What hurts?
Some possible conditions • Foot Pain – Bottom of Foot – Midfoot
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Arthritis -
Arch Pain -
Plantar Fasciitis
Some possible conditions • Foot Pain – Bottom of Foot – Midfoot
Arthritis is a common inflammatory condition that affects bony joints. The most common type of arthritis is Osteoarthritis (OA). It occurs when the cartilage, which acts as a cushion between the bones of the lower limb wears down over time. As the cartilage deteriorates, the bones begin to rub against each other causing pain and inflammation. While it is most common in older adults, osteoarthritis can occur at a younger age. Other types of arthritis include psoriatic arthritis, rheumatoid arthritis and gout.
The most common symptom of foot arthritis is pain, which can range from mild to severe. Depending on the affected joint, pain can be felt throughout the foot. Psoriatic and rheumatoid arthritis primarily affect the toes and cause changes in shape, alignment, and may cause swelling. Along with pain, people with foot arthritis may also experience stiffness, as well as decreased range of motion. These symptoms may be worse after sitting or standing for long periods of time, or with physical activity. Gout can be acute or chronic, but when it first presents, pain, swelling and redness of the joint are the primary indicators.
Osteoarthritis is caused by a combination of genetic and environmental factors. With age comes the natural breakdown of the cartilage. The most common joint in the foot to be affected by OA is the big toe joint. Biomechanics play a significant role in the development of osteoarthritis because the position of our foot joints and how they move can cause increased pressure throughout the area affected. Previous foot injuries or surgeries can cause damage to overall joint structure/cartilage, which can be another factor. Overuse of certain joints is another cause of foot osteoarthritis as the more we work our foot joints, the faster cartilage breaks down. This is why jobs that involve a lot of walking and kneeling will have higher rates of workers with foot osteoarthritis. Psoriatic and Rheumatoid arthritis are a by-product of the disease processes, and have genetic and auto-immune causal factors. Gout is primarily precipitated by diet but ultimately, is a by-product of faulty handling or producing of uric acid by the body. These crystals build up within a joint and are very painful.
Treatment for foot arthritis begins with non-surgical approaches, such as medication, physical therapy, weight loss, bracing/splinting, orthotics and well-fitted shoes. Physical therapy can help to reduce pain and improve function by strengthening the muscles around the joints. Weight loss is also an important aspect of treatment as it can help to reduce the pressure on the foot joints. A brace, splint, orthotic or shoe with a forefoot rocker may be recommended to offer support and aid in pain reduction.
Arch pain can be due to a number of causative factors. However, when someone has a high arch (Pes Cavus) or low arch (Pes Planus), arch pain or fatigue can ensue. Standing for long periods of time or wearing footwear that is not appropriate to the foot shape or activity can exacerbate any arch concerns. Many people opt for added arch supports in their shoes but often don’t investigate why they might need them. Read on to learn more about flat feet and high-arched feet, and how arch pain is related.
Those with high-arched feet are prone to pain in the ball of the foot and arch fatigue. This is because the metatarsal bones are at a higher angle to the ground and cause undue pressure on the sole of the forefoot. Also, the arch, which is high, is left unsupported without an orthotic and can tire easily. Supportive soft tissue structures stretch and weaken with time. This can be exacerbated by pregnancy where ligaments in the body loosen in preparation for labour and delivery. Those with flat feet are prone to over-pronation in gait, tendon fatigue along the inner ankle, and arch/heel pain under the foot. Sometimes, bunions are associated with very flat or overly pronated feet. The arch pain experienced with flat feet tends to be dull and achy after a long day standing, unless the plantar fascia becomes involved. In that case, the pain will be sharp, localized to the heel and present especially in the morning after rest.
The cause for arch pain or fatigue in someone with a high or low arch is often due to genetics, poor footwear choices, the absence of arch supports, injury, arthritis, overuse or a demanding lifestyle. In more rare cases, arch pain can be due to a fracture, strain or sprain in the midfoot. Sometimes, a tendon that runs near the arch, such as the posterior tibial tendon, can become damaged or diseased and cause arch pain. When arch pain is present, it is typically dull or achy. Any sudden sharp pain should be considered an urgent appointment. And arch pain should not radiate elsewhere. This would require an investigation into nerve tissue involvement.
An assessment by a lower limb clinician is important to investigate the cause for the arch pain. If it is due to a high or low medial arch, it is important to consider reducing activities to allow for healing, and optimizing arch support with an orthotic or insole. With any foot pain or discomfort, footwear should be evaluated and a comprehensive footwear fitting should be undertaken. Depending on the location of the arch pain, a cortisone injection or shockwave therapy may be effective. Cross frictional massage of arch tissues may relieve any scarring from injury or surgery and can lessen swelling and pain. Ice and anti-inflammatory medications remain a staple in addressing inflammatory pain. Book your appointment at BioPed for a foot health and shoe evaluation.
The most common cause of heel pain is plantar fasciitis. Plantar fasciitis is grossly defined as a thickening of the ligament (the plantar fascia) that connects the heel bone to the toes. The plantar fascia aids in holding up the arch and with shock absorption for standing and walking. It is also part of a pulley system to aid in toe push off when walking and running. The ligament can have tiny tears from overuse, which causes heel pain with first steps in the morning or after a period of rest. Pain can dissipate after walking, however pain tends to return with prolonged standing and walking. Plantar fasciitis is often associated with a heel spur on the bottom of the heel bone, but a spur does not have to be present to be symptomatic.
Plantar fasciitis presents with symptoms of stabbing/sharp pain in the bottom of the foot at the heel. Mild swelling can be felt in the arch of the foot if persistent ligament thickening is present. Pain is often temporarily relieved with icing the area. Barefoot walking tends to exacerbate the pain, especially on hard surfaces, such as concrete, wood floors or on tile. Pain can radiate to the toes or towards the calf along the back of the heel in more complicated cases but this is very rare. Radiating pain should be investigated for a condition involving the nerves. People often describe the pain as a “stone bruise” feeling to the sole of the heel bone. Limited dorsiflexion or “upward motion” at the ankle is often present in people with plantar fasciitis.
Tension and stress on the fascia can cause small tearing and inflammation leading to pain and swelling in the heel and fascia. Factors that increase the risk of developing plantar fasciitis include age (between 40 and 60 years old); activities, such as long-distance running, ballet dancing, and aerobics; flat feet; atypical gait cycle; obesity; new or inappropriate shoes and finally occupations which require long hours of walking or standing on hard surfaces. A tight gastroc complex (calf muscle) can lead to an overpull of the plantar fascia and lead to pain and inflammation.
Most patients recover with conservative treatment such as arch supports (orthotics), rest, icing, stretching and modifying activities. Supporting the plantar fascia (arch) is one of the most important things you can do to reduce additional ligament tearing and allow for healing. Other valuable treatment options include physical therapy or splinting, such as a night splint to stretch the calf muscle and help reduce overpronation. A localized cortisone injection from a Chiropodist can be immediately effective to reduce pain and swelling. Non-steroidal anti-inflammatory medications, such as ibuprofen may be necessary as well. Ultrasound therapy and Extracorporeal Shock Wave treatments have also been utilized with excellent success, prior to considering surgical options. Severe pain or delayed treatment may require a period of non-weight bearing in a boot to decrease the inflammation present.
