The foot, ankle and lower limb are complex anatomical structures. A review of the bones of the foot alone (excluding all other structures such as blood vessels, nerves, tendons, ligaments etc) and how they function in movement (ie-pronation and supination) clearly demonstrates the level of complexity (videos eight and nine).

As such it is not uncommon for patient to present with multiple sites of pain or concern. This can be associated with patients with systemic disease such as diabetes and inflammatory arthritis (ie - rheumatoid arthritis) where their condition can affect multiple joints. Patients who have suffered a previous trauma (ie- motor vehicle accident or large fracture) may be placed in this category. Such people can benefit greatly from a detailed assessment and management. Often multiple practitioners are required to achieve the best outcomes. In terms of treatment is often best to differentiate the most painful site from the least and to treat accordingly.