The Physiotherapist performs a thorough examination of the (Tarsal Coalition) affected foot and plans the management goals with you.
Your daily functional activities, occupation, age, etc are taken in consideration when planning your management.
The end result of the management is to ensure that you return to your previous activities early without complications and with a minimum recurrence of your symptoms.
Some individuals with this condition may have to undergo surgical interventions and afterwards undergo physiotherapy.
You may be required to use ice in a damp towel over the affected area for 15-20 minutes every two-three- hours daily to reduce pain and swelling. This is done in the initial stages to alleviate symptoms.
Individuals may also derive some benefits from wearing supportive footwear in the initial stages to lessen pain and reduce unnecessary movement in the affected foot.
The supportive shoes or footwear involves the use of an arch support as the condition presents with a decreased foot arch which minimises the level of stability and support in the affected foot.
Footwear which also has a wide toe-box is encouraged to provide enough room for the forefoot and this helps to relax the foot muscles and reduce stiffness and soreness.
The supportive footwear also provides enough cushioning or padding to ease discomfort during walking and standing.
The padding is centred on the ball of the affected foot and also reduces any irritation which may arise as a result of placing your weight on the foot during activities.
The supportive footwear is usually above the ankle joint to provide a level of stability and it’s advisable to avoid wearing sandals during these periods of management.
The symptoms diminish with adequate rest and also the avoidance of factors or activities which would aggravate the condition. You may be required to use assistive devices such as crutches to keep your weight off your affected foot in the initial stages.
Activity modifications are also encouraged to reduce the period of time you place your weight in the affected leg.
Specific exercises are designed to mobilise and strengthen the foot muscles and keep the surrounding structures in the foot and ankle well conditioned.
Frequent movement in the affected foot promotes flexibility and also reduces discomfort associated with the onset of stiffness.
Stiffness may result when you limit movement in the foot as a result of pain over a prolonged period of time.
• The presence of stiffness places extra stress on the affected leg and performing flexibility exercises provides a relief for the foot.
Stand facing the wall and place both hands on the wall at the shoulder level. Place your affected foot slightly behind the uninjured one. Slowly lean into the wall and ensure that you bend the knee of your unaffected leg but straighten the knee of your affected leg.
Make sure that the heel of your foot touches the ground as you lean into the wall. You should feel a painfree stretch at the back of the leg – the calf muscles.
While performing the exercise most of your weight is placed in the unaffected leg as you lean towards the wall. Hold the stretch for 20 – 30 seconds and relax. You may repeat this as often as you can tolerate throughout the day.
• This exercise helps you strengthen the small muscles in your feet and strengthen your arch to provide more stability when you stand and walk.
Take a seat and place your affected foot on a small towel on the floor. Gently lift the towel with your toes and try to hold on to it for a few seconds and allow it to drop to the floor. Repeat this exercise as often as you can.
• Another exercise to strengthen your foot arch is toe raises. This can be performed by standing against a wall or holding onto a stable object such as a table. Slowly raise yourself so that you stand on the balls of both feet.
Maintain the raise for 10 seconds or more and then gently lower yourself onto the floor. The exercise should not cause any pain in the affected foot. You may repeat often throughout the day.
The writer is a Senior Physiotherapist at the 37Military Hospital