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Arch pain and foot pronation can cause problems for people in every stage of life and can even affect an athlete’s performance on the court, field, or track. For many people who experience pain like this, they may not be aware of the 3 common triggers. Most of the causes are easily averted, but several can be hereditary. According to the Cleveland Clinic, three of the easily averted causes for arch pain include high heel shoes, tightly-fitting footwear, and lack of arch support . These ill-decided actions can all cause painful foot problems like bunions, hammertoes, and plantar fasciitis. The Mayo Clinic has found that 2 of the inherited foot problems that can cause foot pronation and foot arch pain include fallen arches or arches that are markedly high. Below we explain some foot procedures that treat these problems and how each of them can be resolved.
When Bunion Removal Procedures are Necessary
Bunion removal, or a bunionectomy, is the process whereby the bone growth that appears to the side of the ball of the foot is shaved down to achieve a more norma foot form and width. In the most serious cases where the big toe has turned under the other toes, the surgeon cuts a triangle-shaped portion out of the big toe’s bone to reset it to its proper angle. One screw is used to hold the bone’s new position. After about 6 months, the screw is taken out of the bone. Though this condition can be brought on by pointed shoes, sometimes people are born with the tendency to form bunions. Foot specialists warn that pointed-toe shoes that force the toes into a crowded position can lead to bunions.
Serious Foot Issues Can Occur Without Proper arch support
Some of the hereditary foot problems include either flat arches or excessively high arches. Both arch problems can affect anyone, including athletes. The result of a flat arch can be foot arch pain and foot pronation because this weakened part of the foot is not performing as it should. When this part of the foot malfunctions, foot over-pronation occurs which can cause a heel spur, a bony protuberance in the heel. Surgery is sometimes necessary to remove the bonespur and relieve the pain. The specialist will use a bone saw to cut away the bony protrusion to relieve the discomfort and ripped muscle tissue it had been causing. The best answer for treating both types of arch disorders so heel spurs can be prevented is by giving the foot with appropriate arch support through orthotics.
Without Proper Shoes, Painful Hammertoes Can Occur
Hammertoes can be brought on by pointy shoes or footwear that is snug. This condition can affect walkers and runners that wear tight shoes during training as well. Hammertoes are, unfortunately, difficult to treat without a corrective operation. First, a surgeon can try to tape the affected toe to try and coax it into a more normal shape. In order for this method to work, wider shoes must be worn form that point on. Hammertoes can occur again if the same type of shoes are worn again. If splinting the toe is unsuccessful, surgery is the lone alternative. The afflicted toe must have a portion of the bone taken out to lessen the curvature of the toe. The recovery period is vital, as patients who do not rest and elevate their feet as prescribed will fail to mend properly. The way to avoid this condition is to wear roomy shoes.
No matter what type of activity level, age, or heredity, foot conditions can occur in a wide range of persons. Though foot procedures can surgically alleviate these conditions, most of the time they are never an issue if people wear well fitting shoes and proper arch support .
Fred Salomon is a foot care specialist with professional and commercial ventures in the podiatry field, including foot care products and foot health treatment options. There are different causes for foot pain, which is difficult to avoid in this fast-paced world. All we can do is to prevent foot pain from happening by taking good care of our feet.
The diagnosis of heel pain is best done by looking at the location of the pain… “where does it hurt?”
Heel pain can occur in two major locations: the back of the heel and the bottom of the heel.
Pain at the back of the heel has three major causes.
Achilles tendonitis is the most common. It is usually the result of injury or overuse. An example is the weekend warrior who decides to go out and run 4 or 5 miles going up hills… or a person who goes on a long walk in flat shoes, shoes with little or no heel. In both cases, stress is placed on the Achilles tendon- the large thick cord located in the back of the heel.
This tendon- the largest in the body- connects the gastrocnemius (calf) muscle to the back of the heel.
The likelihood of Achilles tendonitis developing is increased if a person has flat feet. Older patients taking corticosteroid medications and people treated wtih quinolone antibiotics like ciprofloxacin (Cipro) also are at increased risk of Achilles tendonitis and even Achilles tendon rupture.
Haglunds syndrome presents with a bony bump located at the back of the heel. A bursa (small sack of fluid) located near the bump may contribute to the swelling. The Achilles tendon insertion near the bony swelling may become inflamed. Because of the location, this syndrome is often referred to as “pump bumps” and the cause often attributed to womens’ shoes.
Inflammation of the Achilles tendon at its insertion into the heel can be seen with certain types of arthritis, specifically the spondyloarthropathy group which consists of Reiter’s disease, psoriatic arthritis, and ankylosing spondylitis. Other signs of disease such as low back pain and stiffness, rash, and joint swelling may provide clues to diagnosis.
Pain in the bottom of the heel is usually due to plantar fasciitis.
Pain in the plantar fascia presents with sharp stabbing pain in the bottom of the heel. Plantar fasciitis is a common problem that is due to repetitive trauma to the soft tissue in the heel.
Typically a patient will feel fine so long as they are lying down or sitting. But if they get up to walk, the pain feels like an ice pick is being jammed into the bottom of the heel.
This pain gets better over several minutes but occurs again after inactivity followed by weight-bearing.
Causes of plantar fasciitis include:
? An abrupt increase in activity
? Worn footwear,
? Footwear with no arch support (eg., flip-flops)
? Obesity
? Recent rapid weight gain such as with pregnancy
? Overuse as in excessive running and over-training
? Systemic inflammatory arthritis (particularly ankylosing spondylitis and other spondyloarthropathies such as Reiter’s disease and psoriatic arthritis).
Treatment involves first establishing the diagnosis. Most of the time, the diagnosis can be suspected by the history and physical examination.
Imaging tests such as diagnostic ultrasound and magnetic resonance imaging can confirm the diagnosis, if necessary. X-rays may reveal the presence of a heel spur. A heel spur, by itself, is not the cause of pain in the bottom of the heel and heel pain should not be attributed to “a heel spur”.
Once the diagnosis has been made, treatment options include:
? Identifying likely causative factors such as excessive weight, inappropriate footwear, and errors in training.
? Non-steroidal anti-inflammatory drugs (NSAIDs) sometimes provide symptomatic relief.
? Therapeutic taping gives short-term symptom relief.
? Exercises to stretch the heel cord and plantar fascia.
? Orthotic devices can help in the short-term reduction of pain. These can be off-the-shelf or custom made. For people with Achilles tendonitis, having the patient wear a lift in the shoe to elevate the heel will help reduce symptoms.
? Glucocorticoid (steroid) injection may also work for plantar fasciitis and should be used if the patient has not responded to conservative measures. The use of diagnostic ultrasound to guide the injection is recommended.
Caution should be observed with the Achilles tendon as far as steroid injection. The tendon can be weakened if steroids are directly injected. This then can lead to Achilles rupture.
The bursitis that occasionally accompanies Achilles tendonitis (retrocalcaneal bursitis) will respond to steroid injection.
If a patient is taking a quinolone antibiotic (such as ciprofloxacin), it should be discontinued and the patient should be monitored for tendonitis and tendon rupture.
Night time braces are sometimes used for plantar fasciitis.
Often the best treatment for heel pain, whether it is located in the back or on the bottom, is rest.
A surgical solution should be considered for those patients with intractable pain which remains despite conservative treatment.
Understanding Heel and/or Arch Pain (Plantar Fasciitis)
Heel and arch pain are more common than you may think. No matter the cause, this pain, known as plantar fasciitis, can interfere with daily activities and quality of life. Pain is typically the strongest first thing in the morning or after a extended period of rest for the feet.
Fortunately, with proper diagnosis, there are many options for treating and managing heel pain and arch pain.
Symptoms of Heel and/or Arch Pain
Common symptoms of plantar fasciitis include :
Pain on the bottom of the heel or in the arch
Pain with first step out of bed in the morning
Pain with first steps after sitting for a long time
Pain with or after standing or walking for long periods
Pain in increasing in intensity or frequency
Causes of Heel and/or Arch Pain
Plantar fasciitis can be caused by :
Increase in activity
Foot structure – high arched foot or a flat foot
Unsupportive footwear
Walking or standing on hard surfaces
Weight gain
Treament for Heel and/or Arch Pain
Treatment options for plantar fasciitis can include :
Stretching
Icing
Avoid going barefoot
Shoe modifications
Antiinflammatory medications
Night splint
Over-the-counter
custom molded orthotics
Padding and strapping
Walking cast
Steroid injection
Physical therapy Surgery
Weight loss
The best treatment for your heel or arch pain depends upon the cause as well as the severity of your symptoms. To determine the best course of action, consult with a podiatrist.
Dr. Szpiro is on staff at several area hospitals including Mt. Auburn, a Harvard teaching hospital, as well as hosptials affiliated with the Cambridge Health Alliance. Her practice involves treatment of a wide range of podiatric disorders from diabetic foot care to plantar fasciits.
Dr. Jordana Szpiro is a Boston podiatrist providing comprehensive foot care and surgery to all ages. Dr Szpiro specializes in pediatric podiatry and custom molded orthotics. For more information or to contact Dr. Szpiro, visit Boston Common Podiatry.
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