Common Foot Problems
Foot Dynamics can Help Your Feet from Hurting
Plantar Fasciitis (Foot Pain)
The plantar fascia is a dense band of fibrous tissue that originates at the ball of the foot and connects at the heel. It stretches and contracts each time the foot is used, and is prone to overuse especially if the arch is not supported by proper footwear. As the fascia micro-tears at its attachment to the heel, it can cause heel spurs, or small areas of calcification at the heel. Effective treatment should include arch support with custom orthotics or off-the-shelf inserts. Other treatment includes stretching the gastrocnemius complex, icing, anti-inflammatory medications, ultrasound, taping methods, night splints, and massage.
Metatarsalgia and Neuromas
Interdigital neuromas are among the most common referring diagnoses. Nerves between the toes become compressed and inflamed; typically occurring in the 3rd web space but also common in the 2nd web space (Morton’s neuromas). Neuromas can develop secondary to adjacent joint inflammation (ex: sesamoiditis or hallux limitus). Pain is often described as tingling, numbness, or shooting pain. Treatment includes metatarsal pads (met cookies) or met. bars incorporated into a custom orthotic with ample arch support, and wider shoes. Metatarsalgia is a generic term referring to forefoot pain that may or may not be caused by a neuroma. The treatment for Metatarsalgia is generally the same style of foot orthotics.
IT Band Pain and Other Knee Pain
Pain in the knees can be due to excessive pronation or supination, excess weight, running on an incline, arthritis, prior surgery, overuse, or other reasons. For a cyclist faulty cleat position, overuse, or improper bike fit can cause knee pain. Custom orthotics will help hold the foot in a neutral, supported position that decreases internal rotation of the lower leg thus reducing forces on the knees. IT Band (Iliotibial band) pain is generally caused by excessive rotation of the tibia as a result of excessive pronation. Custom foot orthotics help to control this motion thus reducing inflammation and discomfort. Reducing heel height of the footwear, like Altra “Zero Drop” shoes, will also decrease knee torsions.
Shin splints present as pain along the tibia (shin) that gradually develops over weeks. The medical term for shin splints is periostitis, which means there is inflammation of the periosteum, a dense membrane composed of fibrous connective tissue that closely wraps the bone. Predisposing factors include training errors, anatomic variations, poor running technique, or poor equipment. A weak or tight Achilles tendon may be involved, as are the muscles responsible for lifting up the foot. A custom foot orthotic to support the foot and prevent over pronation, along with supportive, shock absorbing shoe are recommended. Treatment also involves rest, ice, stretching, and massage. Reducing heel height of the footwear, like Altra “Zero Drop” shoes, will also decrease knee torsions.
General arch pain may have a variety of causes including Plantar Fascia strain, midtarsal stress from lack of join mobility in the ankle or arthritic conditions. Custom foot orthotics effectively treat general arch pain by minimizing motion in the midtarsal joint and supports the arch.
The scope of diabetes is too large to fully discuss here, however it is crucial to point out that its affects on the feet can be devastating. Diabetic complications in relation to the feet include insensitivity, pain, motor weakness, vascular impairment, poor wound healing, and autonomic temperature regulation impairment. Loss of protective sensation and poor wound healing can lead to a variety of problems with the integument (skin, hair, nails). Any sort of friction or shearing to diabetic foot will increase the chance of infection and ulcers which can be life threatening. Effective treatment involves educating patients on foot care, ensuring the patient is wearing breathable, protective, seam-free footwear that is not rubbing anywhere on the foot, and custom foot orthotics topped with a plastazote and/or Poron® top cover material.
Hip pain can be associated with a leg length difference, hip surgery, tight or strained muscles, arthritis, degenerative joint disease, poor posture, or a variety of other causes. If, upon evaluation, a leg length difference of ⅜” or more is believed to be a cause for this pain, a heel lift can be incorporated into a custom orthotic or may be placed under the foot inside the shoe. Leg length differences in excess of ¾” will require a build-up made to the outside of the shoe. Reducing heel height of the footwear, like Altra “Zero Drop” shoes, will also decrease hip torsions.
Lower Back Pain
Pain in the lower back can be associated with a leg length difference, excess weight, weak abdominal muscles, tight hamstring muscles, poor posture, arthritis, pinched nerves, injury, herniated discs, or a variety of other conditions. Custom foot orthotics can help ease lower back pain if the pain is associated with poor posture, pronated feet, and/or a leg length discrepancy. Once the feet are supported and aligned properly by a custom orthotic, lower back pain will often disappear.
Arthritic Conditions Managed by Foot Orthotics and Custom Inserts
Age-related wearing of the cartilage, abnormal mechanical stress on a joint, trauma, or infection, will result in inflammation of the joint. As cartilage is destroyed by-products accumulate in the joint, resulting in inflammation. In response to this, osteophytes (bony protuberances) form and there is thickening of the bone around the joint which leads to stiffness.
This type of arthritis is mechanical. Foot joints typically include the first metatarsophalangeal joint and mid foot joints. Sometimes the ankle can also be involved. Symptoms are localized to the affected joint and include pain and stiffness with activity that is relieved by rest. Joint swelling and enlargement are also noted. Custom orthotics can help reduce motion in the affected joint, thereby reducing pain; transfer pressure areas, and provide cushion and shock absorption.
This is a type of seropositive arthritis whereby the destruction occurs from the inside of the joint outwards. The immune system most commonly attacks the cartilage in the metatarsophalangeal, talonavicular, and subtalar joints, causing extreme pain and sometimes deformity. Rheumatoid arthritis also typically affects the joints of the hands and fingers. The rheumatoid patient requires extra depth shoes to accommodate cross-over toes, hammer toes, claw toes, and painful joints. Care should be taken to create a supportive, comfortable orthotic to accommodate the painful metatarsal heads and rheumatoid nodules. A Pedorthist will also fit the patient with extra depth shoes.
People with this arthritis experience a type of inflammatory joint disease along with the skin disorder psoriasis. The psoriasis condition involves discomfort and progressive disfigurement. The arthritis element involves joint pain, swelling, and stiffness. It usually strikes one side of the body, involves the most distal joints of the fingers and toes, and affects both genders equally. A Pedorthist will fit the patient with shoes that allow for swelling and tenderness, and also create a custom foot orthotic which can assist in relieving pressure and friction to the sensitive areas.
Peripheral neuropathy leads to insensitivity of joints that undergo repetitive trauma from use and begin to fragment, leading to deformity. A patient with such deformity will be fitted for a custom made shoes or extra depth shoes made on a last which closely matches the shape of the foot. Overall, the objectives for foot orthotics for a patient with arthritis are to: relieve pressure, transfer pressure, limit or restrict motion, replace lost motion, provide cushion and shock absorption, accommodate deformities, provide support, and decrease shear.