Overview
When sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass. Causes Over-pronation has different causes. Obesity, pregnancy, age or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Over-pronation is also very common with athletes, especially runners and most of them nowadays use orthotics inside their shoes. Over-pronation affects millions of people and contributes to a range of common complaints including sore, aching feet, ball of foot pain, heel Pain, achilles tendonitis, bunions, shin pain, tired, aching legs, knee pain and lower back pain. The most effective treatment solution for over-pronation is wearing an orthotic shoe insert. Orthotics correct over-pronation, thereby providing natural, lasting pain relief from many common biomechanical complaints. Symptoms If ignored, overpronation can lead to complications such as hammer toes, corns and calluses, shin splints, hallux rigidus and many more foot and lower leg problems. Hammer toes appear when the toes are placed under too much pressure and the ligaments and muscles in the toes begin to reduce in size, leading to the curvature of the toes and making them look like little hammers. Overpronators can develop hammertoes if they don?t wear an appropriate pair of shoes. Corns and calluses also appear as a result of overpronation. They form in response to excess pressure, and overpronators may find that they have excessive hard skin on the balls of the feet and inside edge of the big toe. It is the body?s way of protecting against excessive forces and friction. They can be painful. Diagnosis Your healthcare provider will ask about your symptoms, medical history, and activities and examine your feet. Your provider may watch you walk or run. Check the motion of your feet when they strike the ground. Look at your athletic shoes to see if they show an abnormal pattern of wear. Non Surgical Treatment Anti-Pronation Insoles provide a unique foot support system that aligns the lower body. The major cause of foot and leg pain is over pronation (rolling over of the feet) which causes excessive pressure on the muscles, ligaments and bones of the lower body. Running insoles treat the underlying cause of over pronation and prevent future occurrences of the associated foot or leg condition. A project conducted at the NIKE Sport Research Laboratory studied the effects of orthotics on rear foot movement in running. Nine well-trained runners who wore orthotics were chosen as subjects. The results of the study indicated that orthotics reduced rear foot movement by roughly one degree or approximately nine percent of the amount found in runners not using orthotics. The average reduction of the maximum velocity of pronation was fifteen percent. Thus this study indicates that orthotics and insoles control over pronation which will treat and prevent many sporting injuries. Surgical Treatment Subtalar Arthroereisis. The ankle and hindfoot bones/midfoot bones around the joint are fused, locking the bones in place and preventing all joint motion. This may also be done in combination with fusion at other joints. This is a very aggressive option usually reserved for extreme cases where no joint flexibility is present and/or the patient has severe arthritic changes in the joint. Overview
Severs disease is pain in one or both heels when walking. The pain comes from the area between the sections of bone that make up the heel. As you go through a ?growth spurt? the tendon at the back of the heel (Achilles tendon) pulls at the heel bone. This makes you limp or walk on your toes and often creates a lump on your heel. The reason the tendon is tight is because your bones grow faster than your muscles. It usually affects boys between eight to ten years old, girls between ten and 12 years old, children in a ?growth spurt?, children involved in sports, usually those that involve running and jumping. Causes The more active a child is then the greater the chance of suffering from Sever?s disease. Poor foot function such as flat feet causes the calf and Achilles to work harder and pull on the growth plate leading to Sever?s disease. Tight calves or Achilles is common in growing children and can increase tension on the growth plate. Symptoms Sever's disease causes pain and tenderness in the back and bottom of the heel when walking or standing, and the heel is painful when touched. It can occur in one or both feet. Diagnosis Sever?s disease can be diagnosed based on your history and symptoms. Clinically, your physiotherapist will perform a "squeeze test" and some other tests to confirm the diagnosis. Some children suffer Sever?s disease even though they do less exercise than other. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor. The main factors thought to predispose a child to Sever?s disease include decrease ankle dorsiflexion, abnormal hind foot motion eg overpronation or supination, tight calf muscles, excessive weight-bearing activities eg running. Non Surgical Treatment The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon. Overview
Arch pain is often felt as a burning sensation under the long arch of the foot. There are a number of causes of this, but the most common is plantar fasciitis, but can also be due to the strain of any structure in the arch of the foot. Causes There are a variety of causes of flat feet. Flat feet can be genetic, acquired and develop over time. Young children and teens can have no arches. Injury can lead to flat feet. Tendon problems, and arthritis can lead to flat feet. Rigid flat feet may occur from a condition called tarsal coalition, where the bones in the back of the foot are genetically fused or locked together. Symptoms The muscle imbalance around the foot and ankle gives rise to a typical pattern of deformity in addition to the high arch (known as cavus). The bone under the big toe (called the first metatarsal) can become very prominent and the toes can curl or clench like a fist (called claw toes). Excessive amount of weight may be placed on the ball and heel of the foot, which can lead to the ankle weakening and giving way (this is referred to as ankle instability) and soreness. Calluses and sometimes stress fractures may occur where the foot is exposed to extra friction or pressure, such as on the outer (or lateral) border of the foot. Diagnosis The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries. Taking your workout shoes to the exam may also provide valuable information to the medical practitioner. Both feet will be physically and visually examined by the medical practitioner. The foot and arch will be touched and manipulated possibly with a lot of pressure and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch. Non Surgical Treatment Rest is the most important thing you can do. Stay off your feet, or use a cane. Gently apply ice to the arch for at least 30 minutes, and repeat every 3 or 4 hours. Apply mild compression to the foot. Use a Fabriform PSC Foot and Ankle Strap to help support the arch, reduce swelling, and relieve pain and fatigue. This strap is easy to apply and adjust for a custom fit. Low profile allows it to fit in any shoe. Allows you to apply just the right amount of arch support/compression for your foot. Before stepping down after sleeping or resting, stretch the arch of your foot by pulling up on the ball of the foot and toes, as far as you comfortably can; hold the foot in this position for ten seconds. Repeat at least ten times. Consideration should also be given to the use of night splints. These are very effective for stretching the plantar fascia to relieve first weight bearing pain. Surgical Treatment As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include Pain. Inability to function. Failure to improve after a six-month course of specific, directed physical therapy. Failure to improve after using arch supports, orthotics, or ankle and foot bracing. Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. In the past, surgeons would realign and fuse the three hind joints, which would cause patients to lose motion, leaving them with a significantly stiff hind foot, With these newer procedures, if the foot is still flexible, surgeons can realign it and usually restore a close-to-normal or functional range of motion in the joints. Stretching Exercises Calf Raises. Strengthens the tendons in your heels and calf muscles, which support your arch. Raise up on the balls of your feet as high as possible. Slowly lower down. Do three sets of 10 reps. Progress to doing the raises on stairs (with heels hanging off), and then to single-leg raises. Step Stretch. Improves flexibility in your Achilles tendon and calf-when these areas become tight, the arch gets painfully overloaded. Stand at the edge of a step, toes on step, heels hanging off. Lower your heels down, past the step, then raise back up to the start position. Do three sets of 10 reps. Doming. Works the arch muscles and the tibialis posterior (in the calf and foot) to control excess pronation. While standing, press your toes downward into the ground while keeping the heel planted, so that your foot forms an arch (or dome). Release, and do three sets of 10 reps on each foot. Toe Spread and Squeeze. Targets the interossei muscles of the foot, which support the arch. While sitting, loop a small resistance band around your toes. Spread toes; release. Then place a toe separator (used at nail salons) in between toes. Squeeze toes in; release. Do three sets of 10 reps of each exercise on both feet. Towel Curls. Works the toe-flexor muscles that run along your arch to increase overall foot strength. Lay a small hand towel on the floor, and place one foot on the towel. Using just your toes, scrunch the towel toward you, hold, then slowly push the towel away from you back to start position. Do three sets of 10 reps on each foot. Overview
Achilles tendinitis. Achilles tendonitis is inflammation of the Achilles tendon, the largest tendon in the body, which runs from the calf to the heel bone. Noninsertional Achilles tendonitis affects fibers in the middle of the tendon. Insertional Achilles tendonitis affects the lower portion of the tendon where it attaches to the heel bone. Both types can result from repetitive stress to the tendon or from overstressing the tendon during exercise. Damaged tendon fibers can calcify and bone spurs can form where the tendon attaches to the bone. Symptoms may include pain and stiffness of the tendon - which may occur from either inactivity (such as first thing in the morning) or after activity - thickening or swelling of the tendon or bone spurs. Causes Some of the causes of Achilles tendonitis include, overuse injury - this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis - Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected. Foot problems - some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear - wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity - being overweight places more strain on many parts of the body, including the Achilles tendon. Quinolone antibiotics - can in some instances be associated with inflammatory tenosynovitis and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug. Symptoms Patients with this condition typically experience pain in the region of the heel and back of the ankle. In less severe cases, patients may only experience an ache or stiffness in the Achilles region that increases with rest (typically at night or first thing in the morning) following activities which place stress on the Achilles tendon. These activities typically include walking or running excessively (especially uphill or on uneven surfaces), jumping, hopping, performing heel raises or performing calf stretches. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. Pain may also increase when performing a calf stretch or heel raise (i.e. rising up onto tip toes). In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with Achilles tendonitis may also experience swelling, tenderness on firmly touching the Achilles tendon, weakness and sometimes palpable thickening of the affected Achilles tendon when compared with the unaffected side. Diagnosis Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon. MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms. Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. Once the specific diagnosis is confirmed, the appropriate treatment of tendonitis can be initiated. Nonsurgical Treatment Use the R.I.C.E method of treatment when you first notice the pain. Although rest is a key part of treating tendonitis, prolonged inactivity can cause stiffness in your joints. Move the injured ankle through its full range of motion and perform gentle calf and ankle stretches to maintain flexibility. If self-care doesn't work, it's important to get the injury treated because if the tendon continues to sustain small tears through movement, it can rupture under excessive stress. Your doctor may suggest a temporary foot insert that elevates your heel and may relieve strain on the tendon. Other possible treatments include special heel pads or cups to wear in your shoes to cushion and support your heel, or a splint to wear at night. Physical therapy may also help allow the tendon to heal and repair itself over a period of weeks. Surgical Treatment When the tendon tears or ruptures the variety of surgical techniques are available to repair the damage and restore the tendons function. Recent research that is done at Emory University Department of orthopedics have perfected the repair of the Achilles tendon. The procedure is generally involves making an incision in the back of your leg and stitching the torn tendon together using a technique developed and tested by Dr. Labib. Depending on the condition of the torn tissue the repair may be reinforced with other tendons. Prevention Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis. Overview
Fallen arches is a common term used to describe a flatfoot condition that develops during adulthood. This should not be confused with other causes of flatfoot that may develop during childhood or adolescence. Most cases of ?fallen arches? develop when the main arch-supporting tendon (the posterior tibial tendon) becomes weakened or injured, causing the arch to gradually become lower. With time, the shape of the foot changes and secondary symptoms start to appear. Common problems associated with fallen arches include plantar fasciitis, tendonitis, increased fatigue, and arthritis of the foot and ankle. Causes Flat feet are often a congenital problem which has no specific cause. They can however occur after an injury, especially conditions such as Tibialis Posterior Syndrome or more traumatic injuries such as fractures or mid-tarsal joint sprains. The other thing to look out for is Overpronation. Often this is confused with having flat feet (or a fallen arch) although it is not technically the same thing. If an individual does not have flat feet but does overpronate then the arch of their foot appears to be normal when standing. However, when they walk the arch collapses and the foot rolls in excessively. This is more difficult to spot than flat feet. It is estimated that between 60 and 80% of the population overpronate! Symptoms The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem. Congenital vertical talus. The foot of a newborn with congenital vertical talus typically has a convex rocker-bottom shape. This is sometimes combined with an actual fold in the middle of the foot. The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be. If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body. Tarsal coalition. Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains. Lateral subtalar dislocation. Because this often is caused by a traumatic, high-impact injury, the foot may be significantly swollen and deformed. There also may be an open wound with bruising and bleeding. Diagnosis If your child has flatfeet, his or her doctor will ask about any family history of flatfeet or inherited foot problems. In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics. The doctor will examine your feet for foot flexibility and range of motion and feel for any tenderness or bony abnormalities. Depending on the results of this physical examination, foot X-rays may be recommended. X-rays are always performed in a young child with rigid flatfeet and in an adult with acquired flatfeet due to trauma. Non Surgical Treatment Most patients can be treated without surgery using orthotics, supportive shoes and braces. Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. Surgical Treatment Rarely does the physician use surgery to correct a foot that is congenitally flat, which typically does not cause pain. If the patient has a fallen arch that is painful, though, the foot and ankle physicians at Midwest Orthopaedics at Rush may perform surgery to reconstruct the tendon and "lift up" the fallen arch. This requires a combination of tendon re-routing procedures, ligament repairs, and bone cutting or fusion procedures. Prevention Well-fitted shoes with good arch support may help prevent flat feet. Maintaining a healthy weight may also lower wear and tear on the arches. After Care Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon. Overview
Adult acquired flatfoot deformity (AAFD) is a painful situation resulting from your collapse with the longitudinal (lengthwise) arch of the foot. Because the name suggests, this condition isn't present at birth or during childhood. The idea occurs following the skeleton is actually fully matured. Inside days gone by it absolutely was referred to a posterior tibial tendon dysfunction (or insufficiency). However the actual identify had been changed since the situation actually describes any wide range of flatfoot deformities. AAFD will be the majority of often noticed in ladies between your ages of 40 and 60. This kind of guide will enable anyone to know how the issue develops, how doctors diagnose your condition, what remedy options are usually available. Causes The most typical cause involving acquired adult flatfoot can be posterior tibial tendon dysfunction. Precisely what brings about adult acquired flat foot? Fracture as well as dislocation. Tendon laceration. Tarsal Coalition. Arthritis. Neuroarthropathy. Neurological weakness. Symptoms Symptoms tend to be minor and could go unnoticed, Pain dominates, as opposed to deformity. Minor swelling may end up being visible across the course of your tendon. Pain as well as swelling along the length of your tendon. visible decline in arch height. Aduction in the forefoot upon rearfoot. Subluxed tali and also navicular joints. Deformation only in that point can be still flexible. Considerable deformity along with weakness. Significant pain. Arthritic changes within the tarsal joints. Deformation at this point is rigid. Diagnosis The diagnosis associated with tibialis posterior dysfunction can be essentially clinical. However, plain radiographs in the foot as well as ankle are generally useful for assessing your level of deformity also to confirm the presence or perhaps lack of degenerative changes within the subtalar along with ankle articulations. The Particular radiographs are also useful to exclude additional leads to associated with an acquired flatfoot deformity. the nearly all beneficial radiographs are bilateral anteroposterior and lateral radiographs with the foot and a mortise (true anteroposterior) look at your ankle. Almost All radiographs ought to become able to be carried out with the patient standing. Throughout most cases we get seen zero role pertaining to magnetic resonance imaging or perhaps ultrasonography, as the diagnosis can be made clinically. Non surgical Treatment Conservative treatment method additionally depends on the stage of the disease. Early on, the pain as well as swelling without any deformity may become treatable with rest, ice, compression, elevation as well as non-steroidal anti-inflammatory medication. Typically OTC orthotic inserts tend to be advised using stability oriented athletic shoes. In case this fails or even the situation is more advanced, immobilization in a rigid strolling boot is recommended. This rests the tendon and protects it from further irritation, attenuation, or even tearing. When symptoms tend to be greatly improved as well as eliminated then your individual might return to the supportive shoe. to protect the particular individual through reoccurrence, different forms of devices are recommended. Your most frequent device is actually orthotics. Generally custom-made orthotics are generally better than OTC. That They are reserved regarding early staged PTTD. Advanced stages might require a far more aggressive type orthotic or possibly an AFO (ankle-foot orthosis). Right now there are very different types of AFO's. one type features a double-upright/stirrup attached to a footplate. another is truly a gauntlet-type with a custom plastic interior surrounded be described as a lace-up leather exterior. both require the use of a cumbersome type athletic or perhaps orthopedic shoes. Individual compliance is always challenging with these larger braces and also shoes. Surgical Treatment In case conservative therapy fails surgical intervention will be offered. With Regard To a Stage 1 deformity any posterior tibial tendon tenosynovectomy (debridement with the tendon) as well as primary repair may become indicated. Pertaining To Stage two any mixture of Achilles lengthening with bone cuts, calcaneal osteotomies, and tendon transfers will be common. Stage 2 versatile PTTD may always be the most common stage patients present together with for treatment. Inside Stage three as well as 4 PTTD isolated fusions, locking a couple of or even much more joints together, maybe indicated. Most therapy would depend around the stage as well as severity with presentation using the goals along with activity quantity associated with a patient in mind. Remedy can be customized for the individual patient needs. Overview
The arch of the foot is formed by the tarsal and metatarsal bones and is strengthened by ligaments and tendons that enable the foot to correctly support the weight of the body. The underside of the foot is made up of four layers of muscle tissue as well as a length of thick connective tissue called the plantar fascia, which supports the arch. If the surrounding muscles weaken, the plantar fascia will drop and the arch will collapse. If the arch collapses, the whole foot touches the ground, which is known as pes planus or flat feet. Flat feet affect about 15 per cent of Britons. Although usually genetic, the condition may be exacerbated or triggered by poorly fitted shoes or conditions such as arthritis and pregnancy, when sudden changes in shape and weight can alter the body's centre of gravity leading to a weakening of the arches. Causes The plantar fascia is a thick, fibrous band which runs along the sole of the feet. It helps to support the foot arches and transmits forces through the foot as you move. Plantar fasciitis is one of the most common causes of foot arch pain. The most common problem to develop here is plantar fasciitis. If there is too much strain on the plantar fascia (e.g. from long periods on your feet, suddenly increasing activity levels or your foot position is altered), the plantar fascia becomes inflamed and swollen. It is often accompanied by a bone spur, excess growth of the bone which develops due to repeated tension on the area where the plantar fascia attaches to the bone. Plantar fasciitis is one of the most common causes of foot arch pain. It is usually painful after activity or prolonged rest e.g. first thing in the morning. A less common problem with the plantar fascia which casues foot arch pain is plantar fibromatosis. This is when a small nodular growth develops on the plantar fascia, usually in the middle of the foot arch. It often causes pain when walking due to pressure through the lump. Symptoms Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch. Diagnosis Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods. Non Surgical Treatment How the pain in the bottom of your foot is treated will depend heavily on the cause of the pain. Diagnosing the pain while it?s in the early stages is important when determining the best treatment options. If the pain is mild to moderate, simple improvements in footwear can help reduce the symptoms. Most patients must use the RICE method for effective treatment. RICE stands for Rest, Ice, Compression, and Elevation. This is a popular treatment used by athletes. It involves resting the foot, icing it for fifteen to twenty minute intervals, compressing the foot with a bandage, and elevating it at least twelve inches above the heart. Ant-inflammatory and pain medications are also sometimes used to treat bottom-of-foot pain. For more serious cases, steroid injections or foot surgery may help reduce pain and swelling and correct the underlying condition (if there is one.) If you suffer from a severe case of plantar fasciitis and non-surgical methods fail, your doctor may recommend cortisone injections to relieve the pain. If cortisone injections fail, your doctor may recommend a surgical procedure that involves cutting and releasing the plantar fascia. Surgical Treatment Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage. The most common complications of release surgery include incomplete relief of pain and nerve damage. Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. Prevention Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance. Stretching Exercises Try these simple stretches to assist with relieving pain in your arches. (Note: Stretch slowly and gently. You should feel a moderate pull on the muscle and tendon but no pain. If these stretches are painful, stop and seek further advice from a health professional). STRETCH ONE. Stand at arm?s length from a wall with one foot in front of the other, forward knee bent. Keeping your back leg straight and back heel on the floor, lean into the wall until you feel a stretch in your calf. STRETCH TWO. This time, bend your back leg slightly, and lean into the wall. You should feel a stretch in the lower part of your calf. Hold each stretch for 20 seconds and repeat on each leg, a few times daily. Overview
Plantar fasciitis refers to an inflammation of the plantar fascia, a thick, fibrous band running along the sole of the foot. Such inflammation results from direct injury to the plantar fascia, usually, repeated trauma to the tissue where the fascia attaches to the calcaneus or heel bone. The plantar fascia is critical in maintaining the foot?s complex arch system, also playing a role in balance and fine control of certain phases of the athlete?s gait. Injury to the plantar fascia is particularly painful and disabling for runners and can often prove stubbornly resistant to treatment. Rehabilitation is frequently a lengthy and frustrating process. For these reasons, care should be taken where possible to avoid such injury by means of preventative exercises and sensitivity to early warning signs. Causes A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint. Symptoms The primary symptom is pain or aching in the arch area. This can be accompanied by inflammation and tenderness. If the pain is caused by the plantar fascia, it is likely to be considerably more severe in the mornings due to the muscles being unused. If you notice that the twinges of pain you have are most commonly associated with or immediately after exercise, you might want to visit a good athletic shoe store to make sure you are wearing the right kind of shoe. Another cause of arch pain is plantar fasciitis. The plantar fascia is a tough tissue structure that holds the bottom part of the arch in place. The fascia often becomes inflamed and sore, usually as a result of repetitive motion (for example, very common in those who stand on their feet for work). The pain is often noticeable first thing in the morning and worse with activity. Diagnosis In more difficult cases of plantar fasciitis you should see your foot health professional for a thorough examination. They will find out why your arch or heel pain occurred in the first place and devise a treatment plan to relieve your pain and prevent it from reoccurring. They will evaluate your feet, walking pattern (gait), shoes, activities, exercise methods, and other relevant information and then devise your treatment plan. Non Surgical Treatment When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain. Surgical Treatment With flat feet, there is a tendon on the inside of the foot than can often become weakened, injured, split and/or ruptured. This tendon, is called the posterior tibial tendon, and is the main arch supporting tendon. Obviously damage to this tendon can cause collapse of the arch. Some people have genetically inefficient tendon, and tends to be the case in younger people. In mild cases, such as tendon splits, the posterior tibial tendon can be repaired to restore its strength. Acute incontinuity of the tendon can be primarily repaired. Often the posterior tibial tendon is augmented with a tendon transfer of an adjacent tendon to provide both strength and continuity. In any tendon repair, advanced or retensioning of the tendon is performed. In most flat foot surgery a tendon augmentation is often combined with other boney procedures to restore structure and balance to the foot. Stretching Exercises Flexibility is important in preventing injuries. With a simple stretching exercise, you can rehabilitate the muscles of your foot to relieve arch pain and prevent future injuries. This simple exercise by Tammy White and Phyllis Clapis for Relay Health is a good way to strengthen your foot muscles and stretch your plantar fascia. Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat three times. When you can stand comfortably on your injured foot, you can begin standing to stretch the plantar fascia at the bottom of your foot. Overview An Achilles tendon injury can affect both professional and amateur athletes. The Achilles tendon is one of the longer tendons in your body, stretching from the bones of your heel to your calf muscles. You can feel it, a springy band of tissue at the back of your ankle and above your heel. It allows you to extend your foot and point your toes to the floor. Unfortunately, it's a commonly injured tendon. Many Achilles tendon injuries are caused by tendinitis, in which the tendon becomes swollen and painful. In a severe Achilles tendon injury, too much force on the tendon can cause it to tear partially or rupture completely. Causes An Achilles tendon rupture is often caused by overstretching the tendon. This typically occurs during intense physical activity, such as running or playing basketball. Pushing off from the foot while the knee is straight, pivoting, jumping, and running are all movements that can overstretch the Achilles tendon and cause it to rupture. A rupture can also occur as the result of trauma that causes an over-stretching of the tendon, such as suddenly tripping or falling from a significant height. The Achilles tendon is particularly susceptible to injury if it is already weak. Therefore, individuals who have a history of tendinitis or tendinosis are more prone to a tendon rupture. Similarly, individuals who have arthritis and overcompensate for their joint pain by putting more stress on the Achilles tendon may also be more susceptible to an Achilles tendon rupture. Symptoms A classic sign of an Achilles tendon rupture is the feeling of being hit in the Achilles are. There is often a "pop" sound. There may be little pain, but the person can not lift up onto his toes while weight bearing. Diagnosis A detailed history, and examination by an appropriately qualified health professional, will allow a diagnosis to be made. An ultrasound or MRI scan can confirm the diagnosis. Other causes of symptoms in the area, such as those referred from the lumbar spine and local infection, should be excluded. Non Surgical Treatment A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. Use support devices as directed. You may need crutches or a cane for support when you walk. These devices help decrease stress and pressure on your tendon. Your caregiver will tell you how much weight you can put on your leg. Ask for more information about how to use crutches or a cane correctly. Start activity as directed. Your caregiver will tell you when it is okay to walk and play sports. You may not be able to play sports for 6 months or longer. Ask when you can go back to work or school. Do not drive until your caregiver says it is okay. Surgical Treatment Unlike other diseases of the Achilles tendon such as tendonitis or bursitis, Achilles tendon rupture is usually treated with surgical repair. The surgery consists of making a small incision in the back part of the leg, and using sutures to re-attach the two ends of the ruptured tendon. Depending on the condition of the ends of the ruptured tendon and the amount of separation, the surgeon may use other tendons to reinforce the repair. After the surgery, the leg will be immobilized for 6-8 weeks in a walking boot, cast, brace, or splint. Following this time period, patients work with a physical therapist to gradually regain their range of motion and strength. Return to full activity can take quite a long time, usually between 6 months and 1 year. |
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