Hindfoot problems

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Presentation

  • Initial insidious onset of pain
  • Intense pain during the first step of walking or a period of inactivity
  • Lessening pain with moderate foot activity
  • Increased pain after long periods of standing or walking
  • previous trauma and feeling the ankle/foot is giving way
  • Central constant heel pain

Symptoms/signs

  • overweight
  • unable to weight bare
  • increase pain and stiffness first thing in the morning
  • gradual onset of pain
  • swelling
  • decrease in muscle strength
  • deformity
  • unable to perform single heel raise
  • limping
  • loss of medial longitudinal arch
  • inability to carry out normal sporting activity or walk long distances

Differential diagnosis

  • Plantar Fasciitis
  • Calcaneal Stress Fracture
  • Achilles Tendonitis
  • Atrophy of calcaneal fat pad
  • Plantar Calcaneal Bursitis
  • Posterior Tibialis Dysfunction
  • Baxter’s nerve entrapment
  • Severe’s Disease
  • Sinus Tarsi Syndrome

Primary care management

Evidence suggests that 80% of MSK problems are self limiting and will recover within 12-18months. It is important to rule out serious pathology or any problem that warrants escalation but for all other cases a period of initial self directed rehabilitation should be given before any further intervention is considered.

Issue condition specific leaflet

  • Plantar fasciitis
  • Acquired adult flat foot (posterior tibialis dysfunction)

Refer

If symptoms persist following 12 weeks of self management

Patients can self refer via SAP 030 3333 3001

They will be triaged into appropriate service i.e. Physiotherapy, Orthotist or Podiatrist.

SCI-Gateway referral should be completed for the following more urgent presentations:

Urgent referral

  • Previous complex fracture
  • Previous osteomyelitis
  • Non-healing wound
  • Sudden flat foot or sudden collapse of arch

Editorial Information

Last reviewed: 05/07/2024

Next review date: 06/07/2026

Reviewer name(s): Lynne Drennan.