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Sophie Clare

Over-Pronation
Overview


Overpronation and underpronation describe general foot movements. These terms do not necessarily describe a medical problem with a foot. For example, you can overpronate and not have any problems or symptoms at all. It is important to have your foot structure and symptoms adequately assessed by your prescribing physician and a qualified practitioner. Once the underlying conditions and mechanical faults are assessed, an appropriate treatment plan including possible orthotic and footwear recommendations can be made.Foot Pronation


Causes


Congenital "Flat Feet" - an individual may be born with feet that lack an appropriately supportive arch thereby predisposing the individual to this foot condition. Excessive Weight (Obesity) Too much weight on the foot from either obesity or pregnancy may be a factor. Repetitive Impact walking on flat, hard surfaces continuously places unnatural stress on the foot arch.


Symptoms


Overpronation can be a contributing factor in other lower extremity disorders, such as foot pain, plantar fasciitis, ankle injuries, medial tibial stress syndrome (shin splints), periostitis, stress fractures and myofascial trigger points. Overpronation increases the degree of internal tibial rotation, thereby contributing to various knee disorders such as meniscal injury or ligament sprains. The effects of the postural deviation are exaggerated in athletes due to the increase in foot strikes while running and the greater impact load experienced. When running, three to four times the body weight is experienced with each foot strike.2 If overpronation exists, the shock force is not adequately absorbed by the foot and is transmitted further up the kinetic chain.


Diagnosis


Your healthcare provider will ask about your symptoms, medical history, and activities and examine your feet. Your provider may watch you walk or run. Check the motion of your feet when they strike the ground. Look at your athletic shoes to see if they show an abnormal pattern of wear.Foot Pronation


Non Surgical Treatment


If you overpronate, you should talk with a foot and ankle specialist, especially if symptoms have not developed yet. Questions you may want to ask your doctor include what are the best running shoes on the market? Where can I find those shoes? If over-the-counter orthotics don?t work, how long should I wait before contacting you for custom-made orthotics? On my next visit, what type of diagnostic testing should I expect? If I limit the amount of time I spend running, will my overpronation symptoms disappear? What additional treatment options can we try?


Prevention


Wear supportive shoes. If we're talking runners you're going to fall in the camp of needing 'motion control' shoes or shoes built for 'moderate' or 'severe' pronators. There are many good brands of shoes out there. Don't just wear these running, the more often the better. Make slow changes. Sudden changes in your training will aggravate your feet more than typical. Make sure you slowly increase your running/walking distance, speed and even how often you go per week. Strengthen your feet. As part of your running/walking warm up or just as part of a nightly routine try a few simple exercises to strengthen your feet, start with just ten of each and slowly add more sets and intensity. Stand facing a mirror and practice raising your arch higher off the ground without lifting your toes. Sit with a towel under your feet, scrunch your toes and try to pull the towel in under your feet. Sitting again with feet on the ground lift your heels as high as you can, then raise and lower on to toe tips.
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Physical Therapy For Severs Disease
Overview


It is thought to be a traction injury, where the Achilles tendon and Plantar fascia pull in opposite directions. Sever?s occurs in children aged 8 to 16 years old. In children, the heel bone is made up of 2 bones, with a growth plate of cartilage in between the sections, holding these 2 bones together. As the cartilage expands, the edges of it eventually turn to bone, and finally the gap closes. This usually occurs within the first 13-15 years of life. However, because these bones are connected by cartilage they are weaker than normal bones. This is why they are very vulnerable to injury.


Causes


Sever's disease is a common cause of heel pain in physically active growing kids. It usually occurs during the growth spurt of adolescence, the approximately 2-year period in early puberty when kids grow most rapidly. This growth spurt can begin anytime between the ages of 8 to 13 for girls and 10 to 15 for boys. Peak incidences are girls, 8 to 10 years old. boys, 10 to 12 years old.


Symptoms


The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the tendo-achilles inserts into the calcaneus (heel bone), and is tender to deep pressure at that site. Walking on his toes relieves the pain.


Diagnosis


A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot. The doctor may order an x-ray because x-rays can confirm how mature the growth center is and if there are other sources of heel pain, such as a stress fracture or bone cyst. However, x-rays are not necessary to diagnose Sever?s disease, and it is not possible to make the diagnosis based on the x-ray alone.


Non Surgical Treatment


See a doctor, who can diagnose the injury and recommend appropriate treatment options. It will be beneficial to rest the affected heel, and to regularly ice the affected area for the first few days. Anti-inflammatory pain medication can reduce pain and swelling, but first check with your doctor. As the pain diminishes a physical therapist can assist with a program of rehabilitation, incorporating stretching and strengthening exercises focused on the calf, shin and hamstring muscles. For a period after the injury has healed the doctor may advise on changes to your training routines that seek to lessen the strain on the heels. Orthotics are often recommended for your shoes in order to correct any biomechanical problems or lend extra support to the heels.


Exercise


Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The child should do this exercise routine a few times daily.
| Category: None | 03:23 | Trackbacks:0 | Comments:0
Severe Pain In The Arch Of The Foot
Overview


Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when the person stands on his or her toes. The arch develops in childhood, and by adulthood most people have developed normal arches. Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape). Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.


Foot Arch Pain


Causes


The arch of the foot is the concaved, mid-section of the sole. While it only spans an inch or two in most adults, this one small area of the foot bears nearly all of your weight when you walk, and helps to transfer this weight from heel to ball. Just beneath the skin on the sole of the foot, a tough, elastic ligament called the plantar fascia extends from your heel bone to the metatarsal area of the foot. This ligament is designed to bounce gently with the spring of your step, but a number of factors can cause it to become unhealthy. These include. An abnormal walking gait. Vigorous high-impact exercise such as running, playing tennis or basketball. Being overweight. Wearing shoes that slant or cramp any part of the foot. Wearing shoes that have worn down in the heel or sole. A traumatic injury to the foot, including cuts, bruises, strains and fractures. The presence of arthritis or other inflammatory conditions. The normal aging process. In the presence of any of the above factors, the plantar fascia ligament can begin to flex beyond its normal range of motion. Small tears may develop in the tissue and inflammation is commonly present. You may describe your arch pain as sore, sharp, tender, intermittent, constant, burning, tingling or aching. All of these adjectives may be signs that you are experiencing a condition called Plantar Fasciitis.


Symptoms


Bones and ligaments work together to form joints, and bones are joined together by ligaments. Strains occur in ligaments. In the arch, there are ligaments that are located at the ends of each bone. These ligaments connect the bones to other bones on both ends and on the sides. Point tenderness and looseness of a joint are indicators of a sprain. Fractures are indicated by point tenderness that may be severe over the area of bone that is affected. There may be a distinguishable lump or gap at the site of the fracture. A rotated toe or forefoot may also be a sign of a fracture.


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


The most effective treatment for foot arch pain and strain is to use an arch support. The arch support sits under the foot and stops the arch of the foot from collapsing, thereby preventing the stretch of the arch pad which causes pain and discomfort. Wearing an arch support in slippers or house shoes can also prevent pain in the mornings when discomfort it most common and severe. Arch supports usually relieve symptoms within a few days.


Pain In Arch


Surgical Treatment


A procedure that involves placing a metallic implant (most commonly) at the junction where the foot meets the ankle. This device causes the physical blockade that prevent the collapse. It is a procedure that is only indicated for mobile feet, and should not be used with rigid flat feet. Dr. Blitz finds this procedure better for younger patients with flexible flat feet where the bone alignment is still developing so that the foot can adapt to function in a better aligned position.


Prevention


The best method for preventing plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds. To stretch the calf muscles, place hands on a wall and drop affected leg back into a lunge step while keeping the heel of the back leg down. Keep the back knee straight for one stretch and then bend the knee slightly to stretch a deeper muscle in the calf. Hold stretch for 15 seconds and repeat three times.


Stretching Exercises


Gastroc stretch. Stand on the edge of a step. Rise slowly on your toes. Lower yourself slowly as far as you can until you feel a stretch in your calf. Don?t roll your foot inward or outward. Hold for 1-2 seconds. Reps:10-20 (stop before you fatigue). Soleus stretch. Same as above, but start with your knee bent so that you feel a slight stretch in your calf or achilles. Maintain the angle of your knee throughout the stretch. Bicycle stretch. Lie on your side. Keeping your top leg straight, bring your knee toward your nose until you feel a slight stretch in the hamstring. Maintaining this angle at your hip, start pretending you are pedalling a bicycle with the top leg. Make sure you feel a slight stretch each time your knee is straight. Reps: 10-30 for each leg. If you feel any pops or clicks in your hip or back, try raising the top leg a little (making the thighs further apart) to eliminate the popping. Foot Intrinsic Exercises. Assisted metatarsal head raising. Sit in a chair. Find the bumps at the ball of your foot just before your big toe and just before the little toe. These are the first (big toe) and fifth (little toe) metatarsal heads. Place your second and third fingers from one hand under the first metatarsal head, and the second and third fingers from the other hand under the fifth metatarsal head. Now lay the thumbs from each hand in a diagonal across your toes so that they form a right angle meeting at the nail of the second toe. Your hands are now in position to assist your toes. Keep your toes straight, with the toe pads on the floor. Use your fingers to help raise all the metatarsal heads (the ball of your foot). Do not let your toes curl under keep them long. Now relax. Reps 7-10 for each foot. As this exercise gets easier, let your fingers do less of the work until your toes can do the exercise unassisted. This can take up to three weeks. When your strength has improved to this point, you can progress to the following three exercises, which are best done in stocking feet on a slippery floor. Active metatarsal head raising. Stand with your weight on both feet. Raise your metatarsal heads (the ball of your foot) while keeping your toes from curling under and maintaining your heel on the ground. Relax. Reps 6-7. Do one foot at a time. If you do more reps than you are ready for, you may well develop cramping in your foot. I once had a client who thought if seven reps were good, 10 were better. For good measure, she did the 10 reps 10 times in a day, and then she was unable to walk the next day from having used a set of muscles she had never exercised before. Don?t overdo it.
| Category: None | 22:20 | Trackbacks:0 | Comments:0
Fallen Arches Causes And Treatment
Overview


Acquired Flat Feet


?Pes Planus? is the medical term for flat feet. It comes from Latin: Pes = foot and Planus = plain, level ground. Very few people suffer from this condition, as a true flat foot is very rare. Less than 5% of the population has flat feet. The majority of the Australian population, however, has fallen arches (an estimated 60-70% of the population) known in the medical profession as ?excess pronation? or over-pronation. Over-pronation means the foot and ankle tend to roll inwards and the arch collapses with weight-bearing. This is a quite a destructive position for the foot to function in and may cause a wide variety of foot, leg and lower back conditions.






Causes


There is a lack of normal arch development, probably due to inherent ligamentous laxity. Around 20% of adults have Pes planus. The majority have a flexible flat foot and no symptoms. However, if there is also heel cord contracture, there may be symptoms (see 'Contributing factors', below). Loss of support for the arch. Dysfunction of the tibialis posterior tendon, a common and important cause. Tear of the spring ligament (rare). Tibialis anterior rupture (rare). A neuropathic foot, e.g from diabetes, polio, or other neuropathies. Degenerative changes in foot and ankle joints. Inflammatory arthropathy, eg rheumatoid arthritis. Osteoarthritis. Fractures. Bony abnormalities, eg tarsal coalition.






Symptoms


Having flat feet can be painless and is actually normal in some people. But others with flat feet experience pain in the heel or arch area, difficulty standing on tiptoe, or have swelling along the inside of the ankle. They may also experience pain after standing for long periods of time or playing sports. Some back problems can also be attributed to flat feet.






Diagnosis


Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.






Non Surgical Treatment


The type of treatment will depend on the stage of PTTD present. There are four stages of posterior tibial tendon dysfunction. Stage I. The posterior tibial tendon is inflamed but has normal strength. There is little to no change in the arch of the foot. The patient can still perform a single-limb heel rise and has a flexible hindfoot. Orthotic treatment options include modified off the shelf inserts and custom molded orthotics. Stage 2. The tendon is partially torn or shows degenerative changes and as a result loses strength.There is considerable flattening of the arch without arthritic changes in the foot. The patient cannot perform single-limb heel rise. Pain is now present on the lateral aspect of the ankle. Orthotic treatment is similar as that in stage I, with the addition of more rigid arch supports and wedging. Stage 3. Results when the posterior tibial tendon is torn and not functioning. As a result the arch is completely collapsed with arthritic changes in the foot. A solid ankle AFO is suggested in conjunction with a modified orthopedic shoe. Stage 4. Is identical to stage three except that the ankle joint also becomes arthritic. A rigid AFO and modified orthopedic shoe is required.






Surgical Treatment


Adult Acquired Flat Feet


Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.






Prevention


Orthotic inserts, either prescribed or bought over the counter, can help keep the arches fixed into position, but always wear them as although they support, they don?t strengthen, which is why some experts reccomend avoiding them. Gait analysis at a run specialist can help to diagnose overpronation and flat feet. Most brands produce shoes that will give support and help to limit the negative effects of a poor gait on the rest of the body. Barefoot exercises, such as standing on a towel and making fists with the toes, can help to strengthen the arches. Start easy and build up the reps to avoid cramping. Short barefoot running sessions can help take pressure off the arches by using the natural elasticity of the foot?s tendons to take impact and build strength to help prevent flat feet. These should be done on grass for only a few minutes at a time.






After Care


Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or non-union (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.
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Pain In The Arches Causes Symptoms And Treatments
Overview


Arch pain occurs with an inflammation of the plantar arch or fascia. It is the thick membrane that covers and supports all the muscles of the sole of the foot from the heel bone to the base of the toes that is called plantar arch. When this membrane pulls excessively (constant strain), pain developes in the arch of the foot or heel.


Pain In Arch


Causes


Sprains, strains, bruises, and fractures may be the result of a single stress or a combination of stresses to the foot. A blunt-force injury such as someone stepping on your foot may result not only in a bruise (contusion), but also in damage to the primary and secondary structures of the foot. Many of the muscles of the lower leg and foot attach on or near the arch. Injured or tight muscles may lead to incorrect biomechanics and in turn cause arch pain. Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma, which can result in a stress fracture. A sprain of the arch occurs when the ligaments which hold the bones together are overstretched and the fibers tear. The muscles of the foot may be strained by overstretching, overuse, overloading, bruising, or being cut by stepping on a sharp object. Arthritis of the arch joints may also occur if the foot is subjected to repetitive movements that stress the arch.


Symptoms


Symptoms of arch pain and arch strain are found in the underside of the foot, where the foot arch is. Arch pain and arch strain is actually inflammation of the tissue in the midfoot, formed by a band that stretches from the toes to the heel. The arch of the foot is needed for the proper transfer of weight from the heel to toe. When the band forming the arch of the foot or plantar fascia becomes inflamed, it becomes painful to perform simple tasks.


Diagnosis


A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to "raise up on the tip toes" of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet, the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.


Non Surgical Treatment


A new ankle foot orthosis known as the Richie Brace, offered by PAL Health Systems, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot. This is a sport-style brace connected to a custom corrected foot orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light weight and far more cosmetically appealing than the traditional ankle foot orthosis previously prescribed.


Pain In Arch


Surgical Treatment


The soft tissue surgeries usually would include a lengthening of the Achilles tendon, releasing of the plantar fascia as well as tendon transfers. These procedures are usually done in conjunction with bony procedures such as calcaneal osteotomies (to lower the heel bone and get it more under the leg itself), as well as metatarsal osteotomies. These procedures usually involve either cutting or fusion of the bones, and placement of fixation devices to allow the bones to heal. Healing time is usually at least 6-8 weeks and usually the patient must be non-weight bearing during the healing process. These types of surgical corrections are usually reserved for the more difficult, painful and deformed feet. They can require more surgeries down the line. These procedures are usually the last resort after all other modes of treatment have been exhausted (except in children where it is usually best to treat the deformity early). There are many different degrees of high arched feet and these procedures should be left for the more extreme cases. These cases usually require a very high degree of surgical skill and should only be done by those who frequently perform these types of cases.


Prevention


So how do you prevent plantar fasciitis? Factors which can be controlled include training progression, environmental factors, shoes, and strength and flexibility exercises. A useful guideline for a safe training progression is ?the 10% rule.? Limit increases in distance or intensity to 10% a week. For example, if a person is running 60 minutes at a session, 4 times a week, or 240 minutes, she or he can probably increase the running time to 264 minutes (240 + 10%), the following week if all else remains the same. Terrain is also an important factor in training. Running 30 minutes on hills is very different from running 30 minutes on flat surfaces in terms of the forces on the legs and feet. Work up gradually to increase your running time on hills. Also lean forward when running downhill. If you run on a banked or crowned surface, vary the direction you run in so you alternate which leg is higher and which leg is lower on the bank. If you know concrete or asphalt is causing you discomfort, try running on a cinder or composite track. If you are going on vacation and are not used to running on sand or grass, don?t spend your whole vacation doing it.


Stretching Exercises


Below are two simple plantar fasciitis stretching exercises to help improve the flexibility of the muscles and tendons around the foot and ankle. Plantar fasciitis stretch taken from The Stretching Handbook. Kneel on one foot and place your body weight over your knee. Keep your heel on the ground and lean forward. In the photo to the left, the athlete is stretching the arch of her left foot. Kneel on one foot with your hands on the ground. Place your body weight over your knee and slowly move your knee forward. Keep your toes on the ground and arch your foot. In the photo to the right, the athlete is stretching the arch of his right foot.
| Category: None | 06:22 | Trackbacks:0 | Comments:0
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Sophie Clare

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