Plantar Fasciitis

Symptoms

• Pain radiating from the heel or just in front of the heel at the beginning of the arch. The pain can be a dull ache or a sharp stabbing pain.
  
  
• Tends to be most severe first thing in the morning for the first few minutes after getting out of bed. The pain gets better after approximately 5 mins then gets worse throughout the course of the day.
  
  
• Also painful when beginning to stand or walk after a period of sitting.

 

Causes

There are numerous causes including high arched feet, tightness of the calf muscles, tightness of the structures in the bottom of the foot and most commonly, low arched feet (pronated feet). In many cases, a combination of these factors leads to the crippling pain that many patients describe.

Treatment

Treatment is usually conservative (non surgical). Foot orthoses (insoles) are commonly used to treat plantar fasciitis. The biomechanical efficiency of the foot is assessed and an appropriate orthotic device provided to improve the foot posture and efficiency.

Pronated feet (low or collapsed arches) are a common factor in plantar fasciitis. The lowering of the arch places strain on the plantar fascia at the attachment into the heel bone. The strain causes swelling which leads to intense pain. A foot orthosis can reduce the strain by correcting the pronated foot position. Removing this strain will allow the swelling to disappear over a short space of time and the pain will dissipate. Continued use of the insole will reduce the likelihood of the pain recurring.

There are many other foot deficiencies which can cause plantar fasciitis and a biomechanical assessment will flag these problems up. Most foot deficiencies can be treated with orthotics. For more information, please contact us.

Tib Post Tendonitis

Symptoms

• Pain in the arch
• Swelling behind the innermost ankle bone
• Pain behind the innermost ankle bone
• Difficulty standing on tip toes without pain
• Pain is usually limited to weight bearing activities

The image on the below shows the area of inflamation.

 

 

 

 

 

Causes

The cause of tib post tendonitis is overuse of the tibialis posterior muscle. The tendon, which connects the muscle to the bone, becomes strained causing abnormal tendon function. This can happen for various reasons, one of the most common being over pronation of the feet for many years.

Because of abnormal tendon function, damage to the tendon takes place. When the damage heals scar tissue can be present. This scar tissue rubs on the tendon sheath creating inflammation which leads to tendonitis. It is the swelling in this compartmentalized area which is causing the pain.

Treatment

As with most conditions where inflammation is involved, resting the affected area and treating with ice will help the pain. However, if the foot is still functioning abnormally and creating a strain on the tendon, then the problem is likely to recur. Thus, foot orthotics which wedge the foot and support the arch reduce the strain on the tendon and reduce pain.

Unfortunately, all feet are different and there are many other predisposing factors to tib post tendonitis. Professional advice should be obtained to ensure your best chance of recovery.

 

Achilles Tendonitis

• Pain in the lower calf
• Pain behind the heel
• Small lump just above the heel

Causes

Inflammation of the insertion of the Achilles tendon. As with most inflammatory conditions, improper biomechanical function at the foot and ankle can cause achilles tendonitis. Predisposing factors include:

• Tight Achilles tendon
• Pronated feet
• Insufficient shock absorption in footwear
• Supinated feet (loss of foot’s natural shock absorption)

Treatment

Biomechanical assessment will provide an in depth analysis of the problem and the solution. Common orthoses used are anti pronation foot orthoses (pictured below) and silicone heel raises. Silicone heel raises can reduce the excessive strain of the Achilles tendon whilst giving some additional shock absorption. Many people also find this kind of treatment useful as it raises the swollen area at the heel away from the back of the shoe.

Silicone Heel Raise

 

 

 

 

 

 

 

 

Mortons Neuroma

Symptoms

• Pain in the ball of the foot
• Tingling/Burning/Numbness of the middle 3 toes
• Pain is worst when standing on cobbles/pebbles
• Wearing tight fitting shoes makes the pain worst
• Mild swelling on the top of the foot, just behind the toes

Causes

Chronic irritation of the nerve running between the bones in the ball of the foot. Irritation leads to inflammation and when squeezed, the nerve causes a burning or numbness, usually in the middle 3 toes.

It is unsure exactly what causes the irritation of the nerve but clinically there are many predisposing factors. Footwear seems to play a large part which is possibly why the condition is more common in females.

 

• Tight shoes
• Innapropriately shaped shoes (see picture below)
• Less fatty padding on the ball of the foot
• Pronated foot shape

 

 

 

 

 

 

Treatment

Treatment tends to be conservative (non surgical) as many surgical techniques only solve the problem temporarily. In some cases, a change of footwear style to something more suitable for the foot anatomy is sufficient to solve the problem.

Wider and deeper shoes with a little more cushioning can also relieve much of the discomfort which many people experience. However, if this is insufficient, foot orthoses can be worn which are designed to open up the space between the bones and relieve pressure on the nerve.

This type of insole normally has a lump of foam (metatarsal dome) placed just behind the ball of the foot. The placement of the dome is crucial as it displaces pressure to the area behind the ball of the foot and opens up the space for the inflamed nerve.

 

Metatarsal Dome

There are many variations on this particular device but the principle generally remains the same. Sometimes, having pronated feet predisposes to suffering Mortons neuroma. If this is the case, then an anti pronation element may be incorporated.

Hallux Limitus/Rigidus

Symptoms

• Pain in the big toe joint (worse walking uphill and upstairs)
• Hard skin on the inner side of the big toe
• Pain similar to pronated feet – This is a compenstory mechanism as the lack of movement in the big toe is compensated for at other joints.

Causes

Osteoarthritis in the big toe joint will cause stiffness of the big toe. However, previous surgery or trauma can cause stiffness. As there is limited range of motion in the joint, there are larger stresses when going uphill as this requires greater movement.

Treatment

Choice of footwear is essential for hallux limitus and rigidus. A shoe with a large rocker sole unit will give the greatest relief.

For information on suitable footwear see our Specialist Footwear page.

For more information on foot pain please contact us make all contact us into links to Contact Us page.