Overview



?Life begins at 40,? goes an old quote, ?and so do fallen arches.? It?s time to toss that negative idea out the window and get the real facts on fallen arches and what you can do about them. We have all seen what our footprints look like as we walked across sand or left a water trail after getting out of the bathtub. The narrow part of the footprint is where your natural arch exists. What gives you that arch are tendons that pull together to create an upward curve. When your tendons are not properly pulling together, you start to lose that natural arch. This condition is known as flat foot or fallen arch.

Causes

Footwear: shoes which limit toe movement; high heels. Barefoot walking may be protective. A tight Achilles tendon or calf muscles (heel cord contracture). This may help to cause Pes Planus, or may contribute to symptoms such as foot pain when there is existing Pes Planus. Obesity. Other bony abnormalities, eg rotational deformities, tibial abnormalities, coalition (fusion) of tarsal bones, equinus deformity. Ligamentous laxity, eg familial, Marfan's syndrome, Ehlers-Danlos syndrome, Down's syndrome. Other factors causing foot pronation, eg hip abductor weakness and genu valgum.

Symptoms

Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot. Associated discomfort within and near the ankle joint. The knees, hips, and lower back may be the primary source of discomfort. Feet may often feel tired and achy. Painful shin splints may develop with activity. Gait may be awkward.

Diagnosis

Podiatrists are trained in expertly assessing flat feet and identifying different risk factors and the causes for it. Initial assessment will begin with a detailed history attempting to find out if any underlying illness has resulted in this. A detailed clinical examination normally follows. The patient may be asked to perform certain movements such as walking or standing on their toes to assess the function of the foot. Footwear will also be analysed to see if there has been excessive wear or if they are contributing to the pronation of the foot. To assess the structure of the foot further, the podiatrist may perform certain x-rays to get a detailed idea of the way the bones are arranged and how the muscle tissues may be affecting them. It also helps assess any potential birth defects in a bit more detail.

Is flat footedness genetic?

Non Surgical Treatment

For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. Flexible Flatfoot. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot.

Surgical Treatment



Procedures may include the following. Fusing foot or ankle bones together (arthrodesis). Removing bones or bony growths, also called spurs (excision). Cutting or changing the shape of the bone (osteotomy). Cleaning the tendons' protective coverings (synovectomy). Adding tendon from other parts of your body to tendons in your foot to help balance the "pull" of the tendons and form an arch (tendon transfer). Grafting bone to your foot to make the arch rise more naturally (lateral column lengthening).

Prevention

It?s time to take a long hard look at what?s in your closet. Now is the time to toss out shoes that are well worn. You also need to say good-bye to thin-soled shoes that offer zero arch support. If you?re overweight, fallen arches may be a sign the universe is trying to tell you something. You need to lose weight, and odds are, fallen arches are but one of many physical discomforts you are experiencing.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.

Overview

Have you ever been told or noticed that one of your legs is a bit longer than the other? Do you have incidences of lower back pain? These two things could be related. Most individuals have a small difference in their leg lengths. For some, the discrepancy is small and negligible and will not be a contributor to lower back pain. This is usually the case for people if their leg length is less than 5 millimeters. However, a difference of leg lengths greater than 5 millimeters (1/4 inch) can contribute to lower back pain. If you have a leg length difference of greater than 9 mm, then you have a 6X greater likelihood of having an episode of lower back pain.

Causes

LLDs are very common. Sometimes the cause isn?t known. But the known causes of LLD in children include, injury or infection that slows growth of one leg bone. Injury to the growth plate (a soft part of a long bone that allows the bone to grow). Growth plate injury can slow bone growth in that leg. Fracture to a leg bone that causes overgrowth of the bone as it heals. A congenital (present at birth) problem (one whole side of the child?s body may be larger than the other side). Conditions that affect muscles and nerves, such as polio.

Symptoms

Many people walk around with LLD?s of up to 2 cm. and not even know it. However, discrepancies above 2 cm. becomes more noticeable, and a slight limp is present. But even up to 3 cm. a small lift compensates very well, and many patients are quite happy with this arrangement. Beyond 3 cm. however, the limp is quite pronounced, and medical care is often sought at that point. Walking with a short leg gait is not only unsightly, but increases energy expenditure during ambulation. It could also put more stress on the long leg, and causes functional scoliosis. Where the discrepancy is more severe, walking becomes grotesque or virtually impossible.

Diagnosis

Infants, children or adolescents suspected of having a limb-length condition should receive an evaluation at the first sign of difficulty in using their arms or legs. In many cases, signs are subtle and only noticeable in certain situations, such as when buying clothing or playing sports. Proper initial assessments by qualified pediatric orthopedic providers can reduce the likelihood of long-term complications and increase the likelihood that less invasive management will be effective. In most cases, very mild limb length discrepancies require no formal treatment at all.

Non Surgical Treatment

In an adult, we find that we can add a non compressive silicone heel lift to a shoe in increments of 3-4 mm maximum per week. Were we to give a patient with a 20 mm short leg, 20 mm of lift all at once, their entire body would rebel. The various compensations that the body has made, such as curvatures and shortening of muscles on the convex side of the curve, would make such a dramatic change not just noticeable, but painful. When we get close to balancing a patient by lifting a leg with heel inserts, then we perform another gait analysis and follow up xray. At that point, we can typically write them a final prescription to have their shoe modified. A heel lift is typically fine up to 7 mm. When it gets higher than that, the entire shoe must be modified. There are two reasons for this. The back of the shoe is generally too short to accommodate more than 7-8 mm inserted inside the shoes and a heel lift greater than 7 mm will lead to Achilles tendon shortening, which then creates it?s own panoply of problems.



functional leg length discrepancy treatment

Surgical Treatment

Surgery to shorten the longer leg. This is less involved than lengthening the shorter leg. Shortening may be done in one of two ways. Closing the growth plate of the long leg 2-3 years before growth ends (around age 11-13), letting the short leg catch up. This procedure is called an epiphysiodesis. Taking some bone from the longer leg once growth is complete to even out leg lengths. Surgery to lengthen the shorter leg. This surgery is more involved than surgery to shorten a leg. During this surgery, cuts are made in the leg bone. An external metal frame and bar are attached to the leg bone. This frame and bar slowly pull on the leg bone, lengthening it. The frame and bar must be worn constantly for months to years. When the frame and bar are removed, a leg cast is required for several months. This surgery requires careful and continued follow-up with the surgeon to be sure that healing is going well.

Overview



Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected. This guide will help you understand how plantar fasciitis develops, how the condition causes problems, what can be done for your pain.

Causes

As stated above, if biomechanical complaints such as over pronation exist during running then this can lead to planter fascitis and heel pain. Over pronation occurs when there is excessive mobility in the sab-taler joint of the foot which causes hyper mobility of the foot. Conditions such as flat feet can also cause over pronation. This increased mobility adversely affects all the muscles in the foot and can even affect the lower leg, upper leg and cause back pain. The mechanical imbalance is highlighted during running due to the increased forces being applied to the body Runners often complain that the pain increases when they enter the toe off phase of the running cycle as this stretches the muscle away from the heel bone. Apart from over pronation, other causes of planter fascitis are a change of running shoes, dramatic increases in speed work, hill work and mileage.

Symptoms

Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest--when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. The pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you're on the foot. Fasciitis can be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, by being overweight. It doesn't help that fascia doesn't heal particularly quickly because it has relatively poor circulation (which is why it's white in colour).

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

Non Surgical Treatment

Curing posterior heel pain requires calming the inflammation, resting the foot and increasing calf flexibility. Ice therapy and anti-inflammatory medications can be used to reduce the inflammation. Stopping exercises that stress the calf and Achilles is important. This includes walking, running and the use of stair climbers and elliptical machines. Placing a heel lift in each shoe can reduce some of the excess strain on the back of the heel. Stretching exercises to increase calf flexibility are important in curing this problem and preventing its recurrence. Wearing running shoes also provides good foot support and helps with this condition. Sometimes a walking boot is used to immobilize the ankle and let the area completely rest. Physical therapy is sometimes ordered to help reduce the inflammation and pain and to help improve the flexibility of the calf muscles. Occasionally these measures fail to relieve the pain and surgery may be needed. The surgical procedure involves removing bone spurs and repairing any damage to the tendon.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

heel pads shoes too big

Prevention



Flexibility is key when it comes to staving off the pain associated with these heel conditions. The body is designed to work in harmony, so stretching shouldn?t be concentrated solely on the foot itself. The sympathetic tendons and muscles that move the foot should also be stretched and gently exercised to ensure the best results for your heel stretches. Take the time to stretch thighs, calves and ankles to encourage healthy blood flow and relaxed muscle tension that will keep pain to a minimum. If ice is recommended by a doctor, try freezing a half bottle of water and slowly rolling your bare foot back and forth over it for as long as is comfortable. The use of elastic or canvas straps to facilitate stretching of an extended leg can also be helpful when stretching without an assistant handy. Once cleared by a doctor, a daily regimen of over-the-counter anti-inflammatory medication like Naproxen Sodium will keep pain at bay and increase flexibility in those afflicted by heel pain. While this medication is not intended to act as a substitute for medical assessments, orthopedics or stretching, it can nonetheless be helpful in keeping discomfort muted enough to enjoy daily life. When taking any medication for your heel pain, be sure to follow directions regarding food and drink, and ask your pharmacist about possible interactions with existing medications or frequent activities.

Overview

A neuroma develops when a nerve is compressed, injured or pinched, causing swelling and pain. A neuroma in the area between the third and fourth toes, or between the second and third toes, is known as a Morton?s neuroma. Morton?s neuroma causes sharp, burning pain and numbness in the toes and foot. You may feel like you?ve stepped on a tiny hot coal and can?t get rid of it. At the same time, you?ll have the disconcerting experience of not being able to feel your toes. Sometimes the nerve tissue becomes so thickened you can feel or see a lump.

Causes

There are orthoses and corrective shoes that can effectively alleviate disturbances to foot mechanics. A podiatric physician can prescribe the best corrective footwear and shoe inserts for all activities, work, exercise, play, walking, shopping and more, based on an analysis of the patient?s foot and his or her lifestyle. Improper footwear. Podiatric physicians have long believed that constricting, narrow, poor-fitting shoes with a tight or pointed toe box tend to compress the end of the foot, leading to abnormal motion of the foot and to excessive pressure in the area of the nerve. High-heeled shoes are a particular culprit here, since they put pressure on the area around wearer?s toes and the ball of the foot.

Symptoms

What are the symptoms of Morton?s neuroma? A sharp or stinging pain between the toes when standing or walking. Pain in the forefoot between the toes. Swelling between the toes. Tingling (?pins and needles?) and numbness. Feeling like there is a ?bunched up sock? or a pebble or marble under the ball of the foot.

Diagnosis

Morton?s neuroma can be identified during a physical exam, after pressing on the bottom of the foot. This maneuver usually reproduces the patient?s pain. MRI and ultrasound are imaging studiesthat can demonstrate the presence of the neuroma. An x-ray may also be ordered to make sure no other issues exist in the foot. A local anesthetic injection along the neuroma may temporarily abolish the pain, and help confirm the diagnosis.

Non Surgical Treatment

Initial treatment for Morton?s Neuroma may include non-prescription anti-inflammatory medications to reduce pain and swelling. These may consist of standard analgesics such as aspirin and ibuprofen (Advil, Motrin, others). Massaging the painful region three times daily with ice. Change of footwear. Avoid tight shoes, high heels or any footwear that seems to irritate the condition. Low heeled shoes with softer soles are preferable. Arch supports and foot pads to help reduce pressure on the nerve. In some cases, a physician may prescribe a customized shoe insert, molded to fit the contours of the patient?s foot. Reducing activities causing stress to the foot, including jogging, dancing, aerobic activity or any high impact movements of the foot. Injections of a corticosteroid medication to reduce the swelling and inflammation of the nerve and reduce pain. Occasionally other substances may be injected in order to ?ablate? the Neuroma. (The overuse of injected steroids is to be avoided however, as side effects, including weight gain and high blood pressure can result.)

Surgical Treatment

Operative treatment of Morton?s neuroma should be entertained only after failure of non-operative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritated/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although an incision on the sole (plantar) aspect of the foot can be used. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament, and freeing the nerve of local scar tissue. This may also be beneficial.

There are actually not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates you are born with it. One leg is anatomically shorter than the other. Through developmental periods of aging, the brain picks up on the stride pattern and recognizes some variance. The human body usually adapts by dipping one shoulder to the "short" side. A difference of under a quarter inch is not blatantly irregular, demand Shoe Lifts to compensate and typically won't have a profound effect over a lifetime.



Leg length inequality goes mainly undiscovered on a daily basis, however this problem is easily remedied, and can eradicate numerous incidents of back discomfort.

Treatment for leg length inequality commonly involves Shoe Lifts. They are very reasonably priced, normally costing under twenty dollars, compared to a custom orthotic of $200 or higher. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Mid back pain is easily the most widespread condition affecting people today. Over 80 million people experience back pain at some stage in their life. It is a problem that costs businesses millions of dollars yearly due to lost time and production. Innovative and improved treatment methods are constantly sought after in the hope of lowering economical influence this issue causes.



People from all corners of the world experience foot ache as a result of leg length discrepancy. In most of these situations Shoe Lifts are usually of beneficial. The lifts are capable of alleviating any pain in the feet. Shoe Lifts are recommended by numerous specialist orthopaedic physicians.

In order to support the body in a well balanced manner, your feet have a significant function to play. Irrespective of that, it's often the most overlooked zone in the human body. Some people have flat-feet which means there may be unequal force exerted on the feet. This causes other parts of the body such as knees, ankles and backs to be impacted too. Shoe Lifts guarantee that correct posture and balance are restored.

There are actually two different kinds of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is structurally shorter in comparison to the other. Through developmental phases of aging, the brain senses the gait pattern and identifies some variance. The body usually adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch isn't very irregular, does not need Shoe Lifts to compensate and generally doesn't have a profound effect over a lifetime.



Leg length inequality goes largely undiagnosed on a daily basis, yet this issue is simply solved, and can eliminate quite a few cases of back ache.

Treatment for leg length inequality typically consists of Shoe Lifts. These are generally very reasonably priced, frequently priced at under twenty dollars, in comparison to a custom orthotic of $200 or more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Chronic back pain is the most common health problem afflicting men and women today. Around 80 million people have problems with back pain at some stage in their life. It is a problem which costs businesses millions year after year because of lost time and output. Fresh and more effective treatment methods are constantly sought after in the hope of reducing the economic influence this issue causes.



Men and women from all corners of the world suffer the pain of foot ache due to leg length discrepancy. In most of these situations Shoe Lifts are usually of beneficial. The lifts are capable of easing any pain in the feet. Shoe Lifts are recommended by many professional orthopaedic practitioners".

So that they can support the body in a well-balanced manner, your feet have a very important function to play. Despite that, it is often the most overlooked zone in the body. Many people have flat-feet which means there is unequal force placed on the feet. This will cause other areas of the body including knees, ankles and backs to be affected too. Shoe Lifts guarantee that suitable posture and balance are restored.