Our First Steps – Flat Feet

I often hear people tell me that they have the “flattest feet” or their feet are “flat as a board”. In truth, the only people that truly have normal “flatfeet” are infants.

Flatfoot may be defined as an absence of the arch upon standing or walking. It is often associated with excessive inward “rolling” of the foot known as pronation. It is well accepted that children under the age of 7-10 years normally do not possess a significant arch or one that resembles the average adult foot. James Losito, D.P.M., Professor of Biomechanics at Barry University and a team physician for the Miami Heat, University of Miami and Barry University Intercollegiate Athletic Programs and Medical Director for Pro-Tech Sports Medicine, has had lots of experience with care of common pediatric pathologies. ” It is for this reason, that pain and function be emphasized rather than the cosmetic appearance of the foot when determining if a child’s foot is abnormally flat,” says Dr. Losito.

Dr. Losito states that a history of fatigue, cramping, pain, excessive shoewear or “sloppy” gait are the most reliable indicators that an abnormality is present. Several different causes of flatfoot exist including, ligamentous laxity, tightness of the Achilles tendon (equinus), muscular weakness or spasticity, and pigeon-toed gait. In the adult, excessive pronation (flattening of the arch) may produce many problems including tendinitis, fascitis, shin splints and stress fractures. Therefore, treatment of a symptomatic pediatric flatfoot should not be ignored. In some cases, treatment such as muscular strengthening or stretching is the key to improving the flatfoot condition. However, in many instances a functional orthotic device may be used in conjunction with exercises or used alone.

For example, children who walk pigeon-toed (intoed) or slew-foot (out-toed) suffer from severe pronation (flattening of the arch) as compensation during gait. A functional foot orthosis helps prevent the excessive pronation, which can lead to a structural flatfoot. In those children who trip, stumble or are clumsy, the orthotic can be fabricated to reduce the degree and severity of the abnormal gait pattern.

Children who suffer from equinus, defined as a tight Achilles tendon almost always suffer from excessive pronation and a flatfoot. This requires rigorous stretching exercises or surgery to eliminate the abnormal force creating the flatfoot. Functional foot orthosis are useful in eliminating any residual pronation and supporting the foot if any permanent structural changes have occurred.

Shoes and functional foot orthosis are not necessary for normal development of the child’s foot. However, when the aforementioned symptoms are present, functional foot orthotic devices are a proven and successful option that families can benefit from to help correct and prevent future problems.

Shin Splints

Shin splints is a general term used to refer to a painful condition in the shins. It is often caused by running or jumping, and may be very slow to heal. A formal medical term for the condition is medial tibial syndrome.

Shin splints is the general name given to pain at the front of the lower leg. Shin splints is not a diagnosis in itself but a description of symptoms of which there could be a number of causes. The most common cause is inflammation of the periostium of the tibia (sheath surrounding the bone). Traction forces occur from the muscles of the lower leg on the periostium causing shin pain and inflammation.

Symptoms of shin splints:

• Tenderness over the inside of the shin.

• Lower leg pain which goes after a period of rest but comes back when running starts again.

• Sometimes some swelling.

• Lumps and bumps may be felt when feeling the inside of the shin bone.

• Pain when the toes or foot are bent downwards.

• A redness over the inside of the shin.

Shin Splints Treatment

Treatment for shin splints is a simple as reducing pain and inflammation, identifying training and biomechancial problems which may have helped cause the injury initially, restoring muscles to their original condition and gradually returning to training.

What can the athlete do about shin splints?

• Rest to allow the injury to heal.

• Apply ice or cold therapy in the early stages, particularly when it is very painful. Cold therapy reduces pain and inflammation.

• Stretch the muscles of the lower leg. In particular the tibialis posterior is associated with shin splints.

• Wear shock absorbing insoles in shoes. This helps reduce the shock on the lower leg.

• Maintain fitness with other non weight bearing exercises such as swimming, cycling or running in water.

• Apply heat and use a heat retainer or shin and calf support after the initial acute stage and particularly before training. This can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues.

• Visit a sports injury clinic for treatment and rehabilitation.

What can a sports injury clinic or doctor do?

• Prescribe anti-inflammatory medication e.g. ibuprofen. (Always consult a doctor before taking medication).

• Tape the ankle for support. – A taping worn all day will allow the shin to rest properly by taking the pressure off the muscle attachments.

• Perform gait analysis to determine if you overpronate or oversupinate

• Use sports massage techniques on the posterior deep muscle compartment but avoid the inflamed periostium.

• Operate

• Anti inflammatory drugs along with rest and ice can help reduce inflammation, particularly in the early stages. However if the underlying causes such as tight muscles are not treated through stretching and sports massage techniques then the likelihood of the injury returning is higher.

Which products can help with treatment of shin splints?

Some products which can help with treatment and prevention of shin splints are outlined below. Please consult your therapist before using any products as they may not be compatible with your particular therapists approach to treatment.

Shock absorbing insoles… Shock absorbing insoles can help reduce the shock and impact transmitted through the foot to the lower leg, particularly when running on hard surfaces for long periods of time.

Orthotic insoles… Orthotic insoles are firm insoles designed to correct biomechanical dysfunction such as over pronation. They will usually have strong arch support. Off the shelf orthotic insoles are available and suitable for many, although for the perfect fit a Podiatrist will make them specifically for your feet.

Flat Fleet

Flat Feet

Flat Feet is more or less a condition of fallen arches. The instep, or arch, collapses and becomes flat against the ground. Hence the term flat foot. Flat feet are not always a result of a collapse, some arches never develop properly. When we are babies, our feet are flat and the arch normally over time. As long as there is no ball of foot pain or any other difficulties resulting from the condition there is no real need to seek treatment.

If you suspect you have flat feet, just take a look. In general flat feet do have a flat look to them and unusual wear of shoe soles can also indicate flat feet. If you suffer from lower leg pain, pain from the ankle into the instep of the of the foot or foot pain in general, this may be a result of flat feet.

If you suspect you have, and are suffering foot care issues you may wish to see a podiatrist for treatment.  Treatments are available and your podiatrist will prescribe them based on the cause of a particular case of flat feet. These treatments may include but are not limited to shoe inserts, arch supports, custom orthotics, braces, surgery or just anti inflammatory medication.

Living with minor pain from flat feet without treatment might seem normal but if the condition worsens it could lead to complications. Besides the expected swelling an pain in the soles of the feet, shin splints, stress fractures, Achilles tendinitis and bunions can develop. Seek the advice of a podiatrist or a foot specialist who can help with preventative measures.

Preventing Injury and Increasing Your Performance

Athletes often neglect their number one supporter: their feet. Many of us rarely give them a second thought until they cause us pain. We force them into shoes that don’t fit, pound them into the ground and neglect to care for them properly. Yet, a small abnormality in foot function can have a large impact on the entire body causing pain, discomfort and interrupting an athlete’s game. With the strenuous activity athletes’ bodies endure, it is important to understand how to treat sports injuries, maintain treatment and ensure the feet receive the extra T.L.C. they deserve.

Athletes must not only be aware of sports related injuries but more importantly, how to prevent them before they occur. As proper biomechanics begins to gain more popularity and importance in the sports world, trainers and athletes are beginning to think more pro-actively about how to care for the feet. Yet, many are unaware that the symmetrical alignment of their feet affects their entire body. Any deviation can create a deleterious effect on their performance. Because no one person shares the same foot structure, the ultimate solution to preventing injuries, treating existing problems and increasing athletic performance is with precise custom-made functional foot orthotics.

Functional orthotic devices are fabricated by using a neutrally balanced and stable position captured impression of the foot. They are designed by a physician, experienced and trained in the field of Clinical Biomechanics. Medically prescribed, their purpose is to limit excessive motion and align the rear foot to forefoot. It is important that custom-made, functional foot orthotics are not confused with arch-support devices sold at pharmacies or shoe and sporting goods stores. Over-the-counter arch supports are a one-size-fits-all version that provides support to a patient’s arch based on average foot shape and function.

In our practice, we use the latest diagnostic technology to perform my biomechanical evaluations. A thorough study incorporates a medical and family history, video gait analysis, muscle strength testing and range of motion study. The combination of this information helps to determine the best method to increase performance, prevent and/or address injuries.

Some of the most common athletic ailments that we have encountered that could have possibly been prevented with the use of functional foot orthotics are:

Heel Pain

The most frequent cause of heel pain is plantar fasciitis. Plantar Fasciitis can be caused by an abnormal motion of the foot called excessive pronation. If your heel is rotating outwards too much and your arch is lowering too much then you have excessive pronation. It is this extra stretch in the arch that causes the partial pulling, straining or tearing of the plantar fascia and the possibility of spur formation.

Plantar Fasciitis can be controlled with a combination of treatments. Strapping of the feet with the foot held in a neutral position combined with a physical therapy program and an anti-inflammatory medication will usually improve the symptoms. A custom made orthotic will control the excessive pronation and also support the arch taking the tension off the plantar fascia.

If the patient continues to have pain, a physician could conduct injection therapy, the injection of a small amount of cortisone to decrease the inflammation. The patient could receive several injections while still performing the conservative treatment for several weeks or months. For the remaining small percentage of patients who fail to be relieved of the pain, the patient may choose to have Extra-Corporeal Shock Wave Therapy (ESWT). This innovative, non-surgical treatment involves the delivery of sound energy or shock waves to affected areas of the body triggering the body’s own natural repair mechanisms and stimulating healing. ESWT can be done in the office (low energy) and without the need for an anesthetic. Surgical correction is the last choice of treatment. Surgical corrections consist of releasing the part of the plantar fascia from the attachment to the heel bone.

Shin Splints

Medial Tibial Stress Syndrome (MTSS) is commonly known as Shin Splints. The people who are at the greatest risk for developing MTSS are beginning runners, people who over-train and people with a poor selection of shoe gear.

The usual mechanical factors that lead to MTSS are an imbalance between the posterior and anterior muscle groups. The posterior muscles may be both too tight and too strong. The effect of the tight musculature has an impact on the gait cycle at two points, just before and after heel contact and when the foot is leaving the ground at toe off. These stresses cause a repetitive inflammation in the muscle or at the attachment of the muscle to the bone. Other factors that may cause MTSS are continual running on a hard surface and a biomechanical abnormality in the foot such as excessive pronation.

The initial treatment for MTSS is decreasing the amount of training, adequate stretching exercises before and after running and proper shoe gear with shock absorption. Running on hard surfaces should be avoided. Icing immediately after exercise should also be done to control inflammation.

A physician should conduct a thorough evaluation of the training schedule, training surface, shoe gear being used and the biomechanics of the foot and ankle. If a biomechanical fault is found in the lower extremity a custom foot orthotic could help eliminate the fault and reduce the pain.

Leg Length Discrepancy

Another common problem that has been encountered are leg length discrepancies. During our evaluation, we can determine whether this is a functional or structural problem or combination of both. With a length discrepancy an athlete could experience pain in the knees, hips, lower back and neck. These difficulties and biomechanical faults can easily be accommodated with custom-made orthotics.

Turf Toe

Turf Toe is an injury that can occur in all types of athletics. The injury occurs when there is excessive motion behind the big toe which causes the tendon and ligaments of the first metatarsal phalangeal joint to become disrupted. If this injury is not addressed it can lead to a severe limitation of motion, fractures and early arthritis. This also can be treated with a functional foot orthotic with long term excellent results.

Other Injuries

Back and knee pain, ankle sprains, strains, instability and metatarsal issues can also be treated with foot orthotic therapy.

Case Study

In February 2007, Drew Stanton, a quarterback from Michigan State, was referred to Footcare Express to seek treatment for a persistent foot problem. A thorough examination was performed and functional foot orthotics were created to control his foot and accommodate his pain. With the orthotics in place Stanton was able to achieve the fastest time for a quarterback in the 40-meter dash at the 2007 NFL Combine. Stanton was later drafted to the Detroit Lions in the 2007 NFL Draft.

No matter your status on the playing field, it is important that you take care of your feet and not neglect clinical biomechanical problems. It is especially important that the coaches and parents of youth athletes understand the symptoms of sports related injuries.

As athletes improve performance and maximize efficiency, they rely on sports medicine to surpass their performance thresholds. Custom foot orthoses are increasingly making their way onto professional and recreational playing fields as sports medicine is focusing more on biomechanics and kinesthetic awareness to prevent and treat lower extremity injuries. When properly prescribed, foot orthoses can enable the body to work to its potential. Once an athlete’s entire system is in balance, he or she should notice improved performance and enjoy lower risk of injury.