Foot Pain and Heel Pain Information Guide

Sever’s Disease (heel pain in children)

What is Sever’s Disease? 

Sever’s Disease (or Pediatric heel pain) is a symptom, not an actual disease. It is a warning sign that your child has a condition that requires attention. Sever’s Disease is commonly associated with these symptoms:

1) Pain at the back or bottom of the heel

2) Limping or walking on the toes

3) Difficulty participating in sports and/or running

Typically, the child complains of pain in one or both heels whilst running and walking. The pain is located at the point of the heel where the achilles tendons insert into the heel bone. 

What causes Heel Pain in children?

The most common cause of paediatric heel pain is a condition called calcaneal apophysitis, and it usually affects children from 8 to 14-year old. Heel pain is very common in children because of the very nature of their growing feet. In children the heel bone (calcaneus) is not yet fully developed until age 14 or older. Whilst growing new bone is being formed at the growth plate (the apophysis), an area located at the back of the heel. Repetitive stress on the growth plate (due to walking, running and sports) causes inflammation in the heel area. 

Also, the foot is one of the first bodyparts to grow to full size. This usually occurs in early puberty. During this time, bones often grow faster than muscles and tendons. As a result, muscles and tendons become tight. The heel area is less flexible. During weight-bearing activity (activity performed while standing), the tight heel tendons may put too much pressure at the back of the heel (where the Achilles tendon attaches), causing injury to the heel.

The condition frequently occurs before or during the peak growth spurt in boys and girls, often shortly after they begin a new sport or season. Sever’s disease often occurs in running and jumping sports, like athletics. Patients present with intermittent or continuous heel pain occurring with weight bearing. Findings include a positive squeeze test and tight heel cords. Paediatric heel pain cannot be diagnosed radiographically.

Calcaneal apophysitis usually causes pain and tenderness in the back and bottom of the heel when walking. The heel is painful when touched. It can occur in one or both heels. Because the heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain often reflects high activity. Children and adolescents who actively play rugby, soccer, hockey, basketball etc are especially more likely to develop this condition.

Excessive pronation (i.e. lowering of the arches and rolling inwards of the feet) is also a factor because it places increased stress on the the growth plate and and pull on the achilles tendons.

What is the difference between Paedicatric Heel Pain and Heel Pain in adults?

Paediatric heel pain differs from adult heel pain (Plantar Fasciitis) in the way the pain is experienced. Plantar Fasciitis pain is worse when getting out of bed in the morning or after sitting for long periods, and then it subsides after walking around for a while. Paediatric heel pain usually doesn’t improve in this manner. In fact, walking around and running typically aggrevates the pain.

Pediatric Heel Pain treatment options

A a number of treatment options are available including:

1) Rest, reduce activity:  your child should reduce or stop any activity that causes heel pain

2) Anti-inflammatory drugs, such as ibuprofen will help reduce pain and inflammation temporarily.

3) Special exercises will help reduce the stress on the plantar fascia and achilles tendons. In particular calf and hamstring stretches, in particular before sports. Also strengthening of the muscles in the shin area is recommended (foot curls).

4) Wear an orthotic inside the shoe. Orthotic insoles support the feet and re-align the lower leg and ankles. Orthotics are designed to correct the problem of excessive pronation, one of the contributing causes of Sever’s Disease. Also applying a heel lift to the underside of the orthotic can be effective as it releases the tightness in the heel cords.

5) Apply an ice pack onto the sore heel(s) for about 5-10 minutes

Can Sever’s disease be prevented? 

Sever’s disease may be prevented by maintaining good flexibility while your child is growing. The stretching exercises pictured here can lower your child’s risk for injuries during the growth spurt.Again, ask your doctor for advice. Good quality shoes with firm support and a firm heel counter will help. Your child should avoid excessive running on hard surfaces. If your child has already recovered from Sever’s disease, stretching exercises and placing ice on the heel after activity will help keeping the condition from re-occurring. 

Plantar Fasciitis (Heel Pain) research & studies

Plantar Fasciitis (or heel pain) is the most common form of foot pain and affecting millions of people every day, including professional athletes and also children. In the past 10 years, there have been a lot of studies done in regards to the most effective way of treating Plantar Fasciitis. Although opinions are divided, the general consent is that  specific exercises aimed at making the plantar fascia (ligaments under the foot), achilles tendons and calf muscles more flexible are the key to treating and preventing Plantar Fasciitis. 

In additon, many podiatrists and other health professionals believe that an orthotic arch support and/or a night splint will help relieve the tension on the plantar fascia and will aid in the repair of the ligaments and reduction of the inflammation at the heel bone. Below are extracts of a number of Plantar Fasciitis studies.

See also our Heel Pain pages for more information about heel pain treatment and relief.

Study 1) Daily stretching exercises for the treatment of Plantar Fasciitis

A recent study has shown that stretching the plantar fascia ligaments is a very effective treatment for the painful condition of the heel, called Plantar Fasciitis. Heel pain, worse when you first put your foot down, getting out of bed in the morning, used to be blamed on so-called heel spurs (outgrowths of the heel bone) and many GP’s would resort to painful steroid injections to treat heel pain. It now appears that the real reason for the pain is actually micro-tears in the plantar fascia - the fibrous band of tissue which runs from the heel to the toes and forms the arch of the foot.

The condition is called Plantar Fasciitis. One of the mainstays of treatment has been Achilles tendon stretching to pull on the heel. But a recent medical trial has found that stretching the plantar fascia itself works better.

This how the stretching exercise is performed: cross your legs putting the foot across the other knee. Grab the toes and with the other hand press the sole with your thumb. Then pull up just the toes, towards the shin checking you can feel the fascia in the sole of your foot going tight. Hold for a count of ten and repeat ten times three times a day starting from before you get up in the morning. The trial showed benefits lasting 2 years.

For Reference: Journal of Bone and Joint Surgery

Author: DiGiovanni B et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. 2006 online 5 Nov: doi:10.2106/jbjs.e.01281

 Study 2) Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.

In this study, plantar fascia specific stretching was evaluated in 101 patients with chronic plantar fasciitis. The patients studied had diagnosed plantar fasciitis for at least 10 months. The patients were divided into two groups. The first group was given a plantar fascia tissue-stretching program and the second group was given an Achilles tendon-stretching program. All patients were educated by a video on plantar fasciitis, were given specific insoles and an anti-inflammatory medication for 3 weeks.

At 8 weeks, 82 patients had completed the therapy regimen and were reevaluated. The patients with the plantar fascia specific stretching program showed statistically significant improvement compared with the Achilles tendon stretching program.

Conclusion: A plantar fascia specific stretching program provides more benefit than an Achilles tendon stretching program, for those with plantar fasciitis.

J Bone Joint Surg Am. 2003 Jul;85-A(7):1270-7

Study 3) Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis: A Prospective Clinical Trial with Two-Year Follow-Up

This is the follow-up study on the plantar fascia-stretching study mentioned above. This study evaluates the long term outcomes of the plantar fascia specific stretching regimen. After the 8 weeks and success was noted with the specific stretching routine, the patients originally using the Achilles tendon-stretching program were encouraged to use the plantar fascia specific stretching program for 8 weeks.

At 2 years, 82 patients were mailed a questionnaire to address their pain, function and satisfaction with treatment. Sixty six of the 82 patients responded. Ninty-two percent of those who responded reported total satisfaction or satisfaction with some minor reservations regarding their treatment. Sixteen of the 66 who responded said they did seek further treatment by a clinician.

Conclusion: A plantar fascia specific stretching program can provide long term benefits for those with plantar fasciitis.

J Bone Joint Surg Am. 2006 Aug;88(8):1775-81

Study 4) Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors.

This was a retrospective study evaluating 225 patients with plantar fasciitis for 6 months or more and who had failed at least 5 conservative therapies. Each patient underwent extracorporeal shockwave therapy (ESWT) treatment by a single physician between the years 2002 and 2004.

A health questionnaire was used to survey the patients after the procedure and success rates were 70.7% at 3 months and 77.2% at 12 months. The patient’s weight, history of steroid injections, duration of symptoms and the plantar fascia thickness did not influence the outcome of the treatment. Older adults and individuals with diabetes or psychological issues had worse outcomes than those who did not.

Conclusion: Extracorporeal shockwave therapy is an effective treatment for chronic fasciitis, but success rates may not be as high as previously reported.

J Foot Ankle Surg. 2009 Mar-Apr;48(2):148-55.

Study 5) Novel Procedure for Heel Pain (Plantar Fasciitis)

44 patients with plantar fasciitis who were unresponsive to therapy had a local anesthetic at the heel area and then application of dry needling. Dry needling is a technique involving repeated needle punctures without the injection of any medication. The needle insertion is guided by ultrasound. The goal is to cause injury to a localized area to stimulate the healing response. An ultrasound guided steroid injection was then given after the treatment and patients were also given orthotics. They were followed for a period of six months. After 3 weeks, 95% of the patients had complete resolution of their symptoms and remained pain-free after 6 months.

Conclusion: The dry needling technique followed by steroid injection and orthotics may prove to be an effective treatment for plantar fasciitis, but more research is needed to evaluate safety and effectiveness.

RSNA 2008: 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America: Scientific Session A10-07. Presented November 30, 2008.

Study 6) Obesity and pronated foot type may increase the risk of chronic plantar fasciitis: a matched case-control study.

This study included 80 individuals with chronic heel pain and 80 without chronic heel pain. Body Mass Index, foot posture (foot position while standing), ankle range of motion, lower limb stress and calf endurance were measured in each group and questions on activites and time spent were asked. The group with chronic heel pain had a significantly greater body mass index, a more pronated foot position and greater ankle dorsi-flexion (foot movement up at the ankle) range of motion. There was no difference between the groups for calf endurance or on reported time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting.

Conclusion: Obesity and pronation are associated with chronic heel pain but there is not association with limitation of ankle joint dorsiflexion and chronic heel pain.

BMC Musculoskelet Disord. 2007 May 17;8(1):41

Study 7) Comparison of custom and prefabricated orthotics in the initial treatment of proximal plantar fasciitis.

This study evaluated 236 patients with plantar fasciitis who were divided into five treatment groups and followed for 8 weeks. One group performed stretching only, three groups were given different types of over-the-counter/prefabricated inserts and the fifth group was given custom made orthotics. After 8 weeks, all groups showed improvement ranging from 68% with the custom made foot orthoses to 95% with the silicone inserts. All groups using prefabricated inserts and insoles had greater improvements than those using the custom made orthoses.

Conclusion: When stretching is combined with a prefabricated insert, the short term improvements in plantar fasciitis are greater than with those using a custom made foot orthotics.

Foot Ankle Int. 1999 Apr;20(4):214-21.

Study 8. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.

Forty-three patients with plantar fasciitis were divided into three treatment groups; treatment with orthotics, orthotics and night splints or night splints alone. After one year, 88 % of the patients returned for follow up evaluation and all treatment groups had significant improvement compared to their initial evaluation. At one year, the two groups using orthotics had a reduction in pain of 62% compared to a reduction of 48% with the group using only night splints.

Conclusion: Patients with plantar fasciitis were more likely to continue to use orthotics than the night splint at one year. Note: night splints are generally used for a few months of treatment.

Foot Ankle Int. 2006 Aug;27(8):606-11.

Knee Pain and how orthotics can help….

Many of us suffer from chronic pain in the knees, hips or lower back. Often there is a connection between these complaints and the way you walk. This article sheds more light on knee pain and in particular how abnormal foot mechanics or asymmetry in our gait can affect knee function, causing pain and discomfort.

Typical knee pain symptoms…

“A sharp pain in the knee and a grinding sensation, especially when getting up out of chair or walking up stairs.”

This description of knee pain is most common and refers to a condition called Patello-femoral Syndrome. Patello-femoral Syndrome is the most common form of chronic knee pain. It refers to pain occurring between the knee cap (the patella) and the underlying thigh bone (the femur). Patello-femoral Syndrome causes pain and tenderness in the front of the knee. The pain gets worse when you sit for a long period and get up. Or when you walk up stairs. Often, one will experience a grinding or crunching sensation in the knee.

What exactly causes knee pain?

There are number of different causes for knee pain. With age wear and tear occurs in the knee joint. Also over-use causes knee problems (for example in rugby/football players, and in tradespeople such a carpenters, bricklayers etc). Over time softening of the cartilage beneath the knee cap (the patella) will result in tissue breakdown and pain in the knee joint. Instead of gliding smoothly over the knee the knee cap grinds against the thigh bone when the knee moves. In turn this may result in heavy erosion of the cartilage. Apart from age and over-use the third most common cause of knee pain is faulty gait (i.e. the way we walk). Overpronation (=rolling inwards of the feet and lowering of the arches) is a major contributing factor to knee pain.

Here’s why…

The knee joint forms the link between the upper and lower leg. It is a hinge joint, which means it is only designed to flex and extend the lower leg, and not to rotate it. Unlike for instance your elbow joint which allows your underarm to move up and down, as well a twist (rotate). Overpronation of the feet means that with every step your foot rolls inwards too much. As the foot rolls inwards the bones in the lower leg are forced to rotate internally and this results in a twisting motion at the knee joint. This irregular motion of the knee will inevitably lead to excessive wear and tear in the knee joint causing long-term damage and chronic knee pain. Over-pronation not only causes bad knee function. An estimated 70% of the population suffers from some degree of over-pronation and this becomes evident in other areas of the body, especially at an older age. People with overpronation can display symptoms such as frequent ankle sprains, pain in the arches, leg pains, shin splints, hip pain, even lower back pain. 

Over-pronation causes internal leg rotation

Treatment options for knee pain

The most commonly prescribed treatments by physiotherapists include rest (or decreased activity), ice packs and sometimes wearing a knee brace and also strengthening exercises. In addition, orthotic shoe inserts will be recommended to stabilise the feet and correct poor foot function. Footlogics orthotics can be used to prevent the unnatural rotation of the lower leg, thereby treating the cause of this type of knee pain. By supporting the arches they force the ankles and legs back into alignment, reducing the twisting on the knee and thereby providing relief to the painful knee joint. 

A number of studies have shown that bad knee function can be restored by using foot orthotics. Below are the extracts of two of these studies:

Study 1) The Effect of Foot Orthoses on Patellofemoral Pain Syndrome (Knee Pain) - Amol Saxena, DPM and Jack Haddad, DPM - Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA. 

In a retrospective review of 102 patients treated for chondromalacia patellae and patellofemoral knee pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthotics was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved, showing a significant decrease in the level of pain with orthotics intervention (chi-square P < .001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD. (J Am Podiatr Med Assoc 93(4): 264-271, 2003)

Study 2) The Role of Foot Orthotics as an Intervention for Patellofemoral Pain (Knee Pain) - Michael T. Gross, PT, PhD1- Judy L. Foxworth, PT, MS, OCS2

Foot orthotics often are prescribed for patients with patellofemoral knee pain. The purpose of this clinical commentary is to review the theoretical and research basis that might support this intervention and to provide our own clinical experience in providing foot orthoses for these patients. Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, (2) the relationship between foot and lower-extremity/patellofemoral joint mechanics, (3) the effects of foot orthoses on lower-extremity mechanics, and (4) the effects of foot orthoses on patellofemoral joint position. The literature and our own clinical experience suggest that patients with patellofemoral pain may benefit from foot orthoses if they also demonstrate signs of excessive foot pronation and/or a lower-extremity alignment profile that includes excessive lower-extremity internal rotation during weight bearing and increased Q angle. The mechanism for foot orthoses having a positive effect on pain and function for these patients may include (1) a reduction in internal rotation of the lower extremity; (2) a reduction in Q angle; (3) reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and (4) reduced patellofemoral contact pressures and altered patellofemoral contact pressure mapping. Foot orthotics may be a valuable adjunct to other intervention strategies for patients who present with the previously stated structural alignment profile. J Orthop Phys Ther 2003;33:661-670.

Read more about knee pain…

Foot Pain, Plantar Fasciitis (Heel Pain) and how orthotics can help…

The most common foot complaints explained (click for more info)

Plantar Fasciitis

Heel Pain

Heel Spurs

Foot pain is very common and an estimated 75% of people will suffer from some type of foot pain at some point in their life. The foot is a complex structure made of 26 bones, 33 joints and layered with an intertwining web of more than 120 muscles, ligaments, and nerves. With each step we take, a force of 2-3 our body weight is placed on our feet and during a typical day, people take 8,000 - 10,000 steps. Therefore it comes as no surprise that at some time in our lives we  will suffer some type of foot complaint. This article sheds light on the most common types of foot pain and shows how orthotics and special exercises can help. Firstly, let’s have a look at the major factors that contribute to Foot Pain:

- Age: as we age, our feet widen and flatten, plus the fat padding on the sole of the foot wears down. The skin on our feet also becomes dryer. Foot pain in older people may be the first sign of arthritis, diabetes and circulatory disease.

- Gender: Women are at higher risk than men for severe foot pain, most likely because of the high-heeled shoes they wear

- Occupational Risk Factors: people who are on their feet all day because of work are much more likely to suffer from foot pain

- Pregnancy: pregnant women often have foot complaints due to weight gain, swelling in their feet and ankles, and the release of certain hormones that cause ligaments to relax

- Sports/Running/Dancing: especially heel pain, shin splints, and knee pain can increase with sports, running or dancing.

- Weight gain: being overweight puts added stress on the feet and can lead to heel pain, foot pain and ankle injuries

- Over-pronation: rolling inwards of the foot and flattening of the arches (over-pronation) is a major contributing factor to foot pain.

Most common types of foot pain:

- Heel Pain (Heel Spurs and Plantar Fasciitis)

Heel pain is the most common foot problem. Heel pain is often experienced with one’s first steps out of bed in the morning and presented by a sharp stabbing pain in the heel. Commonly heel pain is caused by a painful stretching and micro-tearing of the Plantar Fascia (the flat band of tissue that connects your heel bone to your toes). The Plantar Fascia supports the arch of the foot. Plantar Fasciitis is Latin for inflammation of the Plantar Fascia. Normally, the fascia is flexible and strong.  However, due to factors such as excessive weight, age, over-use and over-pronation the Fascia can become irritated and inflamed. With excessive tension on the Plantar Fascia the attachment of the ligaments onto the calcaneus (heel bone) begins to pull away from the bone. After a while a ‘heel spur’ may develop at the bottom front of the heel bone. During resting (e.g. when you’re asleep), the plantar fascia shortens and tightens up.  When getting up, bodyweight is rapidly applied to the foot and the fascia must stretch and quickly lengthen, causing micro-tears in the fascia. Hence, the stabbing pain with your first steps in the morning.

Plantar Fasciitis, heel pain and heel spurs are best treated with simple, non-surgical methods. However, the longer the heel pain has been present, the longer it takes to fix. Research has shown that the most effective long-term treatment for heel pain is doing some simple stretching exercises, combined with wearing foot orthotics. This way the tension on the Plantar Fascia is being released, treating the cause of the problem, not just the symptom.

Read more about Heel Pain, Heel Spurs and Plantar Fasciitis…

- Arch Pain

Arch Pain is caused by the same problem as heel pain: ‘Plantar Fasciitis’ or inflammation of the Plantar Fascia. The difference is that the inflammation of the fascia occurs under the arch, rather than at the heel bone. Treatment of arch pain, is exactly the same as for heel pain (see above).

Read more about Arch Pain…

- Achilles Tendonitis and Achilles Pain

Achilles Tendonitis is Latin for ‘inflammation of the Achilles Tendon’. The Achilles Tendon connects the calf muscles to the heel bone and sits just behind the ankle joint.  Achilles pain occurs just above the back of the heel and the Achilles Tendon in this area may be thickened and tender to the touch. Pain is present with walking, especially when pushing off on the toes. Achilles Tendonitis should not be left untreated due to the danger that the tendon can become weak and ruptured. Achilles pain is aggravated by activities that repeatedly stress the tendon, causing inflammation. People who suffer from Achilles Tendonitis often notice that their first steps out of bed in the morning are very painful.

The cause of Achilles Tendonits is over-straining of the Achilles Tendons leading to irritation and inflammation. There are several factors that can cause Achilles Tendonitis, including over-use, thight calf muscles and age. The most common cause, however, is over-pronation. When the arch collapses upon weight bearing, extensive stress is placed on the achilles tendons.

Treatment of Achilles Tendontis includes rest (or reduced activity), calf stretching and ice packs (to cool down the inflammation). The use of orthotics is recommend to support the arches, thereby reducing the stress on the achilles tendon.

Read more about Achilles Tendonitis…

- Ball of Foot Pain (Metatarsalgia & Morton’s Neuroma)

Metatarsalgia is the general term for pain in the metatarsal region of the foot more commonly called the Ball of the Foot. Many women suffer from Metatarsalgia as a result of wearing high heels, but this condition can also occur in men. Wearing (high) heels means most of the bodyweight is concentrated on the forefoot, causing excessive pressure in the ball of the foot.

Metatarsalgia  is often described as a burning sensation in the ball of the foot, combined with excess callous forming. Ball of Foot Pain (Metatarsalgia) occurs when the metatarsals (forefoot bones) drop and the surrounding ligaments weaken. The entire forefoot structure collapses, which then leads to excess pressure and friction under the ball of the foot.

Effective treatment of pain the ball of the foot involves reducing the excessive force placed in the forefoot area. Unloading pressure in the ball of the foot can be accomplished by wearing orthotic insoles with a in-built metatarsal support.

For women’s fashion and high heel shoes we recommend Footlogics Catwalk - a thin and flexible footbed that supports the arch, as well as the metatarsal bones. This way, bodyweight is distributed more evenly over the entire foot with less pressure and friction in the ball of the foot.  For men’s shoes there’s Footlogics Comfort which also features a metatarsal support and at the same time controls over-pronation, a major contributing factor to Metartarsalgia.

Morton’s Neuroma is a foot problem associated with Metatarsalgia. It involves swelling and inflammation of a the nerve between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton’s Neuroma may also cause numbness, tingling, or cramping in the forefoot. Treatment of Morton’s Neuroma is the same as for Metatarsalgia.

In addition, one can use ice packs to cool down the inflammation. Also, wearing tight shoes that squeeze the toes should be avoided.

Read more about Ball of Foot pain…

- Bunions (Hallux Valgus Abducto)

A bunion is an often painful enlargement of the joint at the side of the big toe. The big toe is bent inwards and a bony lump forms on the outside. The bump is actually a bone protruding towards the inside of the foot. Over time the lump becomes larger and the bunion can become painful. Stiffness can eventually develop, even arthritis. With the continued movement of the big toe towards the smaller toes it is common to find the big toe resting over the second toe. Symptoms of bunions include inflammation, soreness  and swelling and on the outside the big toe, often causing the sufferer to walk with difficulty.

Bunions can develop from an abnormality in foot function (e.g. over-pronation) or by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box can lead to the formation of a bunion. The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. Orthotics are also recommended for this condition to provide extra comfort, support and protection.

Read more about Bunions…

Irregular shoewear and over-pronation

Over-pronation (fallen arches and rolling inwards of the feet & ankles) is a very common condition, affecting at least 70% of the population. The opposite of pronation is supination: the feet tend to roll outward and the arch remains high during the walking process. Only 5% of the population has this problem (often referred to as Pes Cavus - latin for high arched foot).

Interestingly, many people are convinced they don’t over-pronate at all, because their shoes tend to wear out faster on the outside, not the inside! In other words, they believe that over-supinate, rather than over-pronate…

Shoewear (at the bottom of the shoes) can provide helpful information when assessing a person gait pattern. Ppodiatrists and phyiotherapists often will look for irregular shoewear when a patient presents with a foot or knee problem.

The simple assumption that excessive outside wear of sole indicates supination and conversely excessive inside shoewear indicates over-pronation, is incorrect.

Firstly, we need to understand normal human gait pattern. When we walk our feet always land on the outside heel first (heel strike). This is simply because the distance between our hips is wider than the distance between our feet when they land during walking or running. Women especially place their feet very close together, almost in a one line, during walking and running. The photo below illustrates how our legs are always angled inwards, during walking and running. With women the angle tends to be slightly greater than with men.

The leg is naturally angled inwards during walking and running

Because of this leg angle, when the foot lands it always hits the ground first with the outside of the foot. During our gait our heels touch the ground first, so it comes as no surprise that our footwear wears out first on the outside heel area of the shoe.

This excessive wear on the outside heel is totally normal and occurs in both over-pronators and over-supinators. Some people will only notice slight outside wear, others a lot. Supinators will notice excessive wear not just in the outside heel area, but more likely across the entire outside area of the shoe.

Now let’s have a look at what happens after heel strike. After our heel strikes the ground, the foot makes full ground contact (this is called the midstance phase of gait) and pronation occurs. I.e. the foot muscles loosen allowing the foot and ankle to roll inwards and the arch to flatten. Pronation is a normal process: it is nature’s own shock-absorbing mechanism.

Next the heel lifts off the ground and the foot prepares itself for take-off: a propelling motion to move the body forward (the propulsive phase of gait). At this stage the foot should become rigid and supinate (roll outwards). Unfortunately, this the moment where things go wrong. Most of us don’t supinate, instead the foot remains loose and stays in a pronated position (ankle inwards and arch lowered). This situation is referred to as over-pronation.

Shoewear on the outside heel doesn't mean, you don't suffer from over-pronation!

So in conclusion, if your shoes wear out faster on the outside heels of your shoesoles, it doesn’t mean you’re not an over-pronator! Most likely you are, like 70% of the population.

Over-pronation can be a real problem as it makes walking and running quite inefficient, costing us more energy and increasing the chances of pain and injury such as plantar fasciitis, heel pain, shin splints, knee pain and lower back pain. To combat over-pronation you can 2 things: strengthen the muscles in your feet and legs with exercises and wear a (flexible) orthotic like Footlogics orthotics. The good thing about flexible orthotics (as opposed to hard, rigid) orthotics is that they still allow the foot to pronate naturally, but at the same time they prevent over-pronation.

Plantar Fasciitis explained…

Plantar Fasciitis is the most common foot complaint and the main cause of heel pain, heel spurs and also arch pain. Millions of people suffer from Plantar Fasciitis, especially the over 50’s. Fortunately for 80-90% of Plantar Fasciitis sufferers there are some very effective treatment solutions available.

Definition:

Plantar Fasciitis (pronounced “plantar fash-eee-eye-tiss”) means litterally “inflammation of the plantar fascia”. Plantar Fasciitis is also called “Policeman’s Heel”. Plantar Fasciitis is often associated with calcaneal spurs (heel spurs).

Symptoms:

Plantar Fasciitis usually presents itself as a sharp pain, experienced at the underside or front of the heel bone. Often the pain is worse with your first steps when getting out of bed in the morning. For most people Plantar Fasciitis pain is more severe following periods of inactivity or rest, when getting up. After a short while the sharp pain subsides, turning into a dull ache. In the morning, stiffness and swelling in the heel area may be present.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You’re more likely to feel this after (not during) exercise and walking. Most people will put up with heel pain for at least 6 weeks before seeking (self)treatment, information and/or advice.

If Plantar Fasciitis is left untreated, it may become a chronic condition and treatment will become far more difficult. Also, Plantar Fasciitis sufferers tend to avoid putting weight on the sore heel and will try to walk on the forefoot in order to avoid pressure on the heel. With this abnormal walking pattern one could easily develop problems in the knees, hips or back.

Anatomy:

The Plantar Fascia is a thick, fibrous band of connective tissue that runs from the heel bone (calcaneus) along the sole of the foot like a fan, being attached at its other end to the base of each of the toes. It is a tough and resilient ligament structure that performs a critical function during walking and running.

The Plantar Fascia acts as a ‘bowstring’ connecting the ball of the foot to the heel. It forms the longitudinal arch of the foot and helps to lift the heel off the ground to prepare the foot for the ‘take-off’ (propulsive) phase of the gait cycle. During walking, at the moment the heel begins to lift off the ground, the Plantar Fascia endures tension that is around twice our body weight. The Plantar Fascia also act as a natural shock-absorber during walking and running.

Plantar Fascia

Causes of Plantar Fasciitis:

Plantar Fasciitis is Latin for inflammation of the Plantar Fascia. This inflammation occurs at the point where the fascia attaches to the calcaneus (also known as the heel bone).

So what causes the Plantar Fascia to become inflamed? There are a number of various reasons for this to occur. For example, you are more likely to develop Plantar Fasciitis if you are over 50 years old, if you’re overweight, or pregnant, or if you have a job that requires a lot of walking or standing on hard surfaces. You’re also at risk if you do a lot of walking or running for exercise (overuse injury). And if you have tight calf muscles (which a lot of people have) you’re also more likely to develop Plantar Fasciitis.

Research has shown, however, that the number 1. cause for Plantar Fasciitis is over-pronation (or fallen arches).

Over-pronation of the feet is very common, at least half of the population has this problem, but most people don’t realise they have this condition! Over-pronation simply means that the feet and ankles roll inwards too much during walking and that the arches collapse. With age, most people tend to over-pronate. However, this condition is not uncommon in children and teenagers, as well as athletes.

When the arch collapses the 2 outside points of the bow (being the heel and ball of the foot) are being placed farther away from each other. This puts repetitive stress on the Plantar Fascia. The attachment of the fascia into the heel bone is a tiny area of tissue, compared to the wide attachment area to the toes. Therefore, the constant excess pulling on the fascia will do damage to the weakest attachment point.

Over time irritation occurs at the heel bone, followed by inflammation and micro-tearing of the plantar fascia tissue. Sometimes swelling is present. If the pulling continues the heel bone will ‘respond’ and a bony growth will develop on the front of the heel bone. This is referred to as a ‘heel spur’. Interestingly, the heel spur itself doesn’t cause any pain, but the inflamed tissue around it does.

Plantar Fasciitis Treatment options:

Fortunately, most cases of Plantar Fasciitis can be treated effectively at home. Firstly, you need to refrain from activities that cause pain such as long walks, running, sports and standing for long periods. Rest allows any swelling, inflammation and/or pain to subside.

Applying ice (or a heat pack) to the heel area and using anti-inflammatory pain killers like Advil or Nurofen (both contain ibuprofen) will provide immediate pain relief.

However, long term, effective treatment of Plantar Fasciitis consists of a simple program of daily stretching exercises, combined with wearing an orthotic to support the arches.

Gentle stretching of the Plantar Fascia, the Achilles tendon and the calf muscles will all help making your feet and a lot more flexible, which in turn will help reduce the exessive pulling of the Plantar Fascia. Do the stretches fist thing in the morning and avoid walking barefoot on hard floors and tiles. Instead, slip on a pair of shoes with an orthotic inside them. Repeat the exercises (especially the calf stretches) a few times during the day.

You can find the complete Plantar Fasciitis stretching exercise program here. Or talk to your physiotherapist or podiatrist about specific exercises. Sometimes practitioners will prescribe a night splint, designed to gently stretch the fascia during the night.

With the combination of daily exercises and orthotics you will see a major improvement within a few weeks. If you are overweight, it is recommended to lose some weight as this will reduce the strain on your feet.

In cases where the pain persists, or is severe, Plantar Fasciitis can be treated with a cortisone-steroid injection into the heel. However, this is only a short term fix and the pain will return within 3 months. A newer treatment for Plantar Fasciitis (instituted prior to surgery) is electrocorporeal shock wave therapy. In this procedure, an instrument administers pulses of energy (shock waves) to your heel to relieve pain.

Surgery for Plantar Fasciitis is rarely required, unless all other treatments have failed to relieve the pain. Surgical procedures include removing a portion of the Plantar Fascia.

Plantar Fasciitis and Orthotics

Research in America, Europe and Australia has clearly proven that wearing an orthotic insole is the best way to treat Plantar Fasciitis, especially when combined with daily exercises. However, it must be noted that this treatment regime is mostly effective for people who have started to notice heel pain recently (i.e. no longer than 6-8 weeks ago) or for people who only suffer mild Plantar Fasciitis pain.

The reason an orthotic works is simple: the cause of Plantar Fasciitis is the constant pulling of the “bowstring” under the foot, because of the lowering of the arches. Orthotics prop the arches back up, thereby reducing the excessive tension on the plantar fascia.

With less tension on the plantar fascia, the damage to the ligament can be reversed. The tissue is allowed to heal faster and repair the micro-tearing, which has occurred at the heel bone attachment.

The orthotic will be even more effective when worn in a pair of good, supportive shoes. I.e. a shoe with a strong back (heel counter), stabilising the heel and ankle joints during walking and running.

There are different types of orthotics, including custom-made ones from a Podiatrist. However, not everyone will need a custom-made device. Nowadays, good supportive and inexpensive orthotics are available from retailers and specialty websites. The main factor is support, more so than cushioning. So don’t buy a soft, spongy or gel footbed, but rather an insole with a high arch, made of reasonably firm materials.

Tips for preventing Plantar Fasciitis

Correcting some of the pre-disposing factors will ensure Plantar Fasciitis doesn’t re-occur, for example:

1. lose some weight if needed: this will reduce the physical load placed on the Plantar Fascia during walking

2. wear good quality, supportive shoes: i.e. shoes with a strong heel counter and with good flexibility in the front of the shoe (that allows the toes to bend back easily and naturally). Don’t wear completely flat shoes. A raised heel helps reducing the tension in the plantar fascia.

3. try to avoid walking barefoot on hard surfaces (including hard sand on the beach)

4. when exercising (walking, running or sports) always stretch your calf muscles first. Greater flexibility in the tissue makes them less susceptible to damage.

10 steps to effective heel pain relief

The most common cause of heel pain and heel spurs is a condition called Plantar Fasciitis (sometimes misspelled Planter Fascitis). This is Latin for inflammation of the Plantar Fascia. The Plantar Fascia is the broad band of fibrous tissue that runs under the foot and that forms your arch. Because of a number of different factors the plantar fascia are being overly stretched and this continuous pulling results in inflammation and pain at the heel bone, at the point where the ligaments insert into the heel bone.

Over-pronation of the feet (fallen arches + rolling inward of the feet and ankles), tight calf muscles, as well as ageing and being overweight are the main causes for the plantar fascia being overly stretched.

There are many ways to treat heel pain, heel spurs and Plantar Fasciitis, including cortisone injections and surgery. However, in most cases heel pain relief can be achieved through self-help by following a number of easy, simple steps, most of which are aimed at reducing the pulling of the plantar fascia:

1. Rest, reduced activity:

When you have heel pain avoid any activity that can further aggravate the problem. This includes walking for long distances, walking up or down stairs, running, sports etc. If you want to keep fit swimming is the safest activity, until your heel pain has been treated properly. Or you can ride a bike or a stationary exercise bike. Basically, try to be as little on your feet as possible, allowing the plantar fascia to heal itself.

2. Ice (combined with heat)

Use an ice pack and apply it onto the sore heel for 5-10 mins at a time, 3 to 4 times per day. The ice will reduce the inflammation in the heel area. To help reduce any chronic inflammation, you can try alternating between ice and heat. Place an ice pack on the heel for 5 minutes and then switch to a hot pack (or hot water foot bath) for another 5 minutes. Do this for about 20-30 minutes per day and you’ll notice some considerable heel pain relief.

3. Roll a tennis ball (or rolling pin) under the foot

Many people with Plantar Fasciitis experience a sharp heel pain in the morning, when taking the first steps after getting out of bed. This pain comes from the tightening of the plantar fascia that occurs during sleep. Stretching and massaging the plantar fascia before standing up will help reduce heel pain for the rest of your day! Massaging the plantar fascia can be done simply by rolling a tennisball (or rolling pin) under the foot, all the way from the heel to the toes. You may do this sitting down, applying a fair amount of pressure onto the arch, or even standing up as long this causes not too much discomfort. Keep rolling the ball or pin under the foot for about 5 minutes.

4. Stretch your feet with a towel

Stretching the plantar fascia is your next heel pain exercise, using a bath towel. Put a rolled up towel under the ball of one foot, holding both ends of the towel with your left and right hand. Next, slowly pull the towel towards you, while keeping your knee straight (the other knee may be bent). Hold this position for 15 to 20 seconds. Repeat 4 times and change to the other foot, if necessary. (It’s always good to do these exercises on both feet, even if you only experience heel pain in one foot, as this will help prevent the heel problem to come back in your other foot!)

5. Stretch your calf muscles

This is the last morning exercise and won’t take long.  Stand facing a wall with your hands on the wall at about eye level. Put one leg about a step behind your other leg, keeping your back heel flat on the floor. Make sure this leg stays straight at all times. Now bend the knee of the front leg slowly, lowering your body until you feel a stretch in the calf of the back leg. Hold the stretch for 15 to 20 seconds. Repeat 4 times. Do the same for the other leg.

Now you’re ready to face the day! Please make sure you don’t walk barefoot at home in the morning, as this will undo all the hard work. Wear shoes or supportive sandals as soon as you have done the heel pain exercises.

You can repeat any of these heel pain exercises during the day, if you wish. For example the tennis ball rolling can be done as you watch TV or read the paper. 

There’s one more exercise you may want to do which is called the Achilles Tendon stretch. Stand on a step with both feet on the same step and slowly let your heels down over the edge of the step as you relax your calf muscles. Hold this stretch for about 15 to 20 seconds, then tighten your calf muscle a little to bring your heel back up to the level of the step. Repeat 4 times.

Please note that stretching exercises should create a pulling feeling, they should never cause pain! 

6. Take an anti-inflammatory drug, like Ibuprofen

To ease your heel pain you can take an anti-inflammatory that contains Ibuprofen, like Nurofen or Advil. This is a short term fix that will help decrease the inflammation of the plantar fascia. You still need to do take all the other measures such as stretching, ice, orthotics etc to achieve long term pain relief from your heel problem. For many people Ibuprofen is pretty heavy on the stomach and therefore these drugs should be taken in moderation.

7. Lose some weight

As we get older we tend to put in a bit of extra weight. The combination of weight gain and ageing means we put a lot of extra tension on our muscles and ligaments in the feet, legs and back. Most people tend to over-pronate because of weight gain. Over-pronation (fallen arches) is the main cause of Plantar Fasciitis and heel pain. Therefore by losing weight you will decrease the tension on the plantar fascia.

8. Wear the right footwear

Supportive footwear is paramount, especially as we get older. Floppy footwear causes ankle instability during walking and contributes to the problem of over-pronation, leading to heel pain and other foot problems. A good supportive shoe should only bend at the sole in the forefoot area and should be firm elsewhere, especially the back section of the shoe (heel counter) should be firm. Many footwear companies advertise shock-absorption and cushioning as the major benefits of their (sports) shoes. Stability is far more important than cushioning! 

9. Use a night splint

A night splint holds the foot at 90 degrees during your sleep. The aim of the splints is to keep your foot and calf muscles stretched during the night. Normally during rest the plantar fascia and calves tend to tighten and shorten. So when you wake up in the morning and take your first steps, the fascia are being pulled all of a sudden, causing the sharp pain in the heel. 

The problem with night splints is that they can be quite uncomfortable. This is why they are so-called sock night splints on the market which are more bearable than rigid night splints.

10. Wear orthotics in your shoes

Research has shown that by far the most effective way to treat heel pain, plantar fasciitis and heel spurs is wearing a corrective device inside the shoe. Orthotics are designed to correct the problem of over-pronation, the major cause of plantar fasciitis and heel pain. Orthotics support the arches and control abnormal motion of the feet, thereby greatly reducing the tension in the plantar fascia band. Especially when combined with daily exercises, orthotics will provide relief to the majority of heel pain sufferers. 

Orthotics can be obtained from a foot specialist (podiatrist). These are called custom orthotics and they usually quite hard. Nowadays there are softer orthotics on the market, which are made of EVA and which mould themselves to the wearer’s foot shape because of body heat and body weight. These softer orthotics are pre-made and available without a prescription from pharmacies and specialty websites.

Ball of Foot Pain (Metatarsalgia) explained..

This article sheds light on a very common type of foot pain called Metatarsalgia, more commonly known as ‘Ball of Foot Pain’.

Metatarsalgia - Ball of Foot Pain  - introduction

Pain in the balls of the feet (Latin: Metatarsalgia) is a very common foot complaint, in particular for women. Most women who wear high heels or tight fashion shoes (or who have done so in the past) are likely to suffer from Metatarsalgia. Men can also suffer from this condition, especially if they have to wear hard shoes or boots without any cushioning inside, and their job requires standing or walking for prolonged periods. For example workboots or military/police boots can easily cause ball of foot pain.


What are the symptoms of Ball of Foot Pain?

People suffering from Metatarsalgia often experience a burning sensation under the ball of the foot. Sometimes combined with a sharp, tingling sensation near the toes (this condition is called Morton’s Neuroma, see further below). The pain can also be stabbing pain that comes and goes throughout the day. In some cases people experience a feeling similar to having a pebble sitting under the forefoot.

Ball of Foot pain worsens when wearing high heels/fashion shoes for a longer periods of time or, for men after walking long distances in hard shoes. Typically people with Ball of Foot pain also display excessive callous formation under the balls of their feet. 

Ball of Foot Pain - Metatarsalgia

What causes Metatarsalgia?

Typically, the two main causes for ball of foot pain are:

- wearing high heels/fashion shoes

- over-pronation (fallen arches)

Most (young) women like to look stylish and wear a shoe with a medium to high heel. The problem with high heels is that your bodyweight is not evenly distributed across the underside of the foot, but rather 80% of your weight pushes down on only one area of the foot, the forefoot area. i.e. the balls of your feet. This is totally unnatural and before long the entire forefoot structure collapses, leading to constant pressure and friction in the ball of the foot. The body reacts and builds up thick layers of callous in this area which in turn leads to a burning sensation under the foot.

Also, as part of the ageing process women tend to lose the bulk of the shock-absorbing ‘fibro-fatty’ pad under the ball of the foot. Without this natural padding pain develops due to the pressure on skin over bone.

Another cause of Ball of Foot Pain is over-pronation. Over-pronation (or excess pronation) occurs in a lot of people, especially as they get older. The arches drop and feet and ankles tend to roll inwards. Excessive pronation is a major contributing cause to heel pain and heel spurs, but it also can lead to Metatarsalgia. As the longitidunal arch collapses so does the transverse arch. The transverse arch is the arch that runs across the forefoot and is formed by the 5 metatarsal bones. The bones in the foot drop and the structure of the foot is severely weakened. When we wear shoes that do not provide enough support and cushioning excess pressure is placed on the ball of the foot and often pain is experienced. 

Over-pronation, combined with wearing hard, flat shoes and walking on hard surfaces such as concrete, pavements, tiled floors etc often leads to ball of foot pain, but also other common complaints including aching legs, knee pain and lower back pain.


Treatment of Ball of Foot Pain (Metatarsalgia)

For ladies’ high heel and fashion shoes there is a new, unique solution to ball of foot pain: Footlogics ‘Catwalk.’ Made in Spain these specially designed insoles restore our natural body balance by supporting the longitundinal arch, as well as the metatarsal bones and they shift bodyweight away from the forefoot towards the arch and heel. The result is that your bodyweight is more evenly distributed over the entire surface of the feet, and not just pushing into the balls of the feet. Thus, the insole prevents excessive pressure and friction in the ball of the foot are, and greatly reduces/eliminates the pain and burning sensation under the feet - especially with longer periods of standing or walking.

In case of regular flat footwear - whereby Metatarsalgia is caused by over-pronation -  a full-length orthotic insoles with arch support as well as metatarsal support is recommended to prevent and relieve pain the ball of the foot.

Removal of excess callous by a Pedicurist, Chiropodist or Podiatrist is highly recommended to relieve ball of foot pain. You can also remove hard skin and callous yourself by means of daily light abrasion (using a pumice stone or fine grit foot file).

Choose the right footwear..

Shoes that are very narrow in the forefoot force the metatarsal bones together, pinching nerves and blood vessels that run between the bones. Continued use of shoes that are too narrow can cause one or more of the metatarsal bones to either shift up or down within the transverse arch, causing the arch to completely collapse.

On the other hand, shoes that are too wide can cause shearing stress under the foot as it slides around, causing callus to build up under the ball of the foot and under the toes. A narrow foot in a wide shoe will slide forwards, causing compression and curling of the toes. By allowing your toes to curl inside a shoe, you disturb the resting positions of your extensor and flexor muscles. Over time, this can result in fatigue and even cramp.

Thin soled shoes or shoes without any innersole cushioning will transfer all the hard impact with man-made surfaces directly into the bones of your feet, stimulating callous formation. So always buy shoes with plenty of cushioning and support, or wear orthotics inside your shoes.

Ill-fitting footwear should be replaced by anatomically correct, well-balanced and cushioned shoes. Avoid the use of high-heeled shoes or only wear high heeled shoes for no more than a few hours per day.

If problems persist, please consult a podiatrist.

Related articles:

Morton’s Neuroma (Ball of Foot pain and Tingling sensation/numbness in the toes)

Sesamoiditis

What is an orthotic? How do orthotics work?

“The foot bone is connected to the leg bone, the leg bone is connected to the hip bone, the hip bone is connected to the back…”

The old saying is true. A number of recent studies have shown how the position of our feet and walking pattern affects the rest of the body. Simply put: if your feet are out of alignment your entire body could suffer the consequences. It’s not much different from a tall building with with damaged foundation or if you will a card with bad wheel alignment…

As a result of poor alignment of the feet, you may experience aching legs, knee pain, even low back pain. Not surprisingly, the most common foot problems such as heel pain, heel spurs, plantar fasciitis, Metatarsalgia, Achilles Tendonits etc are all directly linked to poor foot function.

Foot orthotics are devices that you wear inside your shoes to correct a bad walking pattern and also to improve body posture. Orthotics will help relieve not only foot pain, they also assist with shin splints, knee and back pain. This article explains what precisely an orthotic device is, how they work and the different types of orthotics that are available.

What precisely is an ‘orthotic device’?

An orthotic device or orthotic is a generic name for corrective insoles and shoe inserts (also called Orthosis) that are placed inside the shoe to correct and restore the natural function of our feet. Faulty foot biomechanics contribute to many common conditions including as heel pain, knee pain, and lower back pain.

Biomechanics is the Science of Movement - it studies motion during walking, running, and sports.

Exessive pronation is the term used most when referring to poor foot biomechanics. It means that the arches in your feet collapse or flatten while the feet and ankles roll inwards. Podiatrists estimated that around 70 percent of the population suffer from excess pronation. Orthotics are designed to correct over-pronation by restoring the feet and ankles to their natural position, required for natural foot functioning. Orthotics not only help alleviate foot problems, they also help prevent future problems and injuries.

What are the different types of orthotics available?

Generally speaking there are three different types of orthotics. These are:

A) Custom-made (rigid/hard) orthotics

For patients with serious biomechanical disorders custom-made (rigid) orthotics provide the appropriate solution. 

These devices are prescribed and fitted by podiatrists. People who suffer from foot deformities like large bunions, foot ulcers or completely flat feet are often prescribed a functional orthosis. Also patients with a very high arch and rigid feet (Pes Cavus) can benefit from a custom orthotic. After initial diagnosis the podiatrist decides the patient requires a pair of custom orthotics. Next, a plaster cast of the patien’ts foot is taken (i.e. a negative impression of the feet) after which the cast is sent to an Orthotic Fabrication Lab. From this mould a positive impression is formed by pouring plaster into the mould and the result is an accurate copy of the underfoot. The Orthotist (Orthotic technician) fabricates the custom orthotic and will add some adjustments and wedges as instructed by the podiatrist. Even though custom orthotics are very useful devices many patients find the use cumbersome and often they do not easily get used to the orthotic, because they are very hard under the arches.

B) Heat-mouldable orthotics

Heat-mouldable orthoses are a cheaper alternative to expensive custom rigid orthotics that can cost $400 - $600 per pair. They are standard ‘off-the-shelf’ more flexible devices, made from high density EVA materials. The device is heated to slightly alter its shape. Sometimes, wedges are added for a more customised result. Heat-mouldable Orthotics cost around $100 to $140 and are much easier to get used to than custom rigid orthotics. Many physiotherapists and chiropractors now use heat-mouldable orthotics in their clinic.

C) Pre-made ‘over the counter’ orthotic:

Pre-made (or pre-fabricated) orthotics are soft to medium density flexible shoe inserts available from pharmacies, on-line specialist websites, and also from some physiotherapists or chiropractors. No prescription is necessary for pre-made orthotics. One will get used wearing these devices almost immediately and the cost ranges from only $30 to $60 per pair. Research has shown that for most people suffering from over-pronation, a pre-fabricated orthotic will provide sufficient correction and support to help alleviate common foot problems. After a few weeks of wear pre-made orthotics will customise to the wearer’s foot shape as a result of their body weight and body heat. Most pre-fabricated orthotics are made from EVA, a flexible material that supports the foot without hurting the arches. Especially children and elderly people benefit from a softer type of orthotic since they cannot tolerate anything hard under the foot.

What is the difference between orthotics and regular cushioning (gel/rubber) footbeds?

There is a big difference between cushioning footbeds and orthotics! Regular footbeds are quite flat and only designed to provide a cushioning and shock absorption. At first they may feel comfortable however these footbeds do not address any biomechanical issues and they do not correct the problem of over-pronation. Whereas orthotics are functional devices designed to correct and optimise our foot function. Some footbeds may feature a slight arch support but not steep enough to have any appreciable effect. This is especially true if the materials used are very soft and rubber or gel-like.

How do orthotics work?

Orthotics do a lot more than just supporting your arches. They stabilise the foot and ankle, re-align the feet and restore faulty foot function. Additionally, orthotics provide an even weight distribution and take the pressure of sore spots from heels, ball of the foot, corns and between toes, and bunions. Orthotics also support the transversal arch of the foot. I.e. the arch that runs across the forefoot, formed by the metatarsal bones. As a result of excess pronation, the forefoot structure tends to collapses, which means the metatarsal bones drop, causing problems in the ball of the foot.

Though it is not their main purpose, the orthotics do provide some degree of shock absorption as well, especially the softer pre-made orthotics. The main purpose of an orthotic insole is to improve our foot function and for most people orthotics will reduce pain and will help prevent future problems and injury.

There have been suggestions by some that the use of orthotics may weaken the foot muscles. According to a recent research paper from Australia “there are no reasons to doubt any decrease in muscle activity even after four weeks usage. Therefore foot orthoses users may not be worried through these unsupported statements.”

What are the typical complaints which orthotics be used for?

Years of use and prescription have proven that most foot complaints will respond favourably to treatment with foot orthotics. These devices are found to be very effective in the treatment of heel pain, heel spurs, Plantar Fasciitis, pain from bunions, callous and corns, Achilles Tendonitis, ball of foot pain, Metatarsalgia and also Morton’s Neuroma.

Our feet are the foundation of our body. Many problems in the legs, knees and back can be attributed to faulty foot biomechanics. Therefore, orthotics have been proven very useful in the treatment of shin splints, knee pain and lower back pain. This is the reason that many (sports) physiotherapists and chiropractors have started using orthotics. Over-pronation of the feet is the cause for the lower leg to rotate inwards and the pelvis to  tilt forward, in turn putting a lot of stress on the legs, knees and back. Orthotics corrects the problem of over-pronation and therefore greatly reduce internal leg rotation and forward pelvic tilt, thus helping to relieve lower back pain. A study from the USA “identified the nature of a person’s walk as a source of chronic lower back pain”. The study further showed more than a fifty percent improvement in alleviation of back pain after wearing orthotics!

Sources: 

Vol. 94 Number 6 542-549 2004 Journal of American Podiatric Medicine 

The Journal of American Podiatric Medicine May 1999, Sobel E, Levity S T, Caselli MA Division of Orthopedic Sciences,New York College of Podiatric Medicine

“Chronic Low-Back Pain and Its Response to Custom-Made Foot Orthoses” HOWARD J. DANANBERG, DPM, MICHELLE GUILIANO, DPM

”The Conservative Management of Plantar Fasciitis”- Pfeffer GB , University of California, San Francisco, CA.

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Most foot problems, as well as knee and lower back pain stem from over-pronation of the feet. Over-pronation is the collapsing of the arches and rolling inwards of the ankles. Over-pronation is most common with people who are overweight. Simply put the bone structure in the feet is designed to carry your normal, natural weight, not an extra 10 or 20 kilograms!

To prevent common problems such as heel pain, ball of foot pain, aching legs, knee or back pain weight loss is essential. For many losing weight on your own is not that easy. Motivation, advice and guidance are the keys to a successful weight loss program.

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