One of the most frequent questions we get asked as Osteopaths is “do you only treat back pain?” The answer to this is a resounding no. We treat all parts of the body, from the hands to the feet. Anyone who has been to an osteopath will know that they assess and treat more than just the part of the body that is in pain. Osteopaths assess your posture, your gait, and other parts of your body. When it comes to injuries of the foot and ankle area, this is especially important as problems here can cause you to move differently. An example would be limping. Given time, these changes can be adopted and become long term traits. Getting on top of a foot injury sooner than later is important. Let's look a how osteopathic treatment for the foot works.
Your Feet – A Primer
Each foot is made up of 26 bones and 33 individual joints. It’s the foundation of every single movement we do when standing. The dozens of muscles and ligaments in each foot serve to maintain balance and stability through our only contact point to the ground. The feet are not just inert extensions of our lower limbs, they are the vital platform for almost all of our movement, and should be cared for just like any other area when it comes to injury and prevention.
What kind of ankle and foot problems does an Osteopath treat?
The following conditions affecting the foot can be effectively treated by your osteopath
A potentially very painful condition that usually begins as a pulling feeling in the heel or the arch of the foot. This quickly turns into a sharp pain which is often worse in the morning or when initially standing up. It’s a complicated and unique condition that is often misunderstood, and therefore often persists for many months. Fortunately, there are many things we can do to help recover faster and even help prevent plantar fasciitis in the first place.
- Avoid standing for prolonged periods, especially on solid floors like concrete. Many workplaces with solid floors now have rubber matting which can help reduce the fatigue of the foot muscles.
- When standing is unavoidable, the right shoes are essential. You should choose a shoe with a softer sole and arch support to suit your foot. If you’ve got particularly high or flattened arches then orthotic inserts may also be useful.
How to treat Plantar Fasciitis
The best way of treating Plantar Fasciitis is to catch it early. 95% of patients will recover well with conservative treatments that include stretching and strengthening. Depending on what biomechanical issues, issues can be limited to the foot. But problems with the knees or hips can have knock-on effects over time and so these areas should be addressed as well.
You’ll likely also need to make some temporary changes to your daily activities to reduce the strain on the foot. At home, icing the sole of the foot can feel great and give some immediate relief. Keep a bottle of water in the freezer and use it to roll the sole of your foot over it for 15-20 minutes.
More accurately called Achilles Tendinopathy, this is a type of overuse injury in which inflammation is not a big factor. With Achilles Tendinopathy, the tendon struggles to repair itself fast enough. You feel pain either directly on the heel or just above the heel where the tendon joins the calf muscles. You might feel the tendon is thicker in this area compared to the other side, or you might find a small nodule. Nodules come from poor collagen organisation as the injury struggles to heal. This happens when the tendon is being stressed more than usual. For example, rapidly increasing running distances, increased hill running, overtraining, or poor footwear. Biomechanics can also play a part if you have poor knee, hip or ankle stability, or chronically weak muscles/tendons in the first place.
How to Treat Achilles Tendinopathy
Fortunately, tendinopathies can be treated successfully. Recovery is faster when the injury is managed correctly at an early stage. Initially, there will need to be a period of rest followed by progressive and very specific strengthening exercises. Then the underlying biomechanical issue should be addressed – a vital part of prevention. Continuing to run/jump/overwork your tendon can lead to irreversible changes, degeneration and weakening of the tendon, and is a precursor to a full tendon rupture!
Ankle sprains and foot sprains are one of the most common types of injuries. Most active people will have rolled their ankle a few times in their lifetime. It can take quite a while to recover. Each sprain will reduce the amount of stability, making it more and more likely that you’ll sprain it again. And this can lead to chronic ankle instability.
A serious ankle sprain can overstretch the ligaments and can sometimes stretch the tendons around it. The more they stretch, the less stable your ankle will be. Properly diagnosing and treating an ankle sprain in a timely manner is vital to avoid long term complications, re-sprains, and chronic ankle pain. Your rehab will include a lot of strength and balance work to regain proprioception which is absolutely vital for a strong and stable foot.
Heel pain can have a variety of causes and they all need to be treated specifically. Your pain might have crept up gradually, or might be after an impact or a sprain, but either way, it can be one of the most annoying places to hurt. Possible causes of heel pain include stress fractures, heel spurs, bursitis, or a ruptured fat pad, but by far the 2 most common causes are Achilles Tendinopathy and Plantar Fasciitis.
A trapped nerve can happen in any part of the body. The following are the most common kinds of issues caused by trapped nerves in the foot or ankle.
Tarsal tunnel syndrome
In this painful condition, the Tibial Nerve is compressed and irritated as it goes into the foot. It runs down on the inside ankle, between your ankle bone and another smaller bone, and is held in place by a big ligament – creating a kind of tunnel that it passes through (hence the name). This nerve can get compressed from injuries, such as sprains or fractures, or it can happen over time.
Flat-footed individuals are at risk because the outward tilting of the heel can strain the tarsal tunnel and put pressure on the nerve. Typical symptoms of this nerve entrapment are tingling, burning, pain or pins and needles. Usually, this is felt on the inside of the ankle or the bottom of the foot.
Plantar nerve entrapment
This issue is less common than other trapped nerves and can feel very similar to plantar fasciitis. The main difference is that nerve pain tends not to improve at rest and can increase intensity at night. There is usually chronic burning heel pain which is made worse with stretching and standing.
A unique and fairly common condition which is often described as feeling like you have a stone in your shoe. This is caused by a small growth around a nerve between your 3rd and 4th toe, just below the point at which your toes separate from the rest of your foot. Whilst this condition can be quite uncomfortable, it is rarely painful. It’s more likely to affect women as it is often caused by compression of the nerve by tight narrow shoes or high heels.
Gout is a pain kind of arthritis that can affect any joints (but usually the big toe). It will come on quite quickly and present itself as swelling, redness and extreme tenderness in the affected area. It occurs when the body has excess uric acid in the blood causing tiny sharp crystals to form in and around joints. Usually the body will absorb uric acid naturally, but diets high in red meat, seafood, organ meats, and alcohols such as beer, can increase the uric acid levels.
Other risk factors include obesity, kidney disease, untreated high blood pressure, family history, and being a male age 30-50. Those who are disposed to it can have repeated attacks over the years. Each of which might last anywhere from a few days to a few weeks. Prevention is much easier than treatment for this condition as it usually relies on anti-inflammatories and allowing the uric acid crystals enough time to be re-absorbed by the body.
How do Osteopaths treat foot pain?
It should go without saying that the most important element to treating the foot and ankle is getting the right diagnosis! Most conditions have very specific needs when it comes to recovery, but there are a number of things that an osteopath will usually consider regardless of the type of injury:
- Movement: Does the foot move like it should? Does it move too much? Simple questions give us big clues about how your joints and muscles will are functioning. A hypermobile joint might mean instability or indicate previous sprains. A restricted joint could be a result of a dysfunction in your gait. Knowing how your joints move gives us an idea of which parts have been under increased load. We can then use a range of techniques including gentle manipulation (cracking) to increase mobility, or alternatively help you strengthen weaker areas.
- Muscles: In the ankle, muscles play a vital role in balance and stability; they make the micro-movements to keep us standing upright. But these muscles are prone to injury whenever the foot or ankle is injured too. We use a combination of soft tissue techniques, cupping, dry needling, and stretching, as well as using exercises to build strength and balance.
- Compensation from other areas: Issues further up the leg can cause real issues for the foot. For example, a hip rotated outward makes it nearly impossible to walk naturally. Ultimately, it’s your foot that has to take make the compensation because it’s the only contact point to the ground. With most foot/ankle injuries, osteopaths check the knees, hips, pelvis and lower back as well.
- How you stand: Looking at how you stand or walk is a great way to see how your body functions as a whole. Biomechanical issues can be hard to spot when you remain still so your osteopath will ask you to do a range of movements and see how the leg integrates and works together. The aim is to take any unnecessary pressure from the injured area by ensuring you are moving biomechanically as well as possible.
- Your day-to-day life: The goal is to get you back to doing what you love as quickly as possible. So osteopaths will always try to find a way to keep you active through your recovery. This might be through certain activities, specific rehab exercises, or even modifying existing activities to help you avoid aggravating your injury. Your osteopath will advise on the best way to continue working and how to avoid making your injury worse by doing so.
Osteopath & Sports Nutritionist
Jamie is a Queenstown based osteopath treating a full range of muscular and skeletal injuries, particularly sports injuries. He has a practical and empathetic approach and experience treating chronic pain. He finds it incredibly fulfilling to educate and help his patients who have thought they would live with pain forever.
Special areas of interest: Shoulder injuries and rehabilitation, headaches and migraines, chronic pain and arthritis of the neck and joints an exercise rehabilitation.
Favourite technique: Jamie's great with his joint manipulations, cupping and applying a gentle but highly effective treatment. He also loves teaching people breathing techniques.