Foot – understand complaints and treat them specifically

Anatomy and function of the foot

The foot is divided into the forefoot (toes and metatarsal bones), metatarsal and hindfoot (heel bone and ankle bone). Several transverse and longitudinal arches act like shock absorbers. Muscles and tendons – such as the Achilles tendon and the plantar fascia – stabilize and transmit force. Finely tuned joints, ligaments and nerves enable cushioning, push-off and balance on a wide variety of surfaces.

• Forefoot: Toes (phalanges) and metatarsals - important for push-off and stability
• Metatarsal: Sphenoid bones, scaphoid bone, cuboid bone – central role for the arch of the foot
• Rearfoot: Heel bone (calcaneus) and ankle bone (talus) – power transmission from the lower leg
• Tendons/Ligaments: Achilles tendon, peroneal tendons, tibialis posterior tendon, plantar fascia
• Nerves/vessels: sensitive supply to the skin and blood circulation to the toes

Typical symptoms and warning signs

The type of pain provides the first clues to the cause. The decisive factors are the course, stress dependence and accompanying symptoms.

• Start-up pain under the heel: often plantar fasciitis; Improvement typical after short exercise
• Pulling/stinging pain on the Achilles tendon: irritation (tendinopathy) or, rarely, tear
• Pressure pain on the ball of the foot/toes: forefoot overload, hallux valgus, hammer toes, Morton's neuralgia
• Swelling, redness, overheating: inflammation, gout attack or infection – needs to be clarified
• Numbness, tingling, burning: nerve congestion (e.g. tarsal tunnel syndrome) or neuropathy
• Stress-related metatarsal pain: possible stress fracture
• Pain at rest/night: inflammatory processes or advanced osteoarthritis

Immediate medical clarification is important in the case of: acute misalignment after an accident, suspected fracture/tear, pronounced redness/overheating with fever, wounds that heal poorly (especially in the case of diabetes) or sudden blue discoloration/cold foot.

Areas of the foot – orientation and undersides

Depending on the region, we differentiate between typical symptoms. On the following subpages you will find detailed information about causes, diagnostics and therapy:

• Toes & Forefoot: Hallux valgus, hammer/claw toes, Morton's neuralgia, metatarsalgia
• Foot deformities: arched arches, splayed feet, flat feet (flexible/rigid), hollow feet
• Hindfoot-related diseases: Achilles tendon, Haglund heel, posterior heel pain
• Sole of foot (Plantar): Plantar fasciitis, heel spurs, fascia irritation
• Bones & joints: Osteoarthritis (e.g. metatarsophalangeal joint), stress fractures
• Blood circulation/metabolism: diabetic foot, gout, rheumatic diseases
• Foot injuries: bruises, ligament injuries, fractures
• Rare foot diseases: e.g. B. Osteonecrosis in childhood, tarsal coalitions

The ankle joint also has a significant influence on foot function. If the problem is combined, it is worth taking a look at the ankle joint page.

Diagnostics in our practice

We combine clinical experience with targeted diagnostics that contain as little radiation as possible. Many findings emerge from conversation and examination.

The goal is a clear working hypothesis: Which structure causes the complaints? From this we derive an individual, step-by-step treatment concept.

Conservative therapy – our standard approach

In the majority of cases, significant improvement can be achieved through non-surgical measures. We plan conservative therapies in a way that is close to everyday life and comprehensible.

• Advice & activity control: short-term relief from pain-causing activities, alternatives that are gentle on the joints
• Physiotherapy: mobilization, strengthening of the foot and lower leg muscles, neuromuscular training
• Stretching program: v. a. Calf muscles/plantar fascia to reduce pressure on the heel and forefoot
• Insole supply: cushioning, supporting or sensorimotor insoles – adapted to the condition and shoe
• Shoe advice: sufficient space in the forefoot, suitable cushioning/rolling, rocker soles if necessary
• Taping/Orthoses: temporary guidance and relief (e.g. hallux or toe orthoses, night splints)
• Pain therapy: locally effective gels, anti-inflammatory drugs in low doses and for a limited duration
• Shock wave therapy (ESWT): selective for plantar fasciitis or Achilles tendon irritation
• Ultrasound-assisted infiltrations: targeted and restrained; Peritendinous/paraarticular – no intratendinous injections
• Everyday coaching & stress building: gradual return to sport/work with monitoring

Important: The healing process on the foot takes time. We often plan 6-12 weeks of consistent conservative therapy before the next stage is examined - always based on the course and goals.

Regenerative procedures – carefully indexed

Regenerative approaches complement conservative therapy in selected cases. The evidence varies depending on the procedure and findings. We discuss the benefits, limitations, risks and costs individually.

• Platelet-rich plasma (PRP): discussed for chronic plantar fasciitis or Achilles tendon irritation; possible with appropriate indication and after informed consent
• Prolotherapy/needling: sometimes used for tendinopathies; Data situation heterogeneous
• Hyaluronic acid injections: considered for painful osteoarthritis of small ankle joints – evidence limited

Note: Regenerative procedures do not replace basic therapy (load control, training, insoles). In individual cases they can offer a chance of alleviating the symptoms, without any guarantee of success.

Surgical options – if necessary

Surgery is considered when conservative measures have been exhausted or there is clear structural damage/instabilities. We provide open-ended advice and take patient goals into account.

• Correction of deformities (e.g. hallux valgus, hollow foot/flat foot) in cases of significant deformity and restriction
• Tendon/ligament operations for tears or chronic instability
• Arthroscopic/open procedures for osteoarthritis or loose joint bodies
• Fracture treatment for unstable fractures

We work with experienced foot surgery partners in Hamburg. If requested, we can organize a second opinion. We plan the postoperative rehabilitation together.

Prevention, everyday life and training

• Footwear: sufficient toe room, stable heel cap, profile/cushioning suitable for the activity
• Increase stress: slowly increase the amount of exercise you do and break in new shoes carefully
• Regular stretching: calves/plantar fascia, especially during sedentary activities or running training
• Strength & Balance: Arch training, one-legged stance, activating short foot muscles
• Insole care: Check the fit, timely replacement if worn
• Foot care: treat skin/nails gently; in case of diabetes, daily inspection
• Weight management: reduces pressure and shear forces in the foot
• Workplace: standing work with cushioning mats, micro-breaks for mobilization

Foot and general health

Metabolic and systemic diseases influence foot health. That's why we specifically ask about previous illnesses and medications.

• Diabetes mellitus: neuropathy, wound healing disorders – early prevention and wound control are essential
• Gout: sudden, extremely painful attack (often in the metatarsophalangeal joint of the big toe) – laboratory and adapted therapy
• Rheumatoid arthritis: persistent swelling/stiffness – interdisciplinary treatment
• Circulatory disorders: cold, paleness, wound healing problems - vascular evaluation

When should you come to us in Hamburg?

Seek orthopedic clarification if symptoms persist for more than 2-3 weeks, recur or limit your ability to do everyday life or exercise. After acute injuries (ankle, fall), a prompt examination makes sense - especially if there is swelling, bruising or inability to bear weight.

• Persistent heel pain despite protection and stretching
• Increasing misalignment of the toes with pressure points/shoe problems
• Painful swelling along the Achilles tendon
• New numbness/burning in the foot
• Wounds that do not heal (especially with diabetes)
• Suspected stress fracture (stress-dependent, localized bone pain)

Our practice is located at Dorotheenstraße 48, 22301 Hamburg. You can easily book appointments online or request them by email.

This is how your appointment works

Please bring any existing findings/images and suitable footwear with you. Comfortable clothing makes examination and functional analysis easier.