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Pain & Treatment
HIGH ARCHES (PES CAVUS)
SYMPTOMS
Pes Cavus is the term used to describe very high-arched feet. This condition is often associated with a rigid foot structure and does not absorb shock well. Consequently, the heel and forefoot are overburdened when walking or standing. When often combined with the tendency of the foot to roll outward, tendons and ligaments located on the outside (lateral side) of your ankle also become strained.
The most common symptoms associated with pes cavus include:
- Pain and callousing under the ball of the foot
- Pain through the plantar fascia, ligaments and muscles under the midfoot and within the midfoot joints.
- Aching and fatigue in the muscles and joints of the legs and back, resulting from stiffness.
CAUSES
The most common causes of pes cavus include:
- Present from birth (congenital).
- Extreme cases can be associated with neurological conditions (such as Spina Bifida, Polio or Charcot-Marie-Tooth disease).
TREATMENT
Orthotics (Orthoses) – Must be prescribed by a physician
Custom made orthotics support the skeleton, muscles and fascia in the correct position. Orthotics are a long-term solution to prevent reoccurrence by controlling and / or correcting the mechanics that cause the problem.
It is imperative that the orthotics match the arch height of the foot. Over the counter insoles will not correct this condition. Orthotics for Pes Cavus may include:
- Prominent metatarsal pad or bar to lift and separate metatarsal heads.
- Soft forefoot material to cushion metatarsal heads.
- Hollowing out the orthotic under prominent metatarsal heads to reduce pressure as necessary.
- A built in angulation to maintain the foot in a more suitable position.
FOOTWEAR
Certified Pedorthists are trained to fit patients with appropriate footwear. BioPed offers many types of footwear into which an orthotic device may be placed or worn alone. Footwear for Pes Cavus may have any of the following characteristics:
- Footwear with additional lateral stability is ideal for a pes cavus foot type to fit the forefoot properly and resist outward rolling of the feet.
- Sufficient depth for high insteps and clawed toes is a necessity. Lycra and neoprene materials work well to accommodate clawed toes.
- Rocker soles enhance forward propulsion while limiting flexing and plantar pressure of the forefoot metatarsal phalangeal joints.
Modifications to footwear are also available at the discretion of the Pedorthist.
BUNIONS (HALLUX VALGUS)
SYMPTOMS
Often referred to as a bunion, hallux valgus is a deformity at the major joint of the big toe, otherwise known as the 1st metatarsal phalangeal joint. This condition comes about when the end of the big toe angles towards the smaller toes. Such an abnormal angle causes the joint to enlarge. This enlargement (the bunion) can be red and swollen, is often painful and may stiffen over time.
The most common symptoms associated with bunions include:
- Pain at the 1sttoe joint.
- Pain under the 2nd toe joint
- Stiffness of the first toe joint in more advanced cases
- Inflammation of the first toe join
CAUSES
The most common causes of bunions include:
- Improperly fitting footwear such as high heeled and pointy toed shoes.
- Genetic anatomical abnormalities like Morton’s Syndrome and metatarsus varus.
- Overpronation (inward rolling of the foot)
TREATMENT
Orthotics (Orthoses) – Must be prescribed by a physician
Note that following bunion surgery, orthoses may be required to help prevent reoccurrence.
Custom made orthoses support the skeleton, muscles and fascia in the correct position. Orthoses are a long-term solution to prevent reoccurrence by controlling and / or correcting the mechanics that cause the problem.
Orthotics for bunions may include:
- Medial longitudinal arch support which helps to position the weight of the inside arch / bunion onto the center of the foot.
- A built in angulation for more advanced cases
- Forefoot cushioning materials.
- Hollowing out orthotic material under sensitive forefoot joints.
FOOTWEAR
Stability footwear including therapeutic and orthopaedic shoes are integral to the treatment process. Certified Pedorthists are trained to fit patients with appropriate footwear. BioPed offers many types of footwear into which an orthotic device may be placed or worn alone.
Footwear for bunions may have the following characteristics:
- Dress shoes available with lower heels and wider widths.
- Built with a wide stable sole base that provides medial stability – often referred to as Motion Control Footwear and available in athletic shoes, walking shoes, sandals and boots.
- Proper width and depth to adequately accommodate the bunion.
- Forefoot rocker sole – a must for chronic forefoot conditions. Off-the-shelf therapeutic footwear with a rocker can minimize the metatarsal joint bending and plantar pressure.
- Material which can be custom stretched by the Pedorthist to accommodate the surrounding bunion.
Modifications to footwear are also available at the discretion of the Pedorthist.
PLANTAR FASCIITIS
Plantar Fasciitis is inflammation of the plantar fascia. The plantar fascia is a thick band of tissue that originates at the heel bone, extends forward under the arch and inserts itself to the tissue under the balls of the feet. The purpose of the plantar fascia is to maintain the arch shape in one’s foot by binding the bones, muscles, ligaments and soft tissues together.
When the arch flattens, the plantar fascia may stretch excessively, resulting in micro-tears where it attaches at the heel. Inflammation usually occurs at this point. The painful micro-tears subside during rest periods, but upon standing, the fascia re-tears resulting in a
burst of exquisite pain.
SYMPTOMS
The most common symptoms associated with plantar fasciitis include:
- Pain where the heel and arch meet, with pain across the underside of the foot (predominantly on the inside of the foot (medial side).
- Exquisite pain with the first step after a night’s sleep or a prolonged rest period.
CAUSES
The most common causes of plantar fasciitis include:
- Overuse from walking and standing for long hours.
- Hyperpronation and hypersupination.
- Forefoot mal-alignment.
- Weight gain, physical condition, overall muscular conditioning and body weight relative to height.
- Unsupportive footwear.
TREATMENT
Foot Stretching and Icing
In mild cases, research has shown that very simple foot stretching techniques can often provide initial relief from this most common type of heel pain. Icing is also strongly recommended to reduce inflammation.
Orthotics (Orthoses) – Must be prescribed by a physician
Custom made orthotics support the skeleton, muscles and fascia in the correct position. Orthotics are a long-term solution to prevent reoccurrence by controlling and / or correcting the mechanics that cause the problem. Orthotics for plantar fasciitis should include:
- A cupped heel to distribute pressure evenly and away from the painful heel center.
- Arch support to stabilize and relieve muscles and soft tissue.
- Heel raise to lessen tension from gastrocnemius muscle tightening.
- Forefoot postings, often under medial 1st metatarsal phalangeal joint, to correct forefoot alignment (as necessary).
FOOTWEAR
Stability footwear including therapeutic and orthopaedic shoes are integral to the treatment process. Certified Pedorthists are trained to fit patients with appropriate footwear. BioPed offers many types of footwear into which an orthotic device may be placed or worn alone. We also suggest leaving supportive sandals or footwear beside the bed at night. Immediately upon rising, put them on.
Footwear for plantar fasciitis should have the following characteristics:
- Rocker forefoot sole which allows gait without bending through the metatarsal joints and decreases fascia elongation at toe-off.
Modifications to footwear are also available at the discretion of the Pedorthist.
METATARSALGIA (FOREFOOT PAIN)
Metatarsalgia literally means forefoot (metatarsal) pain (algia). The most common use of this term is used to describe pain under the “ball of the foot” at the base of the toes. Depending on the underlying cause, a patient may feel either more or less pain when wearing footwear.
SYMPTOMS
Symptoms of metatarsalgia can include:
- Sharp, aching or burning painin the ball of your foot — the part of the sole just behind your toes
- Pain that worsenswhen you stand, run, flex your feet or walk — especially barefoot on a hard surface — and improves when you rest
- Sharp or shooting pain,numbness, or tingling in your toes
- A feeling ofhaving a pebble in your shoe
CAUSES
Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:
- Intense training or activity.
- Certain foot shapes.
- Foot deformities.
- Excess weight.
- Poorly fitting shoes
- Stress fractures.
- Morton’s neuroma.
TREATMENT
Orthotics (Orthoses) – Must be prescribed by a physician
Custom made orthotics support the skeleton and soft tissues in the correct position. Orthotics are a long-term solution to prevent reoccurrence by controlling and / or correcting the mechanics that cause the problem.
Orthotics for Metatarsalgia may include:
- Prominent metatarsal pad or bar to lift and separate metatarsal heads – positioned in the hollow just behind the balls of the joints.
- Soft forefoot material to cushion metatarsal heads.
- Hollowing out the orthotic under prominent metatarsal heads to reduce pressure.
FOOTWEAR
Certified Pedorthists are trained to fit patients with appropriate footwear. Dynacore offers many types orthotic devices to replace an existing foot bed to accommodate the functionality. Footwear for Metatarsalgia may have any of the following traits:
- Forefoot rocker sole – a must for chronic forefoot conditions. Off-the-shelf therapeutic footwear with a rocker can minimize the metatarsal joint bending and plantar pressure.
Modifications to footwear are also available at the discretion of the Pedorthist.
HEEL SPURS (CALCANEAL SPURS)
A heel spur is a pointed bony outgrowth of the heel (the calcaneus bone).They are also known as calcaneal spurs or osteophytes. Heel spurs can be located at the back of the heel or under the heel, beneath the arch of the foot. Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles tendon (tendinitis) and cause tenderness and heel pain made worse while pushing off the ball of the foot.
SYMPTOMS
Symptoms of heel spurs can include:
- heat radiating from the affected area
- a dull ache in the heel
- a sharp pain in the heel when standing
CAUSES
The most common causes of heel spurs include:
- arthritis
- bruising of the heel
- excess body weight
- poorly fitted shoes
- walking gait issues
- wearing flip-flops too often
- worn-out shoes
TREATMENT
- Heel spurs are treated by measures that decrease the associated inflammation and avoid reinjury. Local ice applications both reduce pain and inflammation. Anti-inflammatory medications, such as naproxen (Aleve) and ibuprofen(Advil), or injections of cortisone, are often helpful.
- Orthotic devices or shoe inserts are used to take pressure off plantar spurs (donut-shaped insert), and heel lifts can reduce stress on the Achilles tendon to relieve painful bone spurs at the back of the heel. Similarly, sports runningshoes with soft, cushioned soles can be helpful in reducing irritation of inflamed tissues from heel spurs. Infrequently, surgery is performed on chronically inflamed spurs.
Orthotics (Orthoses) – Must be prescribed by a physician
Custom made orthotics support the skeleton and soft tissues in the correct position. Orthotics are a long-term solution to prevent reoccurrence by controlling and / or correcting the mechanics that cause the problem.
Orthotics for Heel Spurs may include:
- designed with a heel well, a hole cut out of the bottom of the heel cup, which is then filled with soft material, to cradle or cushion the inflamed area and reduce pressure and impact forces when walking, standing or being active.
- heel spur cushions, which are soft pads put under a patients heel inside their shoes, while other individuals may be advised to purchase new footwear if their existing footwear has lost its cushioning capabilities or its structural integrity.
PES PLANUS (FLAT FEET)
Metatarsalgia literally means forefoot (metatarsal) pain (algia). The most common use of this term is used to describe pain under the “ball of the foot” at the base of the toes. Depending on the underlying cause, a patient may feel either more or less pain when wearing footwear.
SYMPTOMS
Flat feet are also commonly known as fallen arches because the feet appear to have a low inside arch, especially when standing. This condition can either be genetic in nature or acquired. The condition is usually characterized by collapsing of the medial arches (Hyperpronation/Overpronation) and feet which may point away from the body (abducted feet).
The most common symptoms associated with flat feet include:
Medial arch and heel pain, plantar fascia strain.
• Joint pain in foot and / or ankle area.
• Achilles tendon pain.
• Shin pain
• Tired, aching calf muscles.
• Knee pain.
CAUSES
The most common causes of flat feet include:
- Genetically loose ligaments.
- Rapid weight gain.
- Pregnancy
- Previous injuries.
- Foot mal-alignments.
TREATMENT
Orthotics (Orthoses) – Must be prescribed by a physician
Custom made orthotics support the skeleton, muscles and fascia in the correct position. Orthotics are a long-term solution to prevent reoccurrence by controlling and / or correcting the mechanics that cause the problem.
Orthotics for flat feet may include:
- A cupped heel to control excessive heel eversion (rolling down and inwards).
- Extra wedging under the inside of the heel or ball of the foot to correct mal-alignment.
- Arch support that is reflective of the patient foot type and flexibility.
FOOTWEAR
Certified Pedorthists are trained to fit patients with appropriate footwear. Dynacore offers many types orthotic devices to replace an existing foot bed to accommodate the functionality. We also suggest leaving supportive sandals or footwear beside the bed at night. Immediately upon rising, put them on. Footwear for Pes Planus may have any of the following traits:
- Built with a wide stable sole base that provides greater stability – available in athletic shoes, walking shoes, sandals and boots.
Modifications to footwear are also available based on the decision of the Pedorthist.
Your personal case manager will ensure that you receive the best possible care.
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