Common Foot Problems

PLANTAR FASCIITIS

Plantar fasciitis is characterized by stiffness and inflammation of the plantar fascia (fibrous connective tissue) on the plantar (bottom) aspect of the foot. It is occasionally associated with a bone spur on the heel. There may also be a partial or complete tear of the fascia on the bottom of the foot.

COMMON SIGNS AND SYMPTOMS
•Pain and tenderness on the sole of the foot usually localized at the heel bone with standing or walking.
•The pain is particularly noticeable with the first few steps after getting out of bed in the morning or after prolonged sitting.

CAUSES
•Inflexibility in the calf muscles.
•Flat (planus) or high (cavus) arched feet.
•Unhealthy foot pronation.
•Poor footwear.
•Repetitive micro trauma or stress to the heel tissues that may cause inflammation or calcification of the fascia of the foot.
•Irritation of the small nerve that runs under the foot where the fascia attached to the heel bone.

MANAGEMENT
•Ice affected area.
•Stretching.
•Custom foot orthoses and footwear prescription.
•Shockwave Therapy, Massage.


MORTONS NEUROMA
An inter-digital neuroma is a swelling of the nerve and scar tissue arising from the compression of an inter-digital nerve. This most neuroma's often occur between the 3rd and 4th metatarsals. Pain generally radiates towards the toes and is intensifies with forefoot weightbearing and in shoes with insufficient forefoot width.

COMMON SIGNS AND SYMPTOMS
•Localized tenderness between the 3rd and 4th (or 2nd and 3rd) metatarsals with pain that radiates down the involved toes.
•Aching and burning sensation.
•Highly sensitive to pressure either under the foot or from squeezing.
•Pins and needles (paresthesia) in the toes.
•Increased pain and discomfort during forefoot weightbearing and in narrow fitting shoes.

CAUSES
•Swelling of the inter-digital nerve that is impinged by the metatarsals.
•Excessive pronation.
•Improper footwear, i.e. narrow fitting shoes or high heel shoes.

MANAGEMENT
•Ice
•Custom foot orthoses with metatarsal Domes and Bars
•Appropriate shoe prescription.
•Possible cortisone injection


METATARSAL STRESS FRACTURES
Metatarsal stress fractures are partial or complete fractures in the long bones of the foot (Figure 1). The wear and injury to the bone exceeds its ability to remodel or repair the damage inflicted by intense exercise or excessive load. The most common metatarsal stress fracture occurs at the neck of the second metatarsal secondary to excessive pronation and metatarsal loading. In addition, if the second metatarsal is long relative to the first (Morton’s foot) it will be subjected to increased loads. This can also occur in the third metatarsal if it is long relative to the second.

COMMON SIGNS AND SYMPTOMS
•Vague, diffuse pain or ache in the foot.
•Intense localized tenderness at the fracture site.
•Forefoot swelling, redness and occasional increased skin temperature.
•Weakness and inability to bear weight on the foot.
•Pain with non-weightbearing bending stress.
•Pain not severe at start of activity but worsens as activity continues.

CAUSES
•Repetitive forces on the foot that exceed the bone’s ability to repair.
•Sudden changes in exercise intensity, equipment or performance.
•Osteoporosis.

MANAGEMENT
•Ice and relative rest from the deleterious activity.
•Temporary shoe modification to increase shoe stiffness (i.e. spring plate OR a CAM Walker).
•Custom foot orthoses.
•Gradual return to activity.


SHIN PAIN
A shin splint or general shin pain is the most common cause of exercise-induced leg pain encountered by athletes of all levels. In the past the term shin splint has been used to describe all forms of pain in the lower leg. A shin splint is a very specific problem. It is essentially an inflammatory reaction involving the deep tissues of the lower leg and may involve tendons & muscles. Specifically the tibialis anterior muscle and tendon.

COMMON SIGNS AND SYMPTOMS
The inflammatory reaction occurs at the point where the deep tissues insert into the inside (medial) or front (anterior) aspect of the leg bone (tibia). When a patient is suffering from a medial shin splint the pain will be present on the inner aspect of the leg. In an anterior shin splint, pain and tenderness is present on the front and outer aspect of the leg. In both cases, running and walking may be extremely painful. In severe cases, even light weight bearing may be painful. The primary cause of shin pain is over pronation.

CAUSES
One of the most common causes of foot and leg discomfort is a condition known as excessive pronation. Normal pronation, or "turning inward", of the foot is necessary as the foot adapts to the ground. With excessive pronation, the arch flattens, collapses, and soft tissues stretch. This causes the joint surfaces to function at unnatural angles to each other. When this happens, joints that should be stable now become very loose and flexible. At first, excessive pronation may only cause fatigue. As the problem gets worse, strain on the muscles, tendons, and ligaments of the foot and lower leg can cause permanent problems and deformities.

EXCESSIVE PRONATION
1. When standing, your heels lean inward.
2. When standing, one or both of your knee caps turn inward.
3. Conditions such as a flat feet or bunions may occur.
4. You develop knee pain when you are active or involved in athletics. The knee pain slowly goes away when you rest.
5. You abnormally wear out the soles and heels of your shoes very quickly.

SYMPTOMS OF EXCESSIVE PRONATION
Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with over pronation:
•Hallux Abducto Valgus (bunions)
•Hallux Rigidus (stiff 1st toe)
•Arch Pain
•Heel Pain (plantar Facsitus)
•Metatarsalgia (ball of the foot pain)
•Ankle sprains
•Shin Splints
•Achilles Tendonitis
•Osteochondrosis
•Knee Pain
•Corns & Calluses
•Flat Feet
•Hammer Toes


FLAT FEET/FOOT
The arch is referred to as the gap between the inner side of the foot and the ground, flat feet is a condition in which the foot doesn't have a normal arch.
It may affect one foot or both feet. Patients that have a low arch or no arch commonly refer to their condition as flat feet or fallen arches.
Fallen arches can cause problems such bunions, callus, corns, achilles tendonitis, shin pain, severe heel pain, knee and ankle pain.

A symptom to watch for is abnormal shoe wear.
People with flat feet typically have shoes that break down the inside wall of the heel counter and the outside of the forefoot area.

A good test is to look at your foot print. A foot with a normal arch does not leave much of an arch impression since the arch is mostly off the ground.
A flat foot person leaves more of an impression. The primary cause of an flat feet is overpronation.
This can be controlled via insoles. People with flat feet or low arches who have been forced to live with back, knee and foot pain no longer have to put up with pain while standing, walking or running.



TOP OF FOOT PAIN
Top of the foot pain is a general term that is used by patients to describe pain in the top surface of the foot. It is common injury amongst runners and sporting people. A sharp pain on the top of my foot which is usually around the second metatarsal (in line with the second toe). Sometimes the pain can be localized around the 3rd or 4th metatarsal.

The two most common causes of this type of pain are either a stress fracture or tendentious of a metatarsal tendon. Athletes sometimes try and run through injuries such as heel pain, shin pain and achilles tendentious, which leads to this condition. In severe cases, even light weight bearing may be painful. The primary cause of of this condition is overpronation. This can be controlled via insoles.