• Bunions


    Overview

    Bunions are called hallux abductovalgus when the joint of the big toe(hallux) is involved,and are called tailor's bunions or bunionettes when they occur on the little toe side of the foot. A bunion is when your big toe points toward the second toe. This causes a bump on the edge of your foot, at the joint of your big toe.

    Bunions are often caused by narrow-toed, high-heeled shoes. These compress the big toe and push it toward the second toe. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe. This leads to swelling and pain. Bunions occur more frequently in women and sometimes run in families.

    Symptoms

    * Red, calloused skin along the foot at the base of the big toe
    * A bony bump at this site
    * Pain over the joint, aggravated by pressure from shoes
    * Big toe turned toward the other toes

    Signs and Tests

    A doctor can usually diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot and, in some cases, arthritis.

    Treatment

    Most doctors who take care of feet will not just do surgery. Remember, the bunion is there because of walking inefficiency. The majority of doctors will want to try orthotics with patients who have bunions that are not painful. Plus, if the orthotics do not take care of all the pain, they can make it bearable. Or, if you have to have surgery, then you are not going to be back with a recurrence of the bunion, because wearing the orthotics reduces the forces that cause the bunion in the first place.

    Prevention

    Avoid compressing the toes of your foot with narrow, poor-fitting shoes and wear custom orthotics to improve gait.

  • Plantar Fasciitis


    Overview

    Plantar fasciitis is an inflammation (irritation and swelling with presence of extra immune cells) of the thick tissue on the bottom of the foot that causes arch pain, heel pain and disability.

    The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. This fascia can become inflamed and painful in some people with exsessive pronation (calapsing arch), making walking more difficult and often very painful.

    Symptoms

    The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

    Signs and Tests

    Typical physical exam findings include tenderness on the bottom of the heel, closer to the midline, and mild swelling and redness.

    X-rays may be taken to rule out other problems, but the presence or absence of a heel spur is not significant.

    Treatment

    Conservative treatment is almost always successful, given enough time. Duration of treatment can be anywhere from several months to 2 years before symptoms resolve, although about 90% of patients will be better in 9 months.

    Initial treatment usually consists of heel stretching exercises, custom orthotics (with heel cut out cushion accommodation & heel spur accommodation when spurs are present), night splints, and anti-inflammatory medications. If these fail, casting the affected foot in a short leg cast (a cast up to but not above the knee) for 3-6 weeks is very often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.

    Some physicians will offer steroid injections, which provide lasting relief in about 50% of people. However, this injection is very painful and not for everyone.

    In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.

    Prevention

    Maintaining good flexibility around the ankle and wearing custom orthotics with adequate arch support is probably the best way to prevent plantar fasciitis.

  • Heel Spurs


    Overview

    The heel spur (or calcaneal spur) is a nail-like growth of calcium around the ligaments and tendons of the foot where they attach to the heel bone. The spur grows from the bone and into the flesh of the foot.

    A heel spur results from an anatomical change of the calcaneus (heel bone). This involves the area of the heel and commonly associated with plantar fasciitis.

    The heel bone forms one end of the two longitudinal arches of the foot. These arches are held together by ligaments and are activated by the muscles of the foot (some of which are attached beneath the arches and run from the front to the back of the foot). These muscles and ligaments, like the other supporting tissues of the body, are attached in two places. Many are attached at the heel bone. The body reacts to the stress at the heel bone by calcifying the soft tissue attachments and creating a spur.


    Symptoms

    Although it may take years to become a problem, once it appears, it may cause considerable suffering. Because of proximity to the tendons, the spur is a source of continuous painful aching. The sensation has been described as "a toothache in the foot." When you place your weight on the heel, the pain can be sufficient to immobilize you.

    The pain caused by a calcaneal spur is not the result of the pressure of weight on the point of the spur, but results from inflammation around the tendons where they attach to the heel bone. You might expect the pain to increase as you walk on the spur, but actually it decreases. The pain is most severe when you start to walk after a rest. The nerves and capillaries adapt themselves to the situation as you walk. When you rest, the nerves and capillaries rest, also. Then, as you begin to move about again, extreme demands are made on the blood vessels and nerves, which will cause pain until they again adjust to the spur.

    If excessive strain has been placed on the foot the day before, the pain may also be greater. A sudden strain, as might be produced by leaping or jumping, can also increase the pain. The pain might be localized at first, but continued walking and standing will soon cause the entire heel to become tender and painful.


    Treatment

    The most effective treatment of heel spurs is custom orthotics with both a heel spur accommodation (horse-shoe shaped pad at the heel) and a heel cut out cushion accommodation. The idea is to take excess pressure off the center of the heel with the use of the heel spur accommodation and provide extra impact cushion with the use of the heel cut out cushion accommodation.

  • Achilles Tendinitis


    Overview

    Achilles tendinitis is present when your Achilles tendon becomes inflamed or irritated.

    Often, Achilles tendinitis results from sports that place a lot of stress on your calf muscles and Achilles tendon, such as basketball. Achilles tendinitis also is often associated with a sudden increase in the intensity or frequency of exercise.

    When treated promptly, Achilles tendinitis is often short-lived. Left untreated, Achilles tendinitis could cause persistent pain or cause your tendon to tear (rupture). If so, you may need surgery to correct the damage.


    Symptoms

    The signs and symptoms of Achilles tendinitis often develop gradually. They include:

    • Dull ache or pain when pushing off your foot during walking or when rising on your toes
    • Tenderness over your Achilles tendon
    • Stiffness that lessens as your tendon warms up
    • Mild swelling or a "bump" on your tendon
    • A crackling or creaking sound when you touch or move your Achilles tendon

    You may notice that the affected tendon is sore when you get up in the morning or after you've rested, improves slightly once you start moving around, and then worsens again when you increase your activity level.

    If you have sudden pain and swelling near your heel and are unable to bend your foot downward or walk normally, you may have ruptured your Achilles tendon. If you've ruptured the tendon completely, you won't be able to rise on your toes on the injured leg. You may feel as if you've been kicked in the back of your ankle. See your doctor immediately if you suspect you have an Achilles tendon rupture.


    Treatment

    The most effective treatment of achilles tendinitis is custom orthotics with rear foot posting to elevate your heel within the shoe. Heel lifts may be necessary if standard posting with 1-2mm post cap does not provide relief.

  • Metatarsalgia


    Overview

    Metatarsalgia is a condition marked by pain and inflammation in the ball of your foot.

    You may experience metatarsalgia if you're physically active and your feet are impacted by running and jumping. Or, you may develop metatarsalgia by wearing ill-fitting shoes. There are other causes as well.

    Although generally not serious, metatarsalgia can sideline you. Fortunately, proper footwear, along with custom orthotics, may be all you need to prevent or minimize future problems with metatarsalgia.


    Symptoms

    Symptoms of metatarsalgia may include:

    • Pain in the ball of your foot — the part of the sole just behind your toes
    • Sharp, aching or burning pain
    • Pain in the area around your second, third or fourth toes — or, only near your big toe
    • Pain that gets worse when you stand, walk or run and improves when you rest
    • Sharp or shooting pain in your toes
    • Numbness or tingling in your toes
    • Pain that worsens when you flex your feet
    • A feeling in your feet as if you're walking with a pebble in your shoe
    • Increased pain when you're walking barefoot, especially on a hard surface

    Sometimes these symptoms develop suddenly — especially if you've recently increased your usual amount of running, jumping or other high-impact exercise — but problems usually develop over time.


    Treatment

    The most effective treatment of metatarsalgia is custom orthotics with metartarsal pad accommodations.