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Foot Ailments

Achilles Tendonitis

Definition: Achilles Tendonitis is the inflammation of the Achilles tendon, which is the large tendon that attaches to the heel on the back of the leg. Achilles tendonitis should not be left untreated due to the danger that the tendon can become weak and rupture.

Cause: There are several factors that can cause Achilles tendonitis. The most common cause is over-pronation. When the arch collapses it adds stress on the Achilles tendon. Additionally, improper shoe selection, inadequate stretching prior to athletic activities, a short Achilles tendon, congenital or due to overdevelopment without proper stretching, or injury to the tendon can also cause to Achilles tendonitis.

Treatment and Prevention: A stretching program should be used by all athletes, especially runners, to properly warm-up the muscles. Ice can be applied after activities, and a reduction in the length of the activity may help. An orthotic device will provide extra support, control pronation and reduce stress on the Achilles tendon. If the problem persists, consult your orthopedic specialist.

Arch Pain/Strain

Definition: Arch pain refers to a burning sensation or inflammation in the arch of the foot.

Cause: There are many different things that can cause arch pain. A structural imbalance or an injury to the foot can often be the direct cause. Frequently it is related to a condition called plantar fasciitis. The inflammation caused by excessive stretching of the plantar fascia is usually due to over-pronation. The pain usually radiates from the heel into the arch area and can be extreme in the morning.

Treatment and Prevention: This is a common foot condition that takes time to heal. The morning towel stretch and the wall stretch will help to reduce tension in the plantar fascia. Icing at the end of the day is also beneficial. If your plantar fasciitis is caused by over pronation then an orthotic device can provide support and lessen the tension on the plantar fascia.

If the problem persists, consult your orthopedic specialist.

Arthritis

Definition: Arthritis is a destructive disease which affects the body’s joints. Arthritis is a major cause of foot pain. This is because each foot has 33 joints which can become affected by the disease.

Two of the most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis wears away the cartilage in the joints, it often affects the hips, knees, spine, finger, or foot joints. Movement becomes very difficult and painful. Rheumatoid arthritis is the most common form of inflammatory arthritis. It can develop at any age and there is no known cause for this condition.

Rheumatoid arthritis is the most crippling form of the disease that can affect people of all ages. It can cause severe deformities of the joints with associated fatigue of the entire body. People who suffer from rheumatoid arthritis often develop severe forefoot problems such as bunions, hammer toes, claw toes, and others.

Cause: Heredity plays a major role in the cause for arthritis. However, arthritic symptoms may develop due to other factors.

Treatment and Prevention: Increasingly, doctors recommend exercise for arthritis patients to maintain flexibility and cardiovascular fitness. Normal usage of joints helps maintain a person’s muscles, ligaments and other joint supporting structures. The pain associated with arthritis can decrease the ambulatory capacity of the patient. Shoe modifications and foot orthoses may be crucial in allowing more comfortable walking, and help patients retain or enhance their mobility.

Bunions

Definition: Bunions are one of the most common forefoot problems. A bunion is a deformation of the joint of the big toe at the ball of the foot which causes a prominent bump on the inside of the foot around the big toe joint. This is due to the big toe moving inward toward the smaller toes and the joint moving out.

Tailor’s Bunion, also known as a bunionette, forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe. Chafing of either of the 1st or 5th digits due to improper shoe fit can contribute to bunions.

Some of the symptoms of bunions include inflammation, swelling, and soreness on the side surface of the big toe. The discomfort commonly causes a patient to walk improperly.

Cause: Bunions most frequently occur from pronated feet and tend to occur in adolescence and middle age. Other factors can be a congenital predisposition, arthritis or the long-term use of improperly fitting, poor quality footwear.

Treatment and Prevention: Early treatment cannot be emphasized enough. If you notice redness on the side or top of the big toe joint and there is no visible bump started, changing to wider shoes may be enough. Orthotic devices can often halt the progression of a bunion. Orthotics provide extra comfort, support, protection and maintain muscular balance and bony stability to the big toe so that it won’t have a tendency to drift.

If the problem persists, consult your orthopedic specialist.

Corns

Definition: Corns, like calluses, develop from an accumulation of dead skin cells on the foot, forming thick, hardened areas. They contain a cone-shaped core whose point can press on a nerve below, causing pain. Corns can become inflamed due to constant friction and pressure from footwear.

Cause: Some of the common causes of corn development are tight fitting footwear, or the foot sliding forward in a shoe that fits too loosely. Soft corns are result from bony prominences and are located between the toes. Corns can also be caused by imbalances in the foot which lead to irritation and corn formation.

Treatment and Prevention: Always wear properly fitted footwear with extra room in the toe area. Avoid shoes that are too tight or too loose. An orthotic will correct imbalances and absorb shock and shear forces that can cause corns. A pumice stone can be used to remove dead skin, but the cone of the corn can be quite painful.

Diabetics and all other individuals with poor circulation should never use any chemical agents to remove corns.

If the problem persists, consult your orthopedic specialist.

Charcot-Marie-Tooth

Definition: Charcot-Marie-Tooth is a form of progressive neural muscular atrophy, characterized by progressive weakness of muscles of the legs and feet.

Cause: There is no known cause, but it does have hereditary tendencies.

The Diabetic Foot

Definition: Diabetes is a serious disease that can develop from the lack of insulin production in the body or due to the inability of the body’s insulin to perform its normal everyday functions. Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet.

Diabetes frequently results in neuropathy, or nerve damage, in the feet. Nerve damage leads to a loss of sensation and the ability to feel pain, heat, and cold. People with diabetes should pay special attention to their feet. Friction or rubbing can go unnoticed and worsen into a break in the skin, or an ulcer. Diabetes can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet. Charcot feet have deteriorating bone structure.

Due to the consequences of neuropathy, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative foot care measures, it reduces the risks of serious foot conditions.

Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, therefore causing injuries to heal poorly, and can lead to ulcers, infection, and other serious foot conditions.

Treatment of Diabetic Foot Conditions: Footwear and orthotics play an important role in diabetic foot care. Properly fitted footwear is essential. Diabetic footwear needs may include a high and wide space in the toe area, a removable insole (making it possible to insert orthotics if necessary), and a firm heel counter for support and stability. Rocker soles may also be added to shoes to reduce pressure in the areas of the foot most susceptible to pain, most notably the ball of the foot.

Properly crafted orthotics can reduce hot spots and pressure points on the diabetic foot. The material used to treat the diabetic foot must sacrifice durability for comfort and pressure reduction. Routine visits are advised to maintain material integrity and performance.

If you have diabetes and are experiencing a foot problem, immediately consult with your orthopedic specialist.

Hammer Toes/Claw Toes

Definition: A hammer toe is a toe that is contracted at the middle joint in the toe. A claw toe is contracted at the middle and end joints in the toe. Both of these can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe that is pressed against the bottom of the shoe.

Hammer toes and claw toes are classified based on the mobility of the toe joints, flexible or rigid. In a flexible hammer/claw toe, the joint has the ability to move. This type of toe can be straightened manually. In a rigid hammer/claw toe movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball of the foot, and possibly causing pain and the development of corns and calluses.

Cause: Hammer and claw toes can be hereditary, in which case usually more than one toe is affected. The classic hammer toe or claw toe will occur due to mechanical failure within the foot itself. Muscle imbalances cause the tendons to become unnaturally tight. This results in the joints curling downwards. Arthritis can also lead to many different forefoot deformities, including hammer and claw toes.

Treatment and Prevention: When a hammer toe or claw toe is in its initial stages, oftentimes conservative treatment, such as stretches, properly fitting shoes and orthotics are successful. In the severe cases, it is often necessary to construct orthopedic shoes to accommodate the need for extra space and additional support. Surgery is often recommended in the severe stages, but post-op rehabilitation should include orthotics and proper fitting shoes. Prevention consists mainly of proper fitting shoes and adequate support to ensure efficient foot function.

If the problem persists, consult your orthopedic specialist.

Heel Pain

Definition: Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort. Heel pain pathologies include calcaneal epiphysitis, calcaneal bursitis, and plantar fasciitis. All of these are injuries are caused by overuse, poor range of motion, or repetitive stress due to poor biomechanics.

Cause: Heel pain can be caused by repetitive stress which is a soreness resulting from too much impact on a specific area of the foot. This can be caused from shoes with poor cushioning, a thinned out fat pad in the heel area, or from a sudden increase in activity.

Inflammation of the plantar fascia, which is a band of tissue that connects the heel bone to the bones in the ball of your foot, is a very common cause of heel pain. A biomechanical problem, such as over-pronation, usually causes the excessive stretching and inflammation of the plantar fascia.

Treatment and Prevention: To properly treat heel pain, you must absorb shock, provide cushioning and correct any biomechanical imbalances. Orthotics will provide good arch support and will control the pronation. Icing is also very beneficial.

Heel Spurs

Definition: A heel spur is a bony growth occurring on the underside of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or heel spur to develop. Heel spurs can cause extreme pain in the rear of the foot, especially while standing or walking.

Cause: The abnormal stress that causes plantar fasciitis also causes the heel spur, but, instead of involving the fascia in the arch area, it involves the heel bone, where the fascia attaches. This stretching of the plantar fascia is usually the result of over-pronation, but people with unusually high arches can also develop heel spurs.

Treatment and Prevention: Orthotic devices are very helpful in cupping the heel and reducing the pull of the plantar fascia away from the heel bone, therefore correcting the abnormal forces that initiated the injury process. Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock.

If the problem persists, consult your orthopedic specialist.

Metatarsalgia

Definition: Metatarsals are the bones that form the ball of the foot. Metatarsalgia is used to denote a painful foot condition in this area of the foot, usually located under the 2nd, 3rd, and 4th metatarsal heads.

Cause: The metatarsal joints become inflamed and painful due to excessive pressure over a long period of time. As we get older, the fat pad in our foot tends to thin out, making us much more susceptible to metatarsal pain. Other factors that can contribute metatarsalgia are imbalances in the feet that cause excessive pressure in the metatarsal region, improper footwear, or participating in high impact activities without proper footwear and/or orthotics.

Treatment and Prevention: Wearing proper, supportive footwear is crucial to relive the pain involved with metatarsalgia, it is especially important to have a wide enough shoe. Unloading the pressure points and balancing and supporting the foot with a custom orthotic, including a metatarsal pad, should also provide significant relief.

Morton’s Neuroma

Definition: Morton’s Neuroma is a benign tumor or enlargement of one of the nerves that travel between the metatarsal heads, usually between the 2nd and 3rd or 3rd and 4th digits. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton’s Neuroma may also cause numbness, tingling, or cramping in the forefoot.

Cause: Morton’s Neuroma is usually found in an over-pronated foot, which causes the 1st and 5th metatarsals to move up and out and the weight usually born by the 1st and 5th metatarsals is shifted to the 2nd, 3rd, and 4th. This leads to bones squeezing the nerves that run between the metatarsal heads. This condition can also be caused from footwear that is too narrow in the fore foot.

Treatment and Prevention: A custom orthotic with a metatarsal pad and cushioning top cover will correct and support an over pronated foot and relieve the pressure between the metatarsal joints. Proper and supportive footwear is also important.

Morton’s Toe

Definition: Morton’s Toe is a common forefoot disorder where the second toe is longer than the Big Toe.

Cause: The longer 2nd toe takes much of the weight that is usually distributed to the big toe which leads to excessive pressure on the second metatarsal head, resulting in pain similar to the discomfort associated with metatarsalgia.

Treatment and Prevention: Custom orthotics that feature arch support to keep the foot aligned, and a metatarsal pad to reduce stress on the ball of the foot are often recommended when treating this condition. Proper footwear combined with an effective orthotic will provide relief from pain associated with Morton’s Toe.

Over Pronation

Definition: Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person’s arch collapses upon weight bearing. This motion causes many foot imbalances and leads to varying problems and pain in the feet.

Cause: Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding additional stress to other parts of the foot. Therefore over-pronation can often lead to a case of Plantar Fasciitis, Heel Spurs, Metatarsalgia, Posterior-tibial Tendonitis and/or Bunions.

Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation.

Treatment and Prevention: Over-Pronation can be treated with orthotics designed with appropriate arch support and medial rear foot posting to prevent the over-pronation. Footwear with a firm heel counter is often recommended for extra support and stability. Improper fitting footwear can lead to additional problems of the foot.

If problem persists, consult your orthopedic specialist.

Plantar Fasciitis

Definition: The plantar fascia is a band of connective tissue, often called a ligament, that reaches from the heel to the ball of the foot, maintaining the long inside arch. Plantar fasciitis is an inflammation of the plantar fascia caused by excessive straining or partially rupturing this ligament. The pain is often felt in the middle of the heel, extending forward.

The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. Plantar fasciitis can also lead to heel pain, arch pain, and heel spurs.

Cause: The direct cause of the injury or symptoms can be anything that simply stretches this ligament. It can be an acute injury, or it may come on gradually. Over-pronation is the leading cause of plantar fasciitis. Over pronation results in the arch collapsing upon weight bearing, causing the plantar fascia to be stretched away from the heel bone.

Other causes could be a foot with an unusually high arch, a sudden increase in physical activity, excessive weight on the foot, usually attributed to obesity or pregnancy or improperly fitting footwear

Treatment and Prevention: Whether the pain is due to an injury or a gradual onset, the patient will first want to reduce the inflammation with the use of ice directly to the area. Stretching will also help to elongate the plantar fascia and reduce the chance of rupture.

If the plantar fascia is due to abnormal pronation of the foot or extremely high arch prevention is best achieved through the use of orthotics. By supporting the arch, these devices reduce the strain on the plantar fascia.

Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce the strain and stress on the plantar fascia by following these simple instructions: Avoid running on hard or uneven ground, lose any excess weight, and wear shoes and orthotics that support your arch to prevent over-stretching of the plantar fascia.

If problem persists, consult your orthopedic specialist.

Posterior Tibial Tendonitis

Definition: The posterior tibial tendon runs along the inside of the foot, ankle and lower tibia. Tendonitis occurs when there is excessive strain on the tendon. With post-tib tendonitis, pain will be more severe upon weight bearing, especially while walking or running.

Cause: Post-Tib Tendonitis occurs when the muscle is overused and the tendon (soft tissue) that connects the muscle to your bone is strained. Over-pronation can also lead to posterior tibial tendon dysfunction.

Treatment and Prevention: To reduce the symptoms, limit activity to control the pain and swelling. Rest allows the tissues in your foot to heal. Orthotics will provide shock absorption and support the arch and the heel, to reduce strain on the post tibial tendon and prevent excessive stretching of the plantar fascia. The wall stretch with the posterior tibial tendonitis variation will help with this condition.

If the problem persists, consult your orthopedic specialist.

Sesamoiditis

Definition: The sesamoid bones are tiny bones within the tendons that run under the big toe. Its most common symptom is pain in the ball of the foot, especially on the medial or inner side. Every time you push off against the toe the sesamoids are involved, and eventually they can become irritated, even fractured. Because the bones are actually within the tendons, the bones become inflamed as well.

Cause: One of the major causes of sesamoiditis is increased activity, especially activity that forces you to put more pressure on the balls of your feet. Sesamoiditis typically can be distinguished from other forefoot conditions by its gradual onset.

Treatment and Prevention: Treatment for sesamoiditis is almost always non-invasive. In minor cases, it is recommended to decrease or stop activity for a while. This will give your sesamoids time to heal. Orthotics can also be used to reduce pressure on the affected area. Icing and anti-inflammatories will help the swelling go down so healing can begin.

Shin Splints

The first type of shin splint comes from the muscle imbalance of front leg muscles to back leg muscles. In most cases, the front leg muscles are the victims, overpowered by the back leg muscles.

The second type of shin splint comes from running on hard surfaces without adequate shock absorption, causing the muscles to work harder to try to provide mechanical shock absorption.

The third type, which is the most common, occurs in the flat or pronated foot type. This foot has an unsteady position to begin with, so the lower leg muscles have to work overtime trying to stabilize the position as best as they can, again resulting in overuse.

Treatment and Prevention: Preventive measures include shock absorbing footwear, orthotics, regular replacement of worn-out shoes, training slowly, and gradually increasing your pace and distance, and warming up and stretching before exercising. Orthotics will help balance and stabilize the foot, keeping muscles in a state of equilibrium. With orthotics, not only will your feet last longer, but so will your shoes!