Rigid Flat Feet In Adults
Overview
Adult acquired flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common-partial or total collapse (loss) of the arch. Other characteristics shared by most types of flatfoot include ?Toe drift,? where the toes and front part of the foot point outward. The heel tilts toward the outside and the ankle appears to turn in. A short Achilles tendon or calf muscle, which causes the heel to lift off the ground earlier when walking and may act as a deforming force. In addition, other deformities such bunions and hammertoes can occur and cause pain in people with flexible flatfoot. Health problems such as rheumatoid arthritis, diabetes and obesity can increase the risk of developing flatfoot and may (or may not) make it more difficult to treat. This article provides a brief overview of the problems that can result in AAFD. Further details regarding the most common conditions that cause an acquired flatfoot and their treatment options are provided in separate articles. Links to those articles are provided. 
Causes
Posterior tibial tendon dysfunction is the most common cause of acquired adult flatfoot. Sometimes this can be a result of specific trauma, but usually the tendon becomes injured from wear and tear over time. This is more prevalent in individuals with an inherited flat foot but excessive weight, age, and level of activity are also contributing factors.
Symptoms
Some symptoms of adult acquired flat foot are pain along the inside of the foot and ankle, pain that increases with activity, and difficulty walking for long periods of time. You may experience difficulty standing, pain on the outside of the ankle, and bony bumps on the top of the foot and inside the foot. You may also have numbness and tingling of the feet and toes (may result from large bone spurs putting pressure on nerves), swelling, a large bump on the sole of the foot and/or an ulcer (in diabetic patients). Diabetic patients should wear a properly fitting diabetic shoe wear to prevent these complications from happening.
Diagnosis
Diagnostic testing is often used to diagnose the condition and help determine the stage of the disease. The most common test done in the office setting are weightbearing X-rays of the foot and ankle. These assess joint alignment and osteoarthritis. If tendon tearing or rupture is suspected, the gold standard test would be MRI. The MRI is used to check the tendon, surrounding ligament structures and the midfoot and hindfoot joints. An MRI is essential if surgery is being considered.
Non surgical Treatment
Depending on the stage of the deformity and patient?s functional goals, various treatment options are available. Some patients improve with conservative care which includes rest and immobilization, shoe modifications, orthoses and bracing, or physical therapy. Surgery might be warranted for advanced stages of the condition. Often a combination of procedures including tendon and muscle augmentation, tendon transfers, realigning of bones or fusion of certain joints might be necessary in more advanced cases. Your doctor will evaluate and recommend an individualized plan of care with your specific needs in mind. 
Surgical Treatment
A new type of surgery has been developed in which surgeons can re-construct the flat foot deformity and also the deltoid ligament using a tendon called the peroneus longus. A person is able to function fully without use of the peroneus longus but they can also be taken from deceased donors if needed. The new surgery was performed on four men and one woman. An improved alignment of the ankle was still evident nine years later, and all had good mobility 8 to 10 years after the surgery. None had developed arthritis.
Achilles Tendon Repair
Overview
Inflammation of the Achilles tendon.The Achilles is the large tendon connecting the two major calf muscles, gastrocnemius and soleus, to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that is tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.
Causes
The majority of Achilles tendon injuries are due to overuse injuries. Other factors that lead to Achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short Achilles tendon, direct trauma (injury) to the tendon, training errors and heel bone deformity. There is significant evidence that people with feet that role in excessively (over-pronate) are at greater risk for developing Achilles tendinitis. The increased pronation puts additional stress on the tendon, therefore, placing it at greater risk for injury.
Symptoms
Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise. Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area. The pain may get worse when you use your Achilles tendon. You may have more pain and stiffness during the night or when you get up in the morning. The area may be tender, red, warm, or swollen if there is inflammation. You may notice a crunchy sound or feeling when you use the tendon.
Diagnosis
Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. Imaging studies. Plain radiography: Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography: Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst; in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis. Magnetic resonance imaging (MRI): MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis, and bursitis.
Nonsurgical Treatment
Achilles tendinitis can typically be treated at home by following the R.I.C.E. treatment method. Rest. Rest the tendon by avoiding activities that irritate the tendon or increase swelling. However, this does not mean you should be completely inactive for long periods of time, as this can cause stiffness in your joints. It?s still important to stretch in order to maintain strength and flexibility and partake in activities that don?t put direct pressure on the tendon, such as bicycling. Ice. Apply ice to the affected area for 20-minutes at a time, every couple hours, as needed, to reduce swelling and pain. Compression. Use compression bandages to help reduce swelling. Elevation. Elevate your ankle above the level of your heart to help reduce swelling. It is particularly important to do this at night while you sleep. Simply place a pillow or two under your ankle to keep it elevated. Once the tendon has healed, be sure to gradually return to more strenuous activities. If flattened arches contributed to the injury, wear shoes with appropriate support or inserts to prevent the condition from progressing or recurring. If these non-surgical treatments have not been able to provide relief of symptoms after several months, surgery may be performed to remove inflamed tissue. However, this is not usually recommended unless all other options have been exhausted. Consult your doctor for more information about surgical treatment options.
Surgical Treatment
If non-surgical treatment fails to cure the condition then surgery can be considered. This is more likely to be the case if the pain has been present for six months or more. The nature of the surgery depends if you have insertional, or non-insertional disease. In non-insertional tendonosis the damaged tendon is thinned and cleaned. The damage is then repaired. If there is extensive damage one of the tendons which moves your big toe (the flexor hallucis longus) may be used to reinforce the damaged Achilles tendon. In insertional tendonosis there is often rubbing of the tendon by a prominent part of the heel bone. This bone is removed. In removing the bone the attachment of the tendon to the bone may be weakened. In these cases the attachment of the tendon to the bone may need to be reinforced with sutures and bone anchors.
Prevention
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles, because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom orthotics.
Inflammation of the Achilles tendon.The Achilles is the large tendon connecting the two major calf muscles, gastrocnemius and soleus, to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that is tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.
Causes
The majority of Achilles tendon injuries are due to overuse injuries. Other factors that lead to Achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short Achilles tendon, direct trauma (injury) to the tendon, training errors and heel bone deformity. There is significant evidence that people with feet that role in excessively (over-pronate) are at greater risk for developing Achilles tendinitis. The increased pronation puts additional stress on the tendon, therefore, placing it at greater risk for injury.
Symptoms
Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise. Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area. The pain may get worse when you use your Achilles tendon. You may have more pain and stiffness during the night or when you get up in the morning. The area may be tender, red, warm, or swollen if there is inflammation. You may notice a crunchy sound or feeling when you use the tendon.
Diagnosis
Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. Imaging studies. Plain radiography: Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography: Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst; in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis. Magnetic resonance imaging (MRI): MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis, and bursitis.
Nonsurgical Treatment
Achilles tendinitis can typically be treated at home by following the R.I.C.E. treatment method. Rest. Rest the tendon by avoiding activities that irritate the tendon or increase swelling. However, this does not mean you should be completely inactive for long periods of time, as this can cause stiffness in your joints. It?s still important to stretch in order to maintain strength and flexibility and partake in activities that don?t put direct pressure on the tendon, such as bicycling. Ice. Apply ice to the affected area for 20-minutes at a time, every couple hours, as needed, to reduce swelling and pain. Compression. Use compression bandages to help reduce swelling. Elevation. Elevate your ankle above the level of your heart to help reduce swelling. It is particularly important to do this at night while you sleep. Simply place a pillow or two under your ankle to keep it elevated. Once the tendon has healed, be sure to gradually return to more strenuous activities. If flattened arches contributed to the injury, wear shoes with appropriate support or inserts to prevent the condition from progressing or recurring. If these non-surgical treatments have not been able to provide relief of symptoms after several months, surgery may be performed to remove inflamed tissue. However, this is not usually recommended unless all other options have been exhausted. Consult your doctor for more information about surgical treatment options.
Surgical Treatment
If non-surgical treatment fails to cure the condition then surgery can be considered. This is more likely to be the case if the pain has been present for six months or more. The nature of the surgery depends if you have insertional, or non-insertional disease. In non-insertional tendonosis the damaged tendon is thinned and cleaned. The damage is then repaired. If there is extensive damage one of the tendons which moves your big toe (the flexor hallucis longus) may be used to reinforce the damaged Achilles tendon. In insertional tendonosis there is often rubbing of the tendon by a prominent part of the heel bone. This bone is removed. In removing the bone the attachment of the tendon to the bone may be weakened. In these cases the attachment of the tendon to the bone may need to be reinforced with sutures and bone anchors.
Prevention
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles, because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom orthotics.
Pes Planus Causes And Treatment
Overview
Flat feet can develop as an adult ("adult acquired flatfoot") due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics,[5] or as part of the normal aging process. Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin (elasticity) during pregnancy. However, if developed by adulthood, flat feet generally remain flat permanently.
Causes
The arches of most individuals are fully developed by the age of 12 to 13. While some people are born with flat arches, for others, the arches fall over time. The tibial tendon, which runs along the inside of the ankle from above the ankle to the arch, can weaken with age and with heavy activity. The posterior tendon, main support structure for the arch, can become inflamed (tendonitis) or even tear if overloaded. For women, wearing high heels can affect the Achilles tendon and alter the structure and function of the ankle. The posterior tibial tendon may compensate for this stress and break down, causing the arches to fall. Obesity is another contributing factor, as well as a serious injury to the ankle or foot, arthritis and bad circulation such as occurs with diabetes.
Symptoms
A significant number of people with fallen arches (flat feet) experience no pain and have no problems. Some, however, may experience pain in their feet, especially when the connecting ligaments and muscles are strained. The leg joints may also be affected, resulting in pain. If the ankles turn inwards because of flat feet the most likely affected areas will be the feet, ankles and knees. Some people have flat feet because of a developmental fault during childhood, while others may find that the problem develops as they age, or after a pregnancy. There are some simple devices which may prevent the complications of flat feet.
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.
Non Surgical Treatment
Physiotherapists will carry out a detailed biomechanical assessment of your feet and lower limb. Once the causes have been identified a number of treatment methods may be used to help relieve pain and restore function in the feet including the use of custom made orthotics to support the foot and offload the areas which are painful, strengthening exercises for weakened muscles and tendons in the arch, and massage and mobilisation techniques to help mobilise stiff tissue and joints in the foot.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
Flat feet can develop as an adult ("adult acquired flatfoot") due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics,[5] or as part of the normal aging process. Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin (elasticity) during pregnancy. However, if developed by adulthood, flat feet generally remain flat permanently.
Causes
The arches of most individuals are fully developed by the age of 12 to 13. While some people are born with flat arches, for others, the arches fall over time. The tibial tendon, which runs along the inside of the ankle from above the ankle to the arch, can weaken with age and with heavy activity. The posterior tendon, main support structure for the arch, can become inflamed (tendonitis) or even tear if overloaded. For women, wearing high heels can affect the Achilles tendon and alter the structure and function of the ankle. The posterior tibial tendon may compensate for this stress and break down, causing the arches to fall. Obesity is another contributing factor, as well as a serious injury to the ankle or foot, arthritis and bad circulation such as occurs with diabetes.
Symptoms
A significant number of people with fallen arches (flat feet) experience no pain and have no problems. Some, however, may experience pain in their feet, especially when the connecting ligaments and muscles are strained. The leg joints may also be affected, resulting in pain. If the ankles turn inwards because of flat feet the most likely affected areas will be the feet, ankles and knees. Some people have flat feet because of a developmental fault during childhood, while others may find that the problem develops as they age, or after a pregnancy. There are some simple devices which may prevent the complications of flat feet.
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.
Non Surgical Treatment
Physiotherapists will carry out a detailed biomechanical assessment of your feet and lower limb. Once the causes have been identified a number of treatment methods may be used to help relieve pain and restore function in the feet including the use of custom made orthotics to support the foot and offload the areas which are painful, strengthening exercises for weakened muscles and tendons in the arch, and massage and mobilisation techniques to help mobilise stiff tissue and joints in the foot.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
Managing With Pain In The Arches
Overview
Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA.
Causes
Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted.
Symptoms
Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains.
Diagnosis
A professional therapist may use tinels test to diagnose tarsal tunnel syndrome. This involves tapping the nerve just behind the medial malleolus or bony bit of the ankle with a rubber hammer. Pain indicates a positive test. Sometimes it is initially mistaken for plantar fasciitis which also causes pain from the inside heel and throughout the arch of the foot. Neural symptoms (such as tingling or numbness) as well as the location of tenderness when touching the area should help to easily distinguish between the conditions.
Non Surgical Treatment
Treatment must be directed to supporting the individual bones and joints which make up the arch, and to aid the arch in its job as a shock absorber. This in turn alleviates the arch pain, and prevents the further collapse of the arch. This is accomplished through the use of either a high quality arch support or custom-made orthotics. These devices support not only the arch, but each individual bone and joint which makes up the arch; and because of the space-age materials used in their construction, allow the arch to become a much more efficient shock absorber. This not only relieves the arch pain, but also prevents it from returning, and keeps the arch from collapsing further.
Surgical Treatment
As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include Pain. Inability to function. Failure to improve after a six-month course of specific, directed physical therapy. Failure to improve after using arch supports, orthotics, or ankle and foot bracing. Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. In the past, surgeons would realign and fuse the three hind joints, which would cause patients to lose motion, leaving them with a significantly stiff hind foot, With these newer procedures, if the foot is still flexible, surgeons can realign it and usually restore a close-to-normal or functional range of motion in the joints.
Prevention
The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise, walk a lot, or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Maintain a healthy weight. Stretch when you feel a tightening of the ligament that runs along the bottom of your foot. Stop impact sports when symptoms first occur.
Stretching Exercises
Point your toes. To ease foot pain and aching in your feet, lift one foot and roll it downward until the toes are pointed toward the ground. Then flex your foot. Repeat using the other foot. This exercise will help stretch out all the small muscles that are on the bottom of your feet, which can help relieve aching and improve blood circulation. Raise your heels. This exercise is good for relieving toe cramps caused by standing for hours in constricting shoes, says Kurtz. Bonus: It can also strengthen calf muscles and make them look more defined. Stand up and lift your heels so that you are standing on the balls of your feet. Hold for 10 seconds. Repeat 10 times. Squeeze your toes. To strengthen the toes and help alleviate foot pain from hammertoes (when a toe resembles a claw), separate your toes using corks or foam toe separators and then squeeze your toes together for five seconds. Repeat 10 times. Roll a ball. Want to create an instant massage for the bottom of your feet? Roll a golf ball or tennis ball under the ball of your foot. Apply light pressure for about two minutes. This exercise can be helpful for arch pain, cramps, and heel pain from plantar fasciitis. Stretch standing up. A weight-bearing, runners-type stretch can be helpful for foot pain in the arch. Stand up and place your toes against a wall; lean forward a little until you feel your arch stretch. Repeat using the other foot. Stretch sitting down. Sit barefoot and cross your left leg so that your ankle rests on your right thigh. Then hold your toes and bend them back toward your shin, stretching the band of tissue connecting the bottom of the heel to the ball. A University of Rochester study found that people living with plantar fasciitis had a 75 percent chance of having no pain within three to six months of performing this stretch three times daily. Give yourself a foot massage. Nothing spells pain relief like a good foot rub. Use the following technique recommended by Rhonda Crockett, a licensed massage therapist at Ohio State University?s Center for Integrative Medicine in Columbus. Start with your toes, using your thumb to massage them in circular motions. Then move to the arch under your foot and gradually work your way down to the heel, applying pressure with your fingers and palm of your hand. Use lotion to allow your hand to move smoothly over your foot. Relax in a warm bath with Epsom salts. The combination of warm water and Epsom salts will give you a double dose of pain relief and relaxation. Magnesium sulfate, the key compound in Epsom salts, has been found to relax muscles, reduce pain, and sedate the nervous system. Plus, warm water helps improve circulation in the feet and relieve muscle pain. Crockett recommends adding two cups of Epsom salts to a warm bath and soaking for 20 minutes.
Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA.
Causes
Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted.
Symptoms
Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains.
Diagnosis
A professional therapist may use tinels test to diagnose tarsal tunnel syndrome. This involves tapping the nerve just behind the medial malleolus or bony bit of the ankle with a rubber hammer. Pain indicates a positive test. Sometimes it is initially mistaken for plantar fasciitis which also causes pain from the inside heel and throughout the arch of the foot. Neural symptoms (such as tingling or numbness) as well as the location of tenderness when touching the area should help to easily distinguish between the conditions.
Non Surgical Treatment
Treatment must be directed to supporting the individual bones and joints which make up the arch, and to aid the arch in its job as a shock absorber. This in turn alleviates the arch pain, and prevents the further collapse of the arch. This is accomplished through the use of either a high quality arch support or custom-made orthotics. These devices support not only the arch, but each individual bone and joint which makes up the arch; and because of the space-age materials used in their construction, allow the arch to become a much more efficient shock absorber. This not only relieves the arch pain, but also prevents it from returning, and keeps the arch from collapsing further.
Surgical Treatment
As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include Pain. Inability to function. Failure to improve after a six-month course of specific, directed physical therapy. Failure to improve after using arch supports, orthotics, or ankle and foot bracing. Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. In the past, surgeons would realign and fuse the three hind joints, which would cause patients to lose motion, leaving them with a significantly stiff hind foot, With these newer procedures, if the foot is still flexible, surgeons can realign it and usually restore a close-to-normal or functional range of motion in the joints.
Prevention
The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise, walk a lot, or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Maintain a healthy weight. Stretch when you feel a tightening of the ligament that runs along the bottom of your foot. Stop impact sports when symptoms first occur.
Stretching Exercises
Point your toes. To ease foot pain and aching in your feet, lift one foot and roll it downward until the toes are pointed toward the ground. Then flex your foot. Repeat using the other foot. This exercise will help stretch out all the small muscles that are on the bottom of your feet, which can help relieve aching and improve blood circulation. Raise your heels. This exercise is good for relieving toe cramps caused by standing for hours in constricting shoes, says Kurtz. Bonus: It can also strengthen calf muscles and make them look more defined. Stand up and lift your heels so that you are standing on the balls of your feet. Hold for 10 seconds. Repeat 10 times. Squeeze your toes. To strengthen the toes and help alleviate foot pain from hammertoes (when a toe resembles a claw), separate your toes using corks or foam toe separators and then squeeze your toes together for five seconds. Repeat 10 times. Roll a ball. Want to create an instant massage for the bottom of your feet? Roll a golf ball or tennis ball under the ball of your foot. Apply light pressure for about two minutes. This exercise can be helpful for arch pain, cramps, and heel pain from plantar fasciitis. Stretch standing up. A weight-bearing, runners-type stretch can be helpful for foot pain in the arch. Stand up and place your toes against a wall; lean forward a little until you feel your arch stretch. Repeat using the other foot. Stretch sitting down. Sit barefoot and cross your left leg so that your ankle rests on your right thigh. Then hold your toes and bend them back toward your shin, stretching the band of tissue connecting the bottom of the heel to the ball. A University of Rochester study found that people living with plantar fasciitis had a 75 percent chance of having no pain within three to six months of performing this stretch three times daily. Give yourself a foot massage. Nothing spells pain relief like a good foot rub. Use the following technique recommended by Rhonda Crockett, a licensed massage therapist at Ohio State University?s Center for Integrative Medicine in Columbus. Start with your toes, using your thumb to massage them in circular motions. Then move to the arch under your foot and gradually work your way down to the heel, applying pressure with your fingers and palm of your hand. Use lotion to allow your hand to move smoothly over your foot. Relax in a warm bath with Epsom salts. The combination of warm water and Epsom salts will give you a double dose of pain relief and relaxation. Magnesium sulfate, the key compound in Epsom salts, has been found to relax muscles, reduce pain, and sedate the nervous system. Plus, warm water helps improve circulation in the feet and relieve muscle pain. Crockett recommends adding two cups of Epsom salts to a warm bath and soaking for 20 minutes.
Will Adult Aquired FlatFoot Necessitate Surgical Teatments ?
Overview
Often considered only any product regarding genetics, flatfoot rarely carries by utilizing it your stigma associated with presenting over time. The Actual truth, however, is that flatfoot does not discriminate about the schedule involving get older and can grow in order to be a problem within the form of adult-acquired flatfoot. like its congenital cousin, adult-acquired flatfoot deformity is one that, inside causing structural damage to the foot (and specifically to the posterior tibial tendon), produces an imbalance which might bring about virtually any quantity of symptoms, including inflammation, pain, stiffness, limited mobility, as well as arthritis.
Causes
As discussed above, many wellness circumstances could develop a painful flatfoot. Damage to the posterior tibial tendon may be the most typical cause of AAFD. The Actual posterior tibial tendon is actually certainly one of the most important tendons of the leg. That begins with a muscle in the calf, travels down the inside regarding the lower leg along with attaches to the bones around the inside in the foot. the primary perform associated with this tendon will be to carry up your arch along with support your foot whenever you walk. In the particular event that the actual tendon gets to be able to be inflamed or torn, the particular arch will gradually collapse. Females the ones over 40 are generally more inclined to always be able to develop problems using the posterior tibial tendon. other risk aspects consist of obesity, diabetes, and also hypertension. having flat feet since childhood boosts the chance of developing any tear inside the posterior tibial tendon. Throughout addition, people who are involved in high impact sports, for example basketball, tennis, or perhaps soccer, might have got tears in the tendon from repetitive use. Inflammatory arthritis, such as rheumatoid arthritis, could cause a painful flatfoot. This kind involving arthritis attacks not necessarily just the cartilage within the joints, but throughout addition the actual ligaments which offer the foot. Inflammatory arthritis not merely brings about pain, but also leads to your foot in order to change shape and turn into flat. the arthritis could affect the back with the foot or even the middle of foot, both involving which usually can result in a fallen arch.
Symptoms
The symptom most usually associated using AAF is actually PTTD, however it is important to see this simply like a single step together a broader continuum. the most significant perform in the PT tendon is to operate in synergy with almost all the peroneus longus in order to stabilize the midtarsal joint (MTJ). Once the PT muscle mass contracts as well as acts concentrically, it inverts the foot, thereby raising your medial arch. Whenever stretched under tension, acting eccentrically, its operate could be viewed as being a pronation retarder. Your integrity with the PT tendon and also muscle is vital for the correct operate in the foot, but it is far from the lone actor within keeping the particular arch. Presently there is actually a essential codependence on the host involving various other muscles along with ligaments that when disrupted leads to an practically predictable loss in foot architecture and also subsequent pathology.
Diagnosis
First, each feet needs to always be able to be looked at using the affected person standing and additionally the entire lower extremity visible. The Particular foot ought for you to be inspected from over also as via powering your patient, as valgus angulation in the hindfoot is best appreciated when the foot will be viewed through behind. Johnson described the so-called more-toes sign: with more advanced deformity and abduction of the forefoot, really the lateral toes become noticeable if the foot can be viewed coming from behind. The Actual single-limb heel-rise test is definitely an superb determinant of the perform with the posterior tibial tendon. The Particular affected person is actually asked to try to rise to the ball of 1 foot whilst one other foot can be suspended off the particular floor. Beneath typical circumstances, the actual posterior tibial muscle, which in turn inverts along with stabilizes your hindfoot, is actually activated since the affected person starts to rise to the forefoot. The Actual gastrocnemius-soleus muscle team then elevates your calcaneus, and the heel-rise is accomplished. Along With dysfunction with the posterior tibial tendon, however, inversion of the heel can be weak, along with either the particular heel remains inside valgus or even the patient is not able to rise onto the forefoot. In your event that the actual affected person can execute a single-limb heel-rise, the limb might be stressed further by asking the actual affected person to execute this maneuver repetitively.
Non surgical Treatment
Conservative treatment method additionally depends around the stage in the disease. Early on, the anguish as well as swelling with no deformity can be treated using rest, ice, compression, elevation along with non-steroidal anti-inflammatory medication. Typically OTC orthotic inserts are usually recommended together with stability oriented athletic shoes. In your event that this fails or the condition is much more advanced, immobilization inside a rigid walking boot can be recommended. This particular rests the particular tendon as well as protects it via further irritation, attenuation, or even tearing. If signs as well as symptoms are usually greatly improved or perhaps eliminated then your individual might go back to a new supportive shoe. For You To protect the actual affected person from reoccurrence, distinct types of tools are recommended. The Particular most frequent device is orthotics. Typically custom-made orthotics are generally better than OTC. These People are reserved with regard to early staged PTTD. Advanced phases might require an even more aggressive type orthotic or perhaps an AFO (ankle-foot orthosis). Right now there are different forms of AFO's. 1 kind features a double-upright/stirrup mounted on any footplate. An Additional is a gauntlet-type using a custom plastic interior surrounded be a lace-up leather exterior. Each require use of the bulky type athletic as well as orthopedic shoes. Affected Person compliance is definitely challenging with these larger braces and shoes.
Surgical Treatment
If first conservative therapy regarding posterior tibial tendon insufficiency fails, surgical remedy can be considered. Operative treatment regarding stage 1 disease involves discharge of your tendon sheath, tenosynovectomy, debridement of the tendon along with excision associated with flap tears, and repair regarding longitudinal tears. A New short-leg walking cast is worn for 3 weeks postoperatively. Teasdall along with Johnson reported total relief involving pain in 74% associated with 14 patients undergoing this remedy regimen pertaining to stage one disease. Surgical debridement regarding tenosynovitis within early stages is believed to always be able to possibly prevent progression associated with disease to end up being able to later phases involving dysfunction.
Often considered only any product regarding genetics, flatfoot rarely carries by utilizing it your stigma associated with presenting over time. The Actual truth, however, is that flatfoot does not discriminate about the schedule involving get older and can grow in order to be a problem within the form of adult-acquired flatfoot. like its congenital cousin, adult-acquired flatfoot deformity is one that, inside causing structural damage to the foot (and specifically to the posterior tibial tendon), produces an imbalance which might bring about virtually any quantity of symptoms, including inflammation, pain, stiffness, limited mobility, as well as arthritis.
Causes
As discussed above, many wellness circumstances could develop a painful flatfoot. Damage to the posterior tibial tendon may be the most typical cause of AAFD. The Actual posterior tibial tendon is actually certainly one of the most important tendons of the leg. That begins with a muscle in the calf, travels down the inside regarding the lower leg along with attaches to the bones around the inside in the foot. the primary perform associated with this tendon will be to carry up your arch along with support your foot whenever you walk. In the particular event that the actual tendon gets to be able to be inflamed or torn, the particular arch will gradually collapse. Females the ones over 40 are generally more inclined to always be able to develop problems using the posterior tibial tendon. other risk aspects consist of obesity, diabetes, and also hypertension. having flat feet since childhood boosts the chance of developing any tear inside the posterior tibial tendon. Throughout addition, people who are involved in high impact sports, for example basketball, tennis, or perhaps soccer, might have got tears in the tendon from repetitive use. Inflammatory arthritis, such as rheumatoid arthritis, could cause a painful flatfoot. This kind involving arthritis attacks not necessarily just the cartilage within the joints, but throughout addition the actual ligaments which offer the foot. Inflammatory arthritis not merely brings about pain, but also leads to your foot in order to change shape and turn into flat. the arthritis could affect the back with the foot or even the middle of foot, both involving which usually can result in a fallen arch.
Symptoms
The symptom most usually associated using AAF is actually PTTD, however it is important to see this simply like a single step together a broader continuum. the most significant perform in the PT tendon is to operate in synergy with almost all the peroneus longus in order to stabilize the midtarsal joint (MTJ). Once the PT muscle mass contracts as well as acts concentrically, it inverts the foot, thereby raising your medial arch. Whenever stretched under tension, acting eccentrically, its operate could be viewed as being a pronation retarder. Your integrity with the PT tendon and also muscle is vital for the correct operate in the foot, but it is far from the lone actor within keeping the particular arch. Presently there is actually a essential codependence on the host involving various other muscles along with ligaments that when disrupted leads to an practically predictable loss in foot architecture and also subsequent pathology.
Diagnosis
First, each feet needs to always be able to be looked at using the affected person standing and additionally the entire lower extremity visible. The Particular foot ought for you to be inspected from over also as via powering your patient, as valgus angulation in the hindfoot is best appreciated when the foot will be viewed through behind. Johnson described the so-called more-toes sign: with more advanced deformity and abduction of the forefoot, really the lateral toes become noticeable if the foot can be viewed coming from behind. The Actual single-limb heel-rise test is definitely an superb determinant of the perform with the posterior tibial tendon. The Particular affected person is actually asked to try to rise to the ball of 1 foot whilst one other foot can be suspended off the particular floor. Beneath typical circumstances, the actual posterior tibial muscle, which in turn inverts along with stabilizes your hindfoot, is actually activated since the affected person starts to rise to the forefoot. The Actual gastrocnemius-soleus muscle team then elevates your calcaneus, and the heel-rise is accomplished. Along With dysfunction with the posterior tibial tendon, however, inversion of the heel can be weak, along with either the particular heel remains inside valgus or even the patient is not able to rise onto the forefoot. In your event that the actual affected person can execute a single-limb heel-rise, the limb might be stressed further by asking the actual affected person to execute this maneuver repetitively.
Non surgical Treatment
Conservative treatment method additionally depends around the stage in the disease. Early on, the anguish as well as swelling with no deformity can be treated using rest, ice, compression, elevation along with non-steroidal anti-inflammatory medication. Typically OTC orthotic inserts are usually recommended together with stability oriented athletic shoes. In your event that this fails or the condition is much more advanced, immobilization inside a rigid walking boot can be recommended. This particular rests the particular tendon as well as protects it via further irritation, attenuation, or even tearing. If signs as well as symptoms are usually greatly improved or perhaps eliminated then your individual might go back to a new supportive shoe. For You To protect the actual affected person from reoccurrence, distinct types of tools are recommended. The Particular most frequent device is orthotics. Typically custom-made orthotics are generally better than OTC. These People are reserved with regard to early staged PTTD. Advanced phases might require an even more aggressive type orthotic or perhaps an AFO (ankle-foot orthosis). Right now there are different forms of AFO's. 1 kind features a double-upright/stirrup mounted on any footplate. An Additional is a gauntlet-type using a custom plastic interior surrounded be a lace-up leather exterior. Each require use of the bulky type athletic as well as orthopedic shoes. Affected Person compliance is definitely challenging with these larger braces and shoes.
Surgical Treatment
If first conservative therapy regarding posterior tibial tendon insufficiency fails, surgical remedy can be considered. Operative treatment regarding stage 1 disease involves discharge of your tendon sheath, tenosynovectomy, debridement of the tendon along with excision associated with flap tears, and repair regarding longitudinal tears. A New short-leg walking cast is worn for 3 weeks postoperatively. Teasdall along with Johnson reported total relief involving pain in 74% associated with 14 patients undergoing this remedy regimen pertaining to stage one disease. Surgical debridement regarding tenosynovitis within early stages is believed to always be able to possibly prevent progression associated with disease to end up being able to later phases involving dysfunction.
What Could Cause Pain In The Foot's Arch ?
Overview
Posterior tibial tendon dysfunction is one of several terms to describe a painful, progressive flatfoot deformity in adults. Other terms include posterior tibial tendon insufficiency and adult acquired flatfoot. The term adult acquired flatfoot is more appropriate because it allows a broader recognition of causative factors, not only limited to the posterior tibial tendon, an event where the posterior tibial tendon looses strength and function. The adult acquired flatfoot is a progressive, symptomatic (painful) deformity resulting from gradual stretch (attenuation) of the tibialis posterior tendon as well as the ligaments that support the arch of the foot.
Causes
The cause of this condition is too much pressure exerted on the arches, and although common in athletes, the condition can happen because you went hiking or climbing, you were lifting heavy objects, or you simply walked too far too vigorously. Pregnancy places extra strain on the arches because of both the additional body weight and the effect of hormones on muscles and ligaments.
Symptoms
Experiencing chronic pain of any kind can lead to feelings of fatigue, irritability and even depression. Friends may joke about having 'tired dogs' after a long day, but this is completely different from your experience if arch pain has begun to impact your life on a daily basis. You may dread getting out of bed in the morning and wonder how you're going to get through a work day without having to limp home at the end of it.
Diagnosis
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.
Non Surgical Treatment
When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain.
Surgical Treatment
If you have pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave therapy) uses strong electrohydraulic acoustic (sound) energy that triggers the body?s natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques.
Prevention
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.
Posterior tibial tendon dysfunction is one of several terms to describe a painful, progressive flatfoot deformity in adults. Other terms include posterior tibial tendon insufficiency and adult acquired flatfoot. The term adult acquired flatfoot is more appropriate because it allows a broader recognition of causative factors, not only limited to the posterior tibial tendon, an event where the posterior tibial tendon looses strength and function. The adult acquired flatfoot is a progressive, symptomatic (painful) deformity resulting from gradual stretch (attenuation) of the tibialis posterior tendon as well as the ligaments that support the arch of the foot.
Causes
The cause of this condition is too much pressure exerted on the arches, and although common in athletes, the condition can happen because you went hiking or climbing, you were lifting heavy objects, or you simply walked too far too vigorously. Pregnancy places extra strain on the arches because of both the additional body weight and the effect of hormones on muscles and ligaments.
Symptoms
Experiencing chronic pain of any kind can lead to feelings of fatigue, irritability and even depression. Friends may joke about having 'tired dogs' after a long day, but this is completely different from your experience if arch pain has begun to impact your life on a daily basis. You may dread getting out of bed in the morning and wonder how you're going to get through a work day without having to limp home at the end of it.
Diagnosis
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.
Non Surgical Treatment
When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain.
Surgical Treatment
If you have pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave therapy) uses strong electrohydraulic acoustic (sound) energy that triggers the body?s natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques.
Prevention
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of usage. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.
Pain In The Arches Causes Symptoms And Treatments
Overview
The arch of the foot is formed by the tarsal and metatarsal bones and is strengthened by ligaments and tendons that enable the foot to correctly support the weight of the body. The underside of the foot is made up of four layers of muscle tissue as well as a length of thick connective tissue called the plantar fascia, which supports the arch. If the surrounding muscles weaken, the plantar fascia will drop and the arch will collapse. If the arch collapses, the whole foot touches the ground, which is known as pes planus or flat feet. Flat feet affect about 15 per cent of Britons. Although usually genetic, the condition may be exacerbated or triggered by poorly fitted shoes or conditions such as arthritis and pregnancy, when sudden changes in shape and weight can alter the body's centre of gravity leading to a weakening of the arches.
Causes
The arches are the primary structures of the body that absorb and return force to and from the body to the outside world when we are on our feet. When something happens to these structures, pain and injury may result. There can be many causes of arch pain. Direct force trauma, ligament sprains, muscle strains, poor biomechanical alignment,stress fractures, overuse, inflammatory arthritis or the tightness or lack of tightness of the joints in the foot may all cause pain in the arch. Injury to the plantar fascia is a common cause of arch pain. The plantar fascia is the thick, connective tissue which supports the arch on the bottom of the foot. It runs from the calcaneus (heel) forwards to the heads of the metatarsals. When the plantar fascia is damaged, the resulting inflammatory response may become a source of arch pain.
Symptoms
Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).
Diagnosis
The diagnosis of high arch (cavus) foot deformity or Charcot Marie Tooth disease can be made by an orthopedic surgeon in the office. Evaluation includes a thorough history and physical examination as well as imaging studies such as X-rays. The orthopedic surgeon will look at the overall shape, flexibility, and strength of a patient?s foot and ankle to help determine the best treatment. Nerve tests may occasionally need to be performed to help confirm the diagnosis.
Non Surgical Treatment
Treatment must be directed to supporting the individual bones and joints which make up the arch, and to aid the arch in its job as a shock absorber. This in turn alleviates the arch pain, and prevents the further collapse of the arch. This is accomplished through the use of either a high quality arch support or custom-made orthotics. These devices support not only the arch, but each individual bone and joint which makes up the arch; and because of the space-age materials used in their construction, allow the arch to become a much more efficient shock absorber. This not only relieves the arch pain, but also prevents it from returning, and keeps the arch from collapsing further.
Surgical Treatment
In rare cases, surgery may be needed if a child has flat feet caused by a problem they're born with (a congenital abnormality). The foot may need to be straightened or the bones may need to be separated if they're fused together. Painkillers and insoles are the first treatment options for flat feet that are caused by a joint problem, such as arthritis or a torn tendon. However, surgery may be recommended if the injury or condition is severely affecting your feet. Where flat feet are caused by a condition that affects the nervous system, special shoes, insoles, or supportive foot or leg braces may be needed. Again, in severe cases, an operation may be needed to straighten the feet.
Prevention
Maintain a healthy weight, Use insoles to support your arches, Limit how often you wear high heels, Use proper shoes, especially when exercising to evenly distribute weight through your foot.
Stretching Exercises
Achilles stretch. Stand with the ball of one foot on a stair. Reach for the step below with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. Balance and reach exercises. Stand next to a chair with your injured leg farther from the chair. The chair will provide support if you need it. Stand on the foot of your injured leg and bend your knee slightly. Try to raise the arch of this foot while keeping your big toe on the floor. Keep your foot in this position. With the hand that is farther away from the chair, reach forward in front of you by bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15 times. To make the exercise more challenging, reach farther in front of you. Do 2 sets of 15. While keeping your arch raised, reach the hand that is farther away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 15. Towel pickup. With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Resisted ankle plantar flexion. Sit with your injured leg stretched out in front of you. Loop the tubing around the ball of your foot. Hold the ends of the tubing with both hands. Gently press the ball of your foot down and point your toes, stretching the tubing. Return to the starting position. Do 2 sets of 15. Resisted ankle dorsiflexion. Tie a knot in one end of the elastic tubing and shut the knot in a door. Tie a loop in the other end of the tubing and put the foot on your injured side through the loop so that the tubing goes around the top of the foot. Sit facing the door with your injured leg straight out in front of you. Move away from the door until there is tension in the tubing. Keeping your leg straight, pull the top of your foot toward your body, stretching the tubing. Slowly return to the starting position. Do 2 sets of 15. Heel raise. Stand behind a chair or counter with both feet flat on the floor. Using the chair or counter as a support, rise up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the support. (It's OK to keep holding onto the support if you need to.) When this exercise becomes less painful, try doing this exercise while you are standing on the injured leg only. Repeat 15 times. Do 2 sets of 15. Rest 30 seconds between sets.
The arch of the foot is formed by the tarsal and metatarsal bones and is strengthened by ligaments and tendons that enable the foot to correctly support the weight of the body. The underside of the foot is made up of four layers of muscle tissue as well as a length of thick connective tissue called the plantar fascia, which supports the arch. If the surrounding muscles weaken, the plantar fascia will drop and the arch will collapse. If the arch collapses, the whole foot touches the ground, which is known as pes planus or flat feet. Flat feet affect about 15 per cent of Britons. Although usually genetic, the condition may be exacerbated or triggered by poorly fitted shoes or conditions such as arthritis and pregnancy, when sudden changes in shape and weight can alter the body's centre of gravity leading to a weakening of the arches.
Causes
The arches are the primary structures of the body that absorb and return force to and from the body to the outside world when we are on our feet. When something happens to these structures, pain and injury may result. There can be many causes of arch pain. Direct force trauma, ligament sprains, muscle strains, poor biomechanical alignment,stress fractures, overuse, inflammatory arthritis or the tightness or lack of tightness of the joints in the foot may all cause pain in the arch. Injury to the plantar fascia is a common cause of arch pain. The plantar fascia is the thick, connective tissue which supports the arch on the bottom of the foot. It runs from the calcaneus (heel) forwards to the heads of the metatarsals. When the plantar fascia is damaged, the resulting inflammatory response may become a source of arch pain.
Symptoms
Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).
Diagnosis
The diagnosis of high arch (cavus) foot deformity or Charcot Marie Tooth disease can be made by an orthopedic surgeon in the office. Evaluation includes a thorough history and physical examination as well as imaging studies such as X-rays. The orthopedic surgeon will look at the overall shape, flexibility, and strength of a patient?s foot and ankle to help determine the best treatment. Nerve tests may occasionally need to be performed to help confirm the diagnosis.
Non Surgical Treatment
Treatment must be directed to supporting the individual bones and joints which make up the arch, and to aid the arch in its job as a shock absorber. This in turn alleviates the arch pain, and prevents the further collapse of the arch. This is accomplished through the use of either a high quality arch support or custom-made orthotics. These devices support not only the arch, but each individual bone and joint which makes up the arch; and because of the space-age materials used in their construction, allow the arch to become a much more efficient shock absorber. This not only relieves the arch pain, but also prevents it from returning, and keeps the arch from collapsing further.
Surgical Treatment
In rare cases, surgery may be needed if a child has flat feet caused by a problem they're born with (a congenital abnormality). The foot may need to be straightened or the bones may need to be separated if they're fused together. Painkillers and insoles are the first treatment options for flat feet that are caused by a joint problem, such as arthritis or a torn tendon. However, surgery may be recommended if the injury or condition is severely affecting your feet. Where flat feet are caused by a condition that affects the nervous system, special shoes, insoles, or supportive foot or leg braces may be needed. Again, in severe cases, an operation may be needed to straighten the feet.
Prevention
Maintain a healthy weight, Use insoles to support your arches, Limit how often you wear high heels, Use proper shoes, especially when exercising to evenly distribute weight through your foot.
Stretching Exercises
Achilles stretch. Stand with the ball of one foot on a stair. Reach for the step below with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. Balance and reach exercises. Stand next to a chair with your injured leg farther from the chair. The chair will provide support if you need it. Stand on the foot of your injured leg and bend your knee slightly. Try to raise the arch of this foot while keeping your big toe on the floor. Keep your foot in this position. With the hand that is farther away from the chair, reach forward in front of you by bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15 times. To make the exercise more challenging, reach farther in front of you. Do 2 sets of 15. While keeping your arch raised, reach the hand that is farther away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 15. Towel pickup. With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Resisted ankle plantar flexion. Sit with your injured leg stretched out in front of you. Loop the tubing around the ball of your foot. Hold the ends of the tubing with both hands. Gently press the ball of your foot down and point your toes, stretching the tubing. Return to the starting position. Do 2 sets of 15. Resisted ankle dorsiflexion. Tie a knot in one end of the elastic tubing and shut the knot in a door. Tie a loop in the other end of the tubing and put the foot on your injured side through the loop so that the tubing goes around the top of the foot. Sit facing the door with your injured leg straight out in front of you. Move away from the door until there is tension in the tubing. Keeping your leg straight, pull the top of your foot toward your body, stretching the tubing. Slowly return to the starting position. Do 2 sets of 15. Heel raise. Stand behind a chair or counter with both feet flat on the floor. Using the chair or counter as a support, rise up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the support. (It's OK to keep holding onto the support if you need to.) When this exercise becomes less painful, try doing this exercise while you are standing on the injured leg only. Repeat 15 times. Do 2 sets of 15. Rest 30 seconds between sets.
