Did you know that the foot has 26 bones, 33 joints, 107 ligaments and 19 muscles?
Various
biomechanical problems and diseases can affect your feet.
Learn how Michael as a Certified Pedorthist can
help to alleviate your pain.
- Achilles tendonitis
- arthritis
- bunions
- diabetes
- metatarsalgia
- plantar fasciitis
- posterior tibialis tendonitis
Achilles Tendonitis
What is it?
The Achilles tendon is the large tendon
located in the back of the leg that inserts into the heel. Achilles tendinitis is an inflammation of that tendon.
Achilles tendinitis can develop gradually without a history of trauma or can occur from a sudden injury.
Individuals who suffer from Achilles tendinitis often complain that their first steps out of bed in
the morning are extremely painful. Another common complaint is when steps are taken after long periods of sitting. The
pain often lessons with activity.
Achilles tendinitis is aggravated by activities
that repeatedly stress the tendon, causing inflammation (such as walking, running, or jumping). It is a common problem
experienced by athletes, particularly distance runners. Achilles tendinitis can be a difficult injury to treat due to high levels of activity and reluctance to stop or slow down training.
What Causes it?
There are several factors that can cause
Achilles tendinitis. The most common causes are training too hard/too soon without proper strengthening, biomechanical
abnormality such as over-pronation, a high-arch foot type, improper shoes and abnormal stiffness of calf muscle complex.
How can a pedorthist help?
A person suffering from
Achilles tendinitis should incorporate a thorough stretching program to properly warm-up the calf muscles. They should
also decrease the distance and intensity of their walk or run, as well as apply ice after the activity. It is best
to avoid any up hill climbs, which increases the stress on the Achilles tendon.
An
orthotic device should be used to accommodate any biomechanical abnormality and allow the Achilles tendon to function
more normally.
A heel lift may be recommended on a temporary basis to elevate the
heel and reduce stress on the Achilles tendon. The device should be made with shock absorbing materials.
Shoes that do not place unusual pressure on the Achilles tendon or on its insertion site on the heel
will help prevent further injury
Arthritis
What is it?
Arthritis is a general term for a variety
of conditions that cause inflammation and degeneration of the cartilage and lining of the joints of the body. Arthritis
can occur at any joint and is common in the feet and ankles. Arthritis is often considered a disease of aging but can occur
at any age. There are many different kinds of arthritis. Some of the most common types are osteoarthritis and
rheumatoid arthritis.
What causes it?
Osteoarthritis is typically considered to result from normal "wear and tear" or age, but can also result
from previous injury. Rheumatoid arthritis can occur at any age and there is no known cause for this condition.
It can cause severe deformities of the joints, especially in the hands and feet. but can also result from previous injury.
Arthritis causes changes in joints and restriction of motion. These changes
and restrictions can make walking painful.
How can a pedorthist help?
Proper treatment of foot and ankle arthritis addresses both pain and joint deformity. Pain develops
when the joint is injured. Injury to the joint may result from swelling caused by inflammatory arthritis or from the loss
of joint surface (cartilage), often caused by trauma.
Orthotics can be used
to help protect painful, swollen joints and to allow the joints to work in a more natural way. When the joints are allowed
to work in as normal a way as possible, pain can be reduced.
Shoes are also important
in reducing pain and should be properly fitted to the feet. They should not place excessive pressure on painful joints. An
appropriate shoe should have a toe box that is shaped similarly to the foot and has enough depth to accommodate any abnormalities
of the toes such as hammer or claw toes. The toe box should be wide enough so that it doesn't squeeze the forefoot and restrict
movement. A rocker sole is very helpful in relieving pain in the toe region.
Your
pedorthist can help to provide you with an orthotic, choose an appropriate shoe or modify shoes to better fit you
and reduce your pain.
Bunions
What is it?
A bunion is a very common forefoot problem. It is a
prominent bump on the inside of the big toe joint. The big toe may actually point towards the other toes or push the second
or even third toe over as well. The bump is a bony prominence that occurs because of pressure on that spot.
People with bunions often have inflammation, swelling, redness, and soreness on the side of the big
toe joint (where the toe meets the rest of the foot). Shoes often aggravate the problem.
Sometimes
people develop a type of bunion on the little toe. This is called a Tailor's Bunion or Bunionette.
What causes it?
Bunions are more common in women than
men, although both can have them. A bunion can develop from abnormal biomechanics of the foot (especially abnormal pronation),
arthritis, or by wearing poorly-fitted footwear. Shoes that are not shaped like one's foot can slowly, over time,
mold a foot into an abnormal shape leading to a bunion. Women often wear shoes that are not shaped like their feet, that squeeze
their toes together making them more susceptible to bunions forming.
How
can a pedorthist help?
The best way to alleviate bunion pain is to
wear shoes that fit properly. The shoes should be of similar shape to your feet, be deep enough to accommodate your toes and
wide enough to accommodate the width of your foot. Shoes with a rocker sole can help to alleviate the pain of a bunion.
An orthotic should be used to control any abnormal biomechanics that are contributing to the bunion
forming. Keep in mind, however, that putting an orthotic into a poor shoe will not be much of a benefit.
Diabetes
What is it?
Diabetes is a serious disease that can lead to devastating complications related to the feet and legs.
Diabetes is a condition where the body does not produce insulin or when the insulin that it produces cannot adequately perform
its normal functions. Insulin is a substance produced in the body that helps process the food we eat and turn it into
energy.
Diabetes is classified into two different types: Type 1 and Type 2.
Type 1 is usually associated with juvenile diabetes and is often linked through heredity. Type 2 is commonly referred
to as adult-onset diabetes.
Diabetes disrupts the vascular or circulatory system
which can affect how our body heals itself. Persons affected by diabetes may also lose sensation in their feet and this
is called diabetic neuropathy. It can be very dangerous to lose the sensation in your feet, as you may not notice a
"sore" until its too late. Amputation in the population of persons affected by diabetes is much higher than
in the general population because of these complications.
It is essential that persons
affected by diabetes take special care of their feet in order to avoid these complications.
What causes it?
Foot problems caused by diabetes develop from a
combination of causes including poor circulation and neuropathy.
Poor Circulation
Vascular disease in persons affected by diabetes causinga narrowing of the arteries that can lead to sigsignificantly
decreased circulation in the lower part of the legs and the feet. This decreased circulation reduces the the body's
ability to heal its self and persons affected by diabetes often develop sores or ulcers that can take months or even years
to heal. The longer a sore is present, the more likely it is that infection can enter the body causing more serious
problems.
Neuropathy Diabetic neuropathy is a loss of ability to
feel pain, heat and cold. Persons affected by diabetes who have neuropathy can have sores that they are not even aware
of due to insensiitivity. Unlike a person who can sense if a stone is in their shoe and take steps to remove it, a person
affected by diabetes with neuropathy may walk on the stone all day without noticing. This can cause severe problems.
If these injuries are left untreated, complications can arise leading to ulceration and possibly even amputation. Charcot
Foot is a common complication of diabetic neuropathy that leads to a massively deformed foot that requires special care to
prevent ulceration over unusual pressure points.
It is extremely important for persons
affected by diabetes to take the necessary precautions to prevent foot related injuries. It is imperative that the patient
affected by diabetes make daily foot checks a routine, as the consequence of not doing so increases the risk of serious complications.
When a patient affected by diabetes takes the necessary preventative foot care measures, it reduces the risks of serious foot
conditions such as ulceration and amputation.
How can a pedorthist help?
Footwear and orthotics play an important role in foot care for persons affected by diabetes to help
prevent serious injury and help an injury to heal.
The materials used for orthotics
for a foot affected by diabetes depend on the history of complications such as ulceration and the presence or absence of sensation
on the foot. A person affected by diabetes who has no history of complication and has normal sensation should have an
orthotic that will accommodate any abnormal mechanics to alleviate abnormal pressure on the foot. A person affected
by diabetes with an ulcer and no sensation requires an orthotic that will redistribute pressure away from the ulcer site and
allow it to heal. Plastazote is the most common material used to protect the insensitive foot affected by diabetes.
Footwear for the patient affected by diabetes is also key to preventing complications and should have
the following features:
- Footwear should have a toe box that is shaped like the
foot and is deep enough to protect the toes from excessive pressure;
- Removable
insoles are preferred for versatility in fitting, as they can be removed to insert orthotics if necessary, or modified themselves
to relieve pressure;
- Rocker soles on the shoes help to reduce pressure in the ball
of the foot, an area that is susceptible to pressure sores/ulcers;
- Firm Heel Counters
are recommended for support and stability.
Be sure to call your doctor immediately
if a cut, sore, blister, or bruise on your foot does not heal after one day.
What
can you do to protect your feet on a daily basis?
- Wear shoes and socks
at all times, even indoors
- Always check the insides of your shoes before putting
them on.
- Make sure the lining is smooth and there are no foreign objects
in the shoe, such as pebbles.
- Wear shoes that fit well and protect your feet.
- Protect your feet from hot and cold temperatures.
- Keep your
skin soft and smooth and trim toenails straight across.
- Have a professional take
care of your nails and skin if you cannot see well.
Metatarsalgia
What is it?
Metatarsalgia is a general term used to
describe a pain in the ball of the foot. Typically, someone suffering form metatarsalgia will report the pain is worse
when bearing weight and may feel like there is a stone in the shoe. There may be some callus formation at the site of
the pain.
What causes it?
With
this condition one or more metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long
period of time. Ball-of-the foot pain is often caused from poorly fitting footwear, most frequently in women's dress
shoes and other restrictive footwear. Footwear with a narrow toe box causes the ball-of-foot area to be squeezed into
an unnatural shape. This restricts the movement of the bones of the forefoot and can lead to extreme discomfort.
Other factors can cause excessive pressure in the ball-of-the foot area that can result in metatarsalgia.
These include shoes with heels that are too high, or participating in high-impact activities without proper footwear
and/or orthotics. Also as we get older, the fat pad in our foot tends to thin out, making us much more
susceptible to pain in the ball-of the-foot. Arthritis can also cause symptoms similar to metatarsalgia.
How can a pedorthist help?
Footwear is the first consideration
in treating metatarsalgia. If the footwear is inappropriate (if it has a hard sole, is high heeled or has an inappropriate
shape in the toe box) it must be changed in order to relieve pain. Footwear designed with a high, wide toe box (toe area)
and a rocker sole are ideal for treating metatarsalgia. The high wide toe box allows the foot to spread out while the rocker
sole reduces stress on the ball-of-the foot.
Unloading pressure to the ball-of-the
foot can be accomplished with orthotics or modifications to the inside of your shoes. Orthotics designed to relieve
ball-of-the foot pain usually feature a metatarsal pad. The orthotic is constructed with the pad placed behind the
ball-of-the foot to relieve pressure, and redistribute weight from the painful area to more tolerant areas.
Plantar Fasciitis
What is it?
The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot,
attaching at the bottom of the heel bone and extending to the toes. Plantar fasciitis is an imflammation caused by excessive
stretching of the plantar fascia causing micro-tears in the tissue.
Individuals who
suffer from plantar fasciitis often complain that their first steps out of bed in the morning are very painful. The
pain may subside with activity, but worsen again at the end of the day or after sitting for a period of time and then
getting up again.
With Plantar fasciitis, the bottom of your foot usually hurts near
the inside edge where the heel and arch meet. You may also commonly experience pain along the inside edge of your foot
between the heel and the ball of your foot.
What causes it?
Plantar fasciitis is usually an overuse injury that can be caused by:
- Over-pronation (which results in the arch collapsing upon weight bearing and over-stretching the fascia);
- A foot with a high arch (which results in an inflexible foot that does not absorb shock well);
- A sudden increase in physical activity;
- Excessive weight
on the foot (sudden weight gain as in pregnancy);
- Tight calf muscles (which decreases
the ankle's flexibility and increases the strain on the plantar fascia);
- Poor footwear
(which does not help to control the foot's mechanics or is too rigid).
How
can a pedorthist help?
The key for proper treatment of plantar faciitis
is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (common
with a low arched foot), an orthotic with rearfoot posting and longitudinal arch support is an effective device to reduce
the over-pronation and allow the condition to heal.
If the cause is your unusually high
arches, an orthotic that provides cushioning and stability to the foot as well as footwear that will complement your rigid
foot type (a good shock absorbing shoe) will be of most benefit.
Stretching of
the calf muscles is, surprisingly, a key component to helping treat plantar fasciitis. It is particularly useful in
reducing the early morning pain or pain when getting up from rest. The calf should be stretched gently before getting
up in the morning to reduce daily re-injury.
Other common treatments include plantar
fasciitis night splints and shoes with strong heel counters to control the amount of pronation and provide good cushioning
to the foot. A shoe with a good rocker sole at the toes can also be helpful in reducing the strain on the plantar fascia.
Heelpads can help to provide extra comfort and cushion the heel, but do not address the biomechanical abnormality that may
be causing the pain and is often not a good long-term solution.
Avoid running on
hard or uneven ground, lose any excess weight through a balanced exercise program.
Posterior Tibialis Tendonitis
What is it?
The posterior tibialis tendon is a tendon that runs along the inside of the ankle and foot. When
this tendon becomes weakened it does not hold up the arch, and can result in flattening of the arch. This can lead to
heel pain, arch pain, pain and swelling on the inside and below the ankle and tenderness at the inside edge of your foot.
Initally the pain may come and go, but eventually it becomes more regular with any walking or running.
What causes it?
Posterior tibialis tendonitis is an
inflammation of the tendon that runs along the inside of the ankle and attaches to the middle of the foot along the inside
edge. Inflammation may be caused by biomechanical factors such as abnormal pronation that repetitively stretches this
muscle and tendon. It can also result from being overweight, or from previous trauma, inflammatory diseases such as
rheumatoid arthritis, Reiter's syndrome or psoriatic arthritis. Excessive repetitive force such as running on a banked
track or road can also cause the inflammation.
How can a pedorthist help?
Subjective Findings:
- Progressive single sided arch collapse
- Pain may or may not be present
- Shoe distortion
- Difficulty Fitting Shoes
Pedorthist Application
- Properly fit shoe with extended medial counter
- Medial stabilizer
- Medial sole and heel
- Functional/corrective foot orthoses
to stop the over stretching of the posterior tibial tendon