Conditions Treated //
About the importance of your footwear
At Fit to Walk your orthotics are custom-made at our on-site lab, and adapted to your particular foot and/or lower limb condition and lifestyle requirements. How well your orthotics work with your footwear is of utmost importance. It is so important that your footwear is right for your condition that it can make or break whether your orthotics will work for you. Very often if an orthotic feels uncomfortable down the road or stops working for you, the shoes are often the culprit. It is recommended that you "retire your shoes, before they retire you", a slogan well known in our profession.
Forefoot Joint Pain: Metatarsalgia
Metatarsalgia (met-uh-tahr-SAL-juh) is a condition in which the ball of your foot
becomes painful and inflamed. You might develop it if you participate in activities that involve running and jumping. There are other causes as well, including foot deformities and shoes that are too tight or too loose. Poorly made footwear can prematurely break down under the ball of the foot, causing pressure points that may cause inflammation. Besides the joints of the ball of the feet, there are also ligaments, fascia and bursa that can become inflamed. A condition called sesamoiditis is inflammation resulting in pain specifically at the sesamoid bones of the 1st metatarsal joint. Custom-made orthotics are designed to relieve pressure of the inflamed foot structures. Footwear with a built in rocker can provide additional relief. In some cases, footwear may have to be modified to amplify the effect of the shoe rocker to provide more relief.
Osteoarthritis may cause severe pain, joint deformity, impaired mobility and fusion of certain joints such as the 1st metatarsal phalangeal joint, or the big toe joint. Pain in this particular joint may worsen when the toe is bend up during the push-off phase during walking. Custom-made orthotics may include a rigid extension that extends under the toe to keep it from bending. If orthotics are not required for another co-existing condition, a gait plate made from carbon fibre may also help with this condition. Very often though osteoarthritis affects other joints in the foot requiring joint stablization. Again, the use of footwear with rockered soles may be very helpful treating this condition. For someone with poor balance, footwear with a rocker may make the gait more unstable, so care must be taken in deciding to use this type of footwear. In cases of severe arthritis where the whole foot aches we may recommend orthotics made from a softer shell material combined with extra depth footwear to manage the pain.
Shin Splints are typically found with runners and walkers, but not exclusively.
Causes of shin splints may be hyperpronation, inadequate stretching, worn shoes, or excessive stress placed on one leg or one hip from running on cambered roads or always running in the same direction on a track. Typically, one leg is involved and it is almost always the runner's dominant one. The most common site for shin splints is the medial area (the inside of the shin). Anterior shin splints (toward the outside of the leg) usually result from an imbalance between the calf muscles and the muscles in the front of the leg. Theories on how shin splints arise have included small tears in the muscle that's pulled off the bone, an inflammation of the periosteum [a thin sheath of tissue that wraps around the tibia, or shin bone], an inflammation of the muscle, or some combination of these. Medial shin splints are often treated with custom-made orthotics and stability footwear to control hyperpronation.
Pes Planus or Flat Feet
These can be subdivided into two categories: Congenital (from birth) or acquired. For those born with flat feet, they may never have experienced foot pain. Instead, pain may be experienced in the knees, hips and back. The feet are linked through what is called the "closed kinetic chain". When the arch collapses (pronation) after heel strike, the leg rotates inward. If the foot is flat (pronated) already, the legs inward rotation is amplified, and may affect the joints above it, such as the knees and hips. An acquired flat foot is, well acquired. In other words, the foot shape changed from a normal arch shape, to one that is flattened out. This may occur from trauma, repetitive strain, or disease, such as diabetes. Such a foot may experience symptoms of pain, because of the deformity. Flat feet are treated on an as required basis, and based on what pain symptoms or deformities have developed. Sometimes the only diagnosed condition is extreme walking fatigue. Therefore orthotics may be used for treatment of a variety of diagnosed conditions that have the underlying causal condition of flat feet or Pes Planus as this condition is called in Latin.
Pes Cavus or High Arches
As a whole, there are more indviduals seen with flat feet then seen with high arches. Having flat feet or high arches is not an indicator in itself that you will have a problem with your feet. That said, there are individuals that do have problems with this foot type. In this discussion we will focus on the Pes Cavus, or high arched foot. This foot type is characterized by having a higher then normal plantar arch, as the name implies. A distinction can be made between a rigid and a flexible high arched foot. A rigid flat foot retains it's arch structure on weight bearing, exhibiting lesser joint mobility where a flexible high arch will drop significantly upon weight bearing. Individuals with rigid high arches tend to have problems with pain across the ball of the foot and the heel. They may also suffer from lateral ankle pain as this foot type does not roll inward (pronate) as readily as a normal arched foot type. Pre-mature wear on the lateral (outside) side of shoes is seen with a rigid high arch foot type. This can cause the feet to roll out even more, putting strain on the lateral ankle tendons such as the peroneus brevis, and the lateral ankle ligaments such as the calcaneal-fibular ligament. If these individuals are to be fitted with custom-made orthotics, the emphasis will be placed in preventing some of the excessive lateral motion. The footwear plays an important role in this and need to be carefully chosen, for the orthotics to work. Fitting orthotics to a flexible high arch may require a bit more cast modification and a semi-weight bearing cast, as the difference between the non-weight bearing foot shape and weight bearing foot shape can be significant. Individuals with a flexible high arch have their own unique challenges, which may be explained in a separate discussion from this one.
Heel Pain (A.K.A. Plantar Fasciitis)
The plantar fascia is a connective tissue that stretches
from the heel bone to the toes crossing the ball of the foot. The plantar fascia originates at the periosteum, a thin layer of very tough tissue covering the heel bone. It is narrower at the heel and widens near the forefoot. It's function is to keep the long arch from collapsing at mid-stance and to firm the foot during the push-off phase of walking. Excessive strain applied to the long arch of the foot may cause stress within the fascia across its length or may cause a tearing away of the periosteum at the heel bone at the fascia's origin. The inflammation may result in pain along the length of the plantar arch and/or the heel. The pain is usually worse in the morning upon rise and/or after getting up from sitting. It can also manifest as a lingering pain all day and night. Strain of the fascia occurs from excessive lengthening of the long arch of the foot (hyperpronation) during weight bearing activity. Short term treatment includes rest, icing, stretches and exercises. Changing worn out shoes to new, stable footwear may also provide relief. Over the long term, tissue healing may be achieved by supporting and controlling the long arch of the foot with specially adapted orthotics in combination with properly fitted and balanced footwear. Shoes with a rocker sole can often provide additional relief. An orthotic with a cantilever built into the heel is usually recommended for severe cases to further relieve this occasionally very painful condition.
Hallux Abductus Valgus and Bunions
Hallux Abductus Valgus (H.A.V.) is a foot deformity where the 1st toe gradually migrates towards the lateral side of the body i.e. towards the second toe. At the same time, the 1st metatarsal bone migrates into the other direction, causing the forefoot to become wider. In most cases a bunion on the outside of the big toe joint will form as well, but not always. Bunions can also form even if an H.A.V. deformity is not present. This condition can make it difficult to fit footwear and often a wider shoe is required to accommodate the deformity. There is footwear available with stretch panels build right into the toe box to allow a better fit. Existing shoes can be stretched with a bunion stretcher to help improve the shoe fit. Individuals with this condition often have dropped metatarsal- phalangeal joints, and experience pain in particular at the 2nd and 3rd metatarsal phalangeal joint (across the ball of the foot). H.A.V. may be treated with custom-made orthotics and footwear with a rocker sole. The condition may co-exist with foot arthritis where overall joint pain may be experienced.
Runner's knee or Patellar Femoral Syndrome
This condition is characterized by pain deep to the patellar bone (knee cap), and typically occurs with runners and those who walk frequently. Patellar Femoral Syndrome or P.F.S. may be caused by excessive pronation of the feet. Pronation occurs naturally after heel strike of the foot. Due to the inverted position of the heel at heel strike, and the internally rotated position of the leg the foot arch will naturally be released downward (i.e. arch collapse). Because the foot is connected to the leg and hip, with gravity acting on it, the midfoot will change shape and allow the leg to further internally rotate. This creates torsional forces at the knee which result in the knee moving towards the mid-line of the body (valgus). The quadriceps tendon will be forced towards the mid-line of the body together with the patellar bone creating shear forces, which may produce inflammation. By controlling pronation during heel-strike and mid-stance via custom-made orthotics, we can limit the amount of internal rotation and torsion
at the knee. Specialty running shoes that have a straighter last and firmer materials embedded in the mid-sole under the arch area may also help. These running shoes may be referred to as "pronation control" running shoes or runners.
Tibialis Post Tendon dysfunction
This condition is often experienced as pain at the apex of the arch of the foot, behind the ankle and with a tender spot on the inside (medial) of the leg. Individuals with this condition often have a more collapsed arch on the affected foot relative to the other more normal looking foot. The Tibialis Posterior Tendon, or T.P.T. inserts into the navicular bone and middle of the arch bones. It's function is to de-accelerate the drop of the arch (pronation) as the foot is collapsing during mid-stance of the gait cycle. A damaged (subluxed) T.P.T. will not be able to anchor the apex of the arch effectively during this part of the gait cycle, and the foot will roll-in (pronate, collapse) excessively. Sometimes no plantar arch is present at all. This condition may be effectively managed with orthotics, adapted especially for this condition. The navicular bone is often deformed and prominent with this condition and an accommodation has to be built into the orthotics to prevent further soreness at this area. Tibialis Post Tendon dysfunction is often diagnosed as Plantar Fasciitis, due to similar pain locations. Tibialis Posterior Tendon dysfunction may be due to an acquired flat foot, which often occurs in one foot only. Acquired flat feet are often the result of trauma to the foot, or in some cases disease.