• 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