The Problem with Limping

Andrew McMillan, PhD

Eastern Foot Care Podiatrist

One of the most rewarding aspects of being a podiatrist is assisting people to maintain important activities despite having foot and ankle pain. Unfortunately, for many people with foot disorders, life goes on as normal and the demands placed on their feet and legs are ever constant due to their work and home life responsibilities.

Why people often need help with foot pain

The majority of painful disorders seen by podiatrists at Eastern Foot Care have a mechanical origin, whereby a degree of tissue overload or degeneration (wear and tear) has occurred. These factors are frequently related to high- or flat-arched feet, repetitive movements occurring in sport or exercise, or occupation related factors such as long periods of standing or exposure to hard/uneven surfaces. Quite often a combination of these factors are present. Less common causes of foot pain, such as inflammatory joint disease, may not be caused by mechanical factors, but are exacerbated with standing and walking in the same way as a mechanical disorder.

The basic anatomy of our feet and ankles, being our primary weight bearing structures and point of contact with the ground, mean that electing to rest and avoid aggravating activity is often impossible without professional assistance. Unlike upper limb injuries, where rest and protection may often be achieved by activity limitation alone, foot and ankle pain more frequently requires the use of mechanical treatment to support and offload an injured structure while walking and performing normal everyday tasks.

“…limping is an adaptation with risks”

For many people with a foot injury, walking and standing is both painful and unavoidable. For this reason, podiatrists at Eastern Foot Care commonly assist people who have started limping as a result of foot pain. Limping (antalgic gait) is an adaptive walking pattern that can be either overt, with a shortened period of stance on the painful foot and a shuffling walk, or subtle, involving a shifting of pressure away from the injured structure. This latter type of limping commonly involves a repetitive rolling / rocking motion to the side of the foot during walking, and can often go unnoticed by family or work colleagues. Sometimes our patients themselves are not aware of having a protective walking pattern. Subtle limping can be maintained for several days or weeks and allows a person to maintain their essential daily activities despite suffering from a foot disorder.

Despite the advantage of continued function, limping inevitably results in a transfer of load to structures in the foot or ankle that are primarily designed for stabilisation only, rather than support of full body weight. For example, the long tendons on either side of the ankle may become overworked and inflamed (tendonitis), and the small joints at the base of the lesser toes can be similarly damaged. These secondary injuries are frequently observed in people with heel pain or pain in the big toe joint, and can become a higher priority than the original injury if not promptly addressed.

In addition to overloading other structures, limping that is required for more than a few days is not likely to provide the necessary rest or protection required to heal a foot injury. Weight may also be transferred to the other non-painful foot with potentially adverse effects down the track.

How can we help?

The podiatrists at Eastern Foot Care are experts in diagnosing musculoskeletal injuries and recognising the unique mechanical factors that are present in an individual patient. This approach underpins our professional ability to modify the cause of an injury, bring about tissue healing, and reduce the risk of recurrence.

A key skill of our podiatrists in the treatment of foot injury is to offload (or ‘rest’) an injured structure while maintaining a patient’s essential activity level, without the need for limping. A range of supportive materials and devices are utilised daily by our podiatrists to protect a foot or ankle in the presence of injury:

• Permanent footwear modification with durable padding. Many shoes worn by our patients for work, school or sport have been modified by the direct application of customised padding.
• Applied direct to the foot and ankle, our podiatrists can offload injured tissues with immediate effect.
• Moulded silicone wedges. Custom made semi-compressible devices utilised for painful or misaligned toes.
• Custom foot orthoses. Unique supportive devices made from a plaster cast of the patient’s foot and further adjusted to influence mechanical loads. These can be fitted to a variety of footwear and optimised for specific activities.
• Lace-up ankle braces with control stirrups. A commonly used device that fits within most normal shoes and offers our patients convenient control of their ankle stability.
• Rigid forefoot offloading shoe. Various rigid soled shoes are utilised by our podiatrists to temporarily prevent the foot from bending while walking.
• CAM boot. A variety of weight-bearing boots (‘moon boots) are stocked at Eastern Foot Care and fitted by podiatrist as needed for short-term offloading purposes.
• Back slab casting. A non-weight bearing cast expertly made and fitted by our podiatrists for serious foot injuries such as ligament tears and bone fractures.
• Crutches. Eastern Foot Care stocks various forms of crutches to assist patients in the immediate short-term management of acute foot and ankle injuries.

In combination with the mechanical treatments above, podiatrists at Eastern Foot Care utilise a range of tissue-specific, targeted treatments and physical therapies to alleviate pain and restore normal walking. When used for injury management, mechanical treatment is always implemented with a full rehabilitation approach in mind.

If limping is an issue for you or you feel you could benefit from an assessment of your individual biomechanics contact Eastern Foot Care to see one of our Sports Podiatrists today! We have two convenient locations at Eastern Foot Care Ringwood, (03) 9870 1301 and Eastern Foot Care Knox, (03) 9887 2233.