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What are indications to go and see the podiatrist?
Indications podiatry
How importance foot health is for total well-being, one usually only realizes when complaints occur.
In case of 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 performs many tasks for the statics and movement of the body. Foot problems can occur as a result of predisposition, one-sided loading, and unsuitable footwear
Prolonged and one-sided overloading under sub-optimal conditions, however, asks a lot of muscles and joints. (Intensive) practice of sports puts a lot of pressure on feet, ankles and knees. With optimal sports shoes and fitted sports soles, possible erroneous developments can be corrected quite well.
Even with the most suitable (sports) shoe for your situation, walking comfort can often be improved by means of individually measured soles.
And in rheumatism patients pain can often be directly reduced, while in diabetics wounds on the foot through overpressure can be avoided.
The following is an overview of possible indications for podiatry on referral from your GP, since these complaints are treated every week at the podiatrist.
Complaints of the hip/pelvis/lower back
1. Groin symptoms (psoas busitis) 
Pain in the groin area, sometimes with radiation to the front of the upper leg and limitations when walking.
Check for difference in leg length and irregular positions of the legs and feet. If these are found, corrective soles and/or a heel increase will be applied to compensate for the difference in leg length.
(Low) back pain 
Chronic and recurrent pain in (mainly) the region of the lower back.
- Check for difference in leg length, if necessary a heel increase to compensate.
- A different position and/or function of the feet influences the position and function of the pelvis and the spine. Eliminating the cause with corrective podiatric soles.
- If there is insufficient damping when walking, apply shock-absorbing podiatric soles.
- Shoe advice
3. Degeneration of the hip(Coxarthrosis) 
After radiographically established coxarthrosis to preserve the function of the hip.
In case of irregular position and/or function of the hip in combination with irregular position and/or function of the foot (and/or the knee). Check for presence of a difference in leg length. Corrective podiatric soles to normalise the load of the hip as much as possible.
4. Snapping hip 
A popping feeling on the outside of the upper leg at the level of the hip, often found in athletes and ballet dancers. When the leg is stretched backwards (B) from a bent position (A).
Eliminating the cause (often walking on the outside of the foot) with corrective (sports) podiatric soles. In case of a difference in leg length, also apply a heel increase.
Complaints of the knee/upper leg
1. Degeneration of the knee (gonarthrosis) 
Radiographically diagnosed gonarthrosis. Preventively to preserve the function of the knee.
In case of irregular position and function of the knee (and the foot and/or the hip). Check for presence of a difference in leg length. Corrective podiatric soles to normalize the pressure on the knee as much as possible.
2. Jumper’s knee (infrapatellaire insertietendopathie, apexitis patellae) 
Pain in the front of the knee, at or below the kneecap, and limitations when walking.
Check for position or function defects of the foot and/or difference in leg length. If this is present: corrective podiatric insoles and/or heel increase. Preferably in combination with physical therapy.
3. Meniscus irritation 
In case of chronic pain complaints in the inner or outer side of the knee joint at the level of the joint gap (to postpone or while awaiting surgical intervention).
In case of irregular position or function of the feet, the knees are loaded incorrectly. This can cause pressure (compression) in the knee joint. Eliminating the cause with corrective podiatric soles. Preferably treated in combination with physical therapy.
4. Overloading at the level of the inside of the knee (overloading of the collateral medial ligament at the level of pes anserinus) 
Pain on the inside of the knee, around the joint gap.
Eliminating the cause – usually too much inward tilting of the midfoot (overpronation tarsal complex), whether or not accompanied by an inward position of the heel bone (calcaneovalgus), this causes stretching of relevant structures- by corrective podiatric soles.
5. Pain behind the knee cap/damage to the cartilage at the back of the kneecap (retropatellar cartilage) (retropatellar chondropathy) 
Pain behind or around the kneecap when loading and when sitting for a long time.
The cause often lies in the “derailing” of the kneecap, too much inward tilting of the midfoot (overpronation tarsal complex), whether or not accompanied by the inside of the heel bone (calcaneovalgus), can cause/increase this derailment. In case of irregular position and/or function of the feet, corrective podiatric soles are indicated.
6. Tractus iliotibialis friction syndrome(complaints at the level of the outside of the knee) 
Pain on the outside of the knee is common in runners.
The cause often lies in outward position of the foot from the heel (calcaneovarus); corrective (sports) podiatric soles can eliminate this cause. In case of a difference in leg length apply a heel increase. Sports shoes advice. Running advice, such as walking on the other side of the road in connection with the camber of the road.
Complaints of the ankle/lower leg
1. Pain complaints due to the attachment of the Achilles tendon to the heel bone (Achillodynie)
Pain and/or swelling 3-6 cm above the insertion of the Achilles tendon. Pain at the start of or after loading, especially in athletes who do a lot of running.
Corrective podiatric insoles depending on abnormalities in the gait. Training advice with regard to the degree of loading and the surface. Controlled stretching of the calf muscles. Preferably in combination with physical therapy.
2. Degeneration (arthrosis) of the upper ankle joint 
Initial stiffness and/or pain in the ankle.
The restriction of the upper ankle joint hinders normal foot settlement. To remedy this, a heel increase can be applied in the shoe. In addition, an abnormal gait often occurs, giving rise to other complaints and erroneous loading of the other joints. In case of these complaints, physical and/or manual therapy is advisable.
3. Overload of the inside of the knee (superficial) (insertional tendinopathy of the pes anserinus (superficialis) 
Pain and sometimes mild swelling on the lower leg on the inside and at an angle below the knee. Occurs often in swimmers and long distance runners and also as a complication in degeneration of the knee (gonarthrosis).
Eliminating the cause – usually too much inward tilting of the midfoot (overpronation tarsal complex), whether or not accompanied by an inward position of the heel bone (calcaneovalgus), this causes stretching of relevant structures- by corrective podiatric soles.
4. Sinus tarsi syndrome ( (complaints at the level of the ankle) 
Radiating pain at the level of the sinus tarsi during loading, often after a distortion but also through compression
Depending on the cause, taping and/or corrective podiatric sole.
5. Shin splints tibial stress syndrome, usually insertional tendinopathy of the musculus tibialis anterior/posterior) 
Pain in the tibia during or after loading, swelling, loss of function.
Eliminating the cause -usually too much inward tilting of the midfoot (overpronation tarsal complex), whether or not accompanied by the inward position of the heel bone (calcaneovalgus)- by taping and/or correction soles.
Complaints of the foot
Skin
1. Calluses(callus, hyperkeratose) 
Regularly recurring excessive callus formation (despite pedicure treatment) which may be accompanied by a burning or stabbing pain due to local overloading spots.
Eliminating the cause by relieving orthosis and/or podiatric soles.
2. Corn(clavus, kertoma, eksteroog) 
Regularly recurring corns (despite pedicure treatment) which causes shooting pains.
Eliminating the cause by relieving orthosis and/or podiatric soles.
3. Scars 
Pain due to excessive callus formation.
Eliminating the cause by relieving orthosis and/or podiatric soles.
4. Wounds (ulcers / also for wounds caused by diabetes mellitus) 
Non-healing wounds on the underside or on top of the foot.
Eliminating the cause by relieving orthosis and/or podiatric insoles and/or by adjusting or changing footwear.
5. Warts (verrucae) 
In case of prolonged or persistent complaints and/or pain after insufficient effects of a nitrogen application or dectrotimer, chemical treatment e.g. with salicylic acid, or prior to a nitrogen application.
Relieving the wart by podiatric soles, wart is not removed with soles but pressure is relieved, which has a beneficial effect on its treatment.
Toes
1. Bursa (inflammation) (bursa/busitis) 
Pain, swelling, redness, warmth.
Relieving pressure with felt bandage and/or orthosis. Eliminating the cause if necessary with podiatric soles.
2. Chronic dislocation (subluxation) of toes 
Pain when walking, especially at take off at the level of the toe joints.
Determine whether the complaints are caused by the footwear. In acute phase, taping and then if needed eliminating the cause by relieving orthosis and/or podiatric soles.
3. 4. Bone outgrowth(exostoses/osteophytes) 
Pain at the level of excessive bone outgrowth while walking and/or resting, mostly stinging and/or pressure pain.
Eliminating the cause by relieving orthosis and/or podiatric insoles and/or by modifying or changing footwear.
4. Hammer toes/ claw toes    
Pain as a result of overpressure spots at the tips of the toes (apex digiti) or preventively in children (usually no complaints).
Eliminating the cause by relieving orthosis and/or podiatric soles.
5. Overlapping toes (supraduction/infraduction digiti)Â Â 
Pain complaints as a result of friction between the toes (interdigital) or preventively in children (usually no complaints).
Eliminating the cause by relieving orthosis and/or podiatric soles.
6. Chilblains (perniosis/Raynaud’s phenomenon) 
Cold toes especially when it is cold outside.
Recommending hot and cold baths, complemented by foot care and shoe advice (reducing the pressure of the shoe on the foot).
Forefoot
1. Inflammation of the joint capsule at the t.h.v. transition between metatarsal bone and toe(capsulitis MTP-gewricht) 
Pain when walking, especially at take off at the level of the toe joints.
Eliminating the cause by relieving orthosis and/or podiatric soles.
2. Sagging forefoot (pes transversus)
Pain under the ball of the foot at the level of the end of the 2nd and 3rd, and/or 3rd and 4th metatarsal.
Eliminating the cause by relieving orthosis and/or podiatric soles.
3. Leg wash out (exostosen/osteofyten) 
Pain at the level of excessive bone outgrowth while walking and/or resting, mostly stinging and/or pressure pain.
Eliminating the cause by relieving orthosis and/or podiatric insoles and/or by modifying or changing footwear.
4. Thickening (especially) in a tendon (ganglion) 
Thickening of the foot accompanied by local pain complaints.
In some cases, depending on the localization, felt bandaging, but mostly eliminating the cause with podiatric insoles and/or by modifying or changing footwear.
5. Crooked big toe (hallux (abducto) valgus) 
Shoe problems as a result of wider forefoot.
Stage 1: Eliminating the cause and podiatric soles to prevent increased complaints.
Stage 2: Dysfunction of the tendons which attach to the big toe as a result of deviating position of the toe (musculus flexor hallucis longus and musculus extensor hallucis longus); eliminating the cause and podiatric soles to prevent increased complaints. Usually an orthotic to correct the toe position. Stage 3: Pressure spots with callus formation or worse in different places on the big toe; eliminating the cause and podiatric soles to prevent increased complaints. Usually an orthotic to correct the toe position.
Stage 2: Dysfunction of the tendons which attach to the big toe as a result of deviating position of the toe (musculus flexor hallucis longus and musculus extensor hallucis longus); eliminating the cause and podiatric soles to prevent increased complaints. Usually an orthotic to correct the toe position. Stage 3: Pressure spots with callus formation or worse in different places on the big toe; eliminating the cause and podiatric soles to prevent increased complaints. Usually an orthotic to correct the toe position.
6. Reduced mobility/stiffening at the level of the transition from the 1st metatarsal to the big toe (hallux limitus/rigidus) 
Pain at the level of the transition from the 1st metatarsal to the big toe, but may also occur due to a disturbance in the gait as a result of this reduced mobility, causing complaints elsewhere in the foot and/or knee, hip, back.
A corrective podiatric sole to optimize the use of the relevant joint and the settlement of the foot when walking, including correction of the rear foot. In case of a restriction aimed at mobilization and in case of a stiffening aimed at immobilization. If necessary supplemented by adjustment of the shoe, but permanent adjustment is required.
7. Gout 
Lasting pain at the level of the transition from the 1st metatarsal to 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 relevant joint in combination with shoe advice.
8. Radiating pain / “numb” feeling on the inside of the big toe (Joplin’s neuroma/compressie-neuropathie van de nervus plantaris medialis aan de mediale zijde van het MTP-1)
Radiating pain/”numb” feeling on the inside of the big toe.
Eliminating the cause by relieving orthosis and/or podiatric soles.
9. Bone fracture of the 2nd metatarsal (marsfractuur) 
Acute pain (sometimes also swelling) during exercise. After 2-4 weeks the fracture can be diagnosed with radiography.
Eliminating the cause, immobilization with felt bandage and tape. Often a corrective podiatric sole is needed to prevent recurring complaints as a result of overload
10. Radiating/stabbing pain usually between the 3rd and 4th metatarsal  (Morton’s neuroma/compression neuropathy of the plantaris pedis nerve in the inter-metatarsal space) 
Violent radiating/stabbing pain usually between the 3rd and 4th metatarsal, combined with radiation to the toes, numbness in the toes.
Eliminating the cause by relieving orthosis and/or podiatric soles.
111. Overload sesamoid (Sesamoiditis) 
Strong pain under the tip of the 1st metatarsal, especially when standing on the toes and during the take off on the ball of the foot while walking.
In the acute phase, relieving pressure with felt, bandage; later podiatric relieving soles.
12. Bursitis due to the end of the smallest metatarsal bone (tailors bursitis aan de laterale zijde van het caput metatarsale 5, vaak met varisatie van digitus 5, abductie van het os metatarsale 5 en exostosevorimg) 
Pain, redness and swelling at the level of the tip of the smallest metatarsal. In the acute phase, relieving pressure with felt, then protective orthosis and/or shoe adjustment.
In the acute phase, relieving pressure with felt, bandage; later podiatric relieving soles. Eliminating the cause with podiatric soles.
13. Sand toe or volleyball toe 
Pain after falling over the (big) toe (plantar flexion trauma), possibly accompanied by swelling.
Rest, ice-packs. Taping to stabilise the relevant transition from metatarsal to toe. Often also splints on the other toe/toes. Possibly a relieving podiatric sole. After the acute phase, strengthening exercises.
Midfoot
1. Joint inflammation (arthritis)) at the level of the joints of the midfoot
Pain in the joints of the metatarsus (mid-tarsal joints), especially when loading.
Relieving podiatric soles, often in combination with physical and/or manual therapy. Often in combination with a heel increase.
2. Disorder of the attachment of the “musculus peroneus brevis” muscle (insertional tendinopathy peroneus brevis) 
Pain on the outside of the foot at the level of the bulge at the beginning of the small metatarsal (tuberosity metatarsal bone 5).
Eliminating the cause (usually outward position (varus position) of the foot) with podiatric soles.
3. Disorder of the attachment of the “musculus tibialis anterior” muscle(insertional tendinopathy musculus tibialis anterior) 
Pain in the attachment of the relevant tendon at the level of the beginning of the “navicular bone” (bone on the inside of the midfoot). Sometimes associated with swelling, redness and heat.
Eliminating the cause -usually too much inward tilting of the midfoot (overpronation tarsal complex), whether or not accompanied by the inward position of the heel bone (calcaneovalgus)- by taping and/or correction soles.
4. Disorder of the attachment of the “musculus tibialis posterior” muscle (insertietendopathie musculus tibialis posterior) 
Pain in the attachment of the relevant tendon at the level of the beginning of the “navicular bone” (bone on the inside of the midfoot). Sometimes associated with swelling, redness and heat.
Eliminating the cause -usually too much inward tilting of the midfoot (overpronation tarsal complex), whether or not accompanied by the inward position of the heel bone (calcaneovalgus)- by taping and/or correction soles.
5. Holvoet (pes cavus) 
The pain can occur in very different places in the foot, especially on the outside of the foot. In addition, claw or hammer toes and pain under the forefoot are also frequent.
Relief and pressure distribution with a compensating sole. Often there is shortening of the calf muscles. In this case, we also advise stretching exercises.
6. Pes planus(flat feet) 
The pain can occur in very different places in the foot, but especially in the arch and inner side of the foot. Also you may experience pain and fatigue after walking or prolonged standing.
Corrective podiatric sole. (The flat foot continues to exist but complaints will be reduced/disappear, and in children permanent (partial) correction is possible depending on the degree of deviation).
Rearfoot
1. (Local) pain under the heel (calcaneodynia) 
Pain under the heel bone (calcaneus) when loading.
Relieving pressure in case of local pain with felt bandage or corrective, shock-absorbing relieving podiatric soles.
2. Subcutaneous inflammation of the Bursa (bursa) at the level of the Achilles tendon 
Pain in the Achilles tendon, increases when bending the foot down.
Eliminating the cause, usually an unstable gait, creating friction of the Achilles tendon on the Bursa, with corrective podiatric soles. In case of pressure by the footwear, shoe advice and/or shoe adjustment.
3. Nerve compression of the nerve “nervus peroneus superficialis” (compressie-neuropathie van de nervus peroneus superficialis) 
Burning superficial pain at the level of the lower part on the outside (laterodistal) of the lower leg, the instep of the foot and the first four toes.
Corrective podiatric soles to reduce the traction on the bottom part on the outside of the lower leg.
4. Irritation/inflammation of a tendon fascia under the foot, i.e. the “fascia/Plantar fasciitis” irritation/inflammation of the Plantar aponeurosis) 
Especially (starting) pain in the bottom of the heel with radiation to the arch (the gradient of the fascia Plantaris), often also accompanied by swelling.
If complaints are recent, taping may be enough, in case of longer existing (chronic) complaints and sometimes to prevent repetition, eliminating the cause is required using a corrective podiatric sole. In case of shortening the calf musculature, stretching exercises are always advised, sometimes accompanied by taping. Rest, followed by building up of the loading capacity is required.
5. Bone spurs, calcium deposits under the heel bone at the level of the origin of the tendon the “Plantar fascia” (Calcification under the calcaneus, usually at the level of the origo of the Plantar fascia) 
In particular pain during/after loading under the heel bone, often a Plantar Fasciitis is the cause of the complaints.
Correction of the underlying cause, corrective podiatric soles with specific cut-out at the level of local pain in combination with shock absorption.
6. Tarsal tunnel syndrome, constriction of the “tibial nerve” under a 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) 
Pain radiating from the inside of the ankle. Often also only scattered (diffuse) pain around the heel and/or foot sole.
Eliminating the cause -usually too much inward tilting of the midfoot (overpronation tarsal complex), whether or not accompanied by the inward position of the heel bone (calcaneovalgus)- by taping and/or correction soles.
7. Bone outgrowth at the back of the heel bone (Haglund’s exostosis) 
Pain at the back of the heel bone, often also some swelling. Relieve pressure with felt bandage, shoe adjustment.
Eliminating the cause with podiatric soles in order to reduce friction at the level of the bone outgrowth.
8. Instability of the ankle 
In case of pain or frequent spraining. The pain may be localized in very different places.
Eliminating the cause by relieving orthosis and/or podiatric soles.