The mechanics of how we walk and move is important to ensuring that we remain injury free, unfortunately in many cases the architecture of the foot can disrupt our gait (the way we walk), potentially causing long term injury and pain problems.
Over-pronation, or flat feet, is a common biomechanical problem that occurs when a person’s arch collapses too far upon weight bearing, and is said to be “over-pronated”.
Pronation is the natural motion of the foot as it roles inward and flattens out when the foot makes contact with the ground. Pronation is part of the body’s natural complex shock absorption and allows the foot to adapt to the contour of the ground. Too much pronation will cause the arch of the foot to flatten excessively placing stress and pressure on the tissues and ligaments of the foot.
The best way to determine if you over pronate is to visit a Podiatrist who can do a full gait analysis on a treadmill or using forceplates measuring exactly the forces and angles of the foot whilst running. It is not only the amount of over pronation which is important but the timing of it during the gait cycle as well that needs to be assessed.
This is quite a common problem and may lead to a number of injuries, especially in runners, including:
Arch Pain
Shin splints
Plantar fasciitis
Heel Pain
Achilles tendon problems
Stiff big toe (Hallux limitus)
Heel spurs
Bunions (Hallux valgus)
Knee pain
Lower back pain
Pain in the ball of the foot(metatarsalgia or Morton’s neuroma)
Treatment and Prevention
Below are some of the treatment protocols that may be used:
Orthotics provide the required arch support to effectively reduce excessive pronation and restore the foot and its posture to the right biomechanical position. Orthotics should be designed with appropriate arch support and medial rear foot posting to prevent the over-pronation.
Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra adequate control, support and stability. Improperly fitting footwear can lead to additional foot problems.
Strapping/Taping – Taping the foot in a certain way provides support for the foot as well as stability and may be used in acute cases or as a first line treatment.
Exercises – These are used to strengthen certain muscles in order to achieve better foot function.
Stretching protocols – This help in loosening tight muscles and ligaments to prevent further strain.
Joint manual mobilisation – This helps joints that may have become stiff or fixed to loosen up and in turn allowing for better foot function.
Morton’s neuroma is a painful foot condition that often occurs in response to irritation, pressure or traumatic injury to one of the digital nerves leading to the toes. A thickening of nerve tissue results as part of the body’s response to the irritation or injury.
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. Abnormal foot movement used to compensate for bunions, hammertoes, flatfeet and other conditions can lead to irritation and development of Morton’s Neuroma. Pronation of the foot may cause the heads of the metatarsal bones to rotate slightly, thereby pinching the nerve running between the metatarsal heads. Chronic pressure or pinching causes the nerve sheath to enlarge, becoming increasingly squeezed, producing worsening pain over time, if not addressed.
Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.
If you have a Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring:
Tingling, burning, or numbness
Pain
A feeling that something is inside the ball of the foot
A feeling that there’s something in the shoe or a sock is bunched up
In developing a treatment plan, your Podiatrist will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
For mild to moderate neuromas, treatment options may include:
Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
Icing. Placing an icepack on the affected area helps reduce swelling.
Orthotic devices. Custom orthotic devices provided by your Podiatrist provide the support needed to reduce pressure and compression on the nerve.
Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
Shoe modifications. Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
Injection therapy. Treatment may include injections of cortisone, local anesthetics or other agents.
The best time to see your Podiatrist is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.
Tendonitis in the foot is a common problem because we use our feet continuously when playing sport. One of the most frequently affected tendons is the posterior tibial tendon, a structure that is normally hard at work, throughout the contact phase of gait (when the foot is in contact with the ground).
The posterior tibial tendon runs behind the inside bump on the ankle, across the instep, and attaches to the bottom of the foot. It is held in place by thick fibrous tissues which form a lever behind the ankle bone. This lever creates tremendous force, effectively slowing the foot down when the heel strikes the ground.
The symptoms of posterior tibial tendon dysfunction include pain in the instep area of the foot and swelling along the course of the tendon. The athlete may also experience pain and swelling right behind the inner ankle bone. There is usually pain when the area is touched along the course of the posterior tibial tendon behind the inner ankle. There may also be burning, shooting, tingling, stabbing pain often because the main nerve is inflamed along the inside of the ankle. Athletes experience pain when exercising or even just walking, steadily worsening toward the end of the day.
In severe cases there is significant pain when the athlete moves his/her foot, as well as pain upon passive stretching of the posterior tibial tendon, and on eversion or flattening of the foot. In some cases the tendon may actually rupture or tear, due to weakening of the tendon by the inflammatory process.
Treatment
Protection – Your ankle may be splinted, taped or braced to prevent further injury.
Rest – You should rest from all activities that cause pain or limping.
Ice and Compression- Your Podiatrist will advise you on icing and compression techniques.
Elevate – Make sure to elevate the ankle above heart level when possible.
Your Podiatrist will advise if orthotics are necessary.
A combination of ankle stretching and strengthening exercises as advised by your Podiatrist.
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Returning to your activity is determined by how soon your tendon recovers, not by how many days or weeks it has been since your injury occurred.
If exercise were available as a pill, experts say, everyone would be taking it. One reason is that exercise is very good at defusing stress. If you exercise — especially right when the stress response is triggered — you burn off stress hormones just as nature intended, instead of letting them pile up.
What’s more, just about any form of motion on a regular basis helps relieve pent-up tension. Rhythmic, repetitive movements, such as walking, running, swimming, bicycling, and rowing — and specific types of exercise such as yoga and tai chi — actually elicit the relaxation response, too. Regularly engaging in these kinds of activities can help you ward off everyday stress.
Children will often not tell you if their shoes are too small and may not feel discomfort. It is recommended that children have their feet measured regularly to prevent problems such as hammer toes, ingrown nails, corns, callouses and bunions. Foot problems, can be the result of poorly fitted shoes in childhood.
Check the length, there should be a thumbs-width between the end of the shoe and the longest toe (Might not be the big toe!)
The heel counter (back of the shoe) should be strong and stable.
The shoe should bend where the foot bends, across the ball of the foot.
The shoe should be flexible enough in the sole to allow natural flexion in the balls of the feet and not to stiff.
The laces, straps or buckles should hold the heel firmly in the back of the shoe.
Leather and materials that allow the foot to breathe are best.
Shoes should not need to be broken-in they should fit correctly at the time of purchase and not cause rubbing or irritation.
Flat feet, dropped arches, weak ankles or Pronated feet are a common concern in children. In early child hood there is a “fat pad” in the arch of the foot which gives the appearance of a flat foot, which is a normal part of development. However if your child remains flat footed it may need to be checked. There are many different causes of flat feet, from birth deformities to abnormal leg and foot development. Too much pronation can contribute to a number of foot, leg and postural concerns in later life.
If both parents have flat feet, then it is less likely that their child will grow out of it, and it is advisable to have this assessed by your podiatrist.
In-toe and Out-toe walking
In-toeing or Pigeon-toed are terms for when the feet point inwards instead of straight ahead. A common problem with in-toeing is that the child is more likely to trip or look awkward walking. Most children tend to grow out of this naturally by the age of around 2. If in-toeing persists after this period then special shoes, orthotics and stretches may be recommended by your podiatrist.
At around 2, most children will walk with their feet straight ahead or pointing slightly outwards. Out-toeing occurs when the feet splay out to the side excessively. In most cases this is a normal part of development, but in some cases it may be related to other problems such as poor hip and knee alignment.
In most cases in-toeing and out-toeing is normal, but in persistent cases treatment may be needed.
Toe walking
Toe walking is usually a normal part of a child’s development, particularly when they are first starting to walk. Most cases are just habit and the child will tend to grow out of it. There are other causes of toe walking that should be assessed. Toe walking can be caused by neurological problems such as cerebral palsy, muscular dystrophy and spinal cord problems. Other causes include leg length differences or tight achilles tendons. In mild cases stretching, and physical therapy may be indicated. In severe cases then consideration of surgery, casting or neurological assessment may be advisable.
