Heel Pain

by footbiotecadmin on February 5, 2016

Plantar fasciitis

Plantar fasciitis is a painful condition where the plantar fascia of the foot has been traumatised. The plantar fascia is a flat band of tissue under the foot that spans from the heel to the bottom of your toes. In its healthy state, the plantar fascia is strong and resilient enough to support the arch of the foot without causing any pain. Under some circumstances, however, it may be inflamed.

The underlying cause of plantar fasciitis is often excessive subtalar joint pronation. Excessive subtalar joint pronation results in lowering of the arch on the inside of the foot (the medial longitudinal arch). This causes the foot to elongate and may increase tractional (pulling) forces on the plantar fascia. This in turn causes irritation of the origin of the plantar fascia at the heel, resulting in pain.

(From: http://www.drugs.com/health-guide/heel-pain.html)

(From: http://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments)

In addition to plantar fasciitis, some patients may also develop a heel spur. A heel spur is a bony growth, usually occurring at the front of the heel bone (Calcaneus). It is important to understand that not all heel spurs cause pain. The addition of a heel spur to plantar fasciitis usually does not change the management plan.

Symptoms of plantar fasciitis

Most people with plantar fasciitis experience heel pain with their first steps when rising from bed in the morning or simply when standing after long periods of sitting. It normally presents a sharp stabbing pain at the bottom or front of the heel. It usually subsides after a while and may turn into a dull ache.

(From: http://plantarfasciitis.com.au/)

Factors that contribute to the development of heel pain

Unsupportive footwear

Some people require external factors such as footwear to provide additional support to their foot. This is particularly the case in people with excessive foot pronation.

Increasing activity too quickly

A rapid change in the intensity or frequency of activity may place unaccustomed structures within the foot, such as the plantar fascia, at an increased risk of injury.

Body mass

People who are overweight or obese have more force transferred through their foot and its supporting structures. Therefore, more stain is placed on them.

Occupation

Standing or walking for long periods increases the strain on supporting structures in the foot and may lead to fatigue of these structures and therefore potential injury.

Age

Increasing age can reduce the integrity of supporting structures in the foot, potentially increasing their risk of injury.

Pregnancy

A transient increase in weight can suddenly overload structures within the foot, increasing the strain on them and increasing their risk of injury.

Treatment of plantar fasciitis

Plantar fasciitis is a complex condition that often requires tailored treatment that should be developed in consultation with a Health Professional. There are a range of treatment options available such as:

Relative rest

Reducing activities that aggravate the condition may help.

Heat or ice pack

This largely depends on the stage of the condition being experienced. Generally, ice packs can be helpful in the acute stage whereas heat packs may be helpful in the chronic stage.

Weight loss

This should be an aim for the long term when the pain has been treated.

Stretching exercises

Stretching of tight calf muscles may help. Stretching of the plantar fascia before standing has been shown to help reduce first step pain.

Remedial massage

Remedial massage may ease tension in tight muscles or other soft tissue structures in and around the foot that may be contributing to the development of plantar fasciitis.

Acupuncture

Research has shown that acupuncture may reduce inflammation while causing no adverse effect on the body. Acupuncture may provide some relief in patients with plantar fasciitis.

Footwear

Worn-out footwear has a reduced ability to provide support therefore new footwear can help. In addition, advice from a Podiatrist regarding the most appropriate shoe for you may help.

Orthotic shoes / thongs

Orthotic insoles, shoes and orthotic thongs can provide a cost-effective, long-term solution to controlling excessive foot pronation therefore reducing the pain associated with plantar fasciitis.

Achilles Tendonitis

by footbiotecadmin on February 5, 2016

Achilles Tendonitis is the inflammation of the Achilles Tendon. The Achilles Tendon is the longest tendon in the body, connecting our calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus).

(From: http://www.northshoresportspodiatry.com.au/conditions-we-treat/achilles-tendon-bursitis/)

Signs and Symptoms of Achilles Tendonitis

Pain experienced just above the back of the heel when walking
Swelling and inflammation occur where pain is felt
Often experience tight calf muscles
Tender when touching the tendon
Thickening of the tendon
A spur may develop on the back of the heel if repetitive stress and strain on the tendon persists over a long period of time
In extreme cases detachment (breakage) may occur while walking if the condition is left untreated and stress and strain continue to be exerted on the Achilles

Causes of Achilles Tendonitis

Persistent stress and strain
Biomechanical problems of the foot – excessive pronation (inward rolling) or excessive supination (outward rolling)
Shortened Achilles tendon

Over activity of the foot, especially excessive running
Age–the tendon becomes less resilient, more susceptible to stress and strain

Treatments for Achilles Tendonitis

Remedial massage – acupressure work on both the gastrocnemius and soleus muscles (collectively known as our ‘calf muscles’). Be cautious, though, not to use excessive stretching treatment to avoid further aggravating any inflammation.

Acupuncture – reduces pain and inflammation. It has been scientifically proven that acupuncture helps release both natural endorphins, to relieve pain, and natural anti-inflammatory agents, to fight inflammation.

Cortisone injections can give temporary relief. However, avoid extended cortisone treatment as damage to the tendon, including breakage (detachment), could occur.

Orthotics-the root cause for most people with Achilles Tendonitis is over pronation (excessive inward rolling) of the foot. Over-the-counter orthotic footwear can help treat the great majority of people suffering this condition by providing sufficient foot arch support. In contrast, only a small percentage of people (approximately 5%) with a supinated foot structure (excessively high arched) should see a podiatrist for further assessment.

Flat Foot

by footbiotecadmin on February 5, 2016

Flat foot, also medically called Pes Planus, is a condition in which the arches of a person’s feet are not visible and the entire undersides of their feet contact completely onto the ground.

(From: http://boneandspine.com/overpronation-of-foot/)

Over 70% of the population in Australia have flat feet. Although some of the flat feet are “rigid” flat feet, which are inflexible, most of the flat feet are what is actually, and better, described as ‘flexible flat feet’. ‘Flexible flat feet’ do, technically, not have completely collapsed arches, although they may appear to be so while a person is standing, bearing their full weight. The arches of a person who has ‘flexible flat feet’ will typically reappear when they either stand on their heels, or when they pull their toes back whilst keeping the rest of their feet in contact with the ground.

Despite this fact, some people tend to wrongly call all feet that appear to be flat, as “flat foot”.

The condition of ‘flexible flat foot’ is, nonetheless, generally not a foot at its natural best. Such a condition can cause considerable foot pain, shin pain, knee pain, and lower back pain. The root cause of ‘flexible flat foot’ is excessive foot pronation. Another expression, that of ‘Flat arch’, and also known as lower-than-normal arch, is where the angle of the calcaneus (heel bone) is less than 42 degrees from the transverse plane.

(From: http://www.northsiderunners.com.au/fit-process)

How to find if we are flat footed, normal or high arched?

If assessed by a podiatrist Navicular Drop Test is usually used to precisely check if the foot arch is dropped or not.

However, it is actually pretty easy for us as a layman to check our foot arch. It would not be precise, but it can generally tell.

1.Finger test.

Stand still and relaxed with feet apart at your shoulders’ width. Ask our friend to try to snug our index finger into our foot arch. If we can easily our finger in it means it would not be a flat foot. If you cannot even push it in it means you may have a flat foot.

2.Check our feet from behind.

Stand still and relaxed with feet apart at your shoulders’ width. Ask our friend to check from behind. Look at the midline as reference. If it is straight, it means normal (neutral). If it curves inwards, it means flat foot (pronation). If it curves outwards, it means high arched (supination)

lowered foot arch (flat foot)

3.Check footprints.

Use a piece of white paper. Wet your foot and stand on it and walk away. Check the prints on the paper.

Flat feet in children

The arches of young children do typically not normally fully develop until they are about 10 years old. It is therefore normal and common for young children up to this age to have some degree of flat footedness. Furthermore, as little evidence has been found for their efficacy with such young users, it is generally not recommended that children younger than this age wear orthoses.
Rather, children with flat feet are encouraged to walk & play barefooted, especially over soft accommodating terrain, such as a beach or soft grass. Children, however, with rigid flat feet or fasciitis, are not recommended to go barefooted.

A medical study in India involving large numbers of children, some of whom who had grown up wearing shoes and others who had grown up barefooted, was particularly informative in regards to how we can naturally optimize the health & function of a child’s developing foot. It was found that not only were the longitudinal arches of the barefooters generally strongest and highest, but also flat feet were less common in children who had grown up wearing open sandals or slippers, in comparison to those who had worn closed-toe shoes.

Symptoms of Flat Feet

Many people with ‘flexible flat feet’ experience no pain or symptoms. Some ‘flexible flat footers’, however, experience symptoms including:

Foot pain

Heel pain

Ankle pain

Shin pain

Knee pain

Lower back pain

The excessive inward rolling of Flat Feet results in significant unnatural compensatory rotational forces, stresses & strains being exerted upon the bones, ligaments, tendons and soft tissues of the foot. These same compensating forces, however, then transmit upwards, resulting in similar stresses, strains & twisting forces being brought to bear on numerous of the ligaments, tendons, bones & muscles of each of the shin, knee, thigh, pelvis and lower back.

Contributing Factors

for Adult Flat Feet

– Injuries
– Unusual or prolonged stress and strain on the foot
– Faulty biomechanics
– Age
– Overweight/obesity

Treatment

of Flat Feet

The most effective treatment to correct over pronation is to wear quality orthotic footwear such as premium grade, over-the-counter orthotic shoes/thongs/sandals. This very simple & natural treatment will help most people with ‘flexible flat feet’.

People with rigid flat feet, however, may wish to seek specialist advice from either a medical or podiatric specialist.

Ball of the Foot Pain (Metatarsalgia)

by footbiotecadmin on February 5, 2016

Ball of the foot pain is a common painful foot condition that affects the metatarsal area of the foot. This area is usually referred to as the ball of the foot.

(From: http://somerinsana.bravesites.com/)

Metatarsalgia is increasingly prevalent nowadays because more people are more frequently wearing heeled shoes and walking on hard surfaces, such as hard concrete & hard tiles.

Wearing heeled shoes can unnaturally shift up to 70% -80% of our body’s weight forward to the balls of our feet.

Walking on hard, non-accommodative surfaces, such as concrete footpaths and roads, unnaturally provides no cushioning to our movement.

The combination of heels and hard surfaces can result in very damaging stresses & strains being exerted on our feet, especially on the balls of our feet. Our feet were never designed to withstand hours of pounding and high levels of counter forces originating from heeled shoes or walking on non-absorbing hard surfaces.

Persistent unnatural forces originating from heeled shoes and walking on hard surfaces cause our metatarsals to drop and the surrounding ligaments to weaken. As a result, our transverse arches can collapse. In addition, burning pain, inflammation and/or calluses & corns may also develop under our forefeet in response to the excess pressure and friction on the balls of our feet.

(From: http://www.sportspodiatryinfo.co.uk/the-transverse-metatarsal-arch/)

Other Contributing causes of ‘Ball of the Foot’ Pain

Besides wearing high-heeled footwear and walking barefoot on hard surfaces, other causes of ball of the foot pain may include:

Wearing shoes with thin soles.
Faulty foot biomechanics. Excessive foot pronation (inwards rolling) is the main cause.
Underlying diseases that cause a thinning of the fatty pad on the undersides of our feet e.g. rheumatoid arthritis, connective tissue disorders, endocrine diseases, etc.
High arched feet that are rigid, similar to wearing high heeled shoes, shifting pressure to our forefeet.
Injuries that are not properly treated, such as fractured bones or dislocated joints.
Hammertoes.

Treatment of ‘Ball of the Foot’ Pain

Most people with ball of the foot pain tend to excessively pronate their feet.

Orthotic footwear, preferably open-toe styles, such as quality made, affordable over-the-counter orthotic sandals or thongs, would normally be ideally suited for such people. These people can expect to experience both increased comfort and pain relief.

Ideally, the underside of the forefoot region of these orthotic shoes should also incorporate an upward rising concavity to support our transverse arches.

People with supinated, high arched rigid feet (Pes Cavus) or forefoot valgus may need to consult a specialist podiatrist. A pair of prescribed customised shoes or insoles may be required.

Bunions

by footbiotecadmin on February 5, 2016

The medical term for a bunion is Hallux Valgus. Bunions are very common in our modern life. A bunion refers to a deformed great toe (Hallux) with lateral deviation (moving outside). The development of a bunion is caused by pressure applied to the side of the big toe, forcing it inwards towards, and sometimes under or over, the other toes.

(From: http://chicagofootcareclinic.com/footproblems/deformities/bunions.html)

Three Stages of Bunion Development

Primary stage

Begins with only a small protruding lump appearing on the side of the big toe. This generally occurs up to the age of 25 years old.

Secondary stage

The lump enlarges and the lateral deviation of the big toe continues. The adjacent 2nd toe may experience pressure from the big toe.

Advanced stage

If the situation is not controlled, the condition will typically worsen. Both pain and swelling will appear and worsen, the big toe will overlap the adjacent 2nd toe, and normal shoes will no longer suit or fit.

Causes

Underlying faulty foot biomechanics. Excessive pronation causes additional forces in the forefoot (with the 1st metatarsal being the most vulnerable). The ground reaction force, in turn, forces the big toe (hallux) to compensate by deviating away from the parallel median axis of the body (i.e. ‘abducting’). Over time, this deviation will manifest on the outer edge of the foot, forming bunions.
Tight fitting or high heeled shoes
Flat feet
Excessive flexibility of ligaments
Abnormal bone structure
Certain neurological conditions

Treatment

Orthotic footwear (orthoses), especially quality made over-the-counter orthotic shoes/sandals/thongs, often help prevent bunions from developing to the advanced stage. Orthoses can help realign the foot by supporting & controlling the heel bone from deviating outwards, thereby correcting over pronation by taking excess pressure off especially the 1st metatarsophalangeal joint. Preventative measures are generally considered especially important in the treatment of bunions.
Surgery for advanced stage bunions.

Morton’s Neuroma

by footbiotecadmin on February 5, 2016

Morton’s Neuroma refers to intermetatarsal digital nerves (often between the 2nd & 3rd and between the 3rd & 4th metatarsal heads) being squeezed and the surrounding tissue thickening and swelling. It is not a true tumour, but a fibroid formation around the nerves.

Symptoms of Morton’s Neuroma

Pain when standing or walking
Numbness, burning or tingling feeling
Swelling/Fibroid formation apparent between the toes
Increased level of pain when wearing shoes or squeezing toes

Causes of Morton’s Neuroma

(From: http://www.patienteducationcenter.org/articles/mortons-neuroma/)

The root causes are still generally considered unknown. The condition, however, may be associated with the following:

Flat feet, with excessive pronation (excessive inwards rolling), eliciting too much pressure on the toes, leading to strains and damage to the nerves inbetween the toes;
Abnormal positioning of toes;
Forefoot abnormalities, e.g. bunions, hammer toes;
Prolonged wearing of tight shoes or high heeled shoes.

Treatment of Morton’s Neuroma

Professionally designed orthoses.
Acupuncture helps the body release both natural endorphins to relieve pain and natural anti-inflammatory agents to reduce inflammation.
Cortisone injections can temporarily relieve the pain and reduce inflammation. However, generally avoid long term use of cortisones as extended cortisone treatment can cause degeneration of ligaments and tendons. Symptoms may then reoccur after a few weeks.
Alcohol injections to shrink fibroid formations.
Surgery.

Adult Acquired Flat Foot

by footbiotecadmin on February 5, 2016

Adult Acquired Flat Foot

Adult acquired flat foot is a condition that has a number of stages and can be asymptomatic initially but may progress to a painful, chronic condition if untreated.

Signs and Symptoms of Adult Acquired Flat Foot

A change in the height of the arch on the inside of your foot (the medial longitudinal arch) is often one of the initial signs.
This change in height can be subtle and may go unnoticed for a period of time.
In some instances, the change in arch height may be accompanied by pain.

Pain: Pain may be present either in the arch or along the course of muscles and/or tendons that help support the arch.
These tendons and muscles run along the inside of the foot, behind the ankle and up into the calf area.
Accordingly, pain may occur in any of these areas.
Pain may also occur in other parts of the foot.
However, this largely depends on damage to other supporting structures within the foot.

In some cases, pain is preceded by an event that places extra stress loads on various supportive structures within the foot.
For example, this can happen when stepping on a curb awkwardly.
However, in some cases there may be no identifiable cause of the pain and the pain may develop without any obvious change in the height of the arch.
This tends to be the case for people who already have flat feet that excessively pronate (where their feet roll inwards excessively and the arches of their feet have already collapsed).

Factors that may contribute to the development of Adult Acquired Flat Foot

Biomechanics

Excessive pronation (where the feet roll inwards and the arches of the feet collapse) elongates the feet.
This elongation tends to increase the work required of muscles, particularly those within the lower leg.
The increase in work, over a period of time, can cause the muscles to fatigue. This may lead to a further collapse in the medial longitudinal arch.

Some people require footwear that provides additional support to their feet. This is particularly the case for people whose feet excessively pronate.

Unsupportive footwear

Occupation

When excessive pronation is a factor, standing or walking for long periods of time places additional work load demands on the muscles in the lower leg. This further increases the potential for injury to the foot and lower leg.

Increasing activity too quickly

Stages of Adult Acquired Flat Foot

Stage 1 The medial longitudinal arch may have reduced in height with pain and/or swelling below or behind the ankle.

Stage 2 The medial longitudinal arch has collapsed; additionally, pain and swelling around the arch of the foot or below and behind the ankle may be present. The foot can still generally be corrected back to a more neutral position.

Stage 3 The medial longitudinal arch has collapsed and pain and swelling around the arch of the foot or below and behind the ankle may be present. At this stage, the foot can generally no longer be corrected back to a more neutral position. Osteoarthritis is frequently also present in the joints of the rearfoot.

Stage 4 In addition to the above, osteoarthritic changes will likely also be visible within the ankle joint.

Treatment options for Adult Acquired Flat Foot

Stage 1 and 2 Treatments

Conservative treatments tend to be more effective if the problem is identified early and has not progressed passed stage 2.

Some conservative measures include:

Relative Rest

Reducing activities that aggravate the condition.

Stretching Exercises

Stretching of tight muscles, particularly of calf muscles, may help. Tight calf muscles can lead to an increase in the amount of excessive foot pronation and, as a result, Adult Acquired Flat Foot may develop.

Remedial Massage

Massage by a qualified professional can help reduce muscle tightness.

Acupuncture

Research has shown that acupuncture may reduce pain. Acupuncture may therefore provide pain relief for some people who have Adult Acquired Flat Foot.

Footwear

Footwear that is worn-out has a reduced ability to provide effective support. New footwear may therefore assist, including advice from a podiatrist regarding the most appropriate footwear for your condition.

Orthotic Shoes & Thongs

Orthotic insoles and orthotic shoes & thongs can provide a very cost-effective, long-term solution to controlling excessive foot pronation, therefore reducing the pain associated with Adult Acquired Flat Foot.

Stage 3 and 4 Treatments

Conservative treatment (as outlined above) may provide some relief. However, due to the extent of the problem, a surgical opinion is often sought.

Shin Splints (Shin Pain)

by footbiotecadmin on February 5, 2016

Shin Splints, medically termed as Medial Tibial Stress Syndrome (MTSS), is associated with overuse of the legs, and refers to pain in the region between the knee and the ankle. Shin Splint injuries commonly occur in athletes, especially runners.

(From: http://www.foothealthclinic.com.au/conditions/foot-ankle-pain/shin-splints/)

Symptoms of Shin Splints

Pain in front of outer leg below the knee and above the ankle
Pain can be relieved after rest, but recurs when resuming running activities
Pain can be severe enough to halt activities

(From: http://runlikecrazy.com/2014/06/02/shin-splints/)

Causes of Shin Splints

Shin Splints are caused by:

Repeated micro-trauma to the muscles surrounding the tibia (shin bone)

Overuse of muscles of the lower extremities

Biomechanical irregularities (mostly excessive pronation)

Tight calf muscles

Weak ankles

Treatment of Shin Splints

Plantar fasciitis is a complex condition that often requires tailored treatment that should be developed in consultation with a Health Professional. There are a range of treatment options available such as:

Rest – It is recommended to not train beyond the “pain barrier” of the injury as further activity can worsen the condition.
Over-the-counter orthotic footwear to control foot over pronation (this cost-effective solution applies to most people). For those with foot over supination (foot rolls outwards) a podiatrist or chiropractor may need to be consulted for a pair of prescribed orthotic insoles.

Deep tissue massage can be effective to relieve tight calf muscles as well as help break down any adhesions.
Acupuncture is believed to be effective to significantly reduce the pain and inflammation. There is also evidence it helps break down any adhesions.
Exercises to strengthen the ankles.

Stress fractures may develop if shin splint injuries are left untreated.

(From: https://www.orthoticshop.com/over-pronation-insoles/)