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Ona Dunken

Pain In The Arch Causes Symptoms And Treatments
Overview


Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year. Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed. The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot.


Foot Arch Pain


Causes


Arch pain can be caused by several different factors. Tight calf muscles combined with repeated arch collapse on weight bearing, is the most common cause of arch pain.This can then often lead to a condition called plantar fasciitis, which is an inflammation of the connective tissue that connects the heel with the ball of the foot. When the connective tissue in the bottom of the feet gets stretched out too much, plantar fasciitis can result. The inflammation resulting from plantar fasciitis can result in arch pain. Arch pain caused by plantar fasciitis is often worst after long periods of rest, like when you first wake up in the morning. This is because the plantar fascia tightens when you are off your feet. When you wake up in the morning and start walking around, the plantar fascia stretches out again.


Symptoms


The groups of muscles that support the arch can be divided into two groups. The muscles on the top of the arch start on the front lower leg and help to lift the arch, and the muscles that help pull the arch on the bottom of the foot are located the on back of the lower leg. Muscle injury may be indicated when pain is felt when the foot is fully extended, flexed, or turned in or out. Pain may also be felt when working the foot against resistance. Bruises are the result of a direct-force injury to the body. A bruise can occur to the foot by a variety of causes, such as having your foot stepped on or by stepping on a rock. The tissues that compose the arch do not provide that area of the body much protection. Blows to the foot that result in pain, discoloration, swelling, and changes in how you walk may indicate more serious damage.


Diagnosis


After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch. An area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle.


Non Surgical Treatment


Arch pain can be treated with orthotics, inserts that have proper arch support to relieve the strain on the plantar fascia, mild stretching and anti-inflammatory medications. Orthotics will relieve most of the strain put onto the plantar fascia by supporting the band from underneath when pressure is applied. Tape can also be used in conjunction with orthotics to restrict movement and support the plantar fascia. Stretching should be used along with orthotics and continued long after the symptoms of arch pain are gone to prevent it from occurring again.


Foot Arch Pain


Surgical Treatment


Surgery may be necessary in situations where the symptoms are likely to get worse over time, or when pain and instability cannot be corrected with external orthopedic devices. There are many types of surgical procedures, including cavus foot reconstruction, which can be performed to correct the foot and the ankle and restore function and muscle balance.


Prevention


There are several things that you can do to prevent and treat arch pain. This includes Avoiding high heeled shoes, Stretching the calf muscles regularly, Wearing well fitted, comfortable shoes, Using customisedorthotic devices or shoe inserts, Elevating the feet and applying ice and taking over-the-counter anti-inflammatory medications. You can also care for your feet by paying attention to any changes in your feet as you get older. It is normal for feet to lose some of their fat pads as a person ages. Your feet may get bigger, both wider and longer as well. Make sure that you wear shoes that are sturdy, but comfortable, and have your feet measured before you buy shoes to make sure that you are still wearing the right size. Shoe sizes vary from one brand to the next, so it is a good idea to have your feet measured every time you purchase shoes. When choosing shoes, match the shoe to the activity for which it will be worn. Within the broader grouping of athletic shoes, there are different categories with different features. For example, a running shoe has different features than a walking shoe. You may develop some arthritic changes in your feet over time, too. If you notice that you are experiencing more pain in your feet, see your doctor for an evaluation. If the pain is arthritis-related, your doctor may recommend medication or other treatment to slow the progression of the arthritis.
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What'S Adult Aquired Flat Foot ?

Overview
PTTD is a condition of degeneration and dysfunction in the tendon complex that helps control the medial arch of your foot. Essentially what happens is the complex is unable to do its job of supporting the arch and supinating the foot, so a progressive flat foot develops (usually called adult acquired flat foot). Initially pain and often swelling develops on the inside of the ankle and it will continue to get progressively worse. There are a number of stages of PTTD (3 Stages) and it needs to be aggressively treated early on otherwise a surgical reconstruction of the arch will invariably be required. PTTD can develop into a very disabling condition if it is not dealt with properly and promptly. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. Arthritis often develops in the foot and In more severe cases, arthritis may also develop in the ankle.
Adult Acquired Flat Foot

Causes
As discussed above, many different problems can create a painful flatfoot. Damage to the posterior tibial tendon is the most common cause of AAFD. The posterior tibial tendon is one of the most important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot. The main function of this tendon is to support the arch of your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse. Women and people over 40 are more likely to develop problems with the posterior tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition, people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat. The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch. An injury to the tendons or ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. Injuries to tendons of the foot can occur either in one instance (traumatically) or with repeated use over time (overuse injury). Regardless of the cause, if tendon function is altered, the forces that are transmitted across joints in the foot are changed and this can lead to increased stress on joint cartilage and ligaments. In addition to tendon and ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity. People with diabetes or with nerve problems that limits normal feeling in the feet, can have collapse of the arch or of the entire foot. This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate without the patient feeling any pain. This may result in a severely deformed foot that is very challenging to correct with surgery. Special shoes or braces are the best method for dealing with this problem.

Symptoms
PTTD begins with a gradual stretching and loss of strength of the posterior tibial tendon which is the most important tendon supporting the arch of the human foot. Left untreated, this tendon will continue to lengthen and eventually rupture, leading to a progressive visible collapse of the arch of the foot. In the early stages, patients with PTTD will notice a pain and swelling along the inner ankle and arch. Many times, they are diagnosed with ?tendonitis? of the inner ankle. If the foot and ankle are not properly supported during this early phase, the posterior tibial tendon can rupture and devastating consequences will occur to the foot and ankle structure. The progressive adult acquired flatfoot deformity will cause the heel to roll inward in a ?valgus? or pronated direction while the forefoot will rotate outward causing a ?duckfooted? walking pattern. Eventually, significant arthritis can occur in the joints of the foot, the ankle and even the knee. Early diagnosis and treatment is critical so if you have noticed that one, or both, of your feet has become flatter in recent times come in and have it checked out.

Diagnosis
The diagnosis of posterior tibial tendon dysfunction and AAFD is usually made from a combination of symptoms, physical exam and x-ray imaging. The location of pain, shape of the foot, flexibility of the hindfoot joints and gait all may help your physician make the diagnosis and also assess how advanced the problem is.

Non surgical Treatment
The adult acquired flatfoot is best treated early. There is no recommended home treatment other than the general avoidance of prolonged weightbearing in non-supportive footwear until the patient can be seen in the office of the foot and ankle specialist. In Stage I, the inflammation and tendon injury will respond to rest, protected ambulation in a cast, as well as anti-inflammatory therapy. Follow-up treatment with custom-molded foot orthoses and properly designed athletic or orthopedic footwear are critical to maintain stability of the foot and ankle after initial symptoms have been calmed. Once the tendon has been stretched, the foot will become deformed and visibly rolled into a pronated position at the ankle. Non-surgical treatment has a significantly lower chance of success. Total immobilization in a cast or Camwalker may calm down symptoms and arrest progression of the deformity in a smaller percentage of patients. Usually, long-term use of a brace known as an ankle foot orthosis is required to stop progression of the deformity without surgery. A new ankle foot orthosis known as the Richie Brace, offered by PAL Health Systems, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot. This is a sport-style brace connected to a custom corrected foot orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light weight and far more cosmetically appealing than the traditional ankle foot orthosis previously prescribed.
Adult Acquired Flat Foot

Surgical Treatment
Surgery should only be done if the pain does not get better after a few months of conservative treatment. The type of surgery depends on the stage of the PTTD disease. It it also dictated by where tendonitis is located and how much the tendon is damaged. Surgical reconstruction can be extremely complex. Some of the common surgeries include. Tenosynovectomy, removing the inflamed tendon sheath around the PTT. Tendon Transfer, to augment the function of the diseased posterior tibial tendon with a neighbouring tendon. Calcaneo-osteotomy, sometimes the heel bone needs to be corrected to get a better heel bone alignment. Fusion of the Joints, if osteoarthritis of the foot has set in, fusion of the joints may be necessary.
| Adult Aquired Flat Foot | 20:53 |
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Ona Dunken

Author:Ona Dunken
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