Toe walking, commonly referred to as “walking on tippy toes” by parents, is a condition to describe children who walk without heels touching the ground. Toe walking is a form of gait disorder and is associated with several underlying neurological or muscular conditions, such as cerebral palsy, muscular dystrophy, and autism. If left untreated, toe walking can lead to other injuries and conditions to the lower limb.
Juvenile bunions, or juvenile hallux abductovalgus, are a type of foot deformity that affects the big toe joint of children or teenagers under the age of 18 years, where the big toe curves towards the lesser toes. The result of the deviation is a bony protrusion over the inner side of the big toe joint. The appearance of a juvenile bunion is similar to an adult bunion, with the only difference being the age of onset.
Juvenile bunions are considered a progressive deformity; therefore, it is expected that the big toe’s deviation worsens as a child grows up. Children affected by juvenile bunions will often not experience any discomfort in its early stages, however, as the deformity worsens, they will usually complain of pain and redness around the big toe joint.
Fungal skin is an infection of the skin caused by dermatophytes fungi and can occur in any part of the body. Fungal skin infections of the foot, widely referred to as “athlete’s foot” or “foot rot“, are medically termed tinea pedis and are a very common skin condition of the foot. Patients with tinea pedis will often complain of itch, dry flaky skin or even tiny blisters on the affected areas.
Corns and calluses are areas of thickened and hard skin (hyperkeratosis) on the body that forms due to pressure and friction. It is most commonly found on the palms of our hands or the soles of our feet. Calluses are generally painless until it becomes very thick where it starts to cause damage to the underlying tissue. Corns, however, are usually painful when pressure is applied and are often misdiagnosed as plantar warts.
It is a myth that corns have “roots” and will resolve when the “roots” are removed. Corns do not have roots and the only effective way to resolve corns is by reducing the amount of friction and pressure over the area.
Hamstring strain is a common injury of the hamstring muscles that results in posterior thigh pain. Like calf strain, hamstring strain commonly affects individuals who participate in high-impact sports such as football or basketball and can severely affect your ability to walk or run after.
Calf strain is a common injury of the calf muscles that results in posterior leg pain. It commonly affects sports athletes or enthusiasts participating in activities such as football, tennis, or sprints.
Like other muscle strains, such as hamstring strain, a calf strain requires proper management to minimise recurrence risk.
Leg length discrepancy, or leg length inequality, is a common condition that can cause foot pain, ankle pain, knee pain, hip pain, or back pain. This condition is characterized when one of the lower limbs is longer than the other. There are multiple factors that can cause leg length discrepancy, ranging from congenital (inborn), to injury-related, to iatrogenic (past medical treatment such as surgery). A leg length discrepancy of less than 1cm is often considered mild and some individuals may be asymptomatic. However, leg length discrepancy can cause tightness and stress on one side of the lower limb or body over time and is an associated risk factor for many musculoskeletal conditions of the lower limbs.
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.
Sesamoiditis, if untreated, 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 that is characterized by the inability to lift the foot up (dorsiflex) against gravity. It occurs when the nerves (motor nerves) that control our lower leg muscles (ankle dorsiflexors) suffer an injury or stop functioning.
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.
