Foot Pain

Plantar Fascilitis / Heal Spear

These are the two most common cause of pain of the heel and arch of the foot. Also see Orthotics.

Plantar Fascilitis is the painful inflammation of the plantar fascia. The plantar fascia is a thick ligamentous / fibrous band on the bottom of the foot that is attaches to the heel and insert into the ball of the foot. The pain usually occurs at the heel on standing or walking, however can occur anywhere on the plantar fascia.

Heel Spur: Long standing inflammation of plantar fascia causes the deposition of calcium at the point where it inserts into the heel. This results in the appearance of a sharp thorn like heel spur on x-ray. Symptoms include a dull ache which is felt most of the time with episodes of a sharp pain in the centre of the heel or on the inside margin of the heel that can radiate into the arch.

Causes

• Excessive flattening of the arch on weight bearing.
• Biomechanical problems (walking abnormalities) is a major cause of plantar fascilitis.
• Tight plantar fascia (this is often caused by tight calf muscles) A sudden increase in walking or a sporting activity can also be a contributing factor.
• Excessive load on the foot from obesity is a major cause of plantar fascilitis.
• A sudden increase in weight, such as pregnancy can also lead to plantar fascilitis.
• Different types of arthritis can also lead to this condition such as osteoarthritis and rheumatoid arthritis.

Achilles Tendonitis

Achilles tendonitis is a painful condition caused by the inflammation of the Achilles Tendon. The Achilles tendon attaches the heel of the foot to the calf muscles allowing the movement of plantar flexion or pointing of the foot.
Symptoms include pain which may be present at the Achilles tendon, normally 4 inches above the heel, during activity and may also increase once activity has ceased. Tenderness can usually be felt along the course of the tendon and in some cases there may be the presence of a localized nodule (small sack of fluid) on the tendon. Another sign to look for is that the soles of shoes tend to wear out quickly around the heel region.

Causes

• Excess Pronation (rolling over of the foot) causes extra strain on the tendon. Inflammation of the tendon is a common result along with tightening of the calf muscles.
• Mechanical abnormalities of the feet such as over pronation.
• Inappropriate shoes. If the soles of the shoes are too stiff, this causes the forefoot to have limited movement. This can lead to increased tension to the Achilles tendon.
• The biggest contributing factor is ignoring the pain in the tendon.
• Sudden increases in training can lead to Achilles tendonitis.
• Excessive hill running or speed work.
• Tight calf muscles.

Shin Splints

Shin Splints usually applies to pain in the front of the leg, occurring between the ankle and the knee normally 3-16cm above the foot. It is effectively an inflammatory reaction involving the deep tissues of the lower leg and may involve tendons & muscles. The pain is usually initiated by walking, running, or jumping. The pain cam occur anteriorly or medially (the inner side).

Anterior Shin Splints: The Tibialis Anterior Muscle runs at the front of the shin to the foot allowing your foot to flex upwards towards the shin. If the foot and leg are biomechanically correct this muscle functions efficiently and without pain. When inflamed it causes pain. Inflammation can occur when the foot is pronated (the foot rolls inwards) causing tiny tears in the muscle.

Posterior Shin Splints: The Soleus and the Tibialis Posterior muscle attached around the back of the knee running down the back and inner side of the leg attaching to the foot. On pronation of the foot (the foot rolls outward), these muscles are forced to become twisted causing tiny tears or "pulled" producing pain.

Causes

• Mechanical problems with the feet such as "over pronation" or flat feet. This causes your ankles to roll in towards each other and disturbs your normal walking pattern. If a foot over pronates the structures of the leg are stretched and put under stress, which increases the possibility of injury.
• Over training.
• Tight calve muscles.
• Training on hard surfaces such as concrete.
• Improper shoes, inadequate shock absorption.
• Excessive rotation of the hip.

"Runners Knee" / Patello–Femoral Syndrome

Patellofemoral Pain Syndrome is a common cause of pain around the knee cap. When the knee bends or straightens, the knee cap (patella) glides in a special groove on the femur / thigh bone called the 'Patellofemoral groove', controlled by the quadriceps (thigh) muscles. The patella can stray from this path (usually towards the outside of the knee) due to tight quadriceps or biomechanical problems from over pronation of the foot (flat foot). This produces abnormal stresses on the under-surface of the patella that can cause knee cap pain.

Signs & Symptoms

• Pain at the front of the knee while ascending or, more often, descending stairs.
• Pain at the front of the knee whilst running.
• Knee pain during prolonged sitting.

Iliotibial Band Syndrome

The Iliotibial Band is a dense fibrous band of tissue that originates from the pelvis and extends down the lateral (outside) portion of the thigh to below the knee. Iliotibial band syndrome (ITBS) is the result of inflammation and irritation of the distal (lower) portion of the Iliotibial tendon as it rubs against the outside of the knee, or less commonly, the greater tuberosity at the hip region.

Causes

• Repetitive flexion and extension of the knee.
• Pronation (flat foot) of the foot.
• Lack of flexibility of the ITB.
• Excessive internal tibial rotation.
• Genu varum (bowed-legged).

Morton's Neuroma

Morton's Neuroma, is a benign soft tissue mass that forms on the nerve which runs between the metatarsals (normally between the 3rd and 4th toes), in the ball of the foot.

When two metatarsal bones rub together, they pinch the nerve that runs between them. This repeated pinching, or repeated injury to the nerve, will cause the nerve to swell, and eventually a benign mass occurs at the site of the repeated injury.

Signs & Symptoms

Localized sharp or dull pain in the interspace between the third and fourth toes worsened by wearing shoes and by walking.

Causes

• Flat feet / Pes Planus.
• Wearing high heels.
• Wearing pointed toed shoes.

Bunion / Hallux Valgus

A bunion is a complex deformity that results in a bump that develops on the inner side of the foot, in the area where the big toe and the bone it connects to (called the first metatarsal) meet or the turning inward of the big toe, so that it presses against the second toe.

Bunions are a progressive deformity, and if left untreated the bump will become larger, and the big toe will eventually lie over or under the second toe.

Causes

• Wearing high heels or pointed toe shoes.
• Injury to the big toe / first metatarso-phalangeal joint.
• Arthritis of the first metatarso-phalangeal joint.
• Some neurological diseases cause contractures of the joints of the feet and toes, causing bunions to form.

Over Pronation / Flat Foot / Dropped Arch.

The normal foot arch acts as a shock absorber for our body.

With every step we place up to four times our body weight on the foot, depending on whether we are walking, running, or jumping.

Without this shock absortion the force of each step will eventually cause damage to the bones, liganments and muscles of the foot, leg, and lower back.

If left untreated, the foots bones could collapse thus unable to act as a shock absorber resulting in pain in the foot, and eventually the knee, hip, and lower back.

Pronation is the inward roll of the foot during normal motion and occurs as the outer edge of the heal strikes the ground and the foot rolls inward and flattens out. A moderate amount of pronation is required for the foot to function properly. However, when excessive pronation does occur the foot arch flattens out and stretches the muscles, tendons and ligaments underneath the foot.

If left untreated, pronation may be the cause of heel spurs, plantar fasciitis, frequent ankle sprains, shin splints, weak and painful arches, and eventually knee, hip, lower back pain and even headaches.

Our Osteopaths can assess the biomechanics of the feet and body and prescribe bespoke orthotics for the individual, exercises and treatment to prevent these problems.