Fallen Arches Causes And Symptoms

Overview

Flat Feet

Flat feet and fallen arches are common conditions that are in most cases asymptomatic. However, in patients who do have symptoms, treatments are available that can help reduce pain and promote efficient movement. Orthotic devices are well recognised as an excellent treatment and podiatrists can offer these different treatment modalities as individualised treatments for patients.

Causes

Flat feet in adults can appear for a number of reasons. Arches never developed properly. Damage to the tendons that support the arch. Damage or inflammation of the posterior tibial tendon which runs from your lower leg, down and across your ankle, and connects to the middle of the arch. Trauma involving broken bones in the foot. Rheumatoid arthritis. Aging, pregnancy, nerve damage, obesity or even diabetes.

Symptoms

Structural problems in your feet like fallen arches can alter your walking pattern, running pattern and cause pain throughout your body. Clear and accurate assessment of the mechanics of your lower limbs is key to understanding the profound effect that subtle faults in your foot, ankle, knee and hip alignment can cause.

Diagnosis

Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.

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Non Surgical Treatment

If you have flat feet and foot pain, especially if one foot is flatter than the other, you should have an evaluation by an orthopedic surgeon . You may have a problem with the posterior tibial tendon , the main tendon that supports the arch. Factors that can contribute to this problem are obesity, diabetes , high blood pressure , certain types of arthritis and athletic overuse. In some cases a shoe insert/orthotic can be used to alleviate the symptoms of flat feet.

Surgical Treatment

Flat Feet

Generally one of the following procedures is used to surgically repair a flat foot or fallen arch. Arthrodesis. One or more of your bones in the foot or ankle are fused together. Osteotomy. Correcting alignment by cutting and reshaping a bone. Excision. Removing a bone or a bone spur. Synovectomy. Cleaning the sheath that covers the tendon. Tendon transfer. Using a piece of one tendon to lengthen or replace another. Arthroereisis. placing a small device in the subtalar joint to limit motion. For most people, treatment is successful, regardless of the cause, although the cause does does play a major role in determining your prognosis. Some causes do not need treatment, while others require a surgical fix.

Prevention

Orthotic inserts, either prescribed or bought over the counter, can help keep the arches fixed into position, but always wear them as although they support, they don?t strengthen, which is why some experts reccomend avoiding them. Gait analysis at a run specialist can help to diagnose overpronation and flat feet. Most brands produce shoes that will give support and help to limit the negative effects of a poor gait on the rest of the body. Barefoot exercises, such as standing on a towel and making fists with the toes, can help to strengthen the arches. Start easy and build up the reps to avoid cramping. Short barefoot running sessions can help take pressure off the arches by using the natural elasticity of the foot?s tendons to take impact and build strength to help prevent flat feet. These should be done on grass for only a few minutes at a time.
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What Are The Major Causes Of Heel Ache

Overview

Feet Pain

Heel pain is usually felt either under the heel or just behind it. Heel pain has a prevalence of 3.6%. US studies estimate that 7% of older adults report tenderness under the heel. Plantar fasciitis is estimated to account for 8% of all running-related injuries. There are 26 bones in the human foot, of which the heel is the largest. Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe. In most cases the pain is under the foot, towards the front of the heel. The majority of patients recover with conservative treatments within months. Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain. To prevent heel pain, it's recommended to reduce the stress on that part of the body.

Causes

Heel pain can have many causes. If your heel hurts, see your primary care doctor or orthopaedic foot and ankle specialist right away to determine why and get treatment. Tell him or her exactly where you have pain and how long you've had it. Your doctor will examine your heel, looking and feeling for signs of tenderness and swelling. You may be asked to walk, stand on one foot or do other physical tests that help your doctor pinpoint the cause of your sore heel. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.

Symptoms

See your doctor as soon as possible if you experience severe pain accompanied by swelling near your heel. There is numbness or tingling in the heel, as well as pain and fever. There is pain in your heel as well as fever. You are unable to walk normally. You cannot bend your foot downwards. You cannot stand with the backs of the feet raised (you cannot rise onto your toes). You should arrange to see a doctor if the heel pain has persisted for more than one week. There is still heel pain when you are not standing or walking.

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

Curing posterior heel pain requires calming the inflammation, resting the foot and increasing calf flexibility. Ice therapy and anti-inflammatory medications can be used to reduce the inflammation. Stopping exercises that stress the calf and Achilles is important. This includes walking, running and the use of stair climbers and elliptical machines. Placing a heel lift in each shoe can reduce some of the excess strain on the back of the heel. Stretching exercises to increase calf flexibility are important in curing this problem and preventing its recurrence. Wearing running shoes also provides good foot support and helps with this condition. Sometimes a walking boot is used to immobilize the ankle and let the area completely rest. Physical therapy is sometimes ordered to help reduce the inflammation and pain and to help improve the flexibility of the calf muscles. Occasionally these measures fail to relieve the pain and surgery may be needed. The surgical procedure involves removing bone spurs and repairing any damage to the tendon.

Surgical Treatment

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

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Prevention

Foot Pain

Make sure you wear appropriate supportive shoes. Don't over-train in sports. Make sure you warm up, cool down and undertake an exercise regime that helps maintain flexibility. Manage your weight, obesity is a factor in causing plantar fasciitis. Avoid walking and running on hard surfaces if you are prone to pain. You should follow the recognized management protocol "RICED" rest, ice, compression, elevation and diagnosis. Rest, keep off the injured ankle as much as possible. Ice, applied for 20 minutes at a time every hour as long as swelling persists. Compression, support the ankle and foot with a firmly (not tightly) wrapped elastic bandage. Elevation, keep foot above heart level to minimize bruising and swelling. Diagnosis. Consult a medical professional (such as a Podiatrist or doctor) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment. An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.
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Leg Length Discrepancy Measurements

Overview

Leg length discrepancy is the difference in lengths of an individual?s legs. This difference may be anatomical or may be due to scoliosis, trauma/injury, arthritis, overpronation (collapse) of one foot, bowing of one leg or unequal bowing, surgery (hip or knee replacement), pelvic tilting or ageing. The difference can also be functional caused by differing forces of the soft tissues, such as weakness in muscle tissue on one side, or a weakness/tightness in joint tissue. A difference in leg lengths also results when running on indoor banked tracks, beaches and banked streets and side walks (for drainage). Many people have a measurable difference in their leg lengths which is compensated for by their bodies. As we age this compensation does not work as well. An x-ray and physical measurements will define the discrepancy and the adjustment needed.Leg Length Discrepancy

Causes

From an anatomical stand point, the LLD could have been from hereditary, broken bones, diseases and joint replacements. Functional LLD can be from over pronating, knee deformities, tight calves and hamstrings, weak IT band, curvature in the spine and many other such muscular/skeletal issues.

Symptoms

The effects of a short leg depend upon the individual and the extent of discrepancy. The most common manifestation if a lateral deviation of the lumbar spine toward the short side with compensatory curves up the spine that can extend into the neck and even impacts the TMJ. Studies have shown that anterior and posterior curve abnormalities also can result.

Diagnosis

The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.

Non Surgical Treatment

For minor limb length discrepancy in patients with no deformity, treatment may not be necessary. Because the risks may outweigh the benefits, surgical treatment to equalize leg lengths is usually not recommended if the difference is less than 1 inch. For these small differences, the physician may recommend a shoe lift. A lift fitted to the shoe can often improve walking and running, as well as relieve any back pain that may be caused by the limb length discrepancy. Shoe lifts are inexpensive and can be removed if they are not effective.

LLD Shoe Inserts

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Surgical Treatment

Limb deformity or leg length problems can be treated by applying an external frame to the leg. The frame consists of metal rings which go round the limb. The rings are held onto the body by wires and metal pins which pass through the skin and are anchored into the bone. During this operation, the bone is divided. Gradual adjustment of the frame results in creation of a new bone allowing a limb to be lengthened. The procedure involves the child having an anaesthetic. The child is normally in hospital for one week. The child and family are encouraged to clean pin sites around the limb. The adjustments of the frame (distractions) are performed by the child and/or family. The child is normally encouraged to walk on the operated limb and to actively exercise the joints above and below the frame. The child is normally reviewed on a weekly basis in clinic to monitor the correction of the deformity. The frame normally remains in place for 3 months up to one year depending on the condition which is being treated. The frame is normally removed under a general anaesthetic at the end of treatment.
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Mortons Neuroma Overview

Overview

Morton neuromaA morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.

Causes

Unfortunately, the cause of Morton?s Neuroma remains unknown to researchers. It is likely that a variety of factors may play a role in the development of this condition, including the presence of chronic pain conditions like fibromyalgia. Factors that may contribute to the development of Morton?s Neuroma include Wearing improperly fitting shoes can cause pressure on your foot, leading to swelling around the toe nerves. High heels are of particular concern as they cause a large amount of weight to be shifted to the ball of the foot. Repetitive activities like jogging, walking, and aerobics can also place a lot of pressure on the feet. This could lead to Morton?s Neuroma. Having a previous foot or muscle injury may cause you to hold your foot in a poor position when walking, contributing to nerve inflammation. Some people are just born with poorly shaped feet. People with extremely low arches or "flat feet" may suffer from Morton?s Neuroma more than others.

Symptoms

Normally, there are no outward signs, such as a lump, because this is not really a tumor. Burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare. There may also be numbness in the toes, or an unpleasant feeling in the toes. Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position to the push-off, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.

Diagnosis

During the examination, your physician will feel for a palpable mass or a "click" between the bones. He or she will put pressure on the spaces between the toe bones to try to replicate the pain and look for calluses or evidence of stress fractures in the bones that might be the cause of the pain. Range of motion tests will rule out arthritis or joint inflammations. X-rays may be required to rule out a stress fracture or arthritis of the joints that join the toes to the foot.

Non Surgical Treatment

Treatment for Morton?s neuroma will depend on how long you've had the condition and its severity. Simple non-surgical treatments are effective for some people. Others may need surgery. If Morton's neuroma is diagnosed early, treatment will aim to reduce the pressure on the affected nerve. This is usually the nerve between the third and fourth toe bones (metatarsals). Your GP or podiatrist (foot specialist) may recommend changing the type of shoes you usually wear, shoes with a wider toe area may help ease the pressure on the nerve in your foot. Using orthotic devices, such as a support for the arch of your foot to help relieve the pressure on the nerve. Anti-inflammatory painkillers or a course of steroid injections into the affected area of your foot may help ease the pain and inflammation. Alcohol and local anaesthetic is injected into your foot using ultrasound for guidance, studies have shown that this type of treatment is effective. Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.Morton

Surgical Treatment

Operative treatment of Morton?s neuroma should be entertained only after failure of non-operative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritated/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although an incision on the sole (plantar) aspect of the foot can be used. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament, and freeing the nerve of local scar tissue. This may also be beneficial.
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Shoe Lifts For Leg Length Discrepancy

There are actually not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates you are born with it. One leg is structurally shorter compared to the other. As a result of developmental phases of aging, the brain senses the walking pattern and identifies some variation. The human body typically adapts by tilting one shoulder to the "short" side. A difference of under a quarter inch isn't blatantly uncommon, doesn't need Shoe Lifts to compensate and mostly doesn't have a profound effect over a lifetime.

Shoe Lifts

Leg length inequality goes largely undiagnosed on a daily basis, however this issue is easily corrected, and can eliminate many incidents of back ache.

Therapy for leg length inequality commonly involves Shoe Lifts. These are economical, usually priced at under twenty dollars, in comparison to a custom orthotic of $200 or maybe more. 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.

Low back pain is easily the most prevalent ailment afflicting people today. Around 80 million men and women are afflicted by back pain at some stage in their life. It is a problem which costs businesses huge amounts of money year after year as a result of time lost and productivity. New and more effective treatment solutions are continually sought after in the hope of lowering economical impact this issue causes.

Shoe Lift

People from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In most of these cases Shoe Lifts can be of very useful. The lifts are capable of eliminating any discomfort in the feet. Shoe Lifts are recommended by many specialist orthopaedic physicians.

So that you can support the human body in a nicely balanced manner, feet have got a significant task to play. Irrespective of that, it is sometimes the most overlooked area of the human body. Some people have flat-feet meaning there is unequal force exerted on the feet. This causes other parts of the body including knees, ankles and backs to be impacted too. Shoe Lifts ensure that correct posture and balance are restored.
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What Are The Signs And Symptoms Of Calcaneal Spur

Heel Spur

Overview

Heel Spurs should be called a traction spurs because they grow in the same direction that the tendons pull away from the heel bone, which is why it can occur on the bottom of the heel (Plantar Fasciitis) and on the back of the heel (Achilles Tendonitis). Some patients may only develop one type of heel spur, but both these problems are closely related so it's not unusual for a patient to have both heel spurs. It's important to note though that most heel spurs aren't the cause of your heel pain.

Causes

Causes of Heel Spur Syndrome are mostly due to your foot structure. Foot structure is due to hereditary for the most part, meaning it was the way you were when born. Other factors such as increase in weight, injury, improper shoes, or different activities may change the way your foot functions as well. If one leg is longer or shorter than the other, this may make your foot function improperly and be the cause of the heel spur syndrome. Improper shoes may be ones that are new or ones that are worn out and do not give good support. The higher priced shoes do not mean it's a better shoe. Pronation is a term used to describe a foot which allows the arch to fall more than normal and allows for the fascia along the bottom of the foot to put a tighter pull or a different angle of pull on the heel bone. Over time, this constant pull of the tight fascia can force the bone to enlarge and form a spur. It is not the heel spur that causes the pain directly. The spur may cause pressure against a nearby nerve causing a neuritis, or a bursa causing a bursitis.

Inferior Calcaneal Spur

Symptoms

Heel spur is characterised by a sharp pain under the heel when getting out of bed in the morning or getting up after sitting for a period of time. Walking around for a while often helps reduce the pain, turning it into a dull ache. However, sports, running or walking long distance makes the condition worse. In some cases swelling around the heel maybe present.

Diagnosis

A thorough history and physical exam is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.

Non Surgical Treatment

Many treatment options exist, and good results are often observed. Generally, a calcaneal spur develops when proper care is not given to the foot and heels. It is often seen as a repetitive stress injury, and thus lifestyle modification is typically the basic course of management strategies. To alleviate heel spur pain, a person should begin doing foot and calf workouts. Strong muscles in the calves and lower legs will help take the stress off the bone and thus help cure or prevent heel spurs. Icing the area is an effective way to get immediate pain relief.

Surgical Treatment

Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well. Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.

The Best Ways To Prevent Posterior Calcaneal Spur

Heel Spur

Overview

A heel spur is a deposit of calcium on the heel bone. This calcification takes the form of a bony protrusion, which can cause considerable pain when standing and walking. This foot problem is closely related to plantar fasciitis, a condition in which the band of fibrous tissue on the bottom of the foot becomes over-stressed. It pulls away from the heel and causes the calcium deposits to form. For this reason, treating a heel spur involves treating the plantar fascia as well.

Causes

Causes for heel spurs (and related plantar fasciitis) include increase or change in activity, lack of arch support or poor shoe choice, injury, inflexibility in Achilles tendon and calf muscles, and spending hours daily on the feet. Also, arthritis from aging is often a common cause of bone loss and natural cushioning under the heel. Tarsal tunnel syndrome can also be to blame. Ultimately, in the United States, the most likely cause of this pain is being overweight. With more than 60% of the nation obese or morbidly obese, foot pain related to excessive weight is most likely. Dietary changes are most likely to cause long-term relief for bone spurs and plantar fasciitis.

Calcaneal Spur

Symptoms

It is important to be aware that heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain and it may be worse in the morning when you first wake up or during certain physical activities such as, walking, jogging, or running.

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

The majority of heel spurs are treated with non-surgical interventions. These can relieve pain, but may take from about 3 months to up to a year for symptoms to resolve. Rest, icing, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Cortisone injections may also be used. Physical therapists may instruct you to perform stretching exercises to help relax the tissues in the heel. Your doctor may recommend custom orthotics or shoe inserts to position and cushion your heel. Night splints can help position the heel and arch of the foot while you sleep. Some doctors may recommend extracorporeal shock wave therapy (ESWT). This treatment uses energy pulses to start the repair process in the heel tissues. ESWT is recommend when other non-surgical treatments have failed.

Surgical Treatment

Surgery to correct for heel spur syndrome is a common procedure which releases plantar fascia partially from its attachment to the calcaneous (heel bone). This part of the surgery is called a plantar fasciotomy due to the fact the fascia is cut. This is most often done through an open procedure as any heel spur or bursa can be removed at the same time. If the spur is not removed during the surgery, it will probably be just as successful, as the large spur is not the true problem. Some physicians use an endoscopic approach (EPF) where a small camera aids the physician during surgery with typically smaller incisions on each side of your foot.

Prevention

In order to prevent heel spurs, it?s important that you pay attention to the physical activities you engage in. Running or jogging on hard surfaces, such as cement or blacktop, is typical for competitive runners, but doing this for too long without breaks can lead to heel spurs and foot pain. Likewise, the shoes you wear can make a big difference in whether or not you develop heel spurs. Have your shoes and feet checked regularly by our Dallas podiatrist to ensure that you are wearing the proper equipment for the activities. Regular checkups with a foot and ankle specialist can help avoid the development of heel spurs.