INDICATIONS
What are indications to go to the podiatrist?
Indications of podiatry
How important foot health is for your overall well-being is usually only realized when complaints occur.
If you have foot complaints, but also tired legs, burning soles or even knee, hip and back problems, it is advisable to have your feet checked. The human foot is a very complex body part that has many tasks for body statics and movement. Foot problems can occur due to predisposition, one-sided loading and unsuitable footwear.
However, long-term and one-sided loading under non-optimal conditions places great demands on muscles and joints. (Intensive) sports practice places a great deal of strain on the feet, ankles and knees. With optimal sports shoes and fitted sports soles, possible incorrect developments can be countered very well.
Despite the most suitable (sports) shoe for you, walking comfort can often be improved by means of individually fitted soles.
In addition, pain can often be immediately reduced in rheumatic patients, while in diabetics wounds on the foot due to overpressure can be avoided.
Below is an overview of possible indications for podiatry upon referral from the GP, as these complaints are treated weekly by the podiatrist.
Complaints of the hip/pelvis/low back
1. Groin complaints (psoas busitis)
Pain in the groin area, sometimes radiating to the front of the thigh and limitations when walking.
Check for leg length discrepancies and deviations in the position of the legs and feet. If these are found, corrective insoles and/or a heel increase are applied to compensate for the leg length difference.
2. (Low) back problems
Chronic and recurring pain complaints in (mainly) the region of the low back.
- Check for leg length discrepancy, if necessary raise the heel to compensate.
- An abnormal position and/or function of the feet affects the position and function of the pelvis and spine. Eliminating the cause with corrective podiatric insoles.
- If there is insufficient cushioning while walking, use shock-absorbing podiatric insoles.
- Shoe advice
3. Degeneration of the Hip (Coxarthrosis)
After radiographic coxarthrosis to preserve the function of the hip.
In case of abnormal position and/or function of the hip in combination with an abnormal position and/or function of the foot (and/or knee). Check for the presence of a leg length discrepancy. Corrective podiatric insoles to normalize the load on the hip as much as possible.
4. Snapping hip
A snapping sensation on the outside of the thigh at the hip, often in athletes and ballet dancers. When the leg is extended from a bent position (A) towards the back (B).
Eliminate the cause (often walking outside) with corrective (sports) podiatric insoles. If there is a difference in leg length, also apply a heel raise.
Complaints of the knee/thigh
1. Degeneration of the knee (gonarthrosis)
X-ray confirmed gonarthrosis. Preventive to maintain the function of the knee.
In case of abnormal position and function of the knee (and the foot and/or the hip). Check for the presence of a leg length discrepancy. Corrective podiatric insoles to normalize the load on the knee as much as possible.
3. Meniscus irritation
For chronic pain complaints on the inside or outside of the knee at the joint space (to postpone or await surgical intervention).
If the position or function of the feet is abnormal, the knees are also loaded incorrectly. This can cause pressure (compression) in the knee joint. Eliminating the cause with corrective podiatric insoles. Preferably treat in combination with physiotherapy.
4. Overload on the inside of the knee (overload on the medial collateral ligament at the pes anserinus)
Pain on the inside of the knee, around the joint space.
Removing the cause (usually too much inward tilting of the midfoot (tarsal complex overpronation), whether or not accompanied by the heel bone moving inward (calcaneovalgus), which creates stretch on the relevant structures) by correcting podiatric insoles.
5. Pain behind the kneecap / damage to the cartilage at the back of the kneecap (retropatelar cartilage) (retropatelar chondropathy
6. Iliotibial band friction syndrome (complaints on the outside of the knee)
Pain on the outside of the knee is common among runners.
The cause often lies in the outward protrusion of the foot from the heel (calcaneovarus), corrective (sports) podiatric insoles can eliminate this cause. If there is a difference in leg length, use a heel raise. Sports shoe advice. Walking advice: Such as walking on the other side of the road due to the curvature of the road surface.
Complaints of the ankle/lower leg
1. Pain complaints at the attachment of the Achilles tendon to the heel bone (Achillodynia)
Pain and/or swelling 3-6 cm above the attachment of the Achilles tendon. Pain at the beginning of or after strain, especially in athletes who run a lot.
Corrective podiatric insoles depending on the abnormalities in the walking pattern. Training advice regarding the degree of load and the surface. Dosed stretching of the calf musculature. Preferably treat ion in combination with physiotherapy.
2. Degeneration (arthrosis) of the upper hock joint
Initial stiffness and/or pain in the ankle.
The restriction of the upper hock hinders normal gait. For this purpose, a heel increase can be added to the shoe. In addition, an abnormal walking pattern often occurs, which can cause other complaints and places an incorrect load on the other joints. Physio and/or manual therapy is desirable for these complaints.
3. Overload on the inside of the knee (superficial) (insertive endopathy of the pes anserinus (superficialis)
Pain and sometimes mild swelling on the lower leg on the inside and diagonally below the knee. Common in swimmers and long-distance runners, also as a complication of degeneration of the knee joint (gonarthrosis).
Removing the cause (usually too much inward tilting of the midfoot (tarsal complex overpronation), whether or not accompanied by the heel bone moving inward (calcaneovalgus), which creates stretch on the relevant structures) by correcting podiatric insoles.
5. Spring shins or shin splints (tibial stress syndrome, usually insertion endopathy of the tibialis anterior/posterior muscle)
Pain on the outside of the knee is common among runners.
Eliminating the cause (usually too much inward tilting of the midfoot (tarsal complex overpronation), whether or not accompanied by the heel bone turning inward (calcaneovalgus)) taping, especially in acute complaints, but usually corrective podiatric insoles and shoe advice.
Complaints about the foot
Skin
5. Warts (verrucae)
In case of long-term or persistent complaints and/or pain due to insufficient effect of a nitrogen application or dectrotimer, chemical treatment with, for example, salicylic acid or in preparation prior to a nitrogen application.
Relieving the wart by podiatric insoles, the wart is not removed with insoles, but it is relieved of pressure, which has a beneficial effect on its treatment.
Toes
Forefoot
5. Crooked big toe (hallux (abducto) valgus)
Shoe problems due to wider forefoot.
Stage 1: Eliminating the cause and preventing complaints with podiatric soles. Stage 2: Dysfunction of the tendons that attach to the big toe due to abnormal toe position (slipping of the flexor hallucis longus and extensor hallucis longus muscles), eliminating the cause and requesting podiatric soles to prevent complaints. Often an orthosis to correct the toe position. Stage 3: Pressure spots with calluses or worse in various places near the big toe, remedy the cause and request podiatric soles to prevent complaints. Often an orthosis to correct the toe position.
6. Reduced mobility/stiffening at the junction of the 1st metatarsal bone and the big toe (hallux limitus/rigidus)
Pain at the junction of the 1st metatarsal bone and the big toe, but can also be caused by disturbances in the walking pattern, due to this restriction of movement, causing complaints elsewhere in the foot and/or the knee, hip, back.
A corrective podiatric sole to optimize the use of the joint in question and the gait of the foot when walking, including correction of the hindfoot. With a restriction aimed at mobilization and with a stiffening aimed at immobilization. Possibly supplemented with adjustment of the shoe, but permanent adjustment is required.
7. Gout
persistent pain at the junction of the 1st metatarsal bone and the big toe as a result of the pressure of the shoe on the resulting bone outgrowth (exostosis), where drug therapy does not provide sufficient relief.
A corrective podiatric sole to relieve the joint in question in combination with shoe advice.
9. Fracture of the 2nd metatarsal bone (mars fracture)
Acute pain (sometimes also swelling) during exertion. After 2-4 weeks the break (fracture) can be determined radiologically.
Elimination of the cause, immobilization by felt bandage and tape. A corrective podiatric sole is often necessary to prevent recurring complaints due to overload.
10. Radiating / stabbing pain between usually the 3rd and 4th metatarsals (Morton neuralgia / compression neuropathy of the plantaris pedis nerve in the intermetatarsal space) Morton
11. Overuse of the sesamoid bone (Sesamoiditis)
Strong pain under the end of the 1st metatarsal bone, especially when standing on the toes and during push-off on the ball of the foot while walking.
Strong pain under the end of the 1st metatarsal bone, especially when standing on the toes and during push-off on the ball of the foot while walking.
12. Bursitis at the end of the smallest metatarsal bone (tailor's bursitis on the lateral side of the 5th metatarsal head, often with variation of the 5th digitus, abduction of the 5th metatarsal bone and exostosis formation)
13. Sand toe or volleyball toe
Pain after falling over a (big) toe (plantar flexion trauma), possibly accompanied by swelling.
Rest, ice applications. Taping to stabilize the relevant transition from metatarsal to toe. Often also splints on the other toe(s). If necessary, use a relieving podiatric sole. After acute phase muscle strengthening exercises.
Metatarsal
1. Joint inflammation (arthritis) at the joints of the metatarsal
2. Disorder of the attachment of the “peroneus brevis muscle” (peroneus brevis muscle insertion endopathy)
3. Disorder of the attachment of the muscle “tibialis anterior” (inertial endopathy muscle tibialis anterior)
Pain at the attachment of the tendon in question at the beginning of the “navicular bone” (bone on the inside of the midfoot). Sometimes accompanied by swelling, redness and warmth.
Eliminating the cause (usually too much inward tilting of the midfoot (tarsal complex overpronation) with or without the heel bone turning inward (calcaneovalgus) by taping and/or corrective insoles.
4. Disorder of the attachment of the “posterior tibial muscle” muscle (posterior tibial muscle insertion endopathy)
Pain at the attachment of the tendon in question at the beginning of the “navicular bone” (bone on the inside of the midfoot). Sometimes accompanied by swelling, redness and warmth.
Eliminating the cause (usually too much inward tilting of the midfoot (tarsal complex overpronation) with or without the heel bone turning inward (calcaneovalgus) by taping and/or corrective insoles.
5. Hollow foot (pes cavus)
The pain can occur in very different places on the foot, especially on the outside of the foot. In addition, claw or hammer toes and pain under the forefoot also occur frequently.
Relief and pressure distribution through a compensatory sole. There is often a shortening of the calf musculature. In that case, stretching exercises are also given.
6. Pes planus (flat foot)
The pain can occur in very different places on the foot, but mainly in the arch and inside of the foot. Pain and fatigue also occur after walking or standing for a long time.
Corrective podiatric sole. (The flat foot remains, but complaints diminish/disappear and in children, depending on the degree of deviation, (partly) permanent correction is possible).
Hindfoot
1. Joint inflammation (arthritis) at the joints of the metatarsal
2. Subcutaneous inflammation of the bursa at the level of the Achilles tendon (subcutaneous Achillei bursitis)
Pain in the Achilles tendon increases when bending the foot downwards.
Eliminating the cause, often an unstable walking pattern that causes friction of the Achilles tendon on the bursa, by correcting podiatric insoles. In case of pressure due to footwear, shoe advice and/or shoe adjustment.
3. Nerve compression of the nerve “peroneus superficialis” (compression neuropathy of the superficial peroneus nerve)
4. Irritation/inflammation of a tendon leaf under the foot or the “fascia/plantar fasciitis” (irritation/inflammation of the plantar aponeurosis)
Particularly (initial) pain at the bottom of the heel, radiating to the arch of the foot (the course of the plantar fascia), often also accompanied by swelling.
For short-term complaints, taping may be sufficient, for longer-standing (chronic) complaints and sometimes to prevent recurrence, the cause must be eliminated by means of a corrective podiatric sole. In case of shortening of the calf musculature, always perform stretching exercises, sometimes accompanied by taping. Rest, followed by building up resilience is necessary.
5. Heel spur, calcium deposits under the heel bone at the origin of the plantar fascia (Calcifization under the calcaneus, usually at the origin of the plantar fascia)
6. Tarsal tunnel syndrome, compression of the nerve “the tibial nerve” under a piece of bone on the inside of the heel bone behind the inside of the ankle (Compression of the tibial nerve under the retinaculum flexorum behind the medial malleolus)
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