Pain is mostly felt at the heel but can also be panful through the arch, this is often described as especially painful on the first step after getting out of bed in the morning. The plantar fascia acts to absorb the ground on landing and also to provide propulsion when pushing off through your toes and can get over-stressed in a number of ways.
Contributing factors are poor footwear, high levels of activity or exercise, being overweight, older age or in people with lower arches or flat feet. Some people may also have a heel spur, which is an indicator for experiencing heel pain and this can be diagnosed on x-ray. Treatment options may include orthotics, rigid strapping, rock taping, dry needling, stretching regimes and making changes to footwear and activities.
The Achilles tendon connects the calf muscle to the back of the heel bone. This tendon can become strained in anyone, from professional athletes to weekend warriors and may become swollen and painful, especially when trying to ‘push off’ when walking or running.
Poor foot and leg alignment, tight calf muscles and improper footwear can all contribute to pain in the Achilles tendon.
Depending on the severity of the problem, treatment can involve stretching and strengthening of the calf muscle, heel raises and/or orthotics – if it is due to any biomechanical abnormalities.
People with flat feet can be more prone to overuse injuries such as plantar fasciitis and Achilles tendonitis due to abnormal biomechanics. However, research has not found that people with flat feet are more likely to be injured than those people without.
Low arches are actually common in babies and young children as part of their usual development but most kids should form their normal arch by around six years of age. Treatment can involved the use of orthotics, strengthening exercises and footwear recommendations.
As the big toe is no longer aligned, this can cause uneven wearing within the joint space which can cause arthritic changes and excessive bony growth to form that can again add to the ‘lump’ appearing larger.
Bunions can reduce the function of the big toe and lead to other issues such as reduced movement in the joint, causing the body to compensate from the bunion rubbing against shoes. Bunions have a link to family history of the deformity, are progressive, more common in females, people with flexible or flat feet and can also be caused by wearing pointed or high heeled shoes. Treatment includes footwear changes, orthotics and strapping.
(Inversion Ankle Injury)
People with high-arched feet sometimes walk more on the outside of the foot and are more likely to have recurrent ankle inversion sprains. Treatment varies depending on how severe the injury is but can include early rest/icing/compression, using crutches or a CAM walker (moon boot), rigid strapping, footwear advice, muscle strengthening and orthotics if it is an ongoing problem.
Tibialis Posterior Tendon Dysfunction:
(Adult Acquired Flat foot)
The ‘tib post’ muscle runs from the inside of the shin, around the inner ankle and attaches to the middle or highest point of the arch. This is a major supporting muscle of the foot and if this muscle is no longer able to support the foot properly it can cause the arch to collapse. In adults, Tibialis Posterior Tendon Dysfunction is often referred to as; Adult acquired flat foot’.
Initially, pain and swelling usually occur around the inside of the ankle and foot and as this progresses the arch will continue to lower and flatten as well as the ankle rolling in. Treatment involves orthotics and strengthening of the effected muscle with a referral to a specialist being required in severe cases.
(Medial Tibial Stress Syndrome)
The exact cause of shin splints is still not fully understood however, they are most likely caused by inflammation of the shin bone and small muscle tears where the shin attaches to the bone (mostly the ‘tib post’ muscle as mentioned above).
Pain is mostly felt along the inside border of the lower shin and is often caused by a sudden increase in activity, high impact sports or exercising on hard surfaces. Other causes of pain in the shin bone include; stress fractures or pain on the outer side of the shin which may be due to compression syndrome caused by excessive muscle swelling.
Both of these are serious and may require a referral to a specialist. Treatments include footwear and orthotics, strapping, dry needling and changes to activity.
(Patellofemoral Pain Syndrome)
Pain is often gradual and felt at the front of the kneecap, within the joint itself or as generalised discomfort when squatting or walking downstairs.
Poor biomechanics such as flat feet or imbalance of the quadriceps muscle are two of the main causes. Knee pain is common in sports that involve jumping, running or squatting and treatment can involve rock-taping, stretching or strengthening exercises and/or orthotics.
This compression of the nerve branch can lead to a burning pain, numbness or tingling, or the feeling as if standing on something inside the shoe or sock. Pain usually comes on gradually and can be diagnosed on clinical assessment with a conclusive diagnosis by ultrasound/MRI.
Treatment options include; changes to footwear, temporary padding and strapping or orthotics designed to offload the specific area. In certain cases, steroid injections or surgery are required.