Footwear Solutions to Common Foot Problems
Footwear Solutions to Common Foot Problems
Sixty six percent of Americans surveyed by the American College of Foot and Ankle Surgeons say they have foot problems, yet only seven percent see a foot doctor. According to an American Orthopedic Foot and Ankle Society survey, which asked women about their feet and footwear, —80 percent of those polled said their feet hurt and 72 percent complained of one or more foot deformities. Women account for 90 percent of foot surgeries in the country, costing an estimated $3.5 billion annually.
Symptoms: The heel pain caused by plantar fasciitis occurs most often under the heel while standing or walking. It is very common and may begin suddenly for no apparent reason. Pain is often most noticeable first thing in the morning when stepping out of bed.
Causes: Plantar fasciitis occurs when the plantar fascia, a thick fibrous tissue in the sole of the foot, becomes inflamed or torn. The pain is usually felt on the bottom of the foot between the heel bone and the arch. Occasionally, an abnormal bone protrusion (bone spur) may be involved. Onset may be caused by misalignment or overuse, particularly in middle-aged or overweight individuals.
Treatments: Controlling foot movement with a shoe or shoe/insole combination to provide stability, balance and proper arch support often provides fast relief. Some heel elevation provided by a shoe, orthotic or other method will help relieve pressure on the inflamed area. Shock absorbent outsoles are also important to recovery. Occasionally, steroid injections may be necessary to reduce inflammation. Taping and padding may be used to help relieve the strain on the plantar fascia. Physical therapy prescribed may include ultrasound, application of ice, and stretching. Special night splints may be used to stretch the fascia during sleeping. When non-surgical options fail, surgical options also exist to release the plantar fascia and/or excise any bone spurs that exist.
Other causes of heel pain
• Various types of arthritis
• Trauma to the heel
• Inflammation of the tendons around the heel
• Benign tumors of the nerves near the heel
• Abnormality in the shape of the heel bone
• Foreign body in the heel (e.g. splinter)
Make sure you see your doctor!
Interdigital (Morton’s) Neuroma
Symptoms: Exquisite pain between the third and fourth toes. The pain may radiate into the toes and will usually subside to some extent when shoes are removed. On examination, a physician may feel a clicking between the affected toes.
Causes: In the foot, a neuroma is a build-up of extra tissue around the nerves between the toes, trapping the nerves between the toe bones. While some people are predisposed to the development of neuromas, most are caused by tight shoes which squeeze foot bones together causing irritation and enlargement of the nerves. The nerves between the toes, when pinched during walking, respond by forming the build-up of extra tissue.
Treatments: Treatment usually involves properly-fitted footwear that allows adequate room for the forefoot. A pad on the sole of the foot to lift and spread the metatarsal bones is often helpful. Your doctor also may inject cortisone around the nerve. For some patients, surgery to remove the neuroma may be required.
Bunion and Bunionette
Symptoms: Bunions are a sometimes painful deformity of the side of the big-toe joint. When a big toe becomes misaligned, it may begin to point toward and crowd the other toes. The lining of the bones in the joint may become inflamed and tender. A bunionette is a similar condition on the little-toe joint.
Causes: Long-term repetitive stress from ill-fitting shoes can cause or accelerate the onset of the symptoms. The tendency to develop bunions and bunionettes is believed to be genetic. Occasionally, they may develop with no apparent cause.
Treatments: Properly fitted shoes are an important part of treatment for bunions and bunionettes. Pain often subsides with adoption of shoes that accommodate the new shape of the foot. Look for shoes with soft or stretchable uppers without seams in the affected areas. An orthosis may be necessary to support and balance the foot and thus to relieve pressure and pain. There are several types of surgical options that may both relieve pain and improve the appearance of the foot. However, bunions can reform if the original offending footwear is reverted to. Foot orthoses may be an important part of post-surgical recovery and maintenance.
Symptoms: Pain in the bottom of the ball of the foot, often when walking. The pain may radiate from the toes to the ankle and can often cause sensitivity to pressure applied on the top and bottom of the ball of the foot near the big toe. Pain may increase with weight-bearing activity.
Causes: foot-structure abnormalities, trauma, surgery, systemic disease, or changes to the natural padding on the bottom of the foot that occur with age. If metatarsal bones are longer or shorter than they should be, they may bear more or less than their share of the load. The increased pressure can cause pain or lead to a bone fracture.
Treatments: Special “met” pads can help equalize the weight across the forefoot by transferring forces away from the painful metatarsal head and moving them to the shaft of the bone. These pads can be added to the insole of a shoe or directly to a foot orthosis. Shoes with shock absorbent soles or rocker soles can also alleviate pain. Your doctor also has medical and surgical options that can help.
Claw Toe or Hammer Toe
Symptoms: A toe deformity, usually of the second toe, in which the toe is permanently contracted into a rounded position. Pain may accompany the deformity, particularly when shoes are not chosen to accommodate the new shape of the toes. Corns may develop as a result of rubbing.
Causes: Although the tendency for a hammer toe to form is inherited, tightly-fitted shoes aggravate the condition and accelerate the development. Additionally, a long second toe may contract to meet the length of the first or third toes.
Treatments: Accommodating the deformity with depth shoes, toe cushions and/or stretching may relieve symptoms and slow progression. Look for soft or stretchable uppers without seams in the affected areas. Surgery may be performed to straighten the toe.
Posterior Tibial Tendonitis
Symptoms: A severely collapsed arch and flat-feet that cause pain in the heel, arch, and ankle. The pain will be most severe when there is weight on the foot.
Causes: The posterior tibial (post-tib) tendon is located on the inside of the ankle and foot. Overuse or trauma can cause this tendon to rupture, stretch, or tear, and cease to support the arch as it should. At first, the symptoms may come and go, but eventually permanent damage can result.
Treatments: In the early stages of post-tib tendonitis, special foot orthoses or ankle-foot orthoses may be used to support the arch and take the load off the tendon. Modifications may be made to shoes to provide added medial stability and to accommodate the special orthoses. In some cases, however, surgical repair may be required. Even after surgery, special shoes, orthoses, and shoe modifications will be necessary to help support the foot and ankle complex.