Bursitis Of The Foot Treatment
Overview
Bursa is a fluid filled sac of tissue that is often found around the bony prominences over which tendons and soft tissues rub. This therefore helps the tendons to glide with least amount of friction. Retrocalcaneal bursa is found behind the heel under the Achilles tendon. Retrotendoneal bursa is found on the back of the attachment of the tendon where the shoe rubs on the skin. This can cause swelling, pain and difficulty in footwear. Sometimes there is a bony prominence on the heel bone that predisposes to this condition (Haglund?s deformity). Treatment of this can be modification of footwear. However surgery is often required which involves excision of the bursa and also the bony prominence on the heel bone.
Causes
A bursa is a fluid-filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel, where the large Achilles tendon connects the calf muscles to the heel bone (calcaneus). Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for achilles tendonitis. Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.
Symptoms
Pain at the back of the heel at the attachment site of the Achilles tendon when running. Pain on palpation of the back of the heel or bottom of heel. Pain when standing on tiptoes. Swelling and redness at the back and bottom of the heel.
Diagnosis
The doctor will discuss your symptoms and visually assess the bones and soft tissue in your foot. If a soft tissue injury is suspected, an MRI will likely be done to view where and how much the damage is in your ankle. An x-ray may be recommended to rule out a bone spur or other foreign body as the cause of your ankle pain. As the subcutaneous bursa is close to the surface of the skin, it is more susceptible to septic, or infectious, bursitis caused by a cut or scrape at the back of the heel. Septic bursitis required antibiotics to get rid of the infection. Your doctor will be able to determine whether there is an infection or not by drawing a small sample of the bursa fluid with a needle.
Non Surgical Treatment
The following exercises are commonly prescribed to patients with retrocalcaneal bursitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2, 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free.
Surgical Treatment
Surgery is rarely done strictly for treatment of a bursitis. If any underlying cause is the reason, this may be addressed surgically. During surgery for other conditions, a bursa may be seen and removed surgically.
Bursa is a fluid filled sac of tissue that is often found around the bony prominences over which tendons and soft tissues rub. This therefore helps the tendons to glide with least amount of friction. Retrocalcaneal bursa is found behind the heel under the Achilles tendon. Retrotendoneal bursa is found on the back of the attachment of the tendon where the shoe rubs on the skin. This can cause swelling, pain and difficulty in footwear. Sometimes there is a bony prominence on the heel bone that predisposes to this condition (Haglund?s deformity). Treatment of this can be modification of footwear. However surgery is often required which involves excision of the bursa and also the bony prominence on the heel bone.
Causes
A bursa is a fluid-filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel, where the large Achilles tendon connects the calf muscles to the heel bone (calcaneus). Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for achilles tendonitis. Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.
Symptoms
Pain at the back of the heel at the attachment site of the Achilles tendon when running. Pain on palpation of the back of the heel or bottom of heel. Pain when standing on tiptoes. Swelling and redness at the back and bottom of the heel.
Diagnosis
The doctor will discuss your symptoms and visually assess the bones and soft tissue in your foot. If a soft tissue injury is suspected, an MRI will likely be done to view where and how much the damage is in your ankle. An x-ray may be recommended to rule out a bone spur or other foreign body as the cause of your ankle pain. As the subcutaneous bursa is close to the surface of the skin, it is more susceptible to septic, or infectious, bursitis caused by a cut or scrape at the back of the heel. Septic bursitis required antibiotics to get rid of the infection. Your doctor will be able to determine whether there is an infection or not by drawing a small sample of the bursa fluid with a needle.
Non Surgical Treatment
The following exercises are commonly prescribed to patients with retrocalcaneal bursitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2, 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times provided there is no increase in symptoms. Move your foot and ankle in a circle as large as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10, 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free.
Surgical Treatment
Surgery is rarely done strictly for treatment of a bursitis. If any underlying cause is the reason, this may be addressed surgically. During surgery for other conditions, a bursa may be seen and removed surgically.
Hammer Toe Deformity
Overview
The name hammertoes comes from the way the tip of the toe hits or hammers on the floor with each step. The primary deformity seen in a hammer toe is found at the PIPJ (proximal interphalangeal hammertoes joint) which is the first or more proximal of the two joints of the toe. A mallet toe, on the other hand, is a similar deformity but is found in the DIPJ (distal interphalangeal joint). And lastly, claw toes are a deformity where the entire toe grabs and involves the MPJ (metatarsal phalangeal joint) PIPJ and DIPJ. Collectively, these deformities are referred to as hammer toes. Hammer toes can affect one or all of the toes simultaneously.
Causes
While there are a number of causes, there aren't many specific risk factors for hammertoes, women tend to get these problems more than men, but they occur without rhyme or reason. Diabetics, however, are more likely to get a hammertoe if they have underlying nerve damage in the toes and feet.
Symptoms
Patients with hammer toe(s) may develop pain on the top of the toe(s), tip of the toe, and/or on the ball of the foot. Excessive pressure from shoes may result in the formation of a hardened portion of skin (corn or callus) on the knuckle and/or ball of the foot. Some people may not recognize that they have a hammer toe, rather they identity the excess skin build-up of a corn.The toe(s) may become irritated, red, warm, and/or swollen. The pain may be dull and mild or severe and sharp. Pain is often made worse by shoes, especially shoes that crowd the toes. While some hammer toes may result in significant pain, others may not be painful at all. Painful toes can prevent you from wearing stylish shoes.
Diagnosis
A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.
Non Surgical Treatment
Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area. Wear a shoe with a deep toe box. If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid heels more than two inches tall. A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician?s office will be necessary to repair the toe to allow for normal foot function. Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly. See your podiatric physician if pain persists.
Surgical Treatment
Surgery to correct for a hammertoe may be performed as an outpatient procedure at a hospital, surgery center, or in the office of your podiatrist. There are multiple procedures that can be used depending on your individual foot structure and whether the deformity is flexible or rigid. There may be a surgical cut in the bone to get rid of an exostosis, or a joint may be completely removed to allow the toe to lay straight.
What Can Cause Bunions?
Overview
A bunion is a bony bump on the joint at the base of your big toe. The bony growth on the joint sometimes causes your big toe to Bunion Surgery at Nuffield Health Hospitalsturn in towards your second toe. Symptoms include pain, swelling of your big toe and, as the bunion sticks out, it can often rub on the inside of your shoe. The cause is not always known, there may be a deformity of the joint, called hallux valgus (hallux means big toe, valgus means bent outwards). Or it can be as simple as ill fitting footwear not allowing enough width to fit the toes in their natural position. Sometimes bunions are associated with arthritis in the joint at the base of your big toe. Left untreated bunions can continue to grow and become more painful.
Causes
Bunions tend to run in families, but that does not mean that if you have a bunion, your children will inevitably have one too. The connection may be that bunions are a bit commoner in people with unusually flexible joints, and this can be hereditary. They are also commoner in women than in men. Bunions do occur in cultures in which shoes are not worn, but much less commonly. Shoes which squeeze the big toe or do not fit properly, or have an excessively high heel, may worsen the deformity, particularly in people who are at higher risk anyway.
Symptoms
A bunion, also called a hallux valgus, is a bony prominence on the inside of the big toe, caused by a misalignment of the joint. The overlying skin maybe swollen, red and tender. Bunions are often painful and can limit what shoes you can wear.
Diagnosis
Your family doctor or chiropodist /podiatrist can identify a bunion simply by examining your foot. During the exam, your big toe will be moved up and down to determine if your range of motion is limited. You will be examined for signs of redness or swelling and be questioned about your history of pain. A foot x-ray can show an abnormal angle between the big toe and the foot. In some cases, arthritis may also be seen. A X-ray of your foot may help identify the cause of the bunion and rate its severity.
Non Surgical Treatment
Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include the use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems. Removal of corns and calluses on the foot. Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth. Orthotic devices, both over-the-counter and custom made-to help stabilize the joint and place the foot in the correct position for walking and standing. Exercises to maintain joint mobility and prevent stiffness or arthritis. Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable. 
Surgical Treatment
The surgical treatment will vary depending on x-ray analysis and severity of the deformity. Most bunion surgeries focus on realigning the bony deformities of the bunion/big toe joint. At Accent on Feet we practice Ambulatory foot surgery for bunion correction. This method allows for faster healing, lower risk and preferred cosmetic result over traditional hospital surgery. All surgical procedures are performed in the office using local anesthesia (freezing). All patients walk immediately.
Prevention
The best way to reduce your chances of developing bunions is to wear shoes that fit properly. Shoes that are too tight or have high heels can force your toes together. Bunions are rare in populations that don?t wear shoes. Make sure your shoes are the correct size and that there's enough room to move your toes freely. It's best to avoid wearing shoes with high heels or pointed toes.
What Does Over-Pronation Of The Foot Mean
Overview
Feet are supposed to roll inward as a part of every step you take. This helps them to mold to the various terrain that they step on (sand, rocks, various obstacles) without injury. This is called pronation. But, when your feet roll inward excessively, problems often arise. Excessive inward rolling of the feet and ankles is called over-pronation. Sometimes, people who over-pronate are told they have ?flat feet?. The term ?flat feet? can be misleading. When standing, body weight causes the arch of most feet to flatten out somewhat. This does not mean they become flat like pancakes (though some feet do). Instead, the arch shape gets longer and flatter and the arch height gets lower.
Causes
Unless there is a severe, acute injury, overpronation develops as a gradual biomechanical distortion. Several factors contribute to developing overpronation, including tibialis posterior weakness, ligament weakness, excess weight, pes planus (flat foot), genu valgum (knock knees), subtalar eversion, or other biomechanical distortions in the foot or ankle. Tibialis posterior weakness is one of the primary factors leading to overpronation. Pronation primarily is controlled by the architecture of the foot and eccentric activation of the tibialis posterior. If the tibialis posterior is weak, the muscle cannot adequately slow the natural pronation cycle.
Symptoms
People with overpronation may suffer from pain in the knees, hips, and low back. Overpronation itself does not necessarily cause any other symptoms but is a contributing factor of many foot conditions such as Plantar Facsiitis, Heel Spur Syndrome, Posterior Tibialis Tendon Rupture or Tendonitis, Hallux Valgus, Bunion Deformities, Metatarsalgia, Hallux Limitus or Hallux Rigidus, Hammer Toes, and Morton?s Neuroma.
Diagnosis
A quick way to see if you over-pronate is to look for these signs. While standing straight with bare feet on the floor, look so see if the inside of your arch or sole touches the floor. Take a look at your hiking or running shoes; look for wear on the inside of the sole. Wet your feet and walk on a surface that will show the foot mark. If you have a neutral foot you should see your heel connected to the ball of your foot by a mark roughly half of width of your sole. If you over-pronate you will see greater than half and up to the full width of your sole.
Non Surgical Treatment
Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.
Surgical Treatment
The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.
Feet are supposed to roll inward as a part of every step you take. This helps them to mold to the various terrain that they step on (sand, rocks, various obstacles) without injury. This is called pronation. But, when your feet roll inward excessively, problems often arise. Excessive inward rolling of the feet and ankles is called over-pronation. Sometimes, people who over-pronate are told they have ?flat feet?. The term ?flat feet? can be misleading. When standing, body weight causes the arch of most feet to flatten out somewhat. This does not mean they become flat like pancakes (though some feet do). Instead, the arch shape gets longer and flatter and the arch height gets lower.
Causes
Unless there is a severe, acute injury, overpronation develops as a gradual biomechanical distortion. Several factors contribute to developing overpronation, including tibialis posterior weakness, ligament weakness, excess weight, pes planus (flat foot), genu valgum (knock knees), subtalar eversion, or other biomechanical distortions in the foot or ankle. Tibialis posterior weakness is one of the primary factors leading to overpronation. Pronation primarily is controlled by the architecture of the foot and eccentric activation of the tibialis posterior. If the tibialis posterior is weak, the muscle cannot adequately slow the natural pronation cycle.
Symptoms
People with overpronation may suffer from pain in the knees, hips, and low back. Overpronation itself does not necessarily cause any other symptoms but is a contributing factor of many foot conditions such as Plantar Facsiitis, Heel Spur Syndrome, Posterior Tibialis Tendon Rupture or Tendonitis, Hallux Valgus, Bunion Deformities, Metatarsalgia, Hallux Limitus or Hallux Rigidus, Hammer Toes, and Morton?s Neuroma.
Diagnosis
A quick way to see if you over-pronate is to look for these signs. While standing straight with bare feet on the floor, look so see if the inside of your arch or sole touches the floor. Take a look at your hiking or running shoes; look for wear on the inside of the sole. Wet your feet and walk on a surface that will show the foot mark. If you have a neutral foot you should see your heel connected to the ball of your foot by a mark roughly half of width of your sole. If you over-pronate you will see greater than half and up to the full width of your sole.
Non Surgical Treatment
Supportive orthotics in the shoe is a method commonly implemented to treat many common running injuries associated with pronation. An advantage of orthotics is that they often allow the sufferer to continue to participate in athletic activity and avoid other treatment options that could be potentially costly and time consuming. Seventy-five percent of injured runners are successfully treated with the prescription of orthoses. Orthotics are the most effective treatment for symptoms that develop from unusual biomechanics within the body such as overpronation, resulting in either great improvement or complete healing of the injury in about half the cases.
Surgical Treatment
The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.
What Exactly Is Severs Disease?
Overview
Sever?s disease is the most common cause of heel pain in children aged 9 to 14. Sever?s disease results from stress placed on the growth plate of the heel bone. An excessive amount of running or other activities can cause inflammation around the growth plate, which results in pain. Rest, ice and orthotics and proper shoes are usually prescribed.
Causes
The usual cause is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season, or too much weight bearing on the heel. Also, excessive traction could cause this, since the bones and tendons are still developing. Many children who over pronate their feet exhibit symptoms and in most patients, it usually involves both heels.
Symptoms
The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems. Heel pain with limping, especially after running. Difficulty walking. Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel. Symptoms are usually worse during or after activity and get better with rest.
Diagnosis
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through a growth spurt; one or both heels may be affected. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the gastrocnemius.
Non Surgical Treatment
Sever?s disease treatment should be based on eliminating pain and restoring normal foot and leg biomechanics. As with most soft tissue injuries the initial treatment is Rest, Ice, and Protect. In the early phase you?ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking activities. "No Pain. No Gain." does not apply in Sever's disease. If it hurts your child is doing too much exercise. Your child should reduce or cease any activity that causes heel pain. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Most children can tolerate paracetamol as a pain reducing medication. Check with your doctor. To support and protect your heels, you may need to be wear shock absorbing heel cups or a soft orthotic. Kinesio foot taping may help to provide pain relief. Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff ankle or subtalar joints, massage or electrotherapy to assist you during this pain-full phase.
Recovery
Sever?s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks. The disease may also take several years to stop, because it is often triggered by growing too fast. It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9-11.
Sever?s disease is the most common cause of heel pain in children aged 9 to 14. Sever?s disease results from stress placed on the growth plate of the heel bone. An excessive amount of running or other activities can cause inflammation around the growth plate, which results in pain. Rest, ice and orthotics and proper shoes are usually prescribed.
Causes
The usual cause is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season, or too much weight bearing on the heel. Also, excessive traction could cause this, since the bones and tendons are still developing. Many children who over pronate their feet exhibit symptoms and in most patients, it usually involves both heels.
Symptoms
The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems. Heel pain with limping, especially after running. Difficulty walking. Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel. Symptoms are usually worse during or after activity and get better with rest.
Diagnosis
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through a growth spurt; one or both heels may be affected. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the gastrocnemius.
Non Surgical Treatment
Sever?s disease treatment should be based on eliminating pain and restoring normal foot and leg biomechanics. As with most soft tissue injuries the initial treatment is Rest, Ice, and Protect. In the early phase you?ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking activities. "No Pain. No Gain." does not apply in Sever's disease. If it hurts your child is doing too much exercise. Your child should reduce or cease any activity that causes heel pain. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Most children can tolerate paracetamol as a pain reducing medication. Check with your doctor. To support and protect your heels, you may need to be wear shock absorbing heel cups or a soft orthotic. Kinesio foot taping may help to provide pain relief. Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff ankle or subtalar joints, massage or electrotherapy to assist you during this pain-full phase.
Recovery
Sever?s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks. The disease may also take several years to stop, because it is often triggered by growing too fast. It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9-11.
Acquired Flat Foot Causing Toe Pain
Overview
Adult acquired flatfoot is one of the most common problems affecting the foot and ankle. Treatment ranges from nonsurgical methods, such as orthotics and braces to surgery. Your doctor will create a treatment plan for you based on what is causing your AAFD. 
Causes
Flat footedness, most people who develop the condition already have flat feet. With overuse or continuous loading, a change occurs where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Inadequate support from footwear may occasionally be a contributing factor. Trauma or injury, occasionally this condition may be due to fracture, sprain or direct blow to the tendon. Age, the risk of developing Posterior Tibial Tendon Dysfunction increases with age and research has suggested that middle aged women are more commonly affected. Other possible contributing factors - being overweight and inflammatory arthritis.
Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
Diagnosis
In diagnosing flatfoot, the foot & Ankle surgeon examines the foot and observes how it looks when you stand and sit. Weight bearing x-rays are used to determine the severity of the disorder. Advanced imaging, such as magnetic resonance imaging (MRI) and computed tomography (CAT or CT) scans may be used to assess different ligaments, tendons and joint/cartilage damage. The foot & Ankle Institute has three extremity MRI?s on site at our Des Plaines, Highland Park, and Lincoln Park locations. These extremity MRI?s only take about 30 minutes for the study and only requires the patient put their foot into a painless machine avoiding the uncomfortable Claustrophobia that some MRI devices create.
Non surgical Treatment
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support. 
Surgical Treatment
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.
Pain In The Arch Of My Foot After Running
Overview
Arch pain typically is the term used to describe pain under the arch of the foot. Arch pain indicates inflammation of the tissues within the midfoot and is most commonly caused by plantar fasciitis. Plantar fasciitis is inflammation of the fibrous band of tissue that connects the heel to the toes. Arch pain is most commonly found early in the morning due to the plantar fascia becoming contracted and tight during sleep. Walking or standing for long periods of time can also aggravate the plantar fascia, causing it to become inflamed and irritated. Treatment options include orthotics, anti-inflammatory medications and stretching exercises.
Causes
Arch pain is most often caused by plantar fasciitis, which can affect the heel, arch, or both. Plantar fasciitis treatment is the same, regardless of the location of foot pain (see above). For persistent plantar fasciitis, an injection with a mixture of a steroid and local anesthetic can be helpful. Fallen arches or flat feet occur when the arches of the feet flatten out (often when standing or walking), causing foot pain and other problems. Flat feet can be treated with shoe inserts (orthotics), shoe adjustments, rest/ice, using a walking cane or brace, or physical therapy. Occasionally, surgery is necessary.
Symptoms
The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem.
Diagnosis
A professional therapist may use tinels test to diagnose tarsal tunnel syndrome. This involves tapping the nerve just behind the medial malleolus or bony bit of the ankle with a rubber hammer. Pain indicates a positive test. Sometimes it is initially mistaken for plantar fasciitis which also causes pain from the inside heel and throughout the arch of the foot. Neural symptoms (such as tingling or numbness) as well as the location of tenderness when touching the area should help to easily distinguish between the conditions.
Non Surgical Treatment
Relieving the pain caused by plantar fasciitis boils down to two basic needs. Reduce the inflammation. Support and stretch the plantar fascia. If you can accomplish those two goals, you should note pain relief more quickly. Doctors treating plantar fasciitis will recommend the following options for accomplishing this. Rest, Get off your feet as much as possible when the pain is at its worst. If you must walk or run, try to stay off hard, unforgiving surfaces and wear supporting footwear. Use ice on the arch several times a day to help reduce swelling if necessary. Take Tylenol, Advil, or other over-the-counter pain relievers that contain acetaminophen, ibuprofen, or naproxen to help lessen the inflammation and ease pain. Stretch your toes, calves, and foot repeatedly throughout the day to keep the plantar fasciia limber. Purchase insoles, inserts, or orthopedic shoes designed to support the arch of the foot and wear them at all times. Purchase splints that will stretch the Achilles tendon as you sleep, helping to lessen morning heel pain. If none of the above helps, your doctor may prescribe regular injections of cortisone to control the pain. As a last resort, your doctor may attempt surgery to repair the plantar fascia.
Surgical Treatment
The main goal of surgery is to reduce pain and improve function. It may also reduce other injuries such as repeated ankle sprains and broken bones. Surgery may be considered if there is no relief with physical therapy, changes in shoewear and/or changes in activity. Some patients will also have tendon problems, ankle weakness and foot fractures. These patients may require other procedures to address related problems. If you have medical problems that make surgery unsafe, any infections or blood vessel disease, cavus foot surgery may not be appropriate. The surgical procedures involved with the correction of the cavus foot are varied. Theses may include correction of the bony deformity, ankle looseness and the muscle imbalances that cause the deformity. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.
Prevention
Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.
Stretching Exercises
Start in an L-Sit position. (If you?re hips and hamstrings are tight sit up on a box or phone book to be able to achieve a tall back position. You can even sit on a box with your back supported against a wall!) Keeping the legs straight, but not locked, reach both heels out away from your body to ?Flex? the ankles. Try to avoid pulling back with the toes to flex. Keep the toes relaxed and lead from the heel to hinge the foot into the flexed position. Hold the flexed foot and breathe. Take 3-5 breaths and see if you can reach farther through the heel to deepen the flex on each exhale. To transition to the pointed position, begin by pointing the foot to move the ankles as far as possible in the other direction. Once the ankles have reached their endpoint, use the muscles along the sole of the foot to point the toes. Inhale to continue lengthening out through the top of the foot, exhale to deepen the contraction under the sole of the foot to point the toes. Take 3-5 breaths. Then release the toes, and begin reaching out through the heel to hinge the ankle into the flexed position to repeat the exercise. Continue to flex and the point for 5-10 repetitions.
Arch pain typically is the term used to describe pain under the arch of the foot. Arch pain indicates inflammation of the tissues within the midfoot and is most commonly caused by plantar fasciitis. Plantar fasciitis is inflammation of the fibrous band of tissue that connects the heel to the toes. Arch pain is most commonly found early in the morning due to the plantar fascia becoming contracted and tight during sleep. Walking or standing for long periods of time can also aggravate the plantar fascia, causing it to become inflamed and irritated. Treatment options include orthotics, anti-inflammatory medications and stretching exercises.
Causes
Arch pain is most often caused by plantar fasciitis, which can affect the heel, arch, or both. Plantar fasciitis treatment is the same, regardless of the location of foot pain (see above). For persistent plantar fasciitis, an injection with a mixture of a steroid and local anesthetic can be helpful. Fallen arches or flat feet occur when the arches of the feet flatten out (often when standing or walking), causing foot pain and other problems. Flat feet can be treated with shoe inserts (orthotics), shoe adjustments, rest/ice, using a walking cane or brace, or physical therapy. Occasionally, surgery is necessary.
Symptoms
The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem.
Diagnosis
A professional therapist may use tinels test to diagnose tarsal tunnel syndrome. This involves tapping the nerve just behind the medial malleolus or bony bit of the ankle with a rubber hammer. Pain indicates a positive test. Sometimes it is initially mistaken for plantar fasciitis which also causes pain from the inside heel and throughout the arch of the foot. Neural symptoms (such as tingling or numbness) as well as the location of tenderness when touching the area should help to easily distinguish between the conditions.
Non Surgical Treatment
Relieving the pain caused by plantar fasciitis boils down to two basic needs. Reduce the inflammation. Support and stretch the plantar fascia. If you can accomplish those two goals, you should note pain relief more quickly. Doctors treating plantar fasciitis will recommend the following options for accomplishing this. Rest, Get off your feet as much as possible when the pain is at its worst. If you must walk or run, try to stay off hard, unforgiving surfaces and wear supporting footwear. Use ice on the arch several times a day to help reduce swelling if necessary. Take Tylenol, Advil, or other over-the-counter pain relievers that contain acetaminophen, ibuprofen, or naproxen to help lessen the inflammation and ease pain. Stretch your toes, calves, and foot repeatedly throughout the day to keep the plantar fasciia limber. Purchase insoles, inserts, or orthopedic shoes designed to support the arch of the foot and wear them at all times. Purchase splints that will stretch the Achilles tendon as you sleep, helping to lessen morning heel pain. If none of the above helps, your doctor may prescribe regular injections of cortisone to control the pain. As a last resort, your doctor may attempt surgery to repair the plantar fascia.
Surgical Treatment
The main goal of surgery is to reduce pain and improve function. It may also reduce other injuries such as repeated ankle sprains and broken bones. Surgery may be considered if there is no relief with physical therapy, changes in shoewear and/or changes in activity. Some patients will also have tendon problems, ankle weakness and foot fractures. These patients may require other procedures to address related problems. If you have medical problems that make surgery unsafe, any infections or blood vessel disease, cavus foot surgery may not be appropriate. The surgical procedures involved with the correction of the cavus foot are varied. Theses may include correction of the bony deformity, ankle looseness and the muscle imbalances that cause the deformity. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.
Prevention
Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.
Stretching Exercises
Start in an L-Sit position. (If you?re hips and hamstrings are tight sit up on a box or phone book to be able to achieve a tall back position. You can even sit on a box with your back supported against a wall!) Keeping the legs straight, but not locked, reach both heels out away from your body to ?Flex? the ankles. Try to avoid pulling back with the toes to flex. Keep the toes relaxed and lead from the heel to hinge the foot into the flexed position. Hold the flexed foot and breathe. Take 3-5 breaths and see if you can reach farther through the heel to deepen the flex on each exhale. To transition to the pointed position, begin by pointing the foot to move the ankles as far as possible in the other direction. Once the ankles have reached their endpoint, use the muscles along the sole of the foot to point the toes. Inhale to continue lengthening out through the top of the foot, exhale to deepen the contraction under the sole of the foot to point the toes. Take 3-5 breaths. Then release the toes, and begin reaching out through the heel to hinge the ankle into the flexed position to repeat the exercise. Continue to flex and the point for 5-10 repetitions.
