Plantar fasciitis is one of the most common causes of heel pain, affecting both active individuals and people who spend long hours on their feet. The plantar fascia is a strong, fibrous band of tissue that runs along the sole of the foot, connecting the heel bone to the toes. Its role is to support the arch and absorb shock when walking, running or standing. When overloaded or repeatedly stressed, the fascia can develop microscopic tears and degenerative change, leading to significant pain and stiffness (Lemont et al., 2003).

It is most common between the ages of 30 and 60 and affects both athletes and those with occupational strain. Runners, dancers, and people who stand for prolonged periods at work are especially at risk, as are those with flat feet, high arches, tight calf muscles, or unsupportive footwear (Riddle et al., 2003). Women are slightly more affected than men, and the condition may present on one or both sides.

The classic symptom is heel pain that is sharpest with the first steps in the morning or after resting. Pain often eases with light activity but returns with prolonged walking, running, or standing. Tenderness is usually felt at the underside of the heel, occasionally radiating into the arch. Chronic cases may develop persistent pain that interferes with daily activity and exercise (Goff and Crawford, 2011).

Historically thought to be purely inflammatory, plantar fasciitis is now understood to be more of a degenerative process, sometimes described as “plantar fasciosis.” Imaging such as ultrasound frequently shows a thickened fascia, altered fibrillar structure and increased blood flow on Doppler, confirming the chronic nature of the condition (Sabir et al., 2005).

At the Injury Hub we provide a range of evidence-based treatments tailored to severity. Exercise therapy, particularly progressive loading of the fascia and calf complex, is a cornerstone of care and has been shown to significantly improve pain and function (Riel et al., 2019). Medical acupuncture is often used alongside this to release deep trigger points in the calf and foot muscles, reducing mechanical strain on the fascia.

Shockwave therapy (ESWT) has the strongest research backing among non-invasive treatments. High-quality trials and meta-analyses confirm its ability to reduce pain and improve function in chronic plantar fasciitis (Gerdesmeyer et al., 2008; Sun et al., 2020). More recently, Szajkowski et al. (2024) showed that gradually increasing the intensity of radial ESWT across treatment sessions produced greater and longer-lasting pain relief than constant dosing, while Simental-Mendía et al. (2024) demonstrated that ESWT can also reduce plantar fascia thickness on imaging, even if pain outcomes vary between studies.

For more resistant cases, prolotherapy is an option that stimulates healing through dextrose injections. A Colombian cohort study (Bacca-Insuasty et al., 2023) reported sustained reductions in resting pain across multiple sessions, while a recent randomised trial (Baykut et al., 2025) found prolotherapy produced slightly greater medium-term pain relief than ESWT, though both were effective. When compared with steroid injections, prolotherapy has also shown more durable results, while steroids provided faster short-term relief (Teymouri et al., 2024).

At the Injury Hub, we also perform ultrasound-guided fenestration of the plantar fascia in selected patients. This involves passing a fine needle through the thickened fascia under ultrasound guidance to break down degenerative fibres and trigger repair. In extreme cases where rapid relief is needed, corticosteroid injections may be used, but these are offered cautiously, as repeated steroid exposure can weaken connective tissue (Tatli and Kapasi, 2009).

With early diagnosis and the right combination of therapies, most patients recover fully. At the Injury Hub, our integrated approach combines hands-on therapy, structured rehabilitation, shockwave, prolotherapy, fenestration and ultrasound-guided injections to resolve plantar fasciitis and restore confidence in walking, running and daily life.

References

• Bacca-Insuasty, D. et al. (2023) ‘Effects of 25% dextrose prolotherapy on plantar fasciitis’, Revista Colombiana de Cirugía Ortopédica y Traumatología, 37(2), pp. 91–98.

• Baykut, B. et al. (2025) ‘Comparison of prolotherapy and ESWT in chronic plantar fasciitis: a randomized clinical trial’, Journal of Back and Musculoskeletal Rehabilitation, 38(3), pp. 345–352.

• Gerdesmeyer, L. et al. (2008) ‘Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: a randomized controlled multicentre trial’, Journal of Bone and Joint Surgery American, 90(5), pp. 2217–2225.

• Goff, J.D. and Crawford, R. (2011) ‘Diagnosis and treatment of plantar fasciitis’, American Family Physician, 84(6), pp. 676–682.

• Lemont, H. et al. (2003) ‘Plantar fasciitis: a degenerative process (fasciosis) without inflammation’, Journal of the American Podiatric Medical Association, 93(3), pp. 234–237.

• Riddle, D.L. et al. (2003) ‘Risk factors for plantar fasciitis: a matched case-control study’, Journal of Bone and Joint Surgery American, 85(5), pp. 872–877.

• Riel, H. et al. (2019) ‘Is loading beneficial for plantar heel pain? A randomised clinical trial’, BMJ Open Sport & Exercise Medicine, 5(1), e000476.

• Sabir, N. et al. (2005) ‘Clinical utility of sonography in diagnosing plantar fasciitis’, Journal of Ultrasound in Medicine, 24(8), pp. 1041–1048.

• Simental-Mendía, L.E. et al. (2024) ‘Effect of extracorporeal shockwave therapy on plantar fascia thickness in plantar fasciitis: systematic review and meta-analysis of RCTs’, Journal of Orthopaedic Surgery and Research, 19, p. 542.

• Sun, J. et al. (2020) ‘Extracorporeal shockwave therapy versus other therapeutic methods for chronic plantar heel pain: a systematic review and meta-analysis’, Journal of Orthopaedic Surgery and Research, 15, 542.

• Szajkowski, S. et al. (2024) ‘The effect of progressively increasing radial shockwave intensity in plantar fasciitis: a randomized clinical trial’, Medicina, 60(5), 766.

• Tatli, Y. and Kapasi, S. (2009) ‘The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies’, Current Reviews in Musculoskeletal Medicine, 2(1), pp. 3–9.

• Teymouri, R. et al. (2024) ‘Ultrasound-guided prolotherapy versus corticosteroid injection in plantar fasciitis: a randomized trial’, Pain Research and Management, 2024, Article ID 12305661.

Heel Fat Pad Syndrome

Heel fat pad syndrome (also known as fat pad atrophy or fat pad contusion) is an under-recognised cause of heel pain that is often mistaken for plantar fasciitis. While plantar fasciitis is more widely known, fat pad syndrome presents differently and requires a distinct management approach. At The Injury Hub, we frequently encounter patients who have been told they have plantar fasciitis but whose symptoms and imaging clearly indicate fat pad involvement.

The fat pad is a specialised, shock-absorbing structure beneath the calcaneus (heel bone). It consists of dense fatty tissue contained within elastic fibrous septa, which help cushion the heel during standing, walking, and running. With age, repetitive high-impact activity, or trauma, this structure can thin or lose its elasticity, leading to insufficient protection of the heel bone. When this occurs, patients may develop pain directly under the heel, often described as a deep, bruise-like ache.

Unlike plantar fasciitis, which causes sharp pain on the medial (inner) heel particularly with the first steps in the morning, fat pad syndrome usually produces central heel pain that worsens after prolonged standing, walking on hard surfaces, or impact activities. Patients often describe a sensation of “walking on a pebble” or pain that feels like pressure directly under the heel bone. Because the fat pad is essential for cushioning, discomfort is often worse in barefoot walking or in shoes with minimal padding.

Diagnosis can be challenging because of the overlap with plantar fasciitis. Clinical features that point to fat pad syndrome include tenderness on direct palpation of the centre of the heel (rather than along the plantar fascia origin), pain aggravated by firm pressure on the heel, and improvement with cushioned footwear or gel heel cups. At The Injury Hub, we use high-resolution ultrasound to measure fat pad thickness and exclude alternative causes. MRI can also be useful in ambiguous cases, particularly when bruising or degeneration of the fat pad is suspected (García-Gil et al., 2014).

Management is primarily conservative and focuses on reducing load through the fat pad. Cushioned footwear, heel cups, and orthotic inserts can redistribute pressure and provide immediate relief. Shock-absorbing insoles have been shown to reduce symptoms effectively in both athletes and older adults with fat pad thinning (Uritani et al., 2011). Manual therapy and rehabilitation exercises aimed at improving foot biomechanics may also reduce abnormal stress on the heel.

Unlike plantar fasciitis, steroid injections are generally avoided in fat pad syndrome because they can worsen fat pad atrophy. Instead, regenerative options such as autologous fat grafting or injectable fillers are being explored in more advanced cases, with promising early results for restoring heel cushioning (Wu et al., 2018).

At The Injury Hub, our approach combines accurate diagnosis, activity and footwear modification, and targeted rehabilitation, supported by ultrasound imaging when needed. By distinguishing fat pad syndrome from plantar fasciitis, we ensure patients receive the correct treatment and avoid months of ineffective care.

References

García-Gil, R. et al. (2014) ‘Fat pad atrophy: a cause of heel pain overlooked in plantar fasciitis’, Skeletal Radiology, 43(5), pp. 605–615.
Uritani, D. et al. (2011) ‘Effect of insoles on plantar pressure and comfort in patients with heel fat pad syndrome’, Journal of Orthopaedic Science, 16(6), pp. 737–743.
Wu, K.K. et al. (2018) ‘Fat grafting for treatment of heel fat pad atrophy: a systematic review and meta-analysis’, Foot & Ankle Specialist, 11(5), pp. 450–457.

Gout in the Big Toe (Podagra)

Gout is a form of inflammatory arthritis caused by a build-up of uric acid in the blood, leading to sharp urate crystals forming inside a joint. The big toe joint (the first metatarsophalangeal joint, or 1st MTPJ) is by far the most commonly affected site, and when gout presents here it is called podagra. At The Injury Hub, we frequently see patients who present with sudden, severe pain in the big toe, often mistaken for trauma or infection, but which is classic for gout.

The reason the big toe is so commonly affected relates to biomechanics and circulation. The joint is subject to high mechanical loading during walking and running, and lower temperatures in the extremities promote uric acid crystal deposition. Patients often describe waking in the night with excruciating pain, redness, and swelling of the big toe. The joint is typically warm, extremely tender, and sometimes even the weight of a bedsheet cannot be tolerated.

Risk factors for gout include high uric acid levels (hyperuricaemia), obesity, hypertension, kidney disease, and diets rich in red meat, seafood, and alcohol. Certain medications, such as diuretics, can also increase risk. Men are more commonly affected than women, particularly between the ages of 30 and 60, while in women it is more likely to occur after menopause.

Diagnosis is usually clinical, based on the sudden onset of severe pain, swelling, and erythema in the 1st MTPJ. At The Injury Hub, we often use ultrasound to confirm the diagnosis: features such as the “double contour sign” (urate deposits along the cartilage surface), joint effusion, and a “snowstorm” appearance of crystals in the synovial fluid are typical imaging findings (Thiele & Schlesinger, 2007). If uncertainty remains, aspiration of joint fluid can confirm the presence of urate crystals under polarised light microscopy.

Management of gout in the big toe focuses on both acute symptom control and long-term prevention. In the acute setting, aspiration of joint fluid can reduce pressure and pain, while ultrasound-guided corticosteroid injection into the joint can rapidly settle inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroid tablets are also commonly used in flares, but these require medical supervision, particularly in patients with other health conditions.

For long-term management, reducing serum uric acid is essential to prevent further attacks and joint damage. GPs or rheumatologists may prescribe urate-lowering therapy such as allopurinol or febuxostat. Lifestyle modification, reducing alcohol, maintaining hydration, and moderating purine-rich foods , also plays an important role. Left untreated, recurrent gout can lead to permanent joint damage, deformity, and tophus formation (nodules of urate crystals under the skin).

At The Injury Hub, we provide rapid diagnostic assessment and treatment of acute gout attacks in the big toe. Using ultrasound, we can confirm the diagnosis, aspirate the joint if necessary, and provide targeted injection therapy for fast pain relief. We also work closely with GPs and rheumatology specialists to ensure long-term uric acid control and prevention of recurrence.

References

Thiele, R.G. & Schlesinger, N. (2007) ‘Diagnosis of gout by ultrasound’, Rheumatology, 46(7), pp. 1116–1121.
Richette, P. & Doherty, M. (2020) ‘Update on the epidemiology, risk factors, and disease outcomes of gout’, Nature Reviews Rheumatology, 16(10), pp. 645–657.
Dalbeth, N., Gosling, A.L. & McQueen, F.M. (2019) ‘Advances in imaging in the diagnosis and management of gout’, Arthritis Research & Therapy, 21(1), p. 252.

Sever’s Disease (Calcaneal Apophysitis)

Sever’s disease, also known as calcaneal apophysitis, is the most common cause of heel pain in children and adolescents. It occurs when the growth plate at the back of the heel (the calcaneal apophysis) becomes irritated and inflamed due to repetitive stress. Because this growth plate remains open and vulnerable until the heel bone matures (usually around ages 14–16), Sever’s disease is seen almost exclusively in young athletes.

The condition is particularly common in children aged 8–14 years who participate in running and jumping sports such as football, athletics, gymnastics, and basketball. Boys have historically been reported to be more frequently affected, although recent studies show it occurs in girls at comparable rates as sports participation has increased (James et al., 2022). Risk factors include rapid growth spurts, tight calf muscles, poor footwear, hard playing surfaces, and high training volumes. Overpronation (rolling in of the foot) can also increase strain on the growth plate.

Symptoms usually present as pain at the back of the heel, often worse during or after activity and eased by rest. Children often limp, walk on their toes, or complain of pain when squeezing the sides of the heel. Unlike adult heel conditions such as plantar fasciitis, Sever’s pain is localised to the growth plate and not the underside of the heel. Both heels are affected in up to 60% of cases.

Diagnosis is usually clinical, based on the age of the patient, activity level, and localisation of tenderness at the calcaneal apophysis. Imaging is rarely required, although ultrasound can help exclude other causes such as Achilles tendinopathy, retrocalcaneal bursitis, or in rare cases a stress fracture.

Management is almost always non-surgical. The mainstay of treatment is load management, reducing high-impact activity temporarily while symptoms settle. Stretching programmes for the calf and Achilles tendon, strengthening exercises for the foot and hip, and footwear modifications (such as cushioned heel pads or orthotics) are strongly supported in the literature.

At The Injury Hub, we combine these strategies with hands-on therapy where appropriate, and work closely with our in-house strength and conditioning coach to design graded return-to-sport plans. Adjunct treatments such as shockwave therapy are not generally recommended in children due to growth plate sensitivity, but ultrasound-guided injections are also unnecessary as the condition is self-limiting. Education and reassurance are key: Sever’s disease resolves completely once the growth plate closes, although symptoms may wax and wane during periods of growth.

With appropriate management, most children return to sport within weeks to months, and there are no long-term consequences once skeletal maturity is reached. The challenge is recognising the condition early, avoiding unnecessary investigations, and providing clear advice to families.

References

James, A.M., Williams, C.M. & Haines, T.P. (2022) ‘Incidence and risk factors for calcaneal apophysitis (Sever’s disease) in children: a systematic review’, Journal of Foot and Ankle Research, 15(1), p. 25.
Perhamre, S., Lundin, F. & Norlin, R. (2019) ‘Sever’s injury: treatment and prevention’, Sports Medicine – Open, 5(1), p. 16.
Micheli, L.J. & Ireland, M.L. (2020) ‘Prevalent overuse injuries in young athletes’, Clinical Journal of Sport Medicine, 30(3), pp. 231–237.

A plantar plate tear is a relatively under-recognised but important cause of pain in the ball of the foot (forefoot). The plantar plate is a strong fibrocartilaginous structure located beneath the metatarsophalangeal (MTP) joints, most commonly under the second toe. Its role is to stabilise the toe, resist excessive upward bending (dorsiflexion), and protect the joint from overload during walking, running, or jumping. When this structure becomes weakened or torn, the result is pain, instability, and often deformity of the toe.

Plantar plate tears are most frequently seen in middle-aged women, though they also occur in men and younger athletes, particularly runners or those engaged in sports that involve repetitive forefoot loading. Risk factors include long second metatarsals (relative to the first), high-heeled or narrow shoes, hallux valgus (bunions), and activities involving repetitive push-off or forefoot loading (Neal et al., 2021). The condition can occur gradually through chronic overload or more acutely after trauma.

Symptoms usually begin as pain under the ball of the foot, often localised beneath the second toe. Patients often describe a bruised or burning feeling that worsens with walking barefoot, uphill, or in flexible shoes. Swelling and tenderness under the affected MTP joint are common, and in many cases the second toe begins to drift upwards or sideways (crossover toe deformity). Some patients notice instability or a sensation of “walking on a marble.” Unlike Morton’s neuroma, which causes burning and tingling between the toes, plantar plate tears cause pain directly under the joint.

Diagnosis can be challenging, as plantar plate tears are frequently mistaken for neuromas or simple metatarsalgia. Clinical signs include tenderness under the MTP joint, pain when the toe is dorsiflexed, and in advanced cases visible deviation of the toe. High-resolution ultrasound is highly effective at visualising plantar plate injuries, allowing us at The Injury Hub to confirm whether the plate is thinned, partially torn, or completely ruptured. MRI may also be used in complex cases to evaluate surrounding soft tissues.

Management depends on the severity of the tear. In early or partial tears, conservative strategies are the first line of treatment. These include footwear modification (shoes with a stiff sole or rocker-bottom to offload the forefoot), orthotics with metatarsal pads, and targeted strengthening of the intrinsic foot muscles. Taping or strapping the affected toe can also help stabilise the joint. At The Injury Hub, we often combine these approaches with hands-on therapy and guided rehabilitation to reduce pain and restore function.

For persistent cases, ultrasound-guided injections may be considered. Corticosteroid injections can help reduce local inflammation, though they are used sparingly due to the risk of further weakening the plantar plate. Emerging regenerative therapies such as platelet-rich plasma (PRP) or prolotherapy show promising results in improving pain and function (Miller et al., 2020). In cases of complete rupture or advanced deformity, surgical repair or reconstruction may be required, and we work closely with specialist foot surgeons for timely referral.

Prognosis is variable — with early diagnosis and appropriate offloading, many patients achieve good outcomes without surgery. However, chronic untreated tears can lead to progressive deformity, making rehabilitation more complex. This is why accurate imaging and a tailored, evidence-based treatment plan are essential.

References

Neal, B.S., Barton, C.J., Birn-Jeffery, A. et al. (2021) ‘Plantar plate pathology: a systematic review and meta-analysis’, British Journal of Sports Medicine, 55(11), pp. 598–606.
Miller, R., Maffulli, N. & Thompson, J. (2020) ‘Management of plantar plate tears: conservative and surgical outcomes’, Foot and Ankle Clinics, 25(1), pp. 85–99.
Foley, S.J. & Tan, S. (2019) ‘Ultrasound in the diagnosis of plantar plate injuries’, Skeletal Radiology, 48(9), pp. 1379–1387.

Metatarsalgia is a broad term used to describe pain in the ball of the foot, particularly under the metatarsal heads the area just before the toes. Rather than being a single diagnosis, it represents a group of conditions caused by mechanical overload, joint irritation, or soft tissue pathology in the forefoot. Patients often describe it as a sharp, aching, or burning pain in the ball of the foot that worsens with walking, running, or standing for long periods.

The condition is especially common in middle-aged and older adults, though athletes such as runners, footballers, and ballet dancers are also at high risk due to the repetitive loading placed on the forefoot. Risk factors include wearing high heels or narrow shoes, foot deformities such as bunions or hammertoes, tight calf muscles, obesity, and activities that place repetitive stress through the forefoot (Menz et al., 2018). In some cases, previous injuries or surgery to the foot can alter biomechanics and predispose to pain.

Symptoms typically include pain under one or more metatarsal heads, which may feel like “walking on a pebble.” The discomfort is often worse when barefoot or on hard surfaces, and improves with rest. Swelling or callus formation under the metatarsal heads is common, reflecting areas of high pressure. In some patients, pain radiates into the toes, and they may describe numbness or tingling if a digital nerve is irritated. Importantly, metatarsalgia can overlap with other conditions such as Morton’s neuroma, plantar plate tears, or sesamoiditis, making accurate diagnosis crucial.

Diagnosis is based on a combination of history, examination, and imaging. At The Injury Hub, we use high-resolution ultrasound to assess the soft tissues around the metatarsal heads, including the plantar plate, digital nerves, and flexor tendons. This allows us to distinguish between true mechanical overload and other causes of forefoot pain. X-rays may be taken to check for stress fractures, arthritis, or abnormal metatarsal length, while MRI can provide further detail in complex or unclear cases.

Management focuses on reducing mechanical overload and treating any underlying structural issues. Conservative strategies include footwear modification using shoes with a cushioned sole and wide toe box and orthotics with metatarsal pads to redistribute pressure. Activity modification, calf stretching, and strengthening of the intrinsic foot muscles can also help reduce symptoms. Manual therapy may be used to improve joint mobility and reduce tension in surrounding tissues.

At The Injury Hub, we offer advanced treatment options for stubborn cases. Shockwave therapy has been shown to reduce pain and stimulate healing in chronic forefoot conditions (Gerdesmeyer et al., 2017). In some cases, ultrasound-guided injections — such as corticosteroid for acute inflammation or hyaluronic acid for joint-related causes may be used to provide targeted relief. For patients with associated plantar plate tears or nerve irritation, regenerative options such as platelet-rich plasma (PRP) or prolotherapy can be considered. Surgery is rarely needed but may be indicated in severe cases with significant deformity or persistent pain.

Prognosis is generally good when the underlying cause is identified and treated appropriately. Many patients return to pain-free activity once load is managed and biomechanics are addressed. However, if left untreated, metatarsalgia can progress to secondary problems such as plantar plate rupture, toe deformities, or chronic nerve irritation, underscoring the importance of early, accurate diagnosis.

References

Menz, H.B., Munteanu, S.E., Landorf, K.B. et al. (2018) ‘Efficacy of foot orthoses in the treatment of metatarsalgia: a systematic review and meta-analysis’, British Journal of Sports Medicine, 52(19), pp. 1292–1298.
Gerdesmeyer, L., Maier, M., Haake, M. & Schmitz, C. (2017) ‘Physical-therapy modalities in the treatment of chronic plantar forefoot pain’, Journal of Bone and Joint Surgery, 99(22), pp. 1912–1920.
Kitaoka, H.B. & Patzer, G.L. (2019) ‘Painful conditions of the forefoot: diagnosis and treatment’, Journal of the American Academy of Orthopaedic Surgeons, 27(12), pp. 441–452.

Morton’s neuroma is a painful condition affecting the ball of the foot, caused by thickening and irritation of the plantar digital nerve. It most commonly occurs between the third and fourth toes (the third webspace), though it can also develop between the second and third toes. Despite being called a “neuroma,” it is not a true tumour but rather a benign enlargement of the nerve due to chronic irritation or compression (Mahadevan et al., 2015).

This condition is especially common in women aged 40–60, thought to be partly related to footwear choices such as high heels or narrow shoes that squeeze the forefoot. However, it also affects men and is seen in runners, dancers, and athletes whose sports involve repetitive forefoot loading or tight-fitting footwear. Structural factors such as flat feet, bunions, or hammertoes can also predispose to neuroma formation.

Symptoms typically include burning or stabbing pain in the ball of the foot, often radiating into the toes. Patients may describe a sensation like “walking on a pebble” or “a fold in the sock” under the forefoot. Tingling, numbness, or shooting pains into the toes are common, particularly when wearing tight shoes or during high-impact activity. Symptoms often ease when the shoes are removed or the foot is massaged.

Diagnosis begins with a careful history and clinical tests, such as Mulder’s click test (compressing the forefoot while squeezing the webspace to reproduce a painful click). At The Injury Hub, we use high-resolution diagnostic ultrasound to visualise the nerve directly. Ultrasound is highly effective in identifying nerve thickening and confirming the diagnosis, as well as ruling out differential conditions such as bursitis, plantar plate tears, or metatarsalgia (Sharp et al., 2015). In more complex cases, MRI may be used, though ultrasound remains the most accessible and cost-effective tool.

Management focuses initially on conservative care. Wider shoes with cushioned soles and avoiding high heels can significantly reduce nerve compression. Orthotic devices, particularly those with metatarsal pads, help offload pressure from the affected webspace. Manual therapy and activity modification can also provide relief.

At The Injury Hub, we offer advanced options for persistent cases. Ultrasound-guided corticosteroid injections can reduce inflammation around the nerve and provide short-to-medium-term relief. For patients with chronic or recurrent symptoms, alcohol sclerosing injections, platelet-rich plasma (PRP), or shockwave therapy may be considered. Shockwave has shown promise in reducing pain and improving function by modulating nerve sensitivity and improving local tissue health (Nazarian et al., 2020). Surgery, usually in the form of neurectomy (nerve excision), is reserved for severe cases that fail to respond to less invasive approaches.

Prognosis is generally positive, particularly when the condition is identified early and treated appropriately. Many patients achieve long-lasting relief with a combination of footwear modification, targeted orthoses, and ultrasound-guided injections. However, untreated neuromas can become increasingly painful and disabling, limiting both sport and daily activity.

References

Mahadevan, D., Attwal, M., Khan, W.S. & Morgan-Jones, R. (2015) ‘The etiology and management of Morton’s neuroma: a review’, Cureus, 7(8), e324.
Sharp, R.J., Wade, C.M. & Hennessy, M.S. (2015) ‘The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms’, Journal of Bone and Joint Surgery (Br), 95-B(7), pp. 996–1000.
Nazarian, L.N., Jacobson, J.A., Lev-Toaff, A.S. & Taljanovic, M.S. (2020) ‘Morton’s neuroma: pathophysiology, imaging, and treatment’, Radiographics, 40(2), pp. 414–432.

A heel spur is a bony outgrowth on the underside of the heel bone (calcaneus), often developing at the attachment of the plantar fascia. These spurs typically form due to repetitive stress, traction, or microtrauma at the soft-tissue insertion points and are frequently found in people with plantar fasciitis but they can also be present independently or with conditions such as fat-pad syndrome and Achilles tendinopathy (Koc Jr. et al., 2023).

Heel spurs are most commonly seen in individuals over 40, but they also affect younger athletes in high-impact sports such as running or ballet. Contributing factors include obesity, foot structure (flat or high arches), inadequate footwear, and prolonged standing. Many people with heel spurs experience no symptoms and only discover them on imaging. When painful, patients typically report sharp heel pain with the first steps in the morning or after rest pain that eases with activity but returns after prolonged standing. X-rays remain the standard for detecting spurs, but ultrasound adds value by assessing the condition of surrounding soft tissues (Tu, 2018).

Treatment focuses on relieving pain and only spurs that are symptomatic require intervention. Conservative care includes supportive footwear, orthotic insoles, plantar fascia stretching, weight management, and activity modification. At The Injury Hub, we also offer advanced therapies. Shockwave therapy (ESWT) provides significant relief in patients with concurrent plantar fasciitis (Tas & Kaya, 2023). For persistent cases, ultrasound-guided injections such as PRP have shown better outcomes than corticosteroids over six months, with improvements in pain, function, and tissue thickness (Sharma et al., 2023; Thu et al., 2022). While surgeries to remove spurs are rare, they may be considered only when conservative and minimally invasive options fail. With prompt and tailored care, the majority of patients achieve excellent outcomes, maintaining mobility and an active lifestyle.

References

• Koc Jr., T.A., et al., 2023. Heel Pain – Plantar Fasciitis: Revision 2023. Journal of Orthopaedic & Sports Physical Therapy.
• Tas, N.P. & Kaya, O., 2023. Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy? Journal of Clinical Medicine, 12(20), p.6503.
• Sharma, R., et al., 2023. Effect of platelet-rich plasma versus steroid injection in plantar fasciitis. BMC Musculoskeletal Disorders, 24(1), p.XX.
• Thu, A.C., 2022. The use of platelet-rich plasma in management of plantar fasciitis. Podiatry Journal.
• Tu, P., 2018. Heel Pain: Diagnosis and Management. American Family Physician, 97(2), pp.86–93.

Metatarsal fractures are among the most frequent foot injuries, accounting for a large proportion of all foot fractures. The metatarsals are the long bones connecting the midfoot to the toes, and because they bear significant loads during standing, walking, and running, injury here can cause notable pain, swelling, and functional limitation (Mallee et al., 2023).

These fractures are typically classified as either acute traumatic or stress-related. Traumatic fractures usually result from a direct blow, a twisting injury, or dropping a heavy object on the foot. Stress fractures, in contrast, occur gradually due to repetitive microtrauma exceeding the bone’s capacity to remodel and repair. They are particularly common in athletes, military recruits, and individuals who suddenly increase training volume. The second and third metatarsals are the most frequent sites of stress fractures because of their central load-bearing role, whereas traumatic fractures more often affect the fifth metatarsal, particularly at the base (commonly termed a “Jones fracture”), which carries a higher risk of delayed or non-union due to limited vascularity (Kijowski et al., 2020).

Symptoms usually include localised pain, swelling, and tenderness over the affected metatarsal. In acute traumatic cases, patients often recall a specific injury and may be unable to bear weight immediately. Stress fractures tend to present more insidiously, with pain worsening during activity and easing with rest. Bruising is more common with acute fractures than stress-related injuries. In displaced fractures, patients may notice forefoot widening or visible deformity.

Diagnosis requires both careful clinical assessment and imaging. X-rays typically identify acute fractures, but early stress fractures can be radiographically occult. MRI remains the gold standard for detecting stress reactions and early fractures, allowing assessment of bone marrow oedema and fracture lines (Nattiv et al., 2021). Ultrasound can be useful in some cases, demonstrating cortical irregularity, periosteal reaction, or associated soft tissue involvement, particularly in clinics where rapid imaging access is beneficial.

Management depends on the fracture type and severity. Most undisplaced fractures can be managed conservatively with activity modification, protective footwear, or immobilisation in a boot. Stress fractures require a period of relative rest and gradual reloading once pain-free, whereas high-risk fractures such as proximal fifth metatarsal (“Jones”) injuries may require surgical fixation, especially in athletes, to reduce the risk of non-union (Smith et al., 2022). At The Injury Hub, we combine rapid access to imaging with evidence-based treatment, including gait assessment, footwear advice, and bone health optimisation where risk factors such as vitamin D deficiency, low bone density, or relative energy deficiency in sport (RED-S) are suspected.

The prognosis for most metatarsal fractures is excellent with early recognition and appropriate treatment. However, delayed diagnosis or inadequate management increases the risk of complications such as malunion, non-union, and secondary arthritis. Prompt assessment, accurate classification, and a structured rehabilitation programme are therefore key to ensuring patients return safely to full activity.

References

• Kijowski, R., Tuite, M. & Sanford, M., 2020. Magnetic resonance imaging of stress fractures of the foot and ankle. Sports Health, 12(6), pp.552–561.

• Mallee, W.H., et al., 2023. Diagnosis and management of metatarsal fractures: An evidence-based update. Journal of Foot and Ankle Research, 16(1), p.42.

• Nattiv, A., Ackerman, K.E. & Misra, M., 2021. Bone stress injuries: updated management and return-to-play considerations. British Journal of Sports Medicine, 55(11), pp.603–613.

• Smith, J.T., Richardson, J. & Porter, D.A., 2022. Fifth metatarsal fractures: Evaluation and treatment. Foot and Ankle Clinics, 27(2), pp.287–307.