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There are a lot of musculoskeletal (MSK) problems/injuries that can be associated with the foot, ankle and lower limb and it would be impossible to list them all. 

We have highlighted some of the most common problems and created resources which you might find helpful in sections below.

IPC training modules can be accessed via learnPro, or speak to your line manager for alternative IPC training options.

The IPC Teams across all sectors provide education sessions for all staff within NHSGGC as well as further education establishments. These can be either ad hoc sessions or set sessions arranged by Practice Development and Learning & Education. Any Senior Charge Nurse, Team Leader or Department Manager can contact their local IPC Team to discuss training needs and plan dates and sessions tailored to meet the needs of their team and departments.

Below is the link to a session provided by IPC. This should not be used as a substitute to attending the face-to-face sessions or undertaking the module via learnPro, but as a support for the learner, or a reference following attendance.

• Outbreaks

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A painful flat foot will often involve a muscle called tibialis posterior. This can be called several names including posterior tibial tendon dysfunction (PTTD) and it can be the result of a sudden change in activity levels, or it could be a gradual increase in discomfort due to increased demand on the muscle. The main purpose of this muscle is to help stabilise the arch of the foot and, more often than not, it happens because the muscle/tendon is not strong enough to cope with the demand that is being placed on it. The picture below shows the area where the muscle sits on the inside of the leg (shown by the red dotted line) while the tendon is shown by the purple line. Its main insertion point is being pointed out, however it has multiple insertions so the pain may spread around the arch of the foot.

You might notice some swelling or pain around the inside of your ankle bone and into the arch of your foot. A reasonably reliable way of telling if this muscle is involved, is to try multiple heel raises on the unaffected leg – and then seeing if you can do the same on the affected leg without any discomfort. An observational study in 2017 set out some values to guide you and the results of this are below. Please remember though that this is just a guide but can be really useful to gauge your ability.

What causes a painful flat foot? 

Spending long periods standing or walking, especially a sudden increase in these activities is often the reason we see problems around this area. Also, if you are overweight, this will increase the stress through the muscle and tendon. Footwear is important, as is the strength and flexibility of certain muscles.

Exercises and information

The videos below will give you advice on how to manage this problem and some exercises that may be useful in strengthening the muscle to help it cope better with the demand that you are placing on it. 

There are 7 exercises in total. The video relating to tibialis posterior is number 7 but you may find the others useful too.

Don’t expect things to improve overnight though. It takes time for muscles and joints to adapt and get stronger.

More advanced/progressive loading exercises.

As the initial exercises become easier and less painful, it is important to progress and make the rehabilitation more challenging in order to improve the strength and endurance of the muscle/tendon unit. This progression is vital to ensure that the muscles and tendon are capable of coping with whatever activity you want to return to. Click on the link below for some examples of more advanced exercises. There are 5 exercises in total. Numbers 4 and 5 are the ones that relate more to tibialis posterior.  

Please make sure that you are comfortable and ready before making the step up to more challenging rehabilitation, and if in doubt, stay with the current plan until you are.

The leaflets below provide some added information, however, if you feel you would like to talk to a podiatrist about your options, please phone 0141 347 8909 for more advice and support.

Forefoot pain is very common and it is estimated that around 80% of people will suffer from forefoot pain at some point in their life.

Females are more likely than males to suffer from forefoot pain mostly due to footwear choices. Being overweight can also contribute foot pain as can weakness or tightness in specific muscle groups.

It is important to think back to when the problem started and try to link it to a potential change in activity, or change in footwear to see if there is anything you can do to ease the discomfort. Symptoms can range from a burning sensation to a numbness, or it could just be that it is really painful to walk.

Exercise and support

Strengthening the muscles in the feet (known as the intrinsic muscles) can help, as can stretching out the calf muscles as this can reduce the pressure on the front of the foot when walking. 

The video below will demonstrate a range of exercises that might help.There are 7 short videos. Numbers 1 and 2 are relating to calf stretching & Numbers 5 and 6 are relating to the intrinsic muscles, however, you may find the others useful too. 

Don’t expect things to improve overnight though. It can take time for muscles and joints to adapt.

Please note: If you do not see any sign of improvement after 6 – 8 weeks of following the advice and exercises, please phone 0141 347 8909 for more advice and support.

What is a bunion?

Hallux valgus (also known as bunion) is a bony bump on the inside of the foot at the base of the big toe with the big toe tilting towards the second toe.

Many people who have bunions do not get any real problems with their feet and nothing needs to be done.

• Some people will however get pain around the big toe or problems with their shoes
• The bump can make foot wider and it can be difficult to find shoes which are comfortable
• The bump can rub on shoes and become red and swollen and in some cases the skin can blister
• Some people with bunions go on to have problems with their smaller toes too.

What causes bunions?

Inherited factors and the shape of the bones in feet can cause bunions. Footwear which does not fit well probably has a role in making bunions more uncomfortable and increasing problems in the future.

What tests may be done?

You do not need any x-rays or special tests to diagnose bunions, these are only used for planning surgery.

What can you do to help your bunion?

There are many non-surgical treatments that can help.

• Footwear: One of the most important things you can do to help is to wear the right footwear. You should try to wear wide shoes with a low heel that fit you comfortably. Shoes with laces or an adjustable strap are best as they can be adjusted to the width of your foot. Do not wear high heeled, pointed or tight shoes as this will make your pain worse.
• Diet: Losing weight will reduce the strain on your feet.
• Medication: Painkillers such as paracetamol can reduce the pain. Follow the advice from your community pharmacist or other healthcare professional about taking medication. It is important to take medication regularly.
• Exercise: Helps build the strength of the small muscles in your feet, which can take the strain off the toes and we think help to delay or stop problems getting worse.

What else can be done?

Most patients with bunions respond well to non-surgical treatments, especially changing their footwear. Where these have been tried and failed then there may be other options. If your pain does not start improving after a period of 3 months of following the advice above, please phone 0141 347 8909 to see a healthcare professional who can assess your foot.

Some patients may be referred on for Orthopaedic footwear or a surgical opinion.

Surgery

Surgery is considered in patients who have significant problems with their bunions and have tried non-surgical management which has not worked usually over at least 12 months.

An operation will not give you an entirely normal foot, but it will correct the shape of the big toe and narrow your foot back towards a more usual shape.

The aim of bunion surgery is to straighten the big toe and make it more comfortable. There are several procedures for bunion surgery and the best surgery for you depends on the size of your foot.

For most people the surgery is a bony surgery where the bones of your toe are cut and reset to straighten your big toe. This is called an osteotomy, some people who have developed arthritis in their big toe joint need a different type of operation where the big toe joint is surgically stiffened (fused). Very occasionally if your foot is more complicated an operation would be done further back in the middle of your foot to help straighten and support it.

Bunion surgery is largely very successful with around 85% of people happy with the outcome but as with any operation there are some risks.

It may take 3-6 months for you to be back to your normal level of activity where you will be able to work standing all day, however every person is different.

The leaflets below provide some added information, however, if you feel you would like to talk to a podiatrist about your options, please phone 0141 347 8909 for more advice and support.

Information leaflet

Glasgow Royal Infirmary has a specialised Foot and Ankle Service which includes orthopaedic foot and ankle consultants, Advanced Podiatry Practitioners (APP), specialist nurses and other member of the orthopaedic team.

Many foot and ankle problems can be treated by a local Podiatry Service in Community Health Centres. You can self-refer directly to these services without having to ask your GP to refer you.

To access the Community Podiatry Services contact your local area:

Glasgow – 0141 347 8909

Lanarkshire – 01236 731881

If your foot and ankle condition is not improving or if you require further assessment, you may be referred to the Orthopaedic APP for review.

Although you may have already undergone podiatry management before, the specialist podiatrist in the Orthopaedic Department has an advanced role having undertaken additional orthopaedic training. They work in a similar role to the orthopaedic consultants and can arrange and manage further tests such as x-rays, MRI scans and blood tests. In addition, assessment and discussions about foot and ankle surgery can be carried out by our APP Podiatrist.

Appointments with the orthopaedic podiatrist

Appointments to see our specialist podiatrists are arranged by medical professionals. If you need to reschedule or cancel an appointment that has already been organised for you at Glasgow Royal Infirmary Orthopaedic Podiatry Department, please use our Patient Focused Booking lines open during office hours.

• 0141 201 3105
• 0141 201 3114

Pain is always made in the brain. No exception, the brain decides.

About 30-50% of people in the UK live with persistent pain. It is the leading cause of disability in the world. Pain is usually the result of a combination of different things but its impact can be significant and negatively affect our physical and mental health, our social and home lives and our ability to stay in work.

The links below with take you to information on the NHSGGC pain service, as well as some other fantastic online resources and information about pain which will help your understanding of pain and empower you to take back control and manage your pain. 

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