Why are my feet sore?

Plantar Fasciitis

Plantar fasciitis is the most common condition we treat at The Orthotic Clinic and is characterised by pain beneath your heel, especially when standing after periods of rest. It is defined as an overuse injury of the plantar fascia – a tough fibrous band of connective tissue that extends from the heel to the ball of the foot. Plantar fasciitis is more common in women, people who are overweight, and those who work in jobs that require a lot of standing and walking, particularly on hard surfaces. People with sub-optimal foot structure such as flat feet, high arches or tight calf muscles are also at increased risk of developing plantar fasciitis.

Effective treatment for plantar fasciitis usually involves a combination of:

• Plantar fascia stretching and massage
• Calf stretching and massage
• Icing of the plantar fascia
• Foot Orthotics to correct structural abnormalities, cushion/offload the heel, and reduce plantar fascia tensions
• Anti-inflammatories

To determine what’s right for you, contact us or book your consultation now.

Download our plantar fasciitis fact sheet here.

Flat Feet / Overpronation

Pronation refers to the rolling in of your ankle (rearfoot) and the slight flattening of your arch (midfoot) after the foot strikes the ground. This allows the foot to act as a shock absorber when accepting your body weight, however for many people these movements can be excessive. This is referred to as overpronation. It is a common condition, affecting as many as one-third of all people.

When your rearfoot and/or midfoot overpronate, the muscles, tendons and ligaments of the foot and ankle are strained. You may be at risk of developing a range of injuries such as ankle sprains, shin splints, Achilles Tendonitis, Tibialis Posterior Tendonitis, bunions, plantar fasciitis and clawed toes.

As the foundations of your body, overpronating feet can also cause a variety of knee, hip, leg and lower back injuries. Overpronation can be caused by:

• Genetic and developmental factors
• History of foot or ankle injury
• Arthritis of the feet
• Dysfunction/damage to the Tibialis Posterior tendon – the main support structure for the arch
• Neuromuscular disorders such as Cerebral Palsy, Muscular Dystrophy, or Spina Bifida.

People living with obesity or diabetes have a higher risk of developing flat feet. It can also develop during pregnancy due to the combined effects of hormonal changes and increased body weight.

Treatment for pain and discomfort caused by overpronation will usually involve a combination of:

• Orthotics to neutralize foot alignment and reduce stress applied to bones and soft tissues
• Good footwear with the right amount of cushioning and support for your foot type – fitted by a footwear specialist
• Stretching and strengthening exercises for weakened muscles, tendons and ligaments

To determine what’s right for you, contact us or book your consultation now.

Download our overpronation fact sheet here.

Osteoarthritis

Arthritis is a disease involving inflammation in and around your joints. Osteoarthritis is the most common form of arthritis, and involves the gradual wearing down of your joints over many years.

A joint is a point where two or more bones meet, allowing movement. Due to the rough surface of bone, cartilage covers the bone surface to reduce friction at a joint. This lubrication allows for smooth, pain-free movement.

Due to the number of joints in your feet and the constant daily stress they are subjected to, our feet are particularly susceptible to wear-and-tear. In severe cases, complete erosion of joint cartilage can result in “bone on bone” contact – a very painful scenario. X-rays, MRI’s and CT scans are often used to identify arthritic joints and their severity.

Typically, those with osteoarthritis of the feet report pain when standing after periods of rest, increasing pain throughout the day when walking, tenderness when touching or moving the joint, inflammation (warmth or swelling) and joint stiffness, particularly in colder climates. The most common areas of the feet affected are the big toes, the top surface of the arch, and the ankle.

Those at greatest risk of arthritis include people who:

• work in jobs that require standing/walking all day
• participate in high-impact sports (running, football, basketball)
• have poor structural alignment of the feet (flat feet/overpronation)
• are obese
• don’t wear activity-appropriate footwear

Osteoarthritis is an incurable condition as the body cannot repair damaged cartilage. However, it can be successfully managed. This usually involves a combination of:

• Custom orthotics to support degenerated joints, preserve remaining cartilage and minimise pain and inflammation
• Appropriately fitted footwear
• Physiotherapy to maintain joint mobility
• Pain relievers (such as Panadol Osteo)
• Steroidal/non-steroidal anti-inflammatory drugs
• Supplements such as Glucosamine, Fish Oil and Chondroitin
• Surgical intervention – joint fusion or replacement (a last resort!)

To determine what’s right for you, contact us or book your consultation now.

Download our osteoarthritis fact sheet here.

Bunions

A bunion is a bony lump that forms on the joint at the base of your big toe. It occurs when bones in your forefoot fall out of alignment, causing the tip of your big toe to point outwards. This forces the joint at the base of your big toe to become prominent. Research indicates that about 23% of the population aged 18-65 have bunions. This rises to 36% for people aged 65+. Bunions are far more common in women than in men.

A bunionette is a similar, smaller bony lump that forms on the base of your little toe. These are less common than bunions.

If you have a bunion, you may notice a bulging lump on the outside of the base of your big toe accompanied by pain, swelling and redness around the joint. Often you will find that the range of motion of the big toe is limited. Corns and callouses can also develop in several areas due to friction between the bunion and your footwear, or between the first and second toes. Finding shoes to comfortably accommodate the increased width of your forefoot caused by the bunion can also be challenging. Bunions cannot be corrected without surgery, and they usually deteriorate over time so the severity of these symptoms will depend on the size of your bunion.

The exact cause for bunion development is unknown, however most research identifies that potential risk factors include:

• genetic predisposition
• biomechanical factors such as flat feet/overpronation and joint hypermobility
• history of injury to the big toe
• arthritis
• regular use of footwear that is too narrow/pointy in the forefoot, or places the forefoot under excessive load such as high heeled shoes

Bunions are also known to be a potential factor behind the development of other foot conditions such as bursitis, clawed toes (especially the 2^nd toe), and metatarsalgia.

Successful management of bunion pain typically involves a combination of:

• suitable, low-heeled footwear with enough width and elasticity in the toebox to reduce pressure and friction on the big toe and bunion. Shoes with stretchy uppers are great!
• custom foot orthotics to prevent/limit bunion progression and relieve stress to the big toe and bunion if poor structural alignment is identified
• silicone bunion shields to protect the bunion from shearing against the shoe
• bunionectomy surgery – a last resort

To determine what’s right for you, contact us or book your consultation now.

Download our bunions fact sheet here.

Metatarsalgia

Metatarsalgia is a term used to describe a range of conditions that cause the balls of your feet, or metatarsal heads, to become painful and inflamed. It may be caused by excessive walking, running, and jumping, as well as structural irregularities in your feet that lead to an overloading of body weight in the area. Metatarsalgia can affect people of all ages and activity levels.

Symptoms of metatarsalgia include a sharp, aching or burning pain in the balls of your feet. Pain is more intense when standing, walking, and performing high-impact activities, especially on hard surfaces. Often pain is accompanied by sharp, shooting sensations, numbness and tingling in your toes. Dull sensations are also common, with many complaining it feels as though they have a pebble in their shoe.

Mechanical issues such as a high medial arch or a collapsed forefoot (metatarsal arch) often contribute to metatarsalgia as they increase weight taken through the metatarsal heads. Consequently, thickened skin, or callousing can develop, which can be a source of pain in itself.

The balls of our feet have fat pads which serve to provide natural cushioning and disperse the high stresses we apply to this area. In some cases however, this fatty tissue can atrophy with age or migrate from the areas it is needed the most, exposing the bones to more stress. This is also another cause for metatarsagia.

The objective of treatment for metatarsalgia is to cushion and redistribute loads away from the metatarsal head area to relieve pain. This is usually achieved with a combination of:

• relative rest – if you are heavily engaged in high-impact activities (running, jumping), consider substituting them for lower-impact activities such as swimming and cycling.
• icing and anti-inflammatory drugs to relieve pain and inflammation
• custom foot orthotics with forefoot cushioning and ‘metatarsal domes’ to transfer loads away from the painful area. This is the most effective way to achieve lasting relief if the underlying cause is structural
• supportive footwear with a low heel and plenty of built-in cushioning, such as runners. Rocker-soled shoes can also assist in reducing time spent loading the forefoot during walking
• calf stretching (if calves are tight) – to delay loading of the forefoot when walking
• surgery – a last resort

To determine what’s right for you, contact us or book your consultation now.

Download our metatarsalgia fact sheet here.

Achilles Tendonopathy

Often referred to as Achilles tendonitis, tendonosis or dysfunction, Achilles Tendonopathy (AT) is an overuse injury seen in runners, jumpers, and those engaging in other repetitive high-load, high-impact weightbearing activities.

The Achilles Tendon is the largest tendon in the body and connects the calf muscle to the heel bone. Although pain and inflammation may appear to have a sudden onset, it is usually the culmination of many small tears to the tendon over a period of time.

Typically, AT affects more men than women, particularly those above the age of 30. It can be caused by any repetitive movements that place the Achilles Tendon under abnormal or excessive tension, such as:

• Excessive rolling in/pronation of the feet – flattening of the arch pulls on the calf muscles and places the Achilles under strain
• Overtraining – placing the Achilles under excessive stress before it is strong enough to withstand those stresses. Eg, training for steep uphill running before running on flat surfaces.
• Change in training surface – running on surfaces with less shock absorption may trigger pain
• Weight gain
• Excessive wearing of high-heeled shoes – promotes shortening of the Achilles so when flatter shoes are worn, it is under increased tension

AT often starts out as a burning sensation at the beginning of an activity which then begins to ease during the activity, but will worsen following the activity. The Achilles Tendon usually feels very tight when first getting out of bed in the morning, or when standing after long periods of sitting. Typically, sufferers of AT report pain, stiffness and loss of strength in the affected area. It is also common to have a tender, red, warm or swollen lump on the Achilles Tendon about 2cm above the heel bone.

The aim of treatment is to reduce pain, inflammation and tensile stress on the Achilles Tendon. Successful treatment will depend on the underlying cause, however usually involves a combination of:

• Rest/Icing –reduces inflammation and provides pain relief after sport
• Heel Raises – placed inside the shoe to reduce Achilles tension
• Orthotics – to correct any excess pronation or supination that may be putting further strain on the Achilles
• Activity modification – reduce the frequency and/or intensity of high-impact activities, or substitute for low-impact activities.
• Calf Stretching and strengthening exercises – to treat Achilles Tendon shortening if present, and strengthen it so that it can handle the stress you apply to it
• Appropriate footwear – with good shock absorption and arch support if required
• Steroidal/non-steroidal anti inflammatory drugs

To determine what’s right for you, contact us or book your consultation now.

Download our Achilles Tendonopathy fact sheet here.

Shin Splints

Medial Tibial Stress Syndrome, or “shin splints”, is a term used to describe pain along the front of your lower leg, at the shin bone.

The pain caused by shin splints is a result of fatigue and trauma to the muscles and other soft tissues at the points at which they attach to the bones of your leg – the tibia and fibula. To maintain stability of the foot and ankle, the muscles of the lower leg must exert large forces on these bones, particularly during high impact activities like running. These forces can result in partial tearing of the connective tissues at their bony attachments.

Causes for shin splints typically stem from two categories: They can either be related to biomechanical/structural inefficiencies, or training errors which result in overload of the area.

Having flat, overpronating feet is the most common biomechanical inefficiency contributing to shin splint pain, because when the heel strikes the ground in walking/running the foot and ankle roll inward, applying a twisting force to the tibia. This rotational stress stretches the muscles, tendons and fascia of the lower leg. Other biomechanical causes for shin splints include tight, stiff muscles of the lower leg, and poor running technique.

Training errors that can result in the development of shin splints typically relate to:

• Running on hard surfaces that offer minimal shock absorption (ie, concrete)
• A sudden increase in the intensity and/or duration of exercise (Marathon training)
• Excessive uphill/downhill running
• Incorrect footwear choice, or worn out footwear.

Successful management of shin splints will focus on minimising rotational stresses and impact to the shins. This usually involves a combination of:

• Orthotics to stabilise the foot and ankle and minimise tibial rotation (if overpronation present)
• Appropriate, professionally fitted, activity-specific footwear that accounts for biomechanical insufficiencies and accommodates orthotics if required
• Exercises to strengthen and condition the muscles of the lower leg
• Warming up before your exercise to maximise blood, and therefore nutrient flow to the legs and so that muscles and other connective tissues can work within a broader range of movement.

To determine what’s right for you, contact us or book your consultation now.

Download our Shin Splints fact sheet here.