Overview



When standing, most people have a gap under the arch of their foot. Flat feet, or pes planus is the term used to describe collapsed arches, meaning that the entire sole of the foot rests partially or completely on the ground. A simple way to check to see if you have flat feet is to wet your feet and step onto a dry, flat surface. Step away from your footprint; if you see a complete footprint, you more than likely have flat feet. If you only see toes, the pads of your feet, and your heels, you probably do not have flat feet. People who have flat feet usually roll their feet over to the inner side when they walk. The feet may even appear to point outward because of this movement. In most cases, the condition cannot be prevented.

Causes

Fallen arches may be caused by a number of causes, including increased elastin during pregnancy, arthritis, injury, excessive stress on the foot, fused bones in the foot, or an extra bone. They may cause not only foot pain, but also pain in the legs, knees, and back and a loss of mobility. The condition is most often treated with orthotics, structures placed in the shoes to support the feet, but this may not be enough for severe cases. Exercises to strengthen and rebuild the arches can also be helpful. Surgery is sometimes the best method of treatment, as it can completely rebuild the arches and has lasting results, but it is quite expensive and considered a last resort.

Symptoms

Fallen arches symptoms may include the following. Being unable to slip fingers underneath arches. Inwards rolling of foot and ankle when running. Knee problems due to lack of support from feet.

Diagnosis

Runners are often advised to get a gait analysis to determine what type of foot they have and so what kind of running shoe they require. This shouldn?t stop at runners. Anyone that plays sports could benefit from this assessment. Sports shoes such as football boots, astro trainers and squash trainers often have very poor arch support and so for the 60-80% of us who do overpronate or have flat feet they are left unsupported. A change of footwear or the insertion of arch support insoles or orthotics can make a massive difference to your risk of injury, to general aches and pains and even to your performance.

best arch support insoles for flat feet

Non Surgical Treatment

Ligaments hold up arches. Deformed ligaments will not return to their original shape, just as an overstretched rubber band remains elongated. Arch supports help restore more normal function. Not all orthotics are made alike. Sole Supports custom designed orthotics are unique in the way they are cast. Sole Supports compensate for the differences between each foot. They take into account your body weight and the degree of flexibility in your feet. Taking care of fallen arches can be key in dealing with unresolved or recurrent back pain.

Surgical Treatment



A combination of surgical procedures can be used to reconstruct the flatfoot. Generally, these procedures can be separated into those that correct deformities of the bones and those that repair ligaments and tendons. Your orthopaedic surgeon will choose the proper combination of procedures for your foot. Surgery of the foot can be performed under regional anesthesia, which is numbing the foot and ankle with a nerve or spinal block, or general anesthesia, which may require a breathing tube. A nerve block is often placed behind the knee to reduce pain after surgery.

Prevention

oll away pain. If you're feeling pain in the arch area, you can get some relief by massaging the bottom of your foot. A regular massage while you're watching TV can do wonders" Stretch out. Doing the same type of stretching exercises that runners do in their warm-up can help reduce arch pain caused by a tight heel cord. One of the best exercises is to stand about three feet from a wall and place your hands on the wall. Leaning toward the wall, bring one foot forward and bend the knee so that the calf muscles of the other leg stretch. Then switch legs. Stretching is particularly important for women who spend all week in heels and then wear exercise shoes or sneakers on weekends. Get measured each time you buy new shoes. Don't assume that since you always wore a particular size, you always will. Too many people try to squeeze into their 'regular' shoe size and wind up with serious foot problems or sores on their feet. When your arch is falling, your feet may get longer or wider and you may or may not feel pain, so getting your foot measured each time you buy shoes is a good indicator of your arch's degeneration. Examine your shoes. If the heel is worn down, replace it. But if the back portion of the shoe is distorted or bent to one side, get yourself into a new pair of supportive shoes like those made specifically for walking. That's because flat feet can affect your walking stride, and failing to replace worn shoes may lead to knee or hip pain.

After Care

Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.

Overview

Leg length discrepancy is a condition where the length of one leg is different than the other (shorter or longer) because of either or both a functional (muscle/posture) or structural (bone/cartilage) abnormality. In the specific a functional leg length occurs when your legs are the same, but another condition such as pelvic tilt or piriformis shortening creates the appearance of one leg being longer or shorter than the other. A structural leg length inequality it means that there is a true difference. Osteopaths, chiropractors and physiotherapist should be able to determine the degree of leg length inequality using visual inspection and manual tests.

Causes

Common causes include bone infection, bone diseases, previous injuries, or broken bones. Other causes may include birth defects, arthritis where there is a loss of articular surface, or neurological conditions.

Symptoms

The symptoms of limb deformity can range from a mild difference in the appearance of a leg or arm to major loss of function of the use of an extremity. For instance, you may notice that your child has a significant limp. If there is deformity in the extremity, the patient may develop arthritis as he or she gets older, especially if the lower extremities are involved. Patients often present due to the appearance of the extremity (it looks different from the other side).

Diagnosis

The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.

Non Surgical Treatment

Heel lifts Raise the heel on the shorter leg. It is applied either to the heel of the custom orthotic or to the inside of the shoe under the insole at the heel. Generally if the discrepancy is greater than 3/8 of an inch, the modification is applied externally on the footwear. Custom made orthotics help to provide proper support and alignment to the foot, controlling conditions such as over pronation. Orthopedic Footwear, properly fitted, to which a lift might be applied inside or out.



shoe lift inserts

Surgical Treatment

Shortening techniques can be used after skeletal maturity to achieve leg length equality. Shortening can be done in the proximal femur using a blade plate or hip screw, in the mid-diaphysis of the femur using a closed intramedullary (IM) technique, or in the tibia. Shortening is an accurate technique and involves a much shorter convalescence than lengthening techniques. Quadriceps weakness may occur with femoral shortenings, especially if a mid-diaphyseal shortening of greater than 10% is done. If the femoral shortening is done proximally, no significant weakness should result. Tibial shortening can be done, but there may be a residual bulkiness to the leg, and risks of nonunion and compartment syndrome are higher. If a tibial shortening is done, shortening over an IM nail and prophylactic compartment release are recommended. We limit the use of shortenings to 4 to 5 cm leg length inequality in patients who are skeletally mature.

Overview



Heel pain is an extremely common complaint, and there are several common causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have heel pain, some causes include Plantar Fasciitis, Heel Spur,Tarsal Tunnel Syndrome, Stress Fractures, baxter's nerve compression.

Causes

While heel pain has many causes, it is usually the result of faulty biomechanics (abnormalities in the way we walk). This can place too much stress on the heel bone and the soft tissues attached to it. The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces; wearing poorly constructed footwear; or being significantly overweight. Systemic diseases such as arthritis and diabetes can also contribute to heel pain. A common cause of heel pain is the heel spur, a bony growth under the heel bone. There are no visible features on the heel, but a deep painful spot can be found in or around the middle of the sole of the heel (see diagram). Approximately 10 per cent of the population may have heel spurs without any pain. Heel spurs result from strain on the muscles of the foot. This may result from biomechanical imbalance, a condition occurring in many people. Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.Excessive rolling in of the feet when walking. An inflamed bursa (bursitis), a small, irritated sack of fluid at the back of the heel. A neuroma (a nerve growth). Other soft-tissue growths. Heel bumps or ?pump bumps?, a bone enlargement at the back of the heel bone. Bruises or stress fractures to the heel bone.

Symptoms

Pain in the heel can be caused by many things. The commonest cause is plantar fascitis. Other causes include, being overweight, constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear, thinning or weakness of the fat pads of the heel, injury to the bones or padding of the heel, arthritis in the ankle or heel (subtalar) joint, irritation of the nerves on the inner or outer sides of the heel, fracture of the heel bone (calcaneum).

Diagnosis

A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis. Sometimes further diagnostic tests are needed, such as blood tests and imaging scans.

Non Surgical Treatment

Most heel pain is caused by a combination of poor biomechanics, or muscle weakness or tightness. The good news is that heel pain can be effectively managed once the cause is identified. Most heel pain can be successfully treated via pain and pressure relief techniques, biomechanical correction eg orthotics, taping, foot posture exercises, muscle stretches and massage, lower limb muscle strengthening, proprioceptive and balance exercises to stimulate your foot intrinsic muscles. If you feel that your footwear or sports training schedule are potentially causing your heel pain, then we recommend that you seek the advice of a sports physiotherapist, podiatrist or trained footwear specialist (not just a shop assistant) to see if your shoe is a match for your foot; or discuss your training regime to see if you are doing too much. Heel pain and injury are extremely common. With accurate assessment and early treatment most heel pain injuries respond extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living. Please ask you physiotherapist for their professional treatment advice.

Surgical Treatment

When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.

clearly adjustable heel lifts

Prevention



Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.

Overview

Morton's neuroma is a swollen, inflamed nerve in the foot.Morton's neuroma causes a "burning" sharp pain on the bottom of the foot. Treatments for Morton's neuroma include resting the foot, better-fitting shoes, anti-inflammation medications, ice packs, and operation. A neuroma is growth (benign tumor) that arises in nerve cells. A Morton's neuroma is a swollen, inflamed nerve located between the bones at the ball of the foot. The most common location of a Morton's neuroma is in either the second or the third spacing from the base of the big toe.

Causes

Wearing shoes that are too tight can make the pain of Morton's neuroma worse. This is because the toe bones are more likely to press on the affected nerve if your shoes are too tight. High-heeled shoes, particularly those over 5cm (2 inches), or shoes with a pointed or tight toe area, can also compress your toes and make the pain worse. This is why women tend to be affected by Morton's neuroma more than men.

Foot conditions.

Symptoms

Patients will feel pain that worsens with walking, particularly when walking in shoes with thin soles or high heels. Also, anything that squeezes the metatarsal heads together may aggravate symptoms, such as narrow shoes. A patient may feel the need to remove the shoe and rub the foot to soothe the pain.

Diagnosis

You should visit a doctor or podiatrist (foot doctor) if you have pain or tingling that does not stop. Your health care provider will examine your feet and will apply pressure on the spaces between the bones of the toes to determine the location of the foot pain. The doctor may order X-rays to rule out other conditions associated with foot pain, such as a stress fracture or arthritis. X-rays alone will not show whether or not a neuroma is present, so an ultrasound scan or magnetic resonance imaging (MRI) test may be done to confirm the diagnosis. A diagnostic procedure called an electromyography is sometimes used to rule out nerve conditions that may cause symptoms like those of associated with Morton?s neuroma.

Non Surgical Treatment

Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert, molded to fit the exact contours of your foot.

Surgical Treatment

For those who are suffering severely with Morton?s Neuroma, surgery is a possibility. An orthopedic surgeon can remove the growth and repair your foot relatively easily. However, Morton?s Neuroma surgery is associated with a lengthy recovery time and there is a possibility that the neuroma may return.

Prevention

Although the exact causes of neuromas are not completely known, the following preventive steps may help. Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed. Wear shoes with adequate padding in the ball of the foot. Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).

There are actually not one but two different kinds of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is structurally shorter compared to the other. As a result of developmental stages of aging, the human brain picks up on the stride pattern and recognizes some difference. Your body usually adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch is not very irregular, demand Shoe Lifts to compensate and mostly won't have a serious effect over a lifetime.



Leg length inequality goes typically undiagnosed on a daily basis, however this problem is very easily corrected, and can eradicate numerous instances of back discomfort.

Therapy for leg length inequality commonly involves Shoe Lifts. These are typically low-priced, often costing under twenty dollars, compared to a custom orthotic of $200 plus. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Back ache is easily the most common health problem afflicting men and women today. Over 80 million men and women experience back pain at some point in their life. It's a problem that costs businesses millions annually as a result of lost time and output. New and more effective treatment solutions are continually sought after in the hope of decreasing the economic influence this condition causes.



People from all corners of the world suffer from foot ache as a result of leg length discrepancy. In most of these situations Shoe Lifts can be of very helpful. The lifts are capable of reducing any discomfort in the feet. Shoe Lifts are recommended by countless experienced orthopaedic doctors.

So as to support the body in a balanced manner, your feet have a very important function to play. Despite that, it can be the most overlooked region of the human body. Some people have flat-feet meaning there is unequal force exerted on the feet. This causes other body parts like knees, ankles and backs to be affected too. Shoe Lifts make sure that correct posture and balance are restored.

There are not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter compared to the other. As a result of developmental periods of aging, the brain picks up on the walking pattern and recognizes some difference. Your body usually adapts by tilting one shoulder over to the "short" side. A difference of under a quarter inch isn't really abnormal, doesn't need Shoe Lifts to compensate and usually doesn't have a profound effect over a lifetime.



Leg length inequality goes largely undiagnosed on a daily basis, however this problem is easily fixed, and can reduce many instances of low back pain.

Treatment for leg length inequality commonly consists of Shoe Lifts. These are generally low cost, ordinarily costing under twenty dollars, in comparison to a custom orthotic of $200 and up. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Lower back pain is the most widespread ailment affecting people today. Around 80 million people have problems with back pain at some point in their life. It's a problem that costs employers millions every year on account of time lost and production. New and more effective treatment solutions are continually sought after in the hope of reducing the economic influence this issue causes.



Men and women from all corners of the earth suffer from foot ache due to leg length discrepancy. In a lot of these cases Shoe Lifts are usually of immense help. The lifts are capable of decreasing any pain and discomfort in the feet. Shoe Lifts are recommended by countless expert orthopaedic orthopedists.

So that you can support the body in a well-balanced manner, the feet have a very important task to play. Despite that, it is often the most neglected region of the body. Some people have flat-feet which means there is unequal force placed on the feet. This causes other body parts such as knees, ankles and backs to be affected too. Shoe Lifts ensure that correct posture and balance are restored.