Liz Bayley Physiotherapy

08/09/2025

I teamed up with Liz Bayley Physiotherapy to create this progressive rehab programme for Plantar Heel Pain.

We've called it 'LiTHE' (Liz and Tom's Heel Exercises) and it's aimed at active and sporty patients. It's not a recipe though so it's best to adapt it to suit individual needs.

12/07/2025

12/06/2025

Case Study Time 🔍🦶🏼

▶️ This patient came to me about 4 weeks following a grade 2 inversion sprain
▶️ Pain across the front of the ankle
▶️ Tingling and numbness in the 1st webspace with some shooting pain and hypersensitivity - was sleeping with their foot out of the covers in bed

⚠️ If this was a true inversion injury, with no plantarflexion, it was unlikely to injury the anterior structures, so what’s going on??

QUESTIONS:
🔹 What else do you want to know?
🔹 What would be your differentials based on this pain map?
🔹 How could you explain this diagnosis (once you know it) 😉

HINT:
The patient injured his ankle while he was in China and sought help from a local practitioner in the 2nd week of the injury…

01/05/2025

🆕 Assessment Tool for Energy Availability & REDs 🛑

My friend and colleague has developed this new questionnaire (PEAQ) which is designed to assess energy availability status in athlete and dancers ⛹🏾‍♀️🤸🏿‍♀️🏄🏻‍♂️🩰💃🏼
It can be used as part of screening by HCPs who work with these ‘at risk’ groups… 📊

What is Energy Availability? 🤔
Matching your energy intake to your energy demands helps you reach your personal peak health and exercise performance. Failing to meet your energy demands results in low energy availability. This increases your risk of developing relative energy deficiency (REDs) and its adverse health and performance consequences.

PEAQ - Personal Energy Availability Questionnaire 📝
People of any age, whatever their level and type of exercise, can be at risk of developing REDs; from elite dancers and athletes to recreational exercisers. The PEAQ will guide you through a series of questions about exercise, physical characteristics, nutrition, hormone function and well-being. It just takes a few minutes.

Benefits of the PEAQ ✅
Your personal report instantly generates a REDs Risk Score and provides valuable insights into your energy status and potential risks, along with guidance. The PEAQ is intended for those 16 years of age and over.
The PEAQ has been used in several published research studies; however, it is not a substitute for seeking medical advice.

Great research-informed application to clinical practice 📊📉👏🏼

.physio .rogalski .daisyjacinta .sportspodiatrist .dpt

01/05/2025

14/04/2025

Time to Rethink Foot Strengthening 🦶🏼

A recent scoping review by Osbourne et al (2025) has shed light on the often-overlooked area of foot and ankle muscle strengthening. The review highlights a significant gap in current training practices: many foot strengthening programs are underloaded and under-dosed, lacking the intensity and progression seen in training larger muscle groups like the quadriceps or glutes 💪🏼

🔑 Key Findings:
* Many existing foot and ankle strengthening protocols do not apply sufficient external load or follow progressive overload principles.
* There’s a need for more rigorous training parameters to truly enhance foot muscle strength and function

📃 Case in Point: A study by Taddei et al. (2020) which is included in the 2025 review implemented an 8-week foot strengthening program for recreational runners, focusing on intrinsic foot muscles. While the study reported increases in muscle volume and improvements in running mechanics, the training lacked the intensity typically associated with strength gains in larger muscle groups and was over complicated/time consuming- see images in the post above... These exercises were for healthy, long distance runners - they could have been loaded up far better than this 🏋🏼‍♀️

There’s also an over-focus on the INTRINSICS - most of these exercises affect extrinsics as well. So let’s just call it ‘foot strength’ as these muscles work together for optimal function🦶🏼💪🏼

The Takeaway: It’s time to treat foot training with the same seriousness as we do for other major muscle groups. Incorporating external loads and adhering to true strength training parameters could unlock the full potential of foot strengthening, leading to better outcomes in both injury prevention and performance enhancement.

I teach a whole section on this for my Foot and Ankle Rehab Course, which will be coming to London in October 2025 📆

12/04/2025

I’ve got merch… 😂🩰📃🏋🏼‍♀️🦶🏼

Jumping on the band wagon with this one…
Only took about 25 attempts to get right - thanks for the inspiration ✅🙌🏼🙏🏻😂

23/03/2025

Medial Ankle Anatomy & Pathologies 🦶🏼

These are some of the most important things to be aware of, but this isn’t exhaustive 📝

🔹 Medial ankle impingement
🔹 Posteromedial ankle impingement
(There’s no better name for the impingements currently! We could call them ‘tibiotalar or tibiocalcaneal compression’ but it’s a bit of a mouthful) 😂
🔹 Talonavicular joint synovitis
🔹 Deltoid ligament sprain (just 5% of all ankle sprains)!
🔹 Navicular stress fracture (N- spot)
🔹 Tibialis posterior tendinopathy/tenosynovitis
🔹 Subtalar joint synovitis
🔹 Spring ligament rupture
🔹 Os naviculare (at least 20% of population has this)
🔹 FHL tendinopathy/tenosynovitis (often diagnosed as plantar fasciitis - you can see why)

Missing tarsal tunnel (that would sit right in between tib post and FHL, then radiate down the foot into the sole… ⚡️

What else would you add? 🤔
Not including plantar fascia or Baxter’s nerve (as that’s more heel/foot) 🦶🏼

07/03/2025

Gruberi Bursitis: A lesser-recognised cause for dorsolateral foot pain 🦶🏼

Gruberi bursitis, an inflammation of the sinus tarsi bursa on the foot, is an often overlooked cause of dorsal foot pain.
The pain (and bursa) can be localized between the EDL tendons and talus, just below the ATFL. It may communicate with the talonavicular joint, tibiotalar joint and tendon sheaths. The bursa could be flared up by high-sitting footwear or repetitive activities. It could also be aggravated by ankle sprains or mild twisting type mechanisms (It’s Never Just A Sprain)!! 😉

Differential Diagnoses:
* Extensor Digitorum Longus (EDL) Tenosynovitis:
Inflammation of the tendons that extend the toes can mimic the symptoms of Gruberi bursitis.
* Anterior Ankle Impingement: Joint-related pain at the front of the ankle at the lateral gutter.
* Fractures: Particularly stress fractures of the tarsal bones could be mistaken for this bursitis.
* Gout or Inflammatory Arthritis: These can cause swelling and pain around the joint areas, and could be confused with bursitis.
* Osteochrondral Lesion: These have been estimated to feature in up to 80% of chronic ankle pain presentations!

Assessment & Management:

🚶🏾‍♂️ Foot Movement & Dynamic Posture: A dynamic foot posture assessment during gait can be useful to identify potentially problematic motion or alignment contributing to the inflammation.
🥾 Footwear Modifications: High-top trainers or tight laces across the dorsum of the foot can increase friction, causing irritation to the bursa and local tissues. Consider switching to different footwear or loosening proximal laces to reduce pressure.
🥶 Rest & Ice: Reducing load on the affected area and applying ice can help in managing acute inflammatory pain.
🏋🏼‍♀️ Physio Input: Looking at impairments in strength, range of motion, and control and treating these as indicated.
💉 Corticosteroid Injections: In more severe cases, corticosteroid injections may help reduce inflammation and pain. Local anaesthetic included in the injection can also be used diagnostically at the time…

07/03/2025

Gruberi Bursitis: A lesser-recognised cause for dorsolateral foot pain 🦶

Gruberi bursitis, an inflammation of the sinus tarsi bursa on the foot, is an often overlooked cause of dorsal foot pain. The pain (and bursa) can be localized between the EDL tendons and talus, just below the ATFL. It may communicate with the talonavicular joint, tibiotalar joint and tendon sheaths. The bursa could be flared up by high-sitting footwear or repetitive activities. It could also be aggravated by ankle sprains or mild twisting type mechanisms (It’s Never Just A Sprain)!! 😉

Differential Diagnoses:
* Extensor Digitorum Longus (EDL) Tenosynovitis: Inflammation of the tendons that extend the toes can mimic the symptoms of Gruberi bursitis.
* Anterior Ankle Impingement: Joint-related pain at the front of the ankle at the lateral gutter.
* Fractures: Particularly stress fractures of the tarsal bones could be mistaken for this bursitis.
* Gout or Inflammatory Arthritis: These can cause swelling and pain around the joint areas, and could be confused with bursitis.
* Osteochrondral Lesion: These have been estimated to feature in up to 80% of chronic ankle pain presentations!

Assessment & Management:
* Foot Movement & Dynamic Posture: A dynamic foot posture assessment during gait can be useful to identify potentially problematic motion or alignment contributing to the inflammation.
* Footwear Modifications: High-top trainers or tight laces across the dorsum of the foot can increase friction, causing irritation to the bursa and local tissues. Consider switching to different footwear or loosening proximal laces to reduce pressure.
* Rest & Ice: Reducing load on the affected area and applying ice can help in managing acute inflammatory pain.
* Physio Input: Looking at impairments in strength, range of motion, and control and treating these as indicated.
* Corticosteroid Injections: In more severe cases, corticosteroid injections may help reduce inflammation and pain. Local anaesthetic included in the injection can also be used diagnostically at the time 💉

30/12/2024

Foot and Ankle: Anterior Structures - Tendons, Blood Vessels, and Nerves 🦶🏼

➡️ Tender Husbands Are Very Nice Dear Persons (see image)!

1. Extensor Tendons 🦶🏼💪🏼
The primary tendons in the anterior compartment are responsible for dorsiflexion of the foot and extension of the toes. These tendons pass over the ankle joint, and their functions are as follows:

* Tibialis anterior tendon: The most prominent tendon, located medially, it dorsiflexes and inverts the foot.

* Extensor hallucis longus tendon: Located between tibialis anterior and extensor digitorum longus, it extends the big toe and assists in dorsiflexion.

* Extensor digitorum longus tendon: Situated laterally to the tibialis anterior, it extends the second to fifth toes and also aids in dorsiflexion.

* Peroneus tertius tendon: Often considered part of the extensor digitorum longus, it dorsiflexes and everts the foot. Not everyone has one of these!

These tendons are protected by a fibrous sheath called the extensor retinaculum at the ankle.

2. Anterior Tibial Artery 🩸
The anterior tibial artery is a branch of the popliteal artery. At the level of the ankle, the artery becomes the dorsalis pedis artery, which is palpated at the dorsal aspect of the foot to assess circulation.

3. Deep Peroneal Nerve ⚡️
The deep peroneal nerve (also called the deep fibular nerve) is a branch of the common peroneal nerve. It innervates the muscles of the anterior compartment, including the tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius. This nerve also provides sensory innervation to the first dorsal web space (between the first and second toes). The deep peroneal nerve travels along the interosseous membrane and passes under the extensor retinaculum of the ankle.

💡 The POSTERIOR structures have a different mnemonic:

➡️ Tom Dick and A Very Naughty Harry

18/12/2024