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We recently ran into a middle-aged friend and sometime patient who was complaining of growing aches and pains in her knees, hips and back. She wasn't an athlete, or particularly active, so the pain probably wasn't from overuse. She also didn't have a weight problem, so stress on the joints from obesity wasn't the answer. She remarked that she thought she might have Lyme Disease and had set up an appointment with her family physician to be tested. Sorry to hear that, we said, That's truly a painful condition.
And then we looked down at her shoes - the most beat-up, worn-out flats we ever saw.
"You have flat feet, don't you?"
"Yes, I do."
"Do you wear those shoes often?"
"Yes, I love them."
"Throw them away and never wear them again. Those shoes have zero support and flat feet need arch support. I bet if you wear sneakers instead your pain will go away."
"I hadn't thought of that."
Most people assume that the growing pain in their knees, hips, or back is caused by a crippling disease or an unknown injury. But in fact, the source of your pain may actually be rooted in your feet - or more specifically, heels and arches which aren't supported correctly (as in our friend's case), or feet that are out of alignment with your ankle and leg.
The older we get...
As we age we have to take better care of our feet. After forty-plus years of neglect, they gradually become painful, arthritic, misaligned, and prone to bunions and hammertoes. Our feet are designed to distribute and support our body weight evenly across the forefoot and heels, and a critical part of this is the proper alignment of the foot/ankle and the ankle/lower leg. In the case of those who have flat feet, arch support is required for proper alignment and to avoid fatigue.
When we're out of alignment, or lack arch support, we get tired and sore, which causes us to shift our body weight to get comfortable. Then the sides of our foot, forefoot or heel carry too much weight and our ankles, knees, hips and legs compensate, which causes stress on the joints. And when the stress is continuous, the joints become irritated and painful.
It may be hard to believe that such acute and bothersome pain can be caused by a lack of arch support or the misalignment of your foot/ankle/lower leg. In many cases, a simple change in footwear to a quality pair of athletic shoes, worn as often as possible, is the answer. To correct your alignment and relive fatigue, your podiatrist may also recommend custom orthotics to be worn inside your shoes.
And how is our friend doing now, one month later? She reports that she's been wearing sneakers as often as possible and her back, hip and knee pain is nearly gone. Voila!
If you've ever taken a yoga class, one thing was probably clear immediately: your feet and ankles weren't nearly as strong as you thought they were. In the U.S. and much of the world, we go about our daily business in shoes which protect our feet and our health. If we're athletes, we buy shoes which protect our feet from injuries and hopefully give us a little extra juice when we need it.
But on the downside, those shoes can prevent the muscles in our feet from getting the exercise they need. And as we age, it shows: bunions, hammer toes, aching arches, aching toes, poor balance, and a host of other maladies (some of these are inherited traits).
Strong feet and ankles are essential for anyone, and especially as we age, to maintain our balance. Running, biking, weight lifting and any athletic activity is great, but they tend to develop one side of the body more than the other, due to our natural left-hand, right-hand propensity. Yoga aims to create equal strength and also loosens the joints, helping them avoid injury and maintain flexibility.
One of the first lessons in yoga is how to stand. This may seem silly at first, but our feet are our foundation, and we quickly learn that we need to unlearn some bad habits. Over the years we lean into the sides of our feet, lean back on our heels, lean forward, or shift weight from sore areas. All of these habits change the way we walk and stand, throwing our legs and ankles out of alignment and placing stress on other parts of our body. The result is pain and stiffness anywhere between the toes and neck.
Try these simple yoga-based exercises to build strength in your ankles, feet and toes. Do all exercises barefoot on a flat surface. If you have medical problems with your feet or ankles, or are obese, consult your physician before attempting.
Learn To Evenly Distribute Your Weight
The strength of your feet - and especially your arches - determines if your leg is aligned with your ankle. Strengthening your arches starts with an awareness of how you stand.
Standing upright in bare feet, sense where your weight falls in your feet. Your feet are meant to carry your body weight evenly - not back on the heels or on the balls of your feet. Press down evenly through the heels, the balls, and your toes. You'll feel the difference in your balance immediately. While standing upright and evenly balanced, spread the soles and toes as much as you can and reach the toes forward.
Stretch and Strengthen Your Feet
One of the most common yoga poses, Downward-Facing Dog, stretches the soles of your feet and strengthens your arches. In this position, gently push your heels toward the floor as much as possible. Learn how to do it here.
To stretch the tops of your feet and strengthen your ankles, try Hero Pose (only do this if you have no knee problems). Kneel on the floor, keeping your thighs perpendicular to the floor and touch your inner knees together. Slide your feet apart, slightly wider than your hips, but keep the tops of your feet flat on the floor. Then sit down between your feet. If your buttocks don't rest comfortably on the floor, support them with a thick book placed between your feet. Now lift your sternum, sitting as upright as possible, and try to release your shoulder blades away from your ears. Hold for 1 minute.
Raising yourself on your toes is a simple and excellent way to strengthen your feet. While this may seem easy at first, try doing it very slowly. You'll be surprised at how much effort you'll expend.
Strengthen your toes
Stand with your feet so that they're directly under your hips. Try to lift just the big toe on each foot, while keeping the other toes on the floor. Then do the opposite: lift all the toes except the big toe. Switch back and forth. You'll find that one part of that exercise will be a lot easier than the other. That's because those who pronate (roll the foot inward when they walk) typically have a hard time lifting their big toes, and those who supinate (roll the foot outward) have a hard time lifting the other toes.
Leaning is Exercise
Leaning teaches us how to balance our weight across our feet. Those who shift their weight to their heels leave the front of their foot without much to do, and the foot weakens.
Stand with your feet a comfortable distance apart and put a soft bend in your knees. Lean forward at the ankle as if you were about to ski down a slope. Do not lean from the waist or hips - keep the lean in your ankles. This exercise wakes up the muscles in your toes and the soles of your feet.
If your feet feel tired after these exercises, that's good - it means that the muscles are being worked. If your feet are sore, that's not good - back off a little next time around.
But for those who once had arches, Flatfoot slowly develops from wear and tear (aging) or trauma, causing pain in the arches, heels, ankles, knees or hips, as the leg and foot fall out of alignment. The culprit is usually damage to the posterior tibial tendon which runs along the inside of your ankle - when it weakens, it can no longer support the arch.
We all start with zero arch. We're born with flat feet and slowly our arches develop during childhood, becoming fully developed in adulthood.
The arches and the biomechanics of the lower leg are intimately linked - our arches literally put a "spring" in our step, determine how we walk and distribute our body weight proportionally across our feet and legs. Arches also need to be sturdy and flexible to adapt to various surfaces. When the strength or flexibility of the arch fails, the alignment and balance of the foot and leg suffers.
The most common cause of Adult Acquired Flat Foot Deformity (AAFFD) is damage to the posterior tibial tendon, one of the most important tendons in your leg. Starting at the calf, the posterior tibial tendon travels down the inside of your leg and heel, and attaches to the bones on the inside of your foot. The main function of the tendon is to support your arch and foot. If the tendon suffers chronic damage such as persistent inflammation, it may lose its ability to support your arch, and the arch will slowly collapse. Pain and discomfort from AAFFD can be substantial, occurring anywhere in the foot, heel, ankle, knee, back, or hip.
Inflammatory arthritis, especially rheumatoid arthritis, attacks the cartilage in the joints as well as the ligaments that support the foot. The inflammation causes not only pain, but also may change the shape of the foot and cause the arch to drop.
Ligament injury causes the joints to fall out of alignment. The job of the ligaments is to hold the bones in place and prevent them from moving. When the ligaments are damaged, the bones fall, flattening the arch.
Fractures or dislocations of the bones in the midfoot can lead to Flatfoot deformity.
Charcot Foot Disorder, a complication of diabetes, results from a nerve condition (diabetic peripheral neuropathy) which causes a loss of sensation in the feet. An infection in the foot, unknown to the patient, causes weakness in the ligaments and bones, leading to collapse of the arch and other complications. Complicated surgery is required to correct the problem.
Watch the story of how we alleviated the pain of Flatfoot (and other conditions) for one of our patients.
Heel pain and ankle pain usually appear separately. But sometimes, pain in the heel and ankle can occur together as a result of one injury or multiple, associated injuries.
Runners and other athletes are especially prone to overuse injuries in the heel and ankle. Some, especially those with long legs, are also prone to having a stiff Achilles tendon and stiff calf muscles. As the foot and ankle literally hinge on these mechanisms, inflexibility leaves the tendon, heel and ankle at risk of injury, especially when we play sports. Usually, the injury appears in the form of Achilles tendonitis, calcaneal (heel bone) bursitis, or plantar fasciitis.
If, at the first sign of pain you rest, elevate and ice the sore area until the pain subsides, healing may be achieved without medical intervention. If you ignore the pain and keep training, the injury may become very serious. If pain continues for 4 days or more, see a podiatrist.
A stress fracture in the ankle or foot generally occurs gradually from overuse. Depending on the location and severity of the fracture, pain can radiate through the entire foot, ankle and/or heel. The pain may be accompanied by numbness or tingling, redness, swelling and a feeling of instability.
It's essential that any fracture - whether a small stress fracture or a more serious break - be treated by a podiatrist to insure that it heals correctly. Don't blow it off - ask anybody who's middle aged or older and they'll tell you how much these "minor" stress fractures come back to haunt you later in life.
Tarsal Tunnel Syndrome and peripheral neuropathy can cause considerable pain and discomfort. Tarsal Tunnel is an entrapment of the posterior tibial nerve which passes through your ankle. When the nerve becomes compressed, pain can be felt from the sole of the foot and throughout the ankle. Pain may also radiate to the leg and hip. Peripheral neuropathy, usually a side effect of diabetes, can cause tingling and pain at any point in the foot and lower leg.
Both conditions require the intervention of a podiatrist to relieve symptoms.
In or near the ankle, the Achilles tendon is the most likely tendon to cause pain. But pain may also be felt from injury to the peroneal, posterior tibial or flexor hallucis longus tendons. The area of swelling and tenderness usually indicates which tendon has been damaged.
Treat with rest, ice and anti inflammatories, and see a podiatrist for an evaluation.
Ankle Impingement Syndrome
Anterior Ankle Impingement or Posterior Ankle Impingement Syndrome occurs when soft tissues around the ankle become pinched. When the ankle is bent fully up or down, pain occurs. Runners, footballers and dancers are notorious for developing these syndromes.
Treat as above with tendinitis.
An ankle sprain occurs when the ankle ligaments are subjected to an unnatural twisting, causing stretching or tearing of the ligaments. A sprain can easily cause pain in the entire area around the ankle, including the heel.
Treatment by a podiatrist is necessary to insure that the sprain heals correctly. Damaged ligaments which are not cared for properly become weak and are more likely to be reinjured and cause long-term problems.
Arthritis can occur in any joint in the body. It's especially debilitating when it takes up residence in the ankle. Due to the inflexibility of the arthritic ankle, arthritis patients are prone to plantar fasciitis.
This chronic autoimmune disease attacks joints at any point in the body. RA usually starts in the small joints of the hands and feet, and progresses to the larger joints. More than 90% of Rheumatoid Arthritis patients develop symptoms in their feet and ankles, usually occurring in both feet simultaneously. Difficulty climbing stairs is an early sign that the ankle is beset with RA. Difficulty on uneven ground suggests that the hindfoot - the heel area - is showing signs of the disease. A podiatrist can identify your symptoms and you will be referred to a rheumatologist for treatment.
Did you ever have one of those really active days - running, hiking, jumping, maybe just standing for a really long time on your feet - and the balls of your feet ached like crazy? Well my friend, you were probably suffering from the dreaded Metatarsalgia.
Metatarsalgia isn't as serious as it sounds. It simply refers to minor pain and inflammation of fatigued and overused metatarsal bones (the long bones in your feet). The pain appears in the area where the metatarsals join your toe bones, otherwise known as the ball of your foot - the area of your sole behind your toes (not just behind the big toe). The pain usually begins as a mild ache and worsens over a period of months.
Usually, metatarsalgia is caused by ill-fitting shoes combined with lots of activity. Most cases of metatarsalgia aren't serious, and rest, ice and over the counter pain medicine will resolve the pain.
But if left untreated, the classic cascade effect may kick in: The balls of your feet hurt, so you unconsciously shift weight to other parts of your feet, which eventually causes pain in those areas, which again causes you to shift your weight. Since your legs, ankles and feet are drifting farther out of alignment, the joints above your feet start feeling the impact and you suddenly have pain in your knees, back, or hips. And it all began with minor, treatable pain in your feet.
Prolonged metatarsalgia which doesn't resolve in 10 days should always be reported to your podiatrist, as it can be a symptom of other, more serious conditions.
Intense training. Most runners are accustomed to occasional bouts of metatarsalgia, as the front of the foot absorbs significant shock when running. But this can be true of anyone who plays a high impact sport, especially basketball, soccer, tennis, football, or track and field events. It's sometimes a sign that your athletic shoes are worn out and need to be replaced.
The shape of your foot. If you have a high arch, extra pressure is placed on the metatarsals, increasing the chance of pain from overuse. If your second toe is longer than your big toe, more weight than normal is shifted to the 2nd metatarsal head, and that may cause pain as well.
A muscle imbalance. Tight toe extensors or weak toe flexors don't properly support the metatarsal bones and may cause fatigue and pain from overuse. A too-tight tight achilles tendon may be a contributor as well.
Stiff ankles, perhaps the result of a previous injury or arthritis, don't support the foot correctly, placing too much pressure on the forefoot.
Excessive pronation - the side-to-side movement of your foot - may contribute.
Carrying too many pounds. Your forefoot carries most of your body weight when you walk of run. Extra pounds means extra pressure on the metatarsals. Additionally, as we age, the fat pad in the foot tends to thin out, reducing its cushioning effect. A weight management plan may reduce your symptoms.
Poorly fitting shoes and high heels. That's right, ladies. While high heels make you look great, they're murder on your feet (like I had to tell you that). High heel shoes are a very common cause of metatarsalgia in women, as they transfer your body weight to the front of the foot, working against how the foot is designed to carry your weight. Athletic shoes which don't support your feet correctly are also guilty of causing metatarsalgia.
Stress fractures in the metatarsals or in the toe bones change the way you walk, which may result in metatarsalgia.
Morton's Neuroma, a growth of fibrous tissue around the nerve between your 3rd and 4th metatarsal heads causes symptoms similar to metatarsalgia.
Your podiatrist may recommend one or more of these treatments for Metatarsalgia
Plantar Fasciitis is without a doubt the most common cause of heel pain - 10% of people are afflicted with it at some point in their lives. But if your heel pain continues for more than 2 months, it may not be plantar fasciitis at all.
Heel pain that lasts more than 8 weeks may be caused by a ligament tear in the heel, whose initial symptoms are almost identical to plantar fasciitis. However, the treatments for the two conditions are very different. In the case of a misdiagnosis, the treatment for plantar fasciitis can even make your heel pain worse.
Plantar fasciitis is a micro tear of the plantar fascia ligament, which occurs from overuse (too much demand on the ligament). A plantar fascia rupture (or tear) is less common and typically more painful. Pain from either injury will be felt in the bottom of the heel.
Even though the two injuries affect the same ligament, the treatment for plantar fasciitis vs. a plantar fascia tear are practically polar opposite. If you have a typical case of plantar fasciitis, the treatment protocol is usually stretching exercises via physical therapy, rest, ice, over the counter anti-inflammatories (ibuprofen or naproxen), and in some cases custom orthotics. If a patient follows the prescribed treatment, their plantar fasciitis will usually heal in 3-6 weeks.
But if your heel pain is caused by a tear to the plantar fascia ligament, those stretching exercises may make your condition worse. Healing a plantar fascia tear takes anywhere from 2-5 months, depending upon its severity. Treatment typically involves immobilization of the foot and lots of rest, to allow the tissue time to reconstruct without further stress. In some cases, surgery will be necessary to completely repair the ligament.
For this reason, a visit to a podiatrist is always recommended for heel pain. The subtle differences in these injuries can easily be missed by a general physician, and the wrong treatment can worsen your condition. Heel pain also puts more stress on the other joints in your body, as we shift weight off of our heel. It's common to develop pain in the ankle, knees and back as well when we have heel pain.
The best way to prevent heel pain is to be proactive. Wear supportive shoes to work and properly fitting and padded athletic shoes when you exercise. The key to protection is arch support and padding in the heel to absorb impact. It's also a good idea to do a proper warm-up before exercising, including gentle stretching exercises for your legs, ankles and feet.
Every parent knows that their children's feet grow at alarming speed. One day you buy them new shoes and the next day the shoes are too tight. It's enough to make you want to send them into the world barefoot.
The never-ending growth spurts in children's feet are due to the fact that the foot is one of the first parts of the body to grow to full size. This speedy growth is accompanied by uneven development in the lower leg and ankle, making muscles and tendons very tight and the heel less flexible. This inflexibility exposes the heel to injury and places a lot of stress on the growth plate, a soft area at the end of the heel which eventually fuses with the heel bone (calcaneus).
Sever's Disease (calcaneal apophysitis), the most common cause of heel pain in children, is a painful inflammation of the heel's growth plate. The heel bone is not fully developed until age 14 or 15, and is constantly adding new bone at the growth plate (physis). When the growth plate is subjected to a lot of repetitive stress, like that in athletics, inflammation can develop.
It should be noted that the symptoms of heel pain in adults are different from heel pain in children. In adults, heel pain is usually at its worst in the morning and decreases or subsides as the tissue warms up with activity. But in children, heel pain usually doesn’t diminish as the child moves around – in fact it may get much worse.
Fortunately, Sever’s Disease is a temporary condition and with rest and treatment, symptoms will usually subside within 8 weeks. If the condition persists, it's important that your child sees a podiatrist for a thorough evaluation and treatment plan. The risk of recurrence of Sever’s Disease diminishes with age and typically doesn't occur after 15, when foot growth is complete and the growth plate has fused to the rest of the heel bone.
If your child complains about heel pain, don’t take it lightly, as early intervention and treatment by a podiatrist is key to a continued healthy development.
If you're an adult, there's a very good chance that you've fractured or broken a bone in your foot at some point. After all, there are 26 bones in each foot, and they have to take the impact of everything from walking to skydiving. That means there's a high percentage that at least one of them is going to fracture under the stress, which can range from a small crack in the bone known as a stress fracture, to a complete break which penetrates through the skin.
The adult foot is divided into three sections: the forefoot, made up of the toes (phalanges) and the longer bones which connect to them (metatarsals); the midfoot, which contains a collection of bones that form your arches (navicular bone, cuboid bone, and cuneiform bones); and the hindfoot, which contains 2 bones that form part of your ankle and all of your heel (talas bone and calcaneus). Additionally, in most people there are very small bones called sesamoids at the base of the big toe. That's a lot of moving parts, and a fracture can occur in any of them.
It's essential to have a foot fracture treated as soon as possible by a podiatrist, so that the bone and tissue injury heals correctly. Without treatment, you run the risk of developing arthritis in the fractured area, blood clots, deformity, persistent pain, infection, weakness, reduced movement, loss of feeling in your foot or damage to blood vessels, tissues and nerves.
Types of fractures in the foot
There are a number of options your podiatrist may choose to treat your foot fracture. The treatment depends on what kind of fracture you have, where it's located in the foot, and how much discomfort it's causing you. Your podiatrist may choose one or more of the following treatments:
After initial treatment, your podiatrist will order you to rest and elevate the foot whenever possible, and ice the foot if it's swollen or painful. When the bone has healed, they may order physical therapy to help improve range of motion and strength in the bone and help to decrease any residual pain.
One of the most important aspects of a child's physical and emotional development is game play - the kind that doesn't involve sitting in front of a video screen. Organized sports, activities like climbing trees, biking, going for a swim, or just playing imaginary games with other kids in the neighborhood are all positive for their growth (think running, walking, jumping, moving - organized or otherwise). Good habits learned early follow a child into adulthood, and are key in combating the childhood and adult obesity epidemic.
But of course, foot, ankle, and heel pain complaints and other injuries run hand-in-hand with activity. Parents should note that the cause and symptoms of heel pain in children can be considerably different from heel pain in adults. If you've experienced heel pain, specifically plantar fasciitis, you know that its very bad in the morning, but diminishes as the tissue warms up with activity.
But in children, heel pain usually becomes much worse as the day wears on, and may be due to a condition called Sever's disease, an inflammation of the growth plate in their heel. This condition is especially common in children who are highly active or overweight. Heel pain in adolescents may also be due to plantar fasciitis, fractures in the heel bone, bursitis, achilles tendinitis, or other conditions. The good news is, a podiatrist can successfully resolve Sever's disease or other heel pain conditions in your child in almost every case.
Check out the Facebook page for NFL Play 60 to see how you can encourage your child to be more active.
Unfortunately, some children are slow to complain about heel pain and other injuries, which is where parents have to keep a watchful eye. When a child has pain in their heel, or pain elsewhere in their foot or ankle, it can cause any number of changes in the development of their bodies, as they shift weight and change their gait to compensate for the pain. This imbalance also makes them prone to further injuries. Parents should be mindful of changes in their children's body langauge and behavior, so that a heel pain injury can be addressed early.
Your child may be experiencing heel pain if you notice any of these changes:
If your child complains about heel pain (or any other kind of pain), take it seriously and don't encourage them to "walk it off" or "play through it" - that's old school advice and may cause more damage in a person of any age. Your child should immediately leave the game or curtail their activities. To treat the injury at home, they should rest, ice their foot, and use an age and weight appropriate dose of advil or aleve to manage the pain. They should not resume strenuous physical activity until the heel pain has completely subsided. When your child resumes activity, it should be gradually, accompanied by appropriate stretching exercises to warm up their ankles and feet. Children should also wear athletic shoes which support their feet properly (but it's okay to let them run barefoot when appropriate).
If your child's heel pain continues for more than one week, make an appointment to see a podiatrist for an exam and diagnosis. Early intervention and treatment is the key to successfully resolving their complaint so they can get back to kid stuff as soon as possible.
You know plantar fasciitis (PLAN-tur fas-e-I-tis) when you have it - a sharp, searing, knife-like pain on the bottom of your heel. In the morning, that first step out of bed can be excruciating, becoming less so as you walk and warm up the muscles and the plantar fascia ligament. Pain can also make itself known when you stand up after sitting for a while.
"itis" is a medical suffix used to indicate the inflammation of an organ - in this case the plantar fascia.
To understand plantar fasciitis, a little anatomy lesson is handy. The plantar fascia is a thick ligament made of dense, fibrous tissue which has very little stretch in it. It's main function is to act as a shock absorber. The plantar fascia starts at the bottom of your heel, runs across the arch and the ball of your foot, and then spreads out, attaching at the base of the toes.
When you take a step, and as your foot impacts the ground, your foot actually flattens, which lengthens the foot ever so slightly. This causes the plantar fascia to lengthen as well, as much as it can (remember, it doesn't have much stretch in it). Then when your heel lifts off the ground, the ligament returns to normal. When your foot impacts the ground hard, such as when playing sports, the foot flattens a little more than usual, and the plantar fascia stretches a little further than it would like to. As a result, small, usually minute tears develop where the ligament attaches to the heel bone (calcaneus). These small tears cause the ligament to bleed a little, and the tension of the plantar fascia pulling at the heel bone causes a spur to form on the bottom of the heel. However, the heel spur is not the cause of pain - it's caused by the plantar fascia trying to tear away from the heel bone. Many people have heel spurs and have no pain whatsoever.
Why does your foot flatten and tear the plantar fascia? The answer lies just below your ankle. When your foot contacts the earth, the subtalar joint, just below your ankle joint, flexes to absorb the impact. The flexing of the subtalar joint causes the arch of your foot to flatten (pronation) or heighten (supination). If the foot excessively flattens, it's said to overpronate, and the plantar fascia is constantly under strain. Over time this weakens the ligament where it attaches to the heel bone, and pain occurs. Then when you are at rest, the plantar fascia starts to mend itself. But even a full night's deep sleep isn't enough to heal the plantar fascia entirely, and when weight is applied with that first step in the morning, the fascia tears again, causing pain. It is this persistent irritation of the plantar fascia that is known as plantar fasciitis.
Another contributing factor to plantar fasciitis is a tight calf muscle. The calf muscle attaches to the foot by way of the achilles tendon behind your heel. If the calf muscle is tight it limits the movement of the ankle joint, contributing to over pronation. Calf muscles can become rigid due to exercise, but also inactivity. High heels, even boot heels can cause the calf to tighten, and in some people, it's just naturally so.
Read about how PA Foot and Ankle Associates treats the symptoms of plantar fasciitis
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