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一名五歲的陳小妹妹，從會走路開始就容易跌倒，父母以為是正常的，並不以為意，直到今年二月，小妹妹感冒到醫院看診，護理人員發現小妹妹走路「內八」且容易跌倒，建議父母帶小妹妹到復健科看診，才發現陳小妹妹是「扁平足」，使用矯正鞋墊之後，小妹妹步態明顯獲得改善。 童綜合復健科主治醫師吳坤霖安排陳小妹妹接受下肢生物力學評估，發現她是「扁平足」，吳坤霖醫師說，所謂「扁平足」俗稱「鴨母蹄」，是指舟狀骨向下移位，造成內縱足弓的塌陷，因而在踏地荷重時，內縱足弓消失。從出生到2歲的幼兒，腳底脂肪比較多，這個階段的足弓並不明顯。在滿2歲到8歲之間，隨著孩童運動量逐漸增加，足底壓力也跟著增加，肌肉力量會慢慢成熟，足底筋膜慢慢地呈現彎曲，形成所謂的「足弓」。 復建科陳昱景醫師說，扁平足的症狀，在兒童時期可能有鞋跟內側比外側磨損快、走路內八字、走路容易跌倒等；在青少年時期可能有腳痛、膝痛、姆指外翻、走路跑步耐力差等。不對稱的扁平足，在站立時容易導致長短腳，造成骨盆不正，進而會惡化成為脊椎側彎。 醫師說，扁平足的治療，2歲以前觀察為主，不需要做特別的治療，多赤腳走路、穿鞋的時間要儘量減少；2到8歲，此時正值足弓發育的時期，可使用矯正鞋墊，誘導足弓的發育。
最近接到好幾個案例，由復健科治療師轉介過來的案子，大都是腰部疼痛，鞋子長期穿戴相當不舒服，換過好幾個醫生診療，大都介紹他們，換一隻更好的氣墊鞋，一段時間，反而更加嚴重，大都花了白花花的銀子，還得不到舒適的鞋子行走!
陳先生在某家建設公司，擔任招待工作，長時間，站立，行走，一天下來站個7-8個小時，幾個月下來經常性腰酸背痛，讓他不得不開始去復健，治療，經過醫師推薦花了將近上萬元買了雙進口氣墊鞋，剛開始情況有些好轉，不到一個月時間,腰痛的情況又更加嚴重，經配合診所介紹，前來訂製一個背架，來改善腰痛的毛病！
直至試模當天，檢查其合適度，才發現，原來陳先生有長短腳將近１cm左右，因為治療師並沒有察覺及處理個案又加上錯誤建議，使用百貨公司買的號稱可以矯正的矯正鞋，長時間下來不但沒有好轉，反而更加嚴重，經鞋具部裝具師建議幫他訂製一隻矯正鞋墊，改善他長短腳，再定期至診所復健，情況會慢慢改善！
經過三個月來追蹤拜訪,腰部疼痛方面明顯改善，一天下來也比較不疲累，狀況比之前好太多了！
慎選您的鞋具，氣墊鞋不是萬靈丹，找對治療方向避免多走冤枉路！
足底肌膜炎又是怎麼一回事呢？
正常腳是以第一、第五蹠骨及跟骨底突所形成的直角三角形作為觸地的支點；足弓的蹠、跗骨肌群所結合的肌膜，就依此三角形匯集並附著於跟骨的底突上，形成解剖學的「足底肌膜」。
作用上，它像是一束弦，支橕足弓，並隨著腳的動作，時張時弛，吸收來自腳底的震動。生物力學上，腳在日常活動裡所承受的應力，往往是數倍於體重；因此，在歲月的過程裡，足底肌膜終免不了被拉傷、發炎、或逐漸變性、產生退化。
肌腱炎、筋膜炎是「重複累積性傷害」造成，常出現在過度使用的人，像運動員、長期不停地打電腦的上班族、常搬重物的勞動者。症狀主要為紅、腫、熱、痛及讓人十分不方便的機能障礙。
發了炎、彈性變壞又收縮（休息）了一段時間的肌膜，在晨起下床或久坐初起的時刻，應付不了乍然而至的張力，足跟處就像是被撕裂、或像是未癒合的傷口硬被粗手粗腳揭開紗布似的劇痛，一直要等好一段時間才慢慢的緩解…。這就是足底肌膜炎。
這麼說來，足底肌膜炎就像退化性關節炎一樣，是兼有退化性肌腱炎的特質了？這一點在病理學上，也得到呼應。
足底肌膜炎也的確常常看見同時有發炎與肌腱退化的病理變化。這也同時解釋了足底肌膜炎為何那麼難治？因為，退化的組織，要使它再生（新生），恢復原來功能是相當困難的！
近年來，源自歐洲，應用骨震波（ESWT）來治療足底肌膜炎，有了一大突破。骨震波並不是要把骨刺震「碎」，作為治療的目的。這是一種非侵入性的治療方式，將壓力及能量集中在需要治療的骨骼肌肉筋膜上，使缺氧、缺血的組織恢復血液供給，促進組織的代謝、循環修復及再生，症狀得以舒緩，並刺激骨折的癒合。
治療原理是利用震波造成組織的顯微骨折、顯微血腫及局部細胞凋零，誘導組織反應，使血管新生、循環改善，而達到組織修復、再生的目的。初步臨床報告，約有70%-80%的成功率，是一項值得推薦的方式。骨震波治療，不需要住院，可在門診實施，需時約半小時；術後只有輕微足跟腫痛，冰敷一、兩天就好了。不必請假，可如常走路，唯建議應持續門診追蹤６周，６周後效果顯著，６個月內會持續進步，患者必須耐心等待組織修復、再生的過程。修復過程中建議不宜劇烈運動，應給予組織適當的休息，以利修復再生作用的進行。
足底肌膜炎雖不是什麼大不了的病，但總是造成生活上諸多不便。
日常生活中，穿好的鞋，少赤腳走路，不過度慢跑、爬樓梯，運動前先踮踮腳尖…….，可減少足底肌膜炎的發生。已經為此症困擾的人，不妨找醫師好好評估及治療。
自我足部照顧如下：
1. 穿著適當的運動鞋：可諮詢專業治療師。
2. 愛好運動者近期可能須閉關休息一下。
3. 早晚做阿基里斯腱的腿部牽拉運動數回。
4. 晚上在家若有疼痛須冰敷10-15分的疼痛點，才可上床睡覺。
5. 晚間睡覺時穿戴腳部支架可有助於睡覺時筋膜的伸展，使得早晨下床走路時不會那麼疼痛。
6. 最重要的一點，就是走路時就覺得足部不適，或者走路後疼痛指數增高，建議訂製特製的鞋墊，平均分散足部壓力。
7. 可利用日本引進的「肌內效貼布」，其本身不具藥效，但是有彈性且其織法特別，在物理治療師指導下用特別的貼法（必須根據肌肉解剖生理基礎），可幫助受傷的肌肉收縮，保護肌肉、增加肌肉間的血液循環，減低疼痛，在非常疼痛的時候效果尤佳，可十分明顯改善疼痛的狀況，它的功能是支持足弓以及提供暫時性鞋墊平均壓力，若配合使用可減少腳底筋膜因走路時所受的壓力，自然可達到休息的作用，病程得以縮短，也不必長久和「疼痛」為伍。（95.1.22聯合報醫藥版）
What is Sever’s Disease?
Sever’s Disease (or Pediatric heel pain) is a symptom, not an actual disease. It is a warning sign that your child has a condition that requires attention. Sever’s Disease is commonly associated with these symptoms:
1) Pain at the back or bottom of the heel
2) Limping or walking on the toes
3) Difficulty participating in sports and/or running
Typically, the child complains of pain in one or both heels whilst running and walking. The pain is located at the point of the heel where the achilles tendons insert into the heel bone.
What causes Heel Pain in children?
The most common cause of paediatric heel pain is a condition called calcaneal apophysitis, and it usually affects children from 8 to 14-year old. Heel pain is very common in children because of the very nature of their growing feet. In children the heel bone (calcaneus) is not yet fully developed until age 14 or older. Whilst growing new bone is being formed at the growth plate (the apophysis), an area located at the back of the heel. Repetitive stress on the growth plate (due to walking, running and sports) causes inflammation in the heel area.
Also, the foot is one of the first bodyparts to grow to full size. This usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become tight. The heel area is less flexible. During weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches), causing injury to the heel.
The condition frequently occurs before or during the peak growth spurt in boys and girls, often shortly after they begin a new sport or season. Sever’s disease often occurs in running and jumping sports, like athletics. Patients present with intermittent or continuous heel pain occurring with weight bearing. Findings include a positive squeeze test and tight heel cords. Paediatric heel pain cannot be diagnosed radiographically.
Calcaneal apophysitis usually causes pain and tenderness in the back and bottom of the heel when walking. The heel is painful when touched. It can occur in one or both heels. Because the heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain often reflects high activity. Children and adolescents who actively play rugby, soccer, hockey, basketball etc are especially more likely to develop this condition.
Excessive pronation (i.e. lowering of the arches and rolling inwards of the feet) is also a factor because it places increased stress on the the growth plate and and pull on the achilles tendons.
What is the difference between Paedicatric Heel Pain and Heel Pain in adults?
Paediatric heel pain differs from adult heel pain (Plantar Fasciitis) in the way the pain is experienced. Plantar Fasciitis pain is worse when getting out of bed in the morning or after sitting for long periods, and then it subsides after walking around for a while. Paediatric heel pain usually doesn’t improve in this manner. In fact, walking around and running typically aggrevates the pain.
Pediatric Heel Pain treatment options
A a number of treatment options are available including:
1) Rest, reduce activity: your child should reduce or stop any activity that causes heel pain
2) Anti-inflammatory drugs, such as ibuprofen will help reduce pain and inflammation temporarily.
3) Special exercises will help reduce the stress on the plantar fascia and achilles tendons. In particular calf and hamstring stretches, in particular before sports. Also strengthening of the muscles in the shin area is recommended (foot curls).
4) Wear an orthotic inside the shoe. Orthotic insoles support the feet and re-align the lower leg and ankles. Orthotics are designed to correct the problem of excessive pronation, one of the contributing causes of Sever’s Disease. Also applying a heel lift to the underside of the orthotic can be effective as it releases the tightness in the heel cords.
5) Apply an ice pack onto the sore heel(s) for about 5-10 minutes
Can Sever’s disease be prevented?
Sever’s disease may be prevented by maintaining good flexibility while your child is growing. The stretching exercises pictured here can lower your child’s risk for injuries during the growth spurt.Again, ask your doctor for advice. Good quality shoes with firm support and a firm heel counter will help. Your child should avoid excessive running on hard surfaces. If your child has already recovered from Sever’s disease, stretching exercises and placing ice on the heel after activity will help keeping the condition from re-occurring.
一名25歲男性因天生長短腳，左腳比右腳長1公分，並有輕度脊椎側彎，走路重心在單側，長久以來有無法久站立、容易雙腳痠痛、膝蓋痠痛及背痛和肩頸痛等問題，使用熱塑型鞋墊矯正之後，膝蓋疼痛、下背痛、肩頸的疼痛都有顯著的改善。
患者用熱塑型鞋墊把足根矯正至自然位置，並且抑制過度的內旋，再墊高短腳的部分，穿著一段時間後，明顯感覺站立時間可延長，舒適度增加，膝蓋的疼痛、下背痛、肩頸疼痛都有改善，走路時步伐重心也能適當地左右轉移了。
矯正鞋墊，可快速地為病人量身訂製，傳統長短腳治療，若只是墊高單邊的腳，沒有利用矯正鞋墊矯正過度的足內翻，可能造成墊高的一側又產生更嚴重內翻，所以很多傳統的矯正治療效果不佳，運用這類鞋墊治療後，卻能有效改善。
Plantar Fasciitis (or heel pain) is the most common form of foot pain and affecting millions of people every day, including professional athletes and also children. In the past 10 years, there have been a lot of studies done in regards to the most effective way of treating Plantar Fasciitis. Although opinions are divided, the general consent is that specific exercises aimed at making the plantar fascia (ligaments under the foot), achilles tendons and calf muscles more flexible are the key to treating and preventing Plantar Fasciitis.
In additon, many podiatrists and other health professionals believe that an orthotic arch support and/or a night splint will help relieve the tension on the plantar fascia and will aid in the repair of the ligaments and reduction of the inflammation at the heel bone. Below are extracts of a number of Plantar Fasciitis studies.
See also our Heel Pain pages for more information about heel pain treatment and relief.
Study 1) Daily stretching exercises for the treatment of Plantar Fasciitis
A recent study has shown that stretching the plantar fascia ligaments is a very effective treatment for the painful condition of the heel, called Plantar Fasciitis. Heel pain, worse when you first put your foot down, getting out of bed in the morning, used to be blamed on so-called heel spurs (outgrowths of the heel bone) and many GP’s would resort to painful steroid injections to treat heel pain. It now appears that the real reason for the pain is actually micro-tears in the plantar fascia – the fibrous band of tissue which runs from the heel to the toes and forms the arch of the foot.
The condition is called Plantar Fasciitis. One of the mainstays of treatment has been Achilles tendon stretching to pull on the heel. But a recent medical trial has found that stretching the plantar fascia itself works better.
This how the stretching exercise is performed: cross your legs putting the foot across the other knee. Grab the toes and with the other hand press the sole with your thumb. Then pull up just the toes, towards the shin checking you can feel the fascia in the sole of your foot going tight. Hold for a count of ten and repeat ten times three times a day starting from before you get up in the morning. The trial showed benefits lasting 2 years.
For Reference: Journal of Bone and Joint Surgery
Author: DiGiovanni B et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. 2006 online 5 Nov: doi:10.2106/jbjs.e.01281
Study 2) Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.
In this study, plantar fascia specific stretching was evaluated in 101 patients with chronic plantar fasciitis. The patients studied had diagnosed plantar fasciitis for at least 10 months. The patients were divided into two groups. The first group was given a plantar fascia tissue-stretching program and the second group was given an Achilles tendon-stretching program. All patients were educated by a video on plantar fasciitis, were given specific insoles and an anti-inflammatory medication for 3 weeks.
At 8 weeks, 82 patients had completed the therapy regimen and were reevaluated. The patients with the plantar fascia specific stretching program showed statistically significant improvement compared with the Achilles tendon stretching program.
Conclusion: A plantar fascia specific stretching program provides more benefit than an Achilles tendon stretching program, for those with plantar fasciitis.
J Bone Joint Surg Am. 2003 Jul;85-A(7):1270-7
Study 3) Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis: A Prospective Clinical Trial with Two-Year Follow-Up
This is the follow-up study on the plantar fascia-stretching study mentioned above. This study evaluates the long term outcomes of the plantar fascia specific stretching regimen. After the 8 weeks and success was noted with the specific stretching routine, the patients originally using the Achilles tendon-stretching program were encouraged to use the plantar fascia specific stretching program for 8 weeks.
At 2 years, 82 patients were mailed a questionnaire to address their pain, function and satisfaction with treatment. Sixty six of the 82 patients responded. Ninty-two percent of those who responded reported total satisfaction or satisfaction with some minor reservations regarding their treatment. Sixteen of the 66 who responded said they did seek further treatment by a clinician.
Conclusion: A plantar fascia specific stretching program can provide long term benefits for those with plantar fasciitis.
J Bone Joint Surg Am. 2006 Aug;88(8):1775-81
Study 4) Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors.
This was a retrospective study evaluating 225 patients with plantar fasciitis for 6 months or more and who had failed at least 5 conservative therapies. Each patient underwent extracorporeal shockwave therapy (ESWT) treatment by a single physician between the years 2002 and 2004.
A health questionnaire was used to survey the patients after the procedure and success rates were 70.7% at 3 months and 77.2% at 12 months. The patient’s weight, history of steroid injections, duration of symptoms and the plantar fascia thickness did not influence the outcome of the treatment. Older adults and individuals with diabetes or psychological issues had worse outcomes than those who did not.
Conclusion: Extracorporeal shockwave therapy is an effective treatment for chronic fasciitis, but success rates may not be as high as previously reported.
J Foot Ankle Surg. 2009 Mar-Apr;48(2):148-55.
Study 5) Novel Procedure for Heel Pain (Plantar Fasciitis)
44 patients with plantar fasciitis who were unresponsive to therapy had a local anesthetic at the heel area and then application of dry needling. Dry needling is a technique involving repeated needle punctures without the injection of any medication. The needle insertion is guided by ultrasound. The goal is to cause injury to a localized area to stimulate the healing response. An ultrasound guided steroid injection was then given after the treatment and patients were also given orthotics. They were followed for a period of six months. After 3 weeks, 95% of the patients had complete resolution of their symptoms and remained pain-free after 6 months.
Conclusion: The dry needling technique followed by steroid injection and orthotics may prove to be an effective treatment for plantar fasciitis, but more research is needed to evaluate safety and effectiveness.
RSNA 2008: 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America: Scientific Session A10-07. Presented November 30, 2008.
Study 6) Obesity and pronated foot type may increase the risk of chronic plantar fasciitis: a matched case-control study.
This study included 80 individuals with chronic heel pain and 80 without chronic heel pain. Body Mass Index, foot posture (foot position while standing), ankle range of motion, lower limb stress and calf endurance were measured in each group and questions on activites and time spent were asked. The group with chronic heel pain had a significantly greater body mass index, a more pronated foot position and greater ankle dorsi-flexion (foot movement up at the ankle) range of motion. There was no difference between the groups for calf endurance or on reported time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting.
Conclusion: Obesity and pronation are associated with chronic heel pain but there is not association with limitation of ankle joint dorsiflexion and chronic heel pain.
BMC Musculoskelet Disord. 2007 May 17;8(1):41
Study 7) Comparison of custom and prefabricated orthotics in the initial treatment of proximal plantar fasciitis.
This study evaluated 236 patients with plantar fasciitis who were divided into five treatment groups and followed for 8 weeks. One group performed stretching only, three groups were given different types of over-the-counter/prefabricated inserts and the fifth group was given custom made orthotics. After 8 weeks, all groups showed improvement ranging from 68% with the custom made foot orthoses to 95% with the silicone inserts. All groups using prefabricated inserts and insoles had greater improvements than those using the custom made orthoses.
Conclusion: When stretching is combined with a prefabricated insert, the short term improvements in plantar fasciitis are greater than with those using a custom made foot orthotics.
Foot Ankle Int. 1999 Apr;20(4):214-21.
Study 8. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.
Forty-three patients with plantar fasciitis were divided into three treatment groups; treatment with orthotics, orthotics and night splints or night splints alone. After one year, 88 % of the patients returned for follow up evaluation and all treatment groups had significant improvement compared to their initial evaluation. At one year, the two groups using orthotics had a reduction in pain of 62% compared to a reduction of 48% with the group using only night splints.
Conclusion: Patients with plantar fasciitis were more likely to continue to use orthotics than the night splint at one year. Note: night splints are generally used for a few months of treatment.
Foot Ankle Int. 2006 Aug;27(8):606-11.
Many of us suffer from chronic pain in the knees, hips or lower back. Often there is a connection between these complaints and the way you walk. This article sheds more light on knee pain and in particular how abnormal foot mechanics or asymmetry in our gait can affect knee function, causing pain and discomfort.
Typical knee pain symptoms…
“A sharp pain in the knee and a grinding sensation, especially when getting up out of chair or walking up stairs.”
This description of knee pain is most common and refers to a condition called Patello-femoral Syndrome. Patello-femoral Syndrome is the most common form of chronic knee pain. It refers to pain occurring between the knee cap (the patella) and the underlying thigh bone (the femur). Patello-femoral Syndrome causes pain and tenderness in the front of the knee. The pain gets worse when you sit for a long period and get up. Or when you walk up stairs. Often, one will experience a grinding or crunching sensation in the knee.
What exactly causes knee pain?
There are number of different causes for knee pain. With age wear and tear occurs in the knee joint. Also over-use causes knee problems (for example in rugby/football players, and in tradespeople such a carpenters, bricklayers etc). Over time softening of the cartilage beneath the knee cap (the patella) will result in tissue breakdown and pain in the knee joint. Instead of gliding smoothly over the knee the knee cap grinds against the thigh bone when the knee moves. In turn this may result in heavy erosion of the cartilage. Apart from age and over-use the third most common cause of knee pain is faulty gait (i.e. the way we walk). Overpronation (=rolling inwards of the feet and lowering of the arches) is a major contributing factor to knee pain.
Here’s why…
The knee joint forms the link between the upper and lower leg. It is a hinge joint, which means it is only designed to flex and extend the lower leg, and not to rotate it. Unlike for instance your elbow joint which allows your underarm to move up and down, as well a twist (rotate). Overpronation of the feet means that with every step your foot rolls inwards too much. As the foot rolls inwards the bones in the lower leg are forced to rotate internally and this results in a twisting motion at the knee joint. This irregular motion of the knee will inevitably lead to excessive wear and tear in the knee joint causing long-term damage and chronic knee pain. Over-pronation not only causes bad knee function. An estimated 70% of the population suffers from some degree of over-pronation and this becomes evident in other areas of the body, especially at an older age. People with overpronation can display symptoms such as frequent ankle sprains, pain in the arches, leg pains, shin splints, hip pain, even lower back pain.
Over-pronation causes internal leg rotation
Treatment options for knee pain
The most commonly prescribed treatments by physiotherapists include rest (or decreased activity), ice packs and sometimes wearing a knee brace and also strengthening exercises. In addition, orthotic shoe inserts will be recommended to stabilise the feet and correct poor foot function. Footlogics orthotics can be used to prevent the unnatural rotation of the lower leg, thereby treating the cause of this type of knee pain. By supporting the arches they force the ankles and legs back into alignment, reducing the twisting on the knee and thereby providing relief to the painful knee joint.
A number of studies have shown that bad knee function can be restored by using foot orthotics. Below are the extracts of two of these studies:
Study 1) The Effect of Foot Orthoses on Patellofemoral Pain Syndrome (Knee Pain) – Amol Saxena, DPM and Jack Haddad, DPM – Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA.
In a retrospective review of 102 patients treated for chondromalacia patellae and patellofemoral knee pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthotics was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved, showing a significant decrease in the level of pain with orthotics intervention (chi-square P < .001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD. (J Am Podiatr Med Assoc 93(4): 264-271, 2003)
Study 2) The Role of Foot Orthotics as an Intervention for Patellofemoral Pain (Knee Pain) – Michael T. Gross, PT, PhD1- Judy L. Foxworth, PT, MS, OCS2
Foot orthotics often are prescribed for patients with patellofemoral knee pain. The purpose of this clinical commentary is to review the theoretical and research basis that might support this intervention and to provide our own clinical experience in providing foot orthoses for these patients. Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, (2) the relationship between foot and lower-extremity/patellofemoral joint mechanics, (3) the effects of foot orthoses on lower-extremity mechanics, and (4) the effects of foot orthoses on patellofemoral joint position. The literature and our own clinical experience suggest that patients with patellofemoral pain may benefit from foot orthoses if they also demonstrate signs of excessive foot pronation and/or a lower-extremity alignment profile that includes excessive lower-extremity internal rotation during weight bearing and increased Q angle. The mechanism for foot orthoses having a positive effect on pain and function for these patients may include (1) a reduction in internal rotation of the lower extremity; (2) a reduction in Q angle; (3) reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and (4) reduced patellofemoral contact pressures and altered patellofemoral contact pressure mapping. Foot orthotics may be a valuable adjunct to other intervention strategies for patients who present with the previously stated structural alignment profile. J Orthop Phys Ther 2003;33:661-670.
The most common foot complaints explained (click for more info)
Foot pain is very common and an estimated 75% of people will suffer from some type of foot pain at some point in their life. The foot is a complex structure made of 26 bones, 33 joints and layered with an intertwining web of more than 120 muscles, ligaments, and nerves. With each step we take, a force of 2-3 our body weight is placed on our feet and during a typical day, people take 8,000 – 10,000 steps. Therefore it comes as no surprise that at some time in our lives we will suffer some type of foot complaint. This article sheds light on the most common types of foot pain and shows how orthotics and special exercises can help. Firstly, let’s have a look at the major factors that contribute to Foot Pain:
- Age: as we age, our feet widen and flatten, plus the fat padding on the sole of the foot wears down. The skin on our feet also becomes dryer. Foot pain in older people may be the first sign of arthritis, diabetes and circulatory disease.
- Gender: Women are at higher risk than men for severe foot pain, most likely because of the high-heeled shoes they wear
- Occupational Risk Factors: people who are on their feet all day because of work are much more likely to suffer from foot pain
- Pregnancy: pregnant women often have foot complaints due to weight gain, swelling in their feet and ankles, and the release of certain hormones that cause ligaments to relax
- Sports/Running/Dancing: especially heel pain, shin splints, and knee pain can increase with sports, running or dancing.
- Weight gain: being overweight puts added stress on the feet and can lead to heel pain, foot pain and ankle injuries
- Over-pronation: rolling inwards of the foot and flattening of the arches (over-pronation) is a major contributing factor to foot pain.
Most common types of foot pain:
Heel pain is the most common foot problem. Heel pain is often experienced with one’s first steps out of bed in the morning and presented by a sharp stabbing pain in the heel. Commonly heel pain is caused by a painful stretching and micro-tearing of the Plantar Fascia (the flat band of tissue that connects your heel bone to your toes). The Plantar Fascia supports the arch of the foot. Plantar Fasciitis is Latin for inflammation of the Plantar Fascia. Normally, the fascia is flexible and strong. However, due to factors such as excessive weight, age, over-use and over-pronation the Fascia can become irritated and inflamed. With excessive tension on the Plantar Fascia the attachment of the ligaments onto the calcaneus (heel bone) begins to pull away from the bone. After a while a ‘heel spur’ may develop at the bottom front of the heel bone. During resting (e.g. when you’re asleep), the plantar fascia shortens and tightens up. When getting up, bodyweight is rapidly applied to the foot and the fascia must stretch and quickly lengthen, causing micro-tears in the fascia. Hence, the stabbing pain with your first steps in the morning.
Plantar Fasciitis, heel pain and heel spurs are best treated with simple, non-surgical methods. However, the longer the heel pain has been present, the longer it takes to fix. Research has shown that the most effective long-term treatment for heel pain is doing some simple stretching exercises, combined with wearing foot orthotics. This way the tension on the Plantar Fascia is being released, treating the cause of the problem, not just the symptom.
Read more about Heel Pain, Heel Spurs and Plantar Fasciitis…
Arch Pain is caused by the same problem as heel pain: ‘Plantar Fasciitis’ or inflammation of the Plantar Fascia. The difference is that the inflammation of the fascia occurs under the arch, rather than at the heel bone. Treatment of arch pain, is exactly the same as for heel pain (see above).
Achilles Tendonitis is Latin for ‘inflammation of the Achilles Tendon’. The Achilles Tendon connects the calf muscles to the heel bone and sits just behind the ankle joint. Achilles pain occurs just above the back of the heel and the Achilles Tendon in this area may be thickened and tender to the touch. Pain is present with walking, especially when pushing off on the toes. Achilles Tendonitis should not be left untreated due to the danger that the tendon can become weak and ruptured. Achilles pain is aggravated by activities that repeatedly stress the tendon, causing inflammation. People who suffer from Achilles Tendonitis often notice that their first steps out of bed in the morning are very painful.
The cause of Achilles Tendonits is over-straining of the Achilles Tendons leading to irritation and inflammation. There are several factors that can cause Achilles Tendonitis, including over-use, thight calf muscles and age. The most common cause, however, is over-pronation. When the arch collapses upon weight bearing, extensive stress is placed on the achilles tendons.
Treatment of Achilles Tendontis includes rest (or reduced activity), calf stretching and ice packs (to cool down the inflammation). The use of orthotics is recommend to support the arches, thereby reducing the stress on the achilles tendon.
Read more about Achilles Tendonitis…
Metatarsalgia is the general term for pain in the metatarsal region of the foot more commonly called the Ball of the Foot. Many women suffer from Metatarsalgia as a result of wearing high heels, but this condition can also occur in men. Wearing (high) heels means most of the bodyweight is concentrated on the forefoot, causing excessive pressure in the ball of the foot.
Metatarsalgia is often described as a burning sensation in the ball of the foot, combined with excess callous forming. Ball of Foot Pain (Metatarsalgia) occurs when the metatarsals (forefoot bones) drop and the surrounding ligaments weaken. The entire forefoot structure collapses, which then leads to excess pressure and friction under the ball of the foot.
Effective treatment of pain the ball of the foot involves reducing the excessive force placed in the forefoot area. Unloading pressure in the ball of the foot can be accomplished by wearing orthotic insoles with a in-built metatarsal support.
For women’s fashion and high heel shoes we recommend Footlogics Catwalk – a thin and flexible footbed that supports the arch, as well as the metatarsal bones. This way, bodyweight is distributed more evenly over the entire foot with less pressure and friction in the ball of the foot. For men’s shoes there’s Footlogics Comfort which also features a metatarsal support and at the same time controls over-pronation, a major contributing factor to Metartarsalgia.
Morton’s Neuroma is a foot problem associated with Metatarsalgia. It involves swelling and inflammation of a the nerve between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton’s Neuroma may also cause numbness, tingling, or cramping in the forefoot. Treatment of Morton’s Neuroma is the same as for Metatarsalgia.
In addition, one can use ice packs to cool down the inflammation. Also, wearing tight shoes that squeeze the toes should be avoided.
Read more about Ball of Foot pain…
A bunion is an often painful enlargement of the joint at the side of the big toe. The big toe is bent inwards and a bony lump forms on the outside. The bump is actually a bone protruding towards the inside of the foot. Over time the lump becomes larger and the bunion can become painful. Stiffness can eventually develop, even arthritis. With the continued movement of the big toe towards the smaller toes it is common to find the big toe resting over the second toe. Symptoms of bunions include inflammation, soreness and swelling and on the outside the big toe, often causing the sufferer to walk with difficulty.
Bunions can develop from an abnormality in foot function (e.g. over-pronation) or by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box can lead to the formation of a bunion. The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. Orthotics are also recommended for this condition to provide extra comfort, support and protection.
Over-pronation (fallen arches and rolling inwards of the feet & ankles) is a very common condition, affecting at least 70% of the population. The opposite of pronation is supination: the feet tend to roll outward and the arch remains high during the walking process. Only 5% of the population has this problem (often referred to as Pes Cavus – latin for high arched foot).
Interestingly, many people are convinced they don’t over-pronate at all, because their shoes tend to wear out faster on the outside, not the inside! In other words, they believe that over-supinate, rather than over-pronate…
Shoewear (at the bottom of the shoes) can provide helpful information when assessing a person gait pattern. Ppodiatrists and phyiotherapists often will look for irregular shoewear when a patient presents with a foot or knee problem.
The simple assumption that excessive outside wear of sole indicates supination and conversely excessive inside shoewear indicates over-pronation, is incorrect.
Firstly, we need to understand normal human gait pattern. When we walk our feet always land on the outside heel first (heel strike). This is simply because the distance between our hips is wider than the distance between our feet when they land during walking or running. Women especially place their feet very close together, almost in a one line, during walking and running. The photo below illustrates how our legs are always angled inwards, during walking and running. With women the angle tends to be slightly greater than with men.
The leg is naturally angled inwards during walking and running
Because of this leg angle, when the foot lands it always hits the ground first with the outside of the foot. During our gait our heels touch the ground first, so it comes as no surprise that our footwear wears out first on the outside heel area of the shoe.
This excessive wear on the outside heel is totally normal and occurs in both over-pronators and over-supinators. Some people will only notice slight outside wear, others a lot. Supinators will notice excessive wear not just in the outside heel area, but more likely across the entire outside area of the shoe.
Now let’s have a look at what happens after heel strike. After our heel strikes the ground, the foot makes full ground contact (this is called the midstance phase of gait) and pronation occurs. I.e. the foot muscles loosen allowing the foot and ankle to roll inwards and the arch to flatten. Pronation is a normal process: it is nature’s own shock-absorbing mechanism.
Next the heel lifts off the ground and the foot prepares itself for take-off: a propelling motion to move the body forward (the propulsive phase of gait). At this stage the foot should become rigid and supinate (roll outwards). Unfortunately, this the moment where things go wrong. Most of us don’t supinate, instead the foot remains loose and stays in a pronated position (ankle inwards and arch lowered). This situation is referred to as over-pronation.
Shoewear on the outside heel doesn't mean, you don't suffer from over-pronation!
So in conclusion, if your shoes wear out faster on the outside heels of your shoesoles, it doesn’t mean you’re not an over-pronator! Most likely you are, like 70% of the population.
Over-pronation can be a real problem as it makes walking and running quite inefficient, costing us more energy and increasing the chances of pain and injury such as plantar fasciitis, heel pain, shin splints, knee pain and lower back pain. To combat over-pronation you can 2 things: strengthen the muscles in your feet and legs with exercises and wear a (flexible) orthotic like Footlogics orthotics. The good thing about flexible orthotics (as opposed to hard, rigid) orthotics is that they still allow the foot to pronate naturally, but at the same time they prevent over-pronation.