Foot Problems

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Plantar Fascitis

Plantar fasciitis is a common, painful foot condition. Patients, and sometimes doctors often confuse the terms plantar fasciitis and heel spurs. Plantar fasciitis refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot; a heel spur is a hook of bone that can form on the heel bone (calcaneus). About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on X-Ray.


Who gets plantar fasciitis?

Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking.

Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. Plantar fasciitis is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.


Could something other than plantar fasciitis cause this pain?

Plantar fasciitis can be confused with a condition called tarsal tunnel syndrome. In tarsal tunnel syndrome, an important nerve in the foot, the tibial nerve, is trapped and pinched as it passes through the tarsal tunnel, a condition analogous to carpal tunnel syndrome in the wrist. This may cause symptoms similar to the pain of a plantar fasciitis.

There are also other less common problems such as nerve entrapments, stress fractures, and fat pad necrosis, all of which can cause foot pain. Finally, several rheumatologic conditions can cause heel pain. These syndromes such as Reiter's syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis. If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your doctor will consider these possible diagnoses.


Why did I get plantar fasciitis?

Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.

When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities cause plantar fasciitis and can make normal activities quite painful.

Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.

Plantar Fasciitis - Information About Plantar Fasciitis

 

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Fallen Arches

Signs and Symptoms of Flatfeet (fallen arches)

The primary symptom of flatfeet is the absence of an arch upon standing. Additional signs of flatfeet include the following:

* Foot pain
* Pain or weakness in the lower legs
* Pain or swelling on the inside of the ankle
* Uneven shoe wear


Complications

While most cases of flatfeet do not cause problems, complications can sometimes occur. Complications include the following:

* Bunions and calluses
* Inability to walk or run normally
* Inflammation and pain in the bottom of the foot (plantar fasciitis)
* Tendonitis in the Achilles heel and other ligaments
* Pain in the ankles, knees, and hips due to improper alignment
* Shin splints
* Stress fractures in the lower legs


Flatfeet Diagnosis

Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if:

* the feet tire easily or are painful after standing;
* it is difficult to move the foot around or stand on the toes;
* the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot;
* the pain interferes with activity; or
* the person has been diagnosed with rheumatoid arthritis.

Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking.

The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases.

Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.


Flatfeet Treatment

Most cases of flatfeet do not require treatment. However, if there is pain, or if the condition is caused by something other than normal development, there are several treatment options. Self-care options include rest, choosing non-weight-bearing exercise (e.g., swimming, cycling), weight loss, and avoiding high heels.

Flexible flatfeet with some pain can be relieved with the use of orthotics—shoe inserts that support the arch—and/or heel wedges (in some cases). If pronation is a factor, special shoes can be worn that lift the arch and correct the inward leaning. Physical therapy may also be prescribed to stretch or lengthen the heel cord and other tendons.

For rigid or inflexible flatfeet, treatment varies depending on the cause. Tarsal coalition if often treated with rest and the wearing of a cast. If this is ineffective, surgery can be done to separate the bones or to reset the bones into a correct position.

If the flatfoot is caused by an injury to the tendons in the foot or ankle, rest, anti-inflammatory medications (e.g., ibuprofen), and the use of shoe inserts and ankle braces often relieve symptoms. In severe cases, surgery is performed to repair the tendon or to fuse some joints in the foot into a corrected position to reduce stress on the tendon.


Flatfeet Prevention

Flatfeet in children are often an inherited family trait, but it may be possible to prevent the condition in some cases. Recent research has shown that there are several social or cultural factors that can cause flatfeet. These factors include the following:

* Obesity/overweight
* Unnecessary orthopedic treatments
* Wearing rigid shoes at a young age

In 1992, a study in India of 2300 children aged 4–13 demonstrated a significant difference in the rate of flatfeet among those who wore shoes regularly and those who did not. In this study, wearing inflexible, closed-toe shoes in early childhood was shown to have a negative effect on the normal development of arches. Children who were allowed to go barefoot or who wore light sandals and slippers had a much lower rate of flatfeet.

In 1999, a study in Spain of 1181 children aged 4–13 revealed that the use of orthopedic shoes for treatment of flatfeet in children not only failed to correct the problem, but actually worsened the condition by preventing the normal flexing and arch development of bare or lightly protected feet.


Flatfeet Overview - Flatfeet (Fallen Arches) - Podiatry Channel