Foot and ankle conditions

Feet carry everything and get looked at last. People walk on a painful heel for a year, then arrive surprised that it has become harder to treat than it was at six weeks.

Foot and ankle problems sit precisely on the line between physiotherapy and podiatry, which is one reason they are so often half treated. We have both in the same building, so an assessment can look at the tendon, the joint, the way you load the foot and the footwear you are doing it in, rather than at whichever of those the practitioner in front of you happens to treat.

More information

Which page do I need

Heel pain that is worst on the first few steps out of bed is plantar fasciitis, and that pattern is so characteristic it does most of the diagnosing. Stiffness and pain in the tendon at the back of the ankle, worse first thing and at the start of exercise, is Achilles tendon pain. Pain along the inner shin that arrives with a jump in training is shin splints. A rolled or twisted ankle is ankle sprain. A painful bony prominence at the base of the big toe is bunions.

Should I see a physiotherapist or a podiatrist

If the problem is a tendon, a muscle or an injury, start with physiotherapy. If it involves the skin and nails, or you suspect the way your foot loads is causing pain further up the leg, start with podiatry and gait analysis. If you are not sure, ring reception on 01428 642577 and describe it, and they will book you with the right person rather than the next available one.

Why tendons need loading rather than resting

Most of the persistent problems on this page are tendon problems, and the single most useful thing to understand about a tendon is that it adapts to load and de-adapts without it. Rest and anti-inflammatories do not resolve tendon pain, which is why so many people conclude nothing works. Treatment is a carefully graded loading programme where some discomfort during the exercises is expected and acceptable, and where progress is measured in months.

The rehabilitation everybody stops too early

After an ankle sprain, pain and swelling settle in a few weeks but the balance and automatic reactions that stop the ankle rolling take considerably longer. Stopping at the point where walking is comfortable is why having sprained an ankle is the strongest predictor of spraining it again.

Posterior lower legs and heels with Achilles tendon highlighted red
Two lower legs and feet; left in grayscale, right with translucent orange glow highlighting inner structuresSeated person holds bare foot toward camera on patterned bed

Frequently Asked Questions

Should I see a physiotherapist or a podiatrist for foot pain?
Either can be the right answer and we have both. If the problem is a tendon, a muscle or an injury, start with physiotherapy. If it involves the skin and nails, or you suspect the way your foot loads is causing pain further up the leg, start with podiatry and gait analysis. Ring reception and describe it if you are unsure.
Why does my heel hurt most first thing in the morning?
Pain that is worst on the first few steps out of bed and eases as you move is the classic pattern of plantar fasciitis. It responds well to a properly graded loading programme and poorly to being walked off for months, so it is worth having assessed early.
How long does an ankle sprain take to heal?
The pain and swelling of a mild sprain usually settle in a few weeks, but the balance and control take considerably longer to return, and that is what determines whether you sprain it again. Repeat sprains are the most common consequence of stopping rehabilitation when the pain stops.