Jo Vanhauen

Facts Concerning Foot Problems

Are Fallen Arches Flat Feet?

Overview

Flat Foot

The terms fallen arches and flat feet are used interchangeably to refer to a condition in which there is no arch of the foot. An arch is formed by tendons in the foot that stretch from the heel of the foot to the base of the toes, or metatarsals. There are also supporting tendons that originate in the lower leg. Together, these tendons work to form an arch, noticeable as a slight rise in the inner midsole of the foot. This rise or arch can be classified as a normal arch, a high arch, or a fallen arch. When tendons do not work together to pull properly, this results in a fallen arch or flat foot. Aside from the occasional pain associated with flat feet, problems with fallen arches can extend upwards to the ankles, knees, hips, and even the back, altering the biomechanics of the body.

Causes

A fallen arch occurs because one of the main structures that support the arch has broken or torn. Usually it occurs without trauma, although a small injury associated with the onset of the pain is often recalled, it is sometimes difficult to determine whether the injury was clearly big enough to permanently injure the leg. I suspect that even before the symptoms that the structure that broke was weakening and the injury was simply the ?needle that broke the camels back?. The structure that is most commonly torn is the posterior tibial tendon. This tendon is attached to a muscle on the inside of the back of the ankle, and runs along the medial malleolus, the bony prominence on the inside of the ankle, to attach to a bone in the arch called the navicular bone. It usually begins to weaken and stretch along the back of the medial malleolus. It often begins as a swelling and the arch flattens over the next several weeks to months. As the arch flattens, other structures that support the arch begin to stretch and tear. The bones along the outside of the ankle begin to crush together, causing pain and swelling in this are, and the toes may tilt to the outside as the arch collapses. It is not known why this process begins. It is often associated with diabetes and rheumatoid arthritis and other inflammatory diseases. It also is more common as a person enters the fifty to seventy year age range. ?Fallen arches? are much more common in people who are already flat footed.

Symptoms

Flat feet can cause a myriad of symptoms, from experiencing pain in the foot, heels, arch, calves, the shin, the knee, the hip and into the lower back due to overworking of the hip flexors or they may find it hard to stand on tip toes.

Diagnosis

Diagnosis of flat feet or fallen arches can be made by your health practitioner and is based on the following. Clinical assessment involving visual gait assessment, as well as biomechanical assessment. A detailed family and medical history. A pain history assessment determining the location of painful symptoms. Physical palpation of the feet and painful areas. Imaging such as MRI or x-ray can be used by your practitioner to assist in the diagnosis.

What does it mean when you have flat feet?

Non Surgical Treatment

Treatment of flat feet really depends on how far the damage has progressed. Conservative treatments often include immobilization (often by cast or brace) to reduce inflammation. Your doctor may also recommend anti-inflammatory medication (like ibuprofen) to get your inflamed tendon to calm down a bit. Orthotics can also offer significant relief. If these treatments fail to significantly improve symptoms, then surgery may be your best option to get the structure of your body back where it needs to be. Your podiatrist can discuss surgical options with you in great depth.

Surgical Treatment

Flat Feet

Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.

After Care

Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.
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Everything You Might Want To Understand About

Overview

Painful Heel

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Causes

While heel pain has many causes, it is usually the result of faulty biomechanics (abnormalities in the way we walk). This can place too much stress on the heel bone and the soft tissues attached to it. The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces; wearing poorly constructed footwear; or being significantly overweight. Systemic diseases such as arthritis and diabetes can also contribute to heel pain. A common cause of heel pain is the heel spur, a bony growth under the heel bone. There are no visible features on the heel, but a deep painful spot can be found in or around the middle of the sole of the heel (see diagram). Approximately 10 per cent of the population may have heel spurs without any pain. Heel spurs result from strain on the muscles of the foot. This may result from biomechanical imbalance, a condition occurring in many people. Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.Excessive rolling in of the feet when walking. An inflamed bursa (bursitis), a small, irritated sack of fluid at the back of the heel. A neuroma (a nerve growth). Other soft-tissue growths. Heel bumps or ?pump bumps?, a bone enlargement at the back of the heel bone. Bruises or stress fractures to the heel bone.

Symptoms

The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot especially after a long period of rest or inactivity. This is usually most pronounced in the morning when the foot is first placed on the floor. This symptom called first-step pain is typical of plantar fasciitis. Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.

Diagnosis

Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot. Surgery may be recommended in some cases.

Non Surgical Treatment

Once diagnosed, treatment for plantar fasciitis may include one or more of the following: advice on footwear, in particular use of arch-supportive footwear; avoid walking barefoot; stretching exercises, shoe modifications such as heel pads, taping and strapping, anti-inflammatories and orthotic devices to correct abnormal foot mechanics. Injection therapy with corticosteroids is only advisable if all the conservative treatment methods mentioned above have been exhausted due to undesired effects implicated with steroid infusion in the heels.

Surgical Treatment

Surgery to correct heel pain is generally only recommended if orthotic treatment has failed. There are some exceptions to this course of treatment and it is up to you and your doctor to determine the most appropriate course of treatment. Following surgical treatment to correct heel pain the patient will generally have to continue the use of orthotics. The surgery does not correct the cause of the heel pain. The surgery will eliminate the pain but the process that caused the pain will continue without the use of orthotics. If orthotics have been prescribed prior to surgery they generally do not have to be remade.

heel pads shoes too big

Prevention

Pain Under The Heel

You can try to avoid the things that cause heel pain to start avoid becoming overweight, where your job allows, minimise the shock to your feet from constant pounding on hard surfaces, reduce the shocks on your heel by choosing footwear with some padding or shock-absorbing material in the heel, if you have high-arched feet or flat feet a moulded insole in your shoe may reduce the stresses on your feet, if you have an injury to your ankle or foot, make sure you exercise afterwards to get back as much movement as possible to reduce the stresses on your foot and your heel in particular, If you start to get heel pain, doing the above things may enable the natural healing process to get underway and the pain to improve.

Leg Length Discrepancy Lift

Overview

The majority of people in the world actually have some degree of leg length discrepancy, up to 2cm. One study found that only around 1/4 of people have legs of equal lengths. LLD of greater than 2cm is relatively rare, however, and the greater the discrepancy, the greater the chances of having a clinical problem down the road. A limp generally begins when LLD exceeds 2cm and becomes extremely noticeable above 3cm. When patients with LLD develop an abnormal gait, one of the debilitating clinical features can be fatigue because of the relatively high amount of energy needed to walk in the new, inefficient way. Poliomyelitis, or polio, as it is more commonly known, used to account for around 1/3 of all cases of LLD, but due to the effectiveness of polio vaccines, it now represents a negligible cause of the condition. Functional LLD, described above, usually involves treatment focused on the hip, pelvis, and/or lower back, rather than the leg. If you have been diagnosed with functional LLD or pelvic obliquity, please ask your orthopaedic surgeon for more information about treatment of these conditions.Leg Length Discrepancy

Causes

Common causes include bone infection, bone diseases, previous injuries, or broken bones. Other causes may include birth defects, arthritis where there is a loss of articular surface, or neurological conditions.

Symptoms

Many people walk around with LLD?s of up to 2 cm. and not even know it. However, discrepancies above 2 cm. becomes more noticeable, and a slight limp is present. But even up to 3 cm. a small lift compensates very well, and many patients are quite happy with this arrangement. Beyond 3 cm. however, the limp is quite pronounced, and medical care is often sought at that point. Walking with a short leg gait is not only unsightly, but increases energy expenditure during ambulation. It could also put more stress on the long leg, and causes functional scoliosis. Where the discrepancy is more severe, walking becomes grotesque or virtually impossible.

Diagnosis

Asymmetry is a clue that a LLD is present. The center of gravity will shift to the short limb side and patients will try to compensate, displaying indications such as pelvic tilt, lumbar scoliosis, knee flexion, or unilateral foot pronation. Asking simple questions such as, "Do you favor one leg over the other?" or, "Do you find it uncomfortable to stand?" may also provide some valuable information. Performing a gait analysis will yield some clues as to how the patient compensates during ambulation. Using plantar pressure plates can indicate load pressure differences between the feet. It is helpful if the gait analysis can be video-recorded and played back in slow motion to catch the subtle aspects of movement.

Non Surgical Treatment

The key to treatment of LLD in a child is to predict what the discrepancy is at maturity. If it is predicted to be less than 2 cm., no treatment is needed. Limb length discrepancies of up to 2 or 2.5 cm. can be compensated very well with a lift in the shoe. Beyond 2.5 cm., it becomes increasingly difficult to compensate with a left in the insole. Building up the shoe becomes uncosmetic and cumbersome, and some other way of compensating for the discrepancy becomes necessary. The treatment of LLD is long-term treatment, and involves the physician and patient?s family working together as a team. The family needs to weigh the various options available. If leg lengthening is decided on, the family needs to understand the commitment necessary to see it through. The treatment takes 6 months to a year for completion, and complications can happen. But when it works, the results are gratifying.

Leg Length Discrepancy Insoles

how to increase height naturally after 18

Surgical Treatment

Surgical operations to equalize leg lengths include the following. Shortening the longer leg. This is usually done if growth is already complete, and the patient is tall enough that losing an inch is not a problem. Slowing or stopping the growth of the longer leg. Growth of the lower limbs take place mainly in the epiphyseal plates (growth plates) of the lower femur and upper tibia and fibula. Stapling the growth plates in a child for a few years theoretically will stop growth for the period, and when the staples were removed, growth was supposed to resume. This procedure was quite popular till it was found that the amount of growth retarded was not certain, and when the staples where removed, the bone failed to resume its growth. Hence epiphyseal stapling has now been abandoned for the more reliable Epiphyseodesis. By use of modern fluoroscopic equipment, the surgeon can visualize the growth plate, and by making small incisions and using multiple drillings, the growth plate of the lower femur and/or upper tibia and fibula can be ablated. Since growth is stopped permanently by this procedure, the timing of the operation is crucial. This is probably the most commonly done procedure for correcting leg length discrepancy. But there is one limitation. The maximum amount of discrepancy that can be corrected by Epiphyseodesis is 5 cm. Lengthening the short leg. Various procedures have been done over the years to effect this result. External fixation devices are usually needed to hold the bone that is being lengthened. In the past, the bone to be lengthened was cut, and using the external fixation device, the leg was stretched out gradually over weeks. A gap in the bone was thus created, and a second operation was needed to place a bone block in the gap for stability and induce healing as a graft. More recently, a new technique called callotasis is being use. The bone to be lengthened is not cut completely, only partially and called a corticotomy. The bone is then distracted over an external device (usually an Ilizarov or Orthofix apparatus) very slowly so that bone healing is proceeding as the lengthening is being done. This avoids the need for a second procedure to insert bone graft. The procedure involved in leg lengthening is complicated, and fraught with risks. Theoretically, there is no limit to how much lengthening one can obtain, although the more ambitious one is, the higher the complication rate.
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Mortons Neuroma Remedy

Overview

intermetatarsal neuromaMorton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton's neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock. Morton's neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb. High-heeled shoes have been linked to the development of Morton's neuroma. Many people experience relief by switching to lower heeled shoes with wider toe boxes. Sometimes corticosteroid injections or surgery may be necessary.

Causes

A Morton?s Neuroma are a result of complex biomechanical changes that occur in your feet. There are a number of theories as to the exact cause of the scarring and thickening, but it basically boils down to overload of the tissue structure. The body lays down scar tissue to try to protect the overloaded structure. Tight-fitting shoes may exacerbate a Morton?s Neuroma. Shoes such as high heels and shoes with tight toe boxes (eg womens fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box. The slope causes the front of the foot to bear your weight. The angle of the toe box then squeezes your toes together. Footwear is not the only cause of a Morton?s Neuroma. Injuries to the foot can also be a factor in developing the condition by changing your foot biomechanics. Poor foot arch control leading to flat feet or foot overpronation does make you biomechanically susceptible to a neuroma.

Symptoms

Morton's neuroma may cause Burning, pain, tingling, and numbness often shooting into the toes. Discomfort that is worse while walking. Feeling of a lump between the toes. Symptoms are usually temporarily relieved when taking off shoes, flexing toes or rubbing feet.

Diagnosis

The diagnosis of interdigital neuroma is usually made by physical examination and review of the patient's medical history.MRI ad High Definition Ultrasound examination may be useful to confirm the diagnoses however they may still not be 100% reliable. The commonest reason for this is de to natural substances present in between the metatarsal heads and between the fat pad and the intermetatarsal ligament. These natural substances i.e. bursa, fat, capsular thickening and even bony growths, can all be a factor in the impingement process and may need to be surgically cleared.

Non Surgical Treatment

If your Morton's neuroma is painful, your doctor usually will begin treatment with conservative therapies, including a switch to shoes with low heels, wide toes and good arch support. Padding techniques, including metatarsal pads or toe crest pads. Shoe inserts (orthotics) to help correct any mechanical imbalance in the foot. Anti-inflammatory medication, such as ibuprofen (Advil, Motrin and other brand names) or naproxen (Aleve, Naprosyn and other brand names) A local injection of anesthetic and corticosteroid medication into the affected area. Inflamed or injured nerves can take months to improve, even after the underlying problem has been corrected.interdigital neuroma

Surgical Treatment

Should the problem have progressed beyond the point where these measures are sufficient, the podiatric professional may recommend surgery. This procedure involves excision of the involved nerve mass. This will relieve the pain. Many patients report permanent numbness in the spot formerly affected by the neuroma, but prefer it to the pain. Most surgeries are successful; unfortunately, there are cases where the patient suffers another neuroma, sometimes in or near the same spot as before. A podiatric professional can explain the statistics of recurrence in various cases. If you suspect a neuroma, don?t wait for it to get better on its own. The earlier the diagnosis, the higher the likelihood that it can be treated with conservative measures. Don?t think that foot pain of any kind is inevitable, either, even if it runs in your family.
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Are Shoe Lifts The Best Solution To Leg Length Imbalances

There are not one but two different kinds of leg length discrepancies, congenital and acquired. Congenital indicates you are born with it. One leg is anatomically shorter compared to the other. As a result of developmental stages of aging, the brain picks up on the stride pattern and recognizes some variation. The human body typically adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch isn't grossly excessive, does not need Shoe Lifts to compensate and ordinarily won't have a profound effect over a lifetime.

Shoe Lift

Leg length inequality goes mainly undiagnosed on a daily basis, yet this issue is easily fixed, and can eliminate numerous cases of lower back pain.

Therapy for leg length inequality commonly consists of Shoe Lifts . Most are very reasonably priced, ordinarily being less than twenty dollars, compared to a custom orthotic of $200 or higher. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Back ache is easily the most widespread condition afflicting men and women today. Over 80 million men and women suffer from back pain at some point in their life. It's a problem that costs companies millions of dollars yearly as a result of lost time and productivity. Fresh and better treatment methods are constantly sought after in the hope of reducing the economical influence this issue causes.

Shoe Lift

People from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In these types of situations Shoe Lifts can be of very useful. The lifts are capable of alleviating any pain and discomfort in the feet. Shoe Lifts are recommended by countless skilled orthopaedic practitioners".

So as to support the body in a balanced fashion, your feet have got a critical function to play. In spite of that, it is often the most overlooked region in the body. Many people have flat-feet meaning there may be unequal force placed on the feet. This causes other body parts such as knees, ankles and backs to be impacted too. Shoe Lifts make sure that suitable posture and balance are restored.

The Ideal Solution To Leg Length Discrepancy Are Shoe Lifts

There are actually two different kinds of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is structurally shorter than the other. As a result of developmental stages of aging, the human brain senses the walking pattern and identifies some difference. The body usually adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch is not grossly uncommon, require Shoe Lifts to compensate and usually does not have a serious effect over a lifetime.

Leg Length Discrepancy Shoe Lifts

Leg length inequality goes mainly undiscovered on a daily basis, yet this issue is very easily fixed, and can reduce many cases of back pain.

Treatment for leg length inequality typically involves Shoe Lifts. Most are affordable, commonly priced at less than twenty dollars, compared to a custom orthotic of $200 and up. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Chronic back pain is easily the most common ailment afflicting people today. Over 80 million men and women are afflicted by back pain at some stage in their life. It's a problem which costs businesses millions each year due to time lost and productivity. Fresh and superior treatment solutions are always sought after in the hope of minimizing the economic impact this issue causes.

Shoe Lifts

People from all corners of the world experience foot ache due to leg length discrepancy. In a lot of these cases Shoe Lifts can be of very helpful. The lifts are capable of eliminating any discomfort in the feet. Shoe Lifts are recommended by many qualified orthopaedic orthopedists.

So that they can support the body in a well-balanced manner, feet have a critical role to play. Irrespective of that, it's often the most overlooked region of the body. Many people have flat-feet which means there may be unequal force exerted on the feet. This causes other parts of the body such as knees, ankles and backs to be affected too. Shoe Lifts make sure that ideal posture and balance are restored.

Ways To Diagnose Posterior Calcaneal Spur

Calcaneal Spur

Overview

A heel spur is a hook of bone that can form on the heel bone of the foot. Heel spurs are associated with plantar fasciitis. Heel spurs can cause extreme pain in the rearfoot. The pain is most intense while standing or walking. What Causes Heel Spurs? Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia stretches and pulls away from the heel. The plantar fascia is a ligament located at the bottom of your foot. This stretching of the plantar fascia is usually the result of flat feet or unusually high arches.

Causes

You are more likely to develop plantar fasciitis and heel spurs if you are Active. Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. running, ballet dancing and aerobics. Overweight. Carrying around extra weight increases the strain and stress on your plantar fascia. Pregnant. The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation. On your feet. Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses. Flat Feet or High Foot Arches. Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force. Middle-Aged or Older. With ageing the arch of your foot may begin to sag - putting extra stress on the plantar fascia. Wearing shoes with poor support. Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury. Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis. Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.

Calcaneal Spur

Symptoms

If your body has created calcium build-ups in an effort to support your plantar fascia ligament, each time you step down with your foot, the heel spur is being driven into the soft, fatty tissue which lines the bottom of your heel. Heel spur sufferers experience stabbing sensations because the hard protrusion is literally being jabbed into the heel pad. If left untreated, Plantar Fasciitis and heel spurs can erode the fatty pad of the heel and cause permanent damage to the foot. Fortunately, most cases can be resolved without medications or surgeries.

Diagnosis

Your doctor will discuss your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray or blood tests (to rule out diseases or infections) may be requested.

Non Surgical Treatment

Elevation of the affected foot and leg at rest may diminish the pain. Applying gentle heat to the painful area may ease the pain by dilating local blood vessels. One also can protect the heel by placing a foam rubber pad in the heel of the shoe. A pad about one-half inch thick will raise the heel, shift the weight of the body forward, and protect the irritated muscles attached to the heel bone. The same effect can be achieved by using adhesive tape to turn the foot inward. Additional treatment may consist of a number of physical therapies, such as diathermy, ultrasound waves and whirlpool baths.

Surgical Treatment

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide pain relief and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. The procedure may also include removal of heel spurs.