Most common foot problems

The foot is a unique and complex structure that serves us well but it could develop a large variety of problems. This section provide an overview of some of the most common problems seen by us.

Bunions are one of the most common forefoot deformities. A displacement of the bone under the 1st toe occurs. This causes the big toe to move towards the smaller toes. This shifting of the bones causes a bony prominence on the side of the patients foot (the bunion joint). Over a period of time the big toe may come to rest under (occasionally over) the 2nd toe. A bunion is more common in women than men due to women wearing tighter fitting shoes. This condition can cause a variety of different soft tissue and bony complaints which may result in severe pain. Symptoms include redness, swelling and pain which may be present along the inside margin of the foot. The patients feet may become too wide to fit into their normal size shoe and may experience moderate to severe discomfort may occur when the patient is wearing tight shoes. A “hammer toe” may occur at the 2nd toe. This is when the toe contracts and presses on the shoe. Subsequently, this may cause a corn on top of the 2nd toe. Corns and calluses may occur on the soles of the feet, in between toes and on the bunion joint. Stiffness can occur at the big toe due to secondary arthritis, this is known as Hallux Rigidus. Other foot conditions can occur such as in growing toe nails and in severe cases the bunion joint may have a fluid filled sack called a BURSITIS. This can be very painful and can become infected.

Wear wide fitting shoes, preferably with a leather upper which will allow a stretch Avoid high heeled shoes. Orthotics can help slow the progression of the bunion and also treat the associated symptoms.

Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with Excess Pronation: Arch Pain Knee Pain Flat Feet Hallux Abducto Valgus (bunions) Hallux Rigidus (stiff 1st toe) Heel Pain (plantar Facsitus) Metatarsalgia (ball of the foot pain) Ankle Sprains Shin Splints Achilles Tendonitis Corns & Calluses Hammer Toes

Plantar Fasciitis is an inflammation caused by excessive stretching of the plantar fascia (aponeurosis). The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, attaching at the bottom of the heel bone (calcaneous) and extending to the forefoot (metatarsal heads). Plantar Fascia that is excessively stretched can cause plantar fasciitis, which can also lead to heel pain, arch pain, and heel spurs.

The key for the proper treatment of plantar fasciitis is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation, an custom moulded orthotic with rear foot Valgus posting and medial longitudinal arch support is an effective device to reduce the over-pronation and allow the condition to heel. The goal is to get the foot to be in more aligned or “neutral” position of approximately 90 degrees. Over-pronation that stresses the plantar fascia has the foot in more of a Valgus position (foot collapsing inward). Rocker Bottoms are beneficial in the propulsive phase of gait while walking. Rocker Bottoms help do some of the work for the foot and extrinsic muscles during supination so the body can get over the foot with less strain on the plantar fascia.  Perth Surgical Shoemakers can add Rockers to any footwear. Medial flares and Medial flares are footwear modifications that Perth Surgical Shoemakers does on premises which modify your pre-existing footwear to offload and support the feet on the medial side (inside). Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce the strain and stress on the plantar fascia by taking precautions. Avoid running on hard or uneven ground, lose any excess weight, and wear shoes and orthotics that support, accommodate, and bio-mechanically offload your arch to prevent over-stretching of the plantar fascia. Cushion the heel, absorb shock and wear proper footwear that will accommodate and comfort the foot.  Footwear with higher heel heights will help to offload the stress on the heel – where the plantar fascia inserts. Recommendations for Plantar-Fasciitis: Custom moulded Orthotic insoles Supportive Footwear like: Drew, Kumfs, Finn, Rockport and New Balance Sneakers Shoe Modifications like: Rocker Bottom soles, Medial Wedges and Medial Flares

The most important causative factor is poor fitting footwear. This accounts for an higher incidence among women then men. Family history of bunions Abnormal foot function, excessive pronation. If a pedorthist or podiatrist uses this term he is referring to excessive rolling in of the foot at the ankle joint while you are walking. Rheumatoid or osteoarthritis. Genetic and neuromuscular diseases which can result in a muscular imbalance such as Down’s syndrome. If one leg is longer then the other, the longer leg is more inclined to develop a bunion. If the ligaments in the feet are very weak. In some cases, bunions can occur due to trauma or injury to the feet.

Pronation is the inwards roll of the foot. One of the most common causes of foot and leg discomfort is a condition known as excessive/ over pronation. Normal pronation, or “turning inward” of the foot is necessary as the foot adapts to the ground. With excessive pronation/ over pronation, the arch flattens, collapses, and soft tissues stretch. This causes the joint surfaces to function at unnatural angles to each other. When this happens, joints that should be stable now become very loose and flexible. At first, excess pronation may cause fatigue. As the problem gets worse, strain on the muscles, tendons, and ligaments of the foot and lower leg can cause permanent problems and deformities. APPEARANCE OF EXCESSIVE/ OVER PRONATION 1. When standing, your heels lean inward. 2. When standing, one or both of your knee caps turn inward. 3. Conditions such as a flat feet or bunions may occur. 4. You develop knee pain when you are active or involved in athletics. The knee pain slowly goes away when you rest. 5. You abnormally wear out the soles and heels of your shoes very quickly.

Over pronation can be controlled via Orthotics Insoles. Anti-Pronation Orthotic Insoles provide a unique foot support system that aligns the lower body. The major cause of foot and leg pain is over pronation (rolling over of the feet) which causes excessive pressure on the muscles, ligaments and bones of the lower body. These orthotic insole treat the underlying cause of over pronation and prevent future occurrences of the associated foot or leg condition. Patients have reported relief of symptoms within 30 days of using orthotic insoles.

Excessive stretching of the plantar fascia that leads to the inflammation and discomfort can be caused by the following:

  • Over-pronation resulting in the arch collapsing upon weight bearing and pulling on the plantar fascia.
  • A sudden increase in physical activity.
  • Excessive weight on the foot, from activity and repetitive stress, obesity, or pregnancy
  • Improperly fitting footwear, especially footwear too short or too flat.

Over-pronation is the leading cause of plantar fasciitis. Over-pronation occurs in the walking process, when a person’s arch collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone. With Plantar Fasciitis, the bottom of your foot usually hurts near the inside of the foot where the heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. There is a lack of active blood flow and when the blood rushes in it is painful. As the day progresses and the plantar fascia continues to be stretched the pain often subsides. Pain may not always be at heel strike. Pain can be at heel-lift as the “Windlass Mechanism” in the gait cycle (during propulsion) shortens the plantar fascia as the heel lifts off the ground, and thus pulls at the heel bone, as well as at the metatarsal heads in supination. High Arch Feet, which can collapse because of gravity and the fact that we have paved the earth flat (as well as other stresses) are candidates for plantar fasciitis.

Calluses formation is an accumulation of dead skin cells that harden and thicken over an area of the foot. This callus formation is our bodies defence mechanism to protect the foot against excessive pressure and friction. Calluses are normally found on the ball-of-the-foot, the heel, and/or the inside of the big toe. Some calluses have a deep seated core known as a nucleation. This particular type of callus can be especially painful to pressure. This condition is often referred to as Intractable Plantar Keratosis.

Many people try to alleviate the pain caused by calluses by cutting or trimming them with a razor blade or knife. This is not the way to properly treat calluses. This is very dangerous and can worsen the condition resulting in unnecessary injuries. Diabetics especially should never try this type of treatment. In order to relieve the excessive pressure that leads to callus formation, weight should be redistributed equally with the use of an orthotic. An effective orthotic transfers pressure away from the hot spots or high pressure areas to allow the callus to heal. The orthotic should be made with materials that absorb shock and shear (friction) forces. Women should also steer away from wearing high-heeled shoes. If the problem persists, consult a Doctor that specializes in Feet. Recommendations for the prevention and curing of Calluses: Footwear with high, wide toe box (high and wide space in the toe area) Removable insoles for fitting flexibility and the option to insert orthotics if necessary. Rocker Soles designed to facilitate ambulating (walking) and to reduce callus build-up at the ball and other areas of the foot. Custom moulded Orthotic insoles designed to provide comfort, support and extra cushioning are also recommended. Orthotics made with the material Plastazote are often recommended because they mould to your feet to provide customized comfort. The proper footwear and orthotics will reduce pressure on a callus to provide a comfortable and healthy environment for the foot.