Are you struggling with heel pain in Singapore? You’re not alone. An estimated 10 to 15% of cases of foot problems are related to heel pain1. It is also the most common foot problem that most people tend to ignore at its early stage and can severely impact your life. In this comprehensive guide, we aim to provide you with all the information you need to understand, diagnose, and manage heel pain effectively. If you need help with your condition, don’t hesitate to contact us!
Hallux rigidus is the condition that causes stiffness and reduced range of motion of the big toe joint. Patients with this condition will have difficulty trying to bend the big toe and often experience pain at the big toe joint when walking or doing physical activity.
Theoretically, we need a minimum of 65 degrees of extension (bending upwards) of the big toe for normal gait patterns. Restriction at the big toe joint affects our propulsion significantly and causes problems to other parts of the foot.
Sesamoiditis is a condition that causes metatarsalgia or foot pain under the ball of the big toe joint. It is a result of inflammation when the sesamoid bones are injured. Sesamoids are a pair of oval-shaped bones that sits under the first metatarsal bone, and it plays a vital part in acting as a fulcrum to allow the tendon (flexor hallucis longus) to pull and flex our big toe effectively and efficiently.
If poorly managed, Sesamoiditis can lead to a stress fracture, fracture or even avascular necrosis (“dying”) of the sesamoid bones.
A plantar plate injury or plantar plate tear is a condition that causes foot pain around the ball of the foot, most commonly around the second or third toe. A plantar plate is a piece of fibrocartilage that holds our toe joint (metatarsophalangeal joint) together and provides structural stability. It originates at the head of the metatarsal bone and attaches to the base of the proximal phalanx bone.
Plantar plate injury is commonly called “floating toe syndrome” as it causes the affected toe to retract off the ground when standing. Patients with this condition will normally report pain and a “stepping on a pebble” sensation, especially when walking barefoot.
Metatarsalgia is an umbrella term for conditions that cause pain over the forefoot or around the ball of the foot. It should be regarded as a description of pain than a diagnosis. Patients with metatarsalgia should be further assessed to determine the underlying diagnosis of the pain.
Foot drop is a condition where the muscles in the front of the leg weaken, causing difficulty in lifting the foot and toes. It can happen due to nerve damage, injury, or underlying medical conditions. The condition can affect people of all ages and cause difficulties in walking and performing daily activities.
Lifting the foot up, an action known as ankle dorsiflexion is important for normal gait functions. Ankle dorsiflexion helps to clear the foot off the ground as our leg swings forward when we walk or run. Foot drop can cause tripping and falling, and can severely impact a person’s ability to carry out daily activities.
Tarsal tunnel syndrome is a condition that causes ankle pain along with neurological symptoms such as burning, numbness and tingling sensation. It occurs when the tibia nerve is compressed at the inside (medial) of the ankle, at an area referred to as the “tarsal tunnel“. This condition is very similar to carpal tunnel syndrome, which occurs at the wrist.
Baxter’s nerve entrapment is a condition that causes heel pain in up to 20%1 of the population suffering from heel pain. It occurs when the inferior calcaneal nerve is entrapped between the heel bone and the surrounding muscles of the foot. This condition is often overlooked and many patients have been misdiagnosed with plantar fasciitis. Pain caused by Baxter’s nerve entrapment usually presents with other neurological symptoms such as burning, numbness and tingling sensation.
Clawed toes and hammer toes are toe deformities that can cause foot pain or other foot conditions. They often occur when there is a muscular imbalance in the foot, causing the toe to remain in a bent position. Clawed and hammer toes can be flexible (able to straighten) or fixed deformity (unable to straighten).
Clawed toes appear as toes that curl downwards like a “claw”, characterized by hyperextension of the metatarsophalangeal joint (MTPJ) and flexion of the proximal interphalangeal joint (PIPJ) and distal interphalangeal joint (DIPJ).
Hammer toes differ from clawed toes slightly where only the middle part of the toe is curled, and are characterized by hyperextension of the MTPJ, flexion of the PIPJ and extension of the DIPJ. There is a third type of toe deformity known as mallet toe, where only the tip of the toe is curled downwards.
Heel spur or calcaneal spur is a condition associated with heel pain caused by an outgrowth of bone that extends from the heel bone (calcaneus). However, it is important to know that heel spurs usually do not cause heel pain. The heel pain from patients with heel spurs is typically due to the presence of underlying plantar fasciitis or Achilles tendinitis.
There are 2 areas of the heel bone where spurs are commonly found – plantar (bottom of the heel) and posterior (back of the heel).
High arch feet or pes cavus is a type of foot posture characterized by abnormally high arch height along the inner side of the foot. This foot type is also described as “supinated” feet or walking with excessive supination. A person with high arch feet will notice that their footprints have greater curvature and less surface area touching the ground.
High arch feet are mostly congenital (inborn) but can also be due to underlying neuromuscular conditions such as Charcot-Marie-Tooth disease, muscular dystrophy, cerebral palsy, and post-poliomyelitis syndrome.
Bunions or hallux abductovalgus, are a joint deformity where the big toe curve towards the lesser toes. People with bunions often complain of difficulty fitting into shoes due to the wide forefoot caused by bunions. Bunions are a progressive condition and cause overlapping toes to develop at their severe stages. It can affect adults and children, with the latter known as juvenile bunions.
Bunions affect the function of our big toe joint in walking, causing stress to other foot or toe joints and disrupting the pressure distribution under the foot. Commonly associated conditions caused by bunions include corns or calluses, plantar plate injury or hallux rigidus.
