long-term diseases such as heart problems and diabetes which can also lead to musculoskeletal problems.

Independence Trust
Independence Trust provides a range of services that'll support you in strengthening your emotional and physical wellbeing. Click here to view their patient information leaflet.

 

Activity

Physical activity on a regular basis can reduce the risk of musculoskeletal disorders such as foot and back pain.  Regular physical activity is also linked to reduced risk of obesity and therefore reduced foot pressure and reduced foot pain.

Regular weight bearing activity such as walking etc can help to prevent osteoporosis. The pulling and tugging on bones by muscles during exercise help strengthen bones and can lead to weight loss and continuity of a healthy weight.

Musculoskeletal problems and foot, leg and back pain in particular, are common conditions which can affect people’s health, well-being and ability to work.   You may be worried that you have some serious underlying condition and may stay in bed or seated to prevent further damage.   Musculoskeletal pain can however take 6 weeks or so to recover so a reduction in activity may be required however complete rest can be less beneficial. If your pain is worsening considerably or has not improved after 6-8 weeks please see your GP.

Keep active and avoid a sedentary lifestyle. Aim to do at least 30 minutes of moderate physical activity most days of the week including exercises which encourage flexibility and strength such as pilates. 

Visit Change4Life on https://www.nhs.uk/change4life/ or telephone 0300 123 4567 for ideas to help you keep fit and active.

Sports Partnership Herefordshire and Worcestershire

 

Weight

Being overweight or obese can cause musculoskeletal pain and mobility problems as well as depression and anxiety.   Increased weight will add pressure onto your feet and increase any pain you are suffering.

Keeping active and eating a healthy, balanced diet will help reduce weight loss.  Reducing your sugar and fat content and eating smaller sized portions will help with this. 

Visit Change4Life on https://www.nhs.uk/change4life/ or telephone 0300 123 4567 for healthy eating ideas and recipes. 

 

Mental Health

Changes in your mental health can negatively impact on your physical health resulting in an increased risk of developing some conditions such as heart and respiratory diseases.

If you are struggling with any mental health problems you can discuss this with your GP or self-refer to Worcestershire Healthy Minds online or telephone 0300 302 1313.

Or visit http://www.worcestershire.gov.uk/healthandwellbeing

 

Smoking

Smoking is linked to impaired wound and tissue healing and therefore prolonging musculoskeletal damage and slowing down repair of this tissue.  You may find that it takes longer for your body to heal, particularly if you suffer with foot, heel or leg pain.

Quit smoking.  You are 4 times more likely to quit smoking with support from Stop Smoking Services than by going it alone.