achilles tendonitis

What is it?

A condition where the Achilles tendon at the back of the heel becomes inflamed and causes pain. 

What are the common symptoms/complaints?

Severe aching or burning pain felt in the back of the heel, which increases with movements such as rising up onto the toes.

How is it caused?

It is commonly caused by overpronation, resulting in undue stress to the tendon. Risk factors include tight heel cords, foot malalignment deformities, and recent change in activities or shoes.

How is it treated?

Relieving the stress on the tendon is the first course of action. It is recommended to be fitted with orthotics to control hind foot motion and maintain proper alignment, in order to relieve the stress on the Achilles tendon. Tightness in the tendon itself can be helped by an extra heel lift added to the orthotics. A slow recovery over a period of months is to be expected. 

hallux valgus (bunion)

What is it?

A bunion is a valgus deformity (i.e. medial bowing) of the metatarsophalangeal (MTP) joint of the great toe. It’s also known as Hallux Valgus.

What are the common symptoms/complaints?

Patients complain of pain in the MTP joint and/or the the deformity of their great toe. Because of this deformity, they are often only able to wear very wide shoes.

How is it caused?

Prolonged pressure against the medial aspect of the first MTP joint can lead to inflammation and thickening of the medial capsule and bursa, resulting in severe valgus deformity of the great toe. Normally “toe-off” occurs from the underside of the big toe. Overpronation (i.e. excessive inwards rolling of the foot) can cause the propulsion phase of the gait to take off from the medial side of the big toe instead of the underside. As a result, there is a retrograde force into the joint which pushes it out medially and stretches the joint capsule. This tearing and stretching of the joint capsule as well as the wear and tear on the cartilage leads to degeneration and can eventually lead to pain.

How is it treated?

Since the problem is overpronation of the foot, the patient should be fitted with orthotics. Although, orthotics will not cause the physical deformity to regress, they will correct the over-pronation, arrest further progression, and relieve the pain. It is important to note however, that when bunions are severe and require surgery, the bunion can be corrected, but will develop again unless the root cause of overpronation is corrected. Since over-pronation is the root cause, orthotics are still necessary and a viral part of treatment.

Calluses

What is it?

Calluses are areas of thickened skin tissue on the bottom of the foot due to irritation. They are localized to high-friction areas, typically under bony prominences.

What are the common symptoms/complaints?

Patients often complain of pain at the site of the callus, especially with direct pressure.

How is it caused?

When a patient overpronates during gait (i.e. excessive inward rolling of the foot), the foot rolls across the metatarsal heads –one at a time– instead of distributing the weight equally. This happens because the foot looses its structural integrity during overpronation, causing hypermobility of the foot. As a result, skin can get trapped between the bones in the foot and the ground, and the friction of individual metatarsal heads bearing all the weight can cause inflammation. The skin thickens in the inflamed area and forms a callus to protect the sore spot against blistering and ulceration. If the callus is close to the nerve endings in the bottom of the foot, it can cause pain.

How is it treated?

Soft tissue care and maintenance is recommended. However, since the problem is high vertical shear loading due to overpronation,  the patient should be fitted with orthotics to properly redistribute plantar pressures and relieve pressure on the callus. The calluses can be cut away or will eventually go away on their own once the irritation no longer exists. Within weeks, the patient will likely feel pain relief.

chondomalacia patella

What is it?

Also known as patellofemoral pain syndrome (PFPS), chondomalacia patella is a painful, degenerative condition affecting the cartilage of the medial part of the knee joint (i.e. medial femoral condyle).

What are the common symptoms/complaints?

Patients complain of dull, aching pain leading to sharp localized pain in the front of the knee, particularly while going up or down stairs and hills. They may feel a grinding sensation and stiffness when squatting, bending, and climbing stairs. The patient may experience the sensation of the knee ‘giving away’ beneath them.

What causes it?

During normal walking, the thigh bone (femur) and the shin bone (tibia) rotate in unison. An abnormal walking pattern such as over-pronation (i.e. excessive inward rolling of the foot) may cause the thigh and lower leg to rotate out of sync causing misalignment of the lower extremity. The resulting counter rotation of the thigh bone and the shin bone causes the knee cap (patella) to rub against the medial aspect of the knee (medial femoral condyle) instead of moving smoothly up and down in its normal track, causing damage to the cartilage and pain.

How is it treated?

Since overpronation is known to cause malalignment of the lower extremities and undue stress on the medial knee, the patient should be fitted with custom orthotics to restore proper lower extremity alignment. The patient may also respond well to quadriceps strengthening exercises and a hamstring stretching. Movements such as crouching, knee bends, and resistance exercises with knee extension from a fully flexed position should be avoided. The patient will likely experience pain relief within weeks and complete recovery within months (generally 2–3 months). 

Custom orthotics relieve foot pain, knee pain, low back pain, and more – effectively and comfortably.

Corns

What is it?

Corns are areas of thickened skin tissue on the top of the toes or in between the toes due to irritation and friction from a bony prominence.

What are the common symptoms/complaints?

Patients will complain of pain at the site of the corn. Soft corns at the webspace may become infected.

What causes it?

Corns are caused or aggravated by abnormal friction between bony prominences. When a patient over-pronates during gait (i.e. excessive inward rolling of the foot), the foot looses its structural integrity, causing hypermobility of the foot. As a result, the skin can get trapped between the bony prominences in the foot or between bony prominences in the foot and the inside of the shoe, causing friction and irritation. The skin of the foot thickens to protect itself from the irritation and against blistering but then leaves even less room between itself and the inside of the shoe, which can result in pain.

How is it treated?

As a temporary solution, corns can be cut away; however, since over-pronation can predispose to abnormal friction due to overpronation, the patient should be fitted with custom orthotics that correct overpronation and reduce friction. The patient will likely experience relief within weeks.

Dropped metatarsal heads

What is it?

A dropped metatarsal head is a condition where one of the metatarsal bones (usually the second metatarsal) is lower than the others at the distal end.

What are the common symptoms/complaints?

Patients may complain of pain and a sensation of walking on a stone. Callus formation under the head of the ‘dropped’ metatarsal is common.

What causes it?

This condition is very common and the cause is considered to be almost strictly hereditary. Overpronation (i.e. excessive inward rolling of the foot) does play a role as abnormal weight distribution in an excessively pronated foot tends to distribute too much weight onto the second metatarsal, which can lead to pain and callus formation.

How is it treated?

Custom orthotics fitted with a metatarsal pad should be used to correct overpronation as well as to redistribute the pressure on the sole of the foot and off-load the dropped metatarsal head and callus. Depending on the thickness of the callus, soft tissue care may be recommended; the calluses will eventually go away on its own once the pressure has been relieved. 

hammer toe

What is it?

Hammer toe is a foot deformity characterized by an abnormal bend in the middle joint of a toe (typically second, third, or fourth toe).

What are the common symptoms/complaints?

Patients may feel pressure against the shoe and under the metatarsal head, particularly the second toe, which is often caused by the retrograde pressure on the big toe. Patients complain of pain felt on the upper part of the middle joint of the hammer toe, usually due to a corn/callus that has developed. Once this happens, it is painful to wear regular shoes.

What causes it?

A hammer toe may be caused by a series of causes, including diabetes, arthritis, neuromuscular disease, polio, trauma, improperly fitted shoes, or a dropped metatarsal head.

How is it treated?

If the affected toe straightens out when pushing up underneath the metatarsal head, a custom orthotic fitted with a metatarsal pad could correct the problem. If the toe does not straighten out when the metatarsal head is pushed up, it is indicated that there is a contracture in the capsule and ligaments of the metatarsophalangeal (MTP) joint. Custom orthotics together with properly fitted footwear can help to relieve pain and pressure of the hammertoe. Surgery may be required, however, to release the contracture. 

it band syndrome (itbs)

What is it?

liotibial Band Syndrome (ITBS) is a condition wherein the iliotibial band rubs across the outside of the knee (lateral condyle of the femur).

What are the common symptoms/complaints?

Patients complain of pain on the outside side of the knee often extending up the out side of the thigh as high as the hip.

What causes it?

During a normal gait cycle, the thigh bone (femur) and the shin bone (tibia) rotate in unison (i.e. internally during pronation and externally during supination); however, when a person overpronates (i.e. the feet roll inwards excessively), the tibia is locked into the ankle bone (talus) and therefore continues to rotate internally past the end of the contact phase while the femur begins to externally rotate with the pelvis during midstance phase. The resulting counter rotation of the femur and the tibia causes a shearing force and torque to the iliotibial band. The result is that the distal end of the band rubs across the outside of the knee and gets irritated. 

How is it treated?

Since the problem is the abnormal pronation of the feet, the patient should be fitted with functional orthotics to correct the prolonged pronation, thereby reducing the counter rotation between the femur and the tibia and alleviating stress off of the iliotibial band. Massage and stretching of surrounding muscles to help ease the tightness and ice to reduce inflammation in acute cases or flare-ups can be applied concurrently.

Custom orthotics relieve foot pain, knee pain, low back pain, and more – effectively and comfortably.

METATARSALGIA

What is it?

Metatarsalgia is a common foot condition characterized by generalized pain underneath the metatarsals. 

What are the common symptoms/complaints?

Patients will complain of pain or tenderness underneath the foot in the metatarsal area and/or diffused pain in the metatarsal joints.

What causes it?

Metatarsalgia is commonly caused by abnormal weight distribution due to overpronation.

How is it treated?

Custom orthotics should be worn to correct overpronation and redistribute the weight more evenly along the underside of the foot. If shoe fit allows, a metatarsal bar will assist by off-loading the metatarsal heads, alleviating pain localized under the metatarsal heads.

Custom orthotics relieve foot pain, knee pain, low back pain, and more – effectively and comfortably.

morton’s neuroma

What is it?

Morton’s neuroma is characterized by pain, most commonly located in the third interspace. The next most common locations are the second, fourth and first interspaces.

What are the common symptoms/complaints?

A burning sensation is present in the interspace and typically radiates to the adjacent digits. Patients will complain of numbness, a “pins and needles” type of tingling and loss of sensation in the corresponding toes.

How is it caused?

Pivoting on the 3rd and 4th metatarsals can cause a shearing force. This shearing force between the 3rd and 4th metatarsals entraps the digital nerve and causes inflammation. The inflammation is what causes the pain. In cases of abnormal subtalar and midtarsal joint pronation, there is excessive transverse plane movement of the metatarsals. Since the 1st, 2nd and 3rd metatarsals articulate with the cuneiforms and act as one functional unit, and the 4th and 5th metatarsals articulate with the cuboid and act as another, there can be significant motion between the 3rd and 4th metatarsals which can cause painful irritation and inflammation of the nerve that runs between them.

How is it treated?

Control of the abnormal transverse plane motion of the foot is successful in reducing the symptoms associated with a neuroma. Orthotics should be prescribed, as they will diminish excessive transverse plane rotation between the medial and lateral columns of the foot, reducing pain and inflammation. In instances where the symptoms are non-responsive, a neuroma pad should be added as accommodation to assist in diminishing transverse plane metatarsal movement and compression. The patient will likely experience some pain relief within weeks and complete recovery within months (generally 2 – 3 months, but may take as long as 12 months). Pain can be momentarily relieved by massaging the affected interspace. 

PIRIFORMIS SYNDROME

What is it?

Piriformis syndrome is a condition in which the piriformis muscle compresses or irritates the sciatic nerve, causing pain in the buttocks, the outside of the hip, and referred pain down the leg along the path of the sciatic nerve.

What are the common symptoms/complaints?

Patients may complain of sharp pain in the buttocks and outside hip and down the leg along the path of the sciatic nerve. Pain is aggravated by sitting, squatting or walking. When relaxed, the affected leg is often turned outwards.

What causes it?

In many cases, apiriformis syndrome is the result of repetitive activities such as walking, running, and intense cycling, or prolonged sitting and standing, which could result in an overuse injury of the piriformis muscle causing inflammation of the muscle and leading to compression and/or irritation of the sciatic nerve. Overpronation (i.e. excessive inward rolling of the foot) is a common foot dysfunction that can lead to repetitive strain of the piriformis muscle, as it causes the thigh (femur) to turn inwards while the piriformis muscle tries to turn the leg outwards in an effort to compensate for the dysfunction. As a result, the piriformis muscle may get overworked and increase in size, which can compress and irritate the sciatic nerve in its proximity. 

How is it treated?

Faulty pelvic and foot mechanics need to be addressed. If internal rotation of the femur and prolonged pronation is evident, an orthotic device should be prescribed to arrest overpronation and control the leg from internally rotating too much and too long. Stretching or strengthening of the piriformis muscle may be advised depending on the mechanism of injury.

Custom orthotics relieve foot pain, knee pain, low back pain, and more – effectively and comfortably.

PLANTAR FASCIITIS + ‘HEEL SPURS’

What is it?

Plantar Fasciitis is a condition wherein the plantar fascia is pulling on the fibrous membrane covering the heel bone (calcaneus), causing inflammation and pain.

What are the common symptoms/complaints?

Patients complain of severe pain felt in the heel at the hindfoot (underneath the heel bone), particularly when they take their first few steps of the day, or after they have been off their feet for a prolonged period of time (i.e. pain after rest)

What causes it?

The plantar fascia is repeatedly over-torqued because the calcaneus in the hindfoot is stable while the forefoot is overpronating. This shearing force causes the plantar fascia to become inflamed. Because the weakest part of the plantar fascia is the attachment to the fibrous membrane covering the bone at the calcaneus, pain on the medial side of the calcaneus is felt. When the plantar fascia is repeatedly twisted, it pulls the membrane away from the calcaneus and causes pain and inflammation.

If this happens often enough, the calcaneus will eventually grow toward the plantar fascia in an effort to re-attach itself. That bone growth is called a heel spur. The pain is felt during the first few steps of the day because during the night, the fibres of the fascia try to heal themselves by forming fragile new fibre, and when the person puts weight on the foot, renewed tearing takes place and the pain becomes severe.

How is it treated?

If the plantar fasciitis is caused by overpronation and continuous torquing of the fascia, orthotics that control pronation and arch elongation should be prescribed to control the hind foot or stabilize the the forefoot and arrest the torquing. Patients can expect a 20-25% improvement every 2 weeks until complete recovery, which generally takes 2 to 3 months. Pain from heel spurs can be alleviated with accommodations to the orthotics. 

SHIN SPLINTS

What is it?

Shin splints refers to activity-induced pain in the lower leg. It It is a condition wherein the periosteum of the tibia (i.e. the fibrous membrane covering the shin bone) is damaged when it is pulled away by an overstressed tibialis posterior muscle.

What are the common symptoms/complaints?

Medial shin splints: Patients complain of a dull, aching pain felt along the inner side of the shin bone. It is usually aggravated by any activity.

Anterior shin splints: Patients complain of dull, aching pain felt along the front of the shin. This can be a medical emergency due to lack of blood flow that can lead to necrosis and gangrene of muscle on the front of the leg.

How is it caused?

Shin splints can usually be described as an overuse injury caused by abnormal biomechanics (i.e. overpronation), lack of conditioning and improper technique, as well as environmental factors such as running on hard or uneven surfaces or hills.

Medial shin splints (aka Medial Tibial Stress Syndrome): The tibialis posterior muscle acts as an anti-pronator due to its distal attachment (insertion) on the medial aspect of the foot. During overpronation the tendon of the tibialis posterior is stretched and pulled upon excessively, thereby attacking the weakest area, namely its origin (proximal attachment) on the periosteum of the tibia. The small pain fibres of the periosteum are torn away, causing pain and chronic inflammation.

Anterior shin splints (aka Compartment Syndrome): The tibialis anterior muscle acts as an anti-pronator due to its distal attachment (insertion) on the medial aspect and base of the first metatarsal. During overpronation the tibialis anterior muscle fibres must fire constantly to oppose (re-supinate) the overpronation, thus causing hypertrophy (swelling) of the tibialis anterior compartment. With the anterior compartment being tightly constricted, the swollen tibialis anterior can cause an obstruction of blood flow, which, in turn can cause severe pain due to ischemia (lack of oxygen). This can be very serious, and may require emergency surgery (i.e. acute compartment syndrome).

How is it treated?

Medial and anterior shin splints: Depending on the severity of the injury, treatment may include standard acute care, restricted or modified activity, and an orthotic device that corrects overpronation to reduce the strain on the tibialis posterior muscle and/or facilitates proper foot function and timing to reduce the stress on the tibialis anterior muscle.

Custom orthotics relieve foot pain, knee pain, low back pain, and more – effectively and comfortably.