Over-Pronation Of The Feet What Are The Causes
Overview
Overpronation is when there is excessive rotation beyond the optimum level, more specifically involving more than 15 degrees of difference in angle between the plane of the foot and the plane of the leg. It is often linked with flat feet, fallen arches and collapsed arches. When the arches are high, there is not usually sufficient pronation. This is called underpronation or supination.
Causes
For those not familiar with the term pronation, you might be familiar with terms related to shoes and pronation such as ?motion control?, ?stability,? and ?neutral cushioned.? The terms motion control and stability are typically associated with the word ?over-pronation? or a foot that is supposedly pronating too much and needs correction. According to the running shoe industry, ?over-pronation? is a biomechanical affliction evident when the foot and or ankle rolls inward past the vertical line created by your leg when standing.
Symptoms
Common conditions that develop with prolonged overpronation typically include plantar fasciitis, achilles tendonitis, shin splints, posterior tibial stress syndrome and even IT band syndrome. With long term neglect you may see the development of bunyons, foot deformities and early onset of hip and knee arthritis.
Diagnosis
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).
Non Surgical Treatment
Side Step with Opposite Reach. This exercise is designed to load the "bungee cord system" of the gluteal muscle and its opposite, latissimus dorsi muscle to keep the foot from overpronating. Because the opposite arm swings across the front leg when walking, this exercise creates tension in the muscles all the way from the front foot, across the back of the hips and back, to the fingers of the opposite hand. Movement Directions. Stand with left foot on top of the dome of the BT. (Note: For added balance, the right foot can tap on the ground, if needed). Reach right leg out to the side of the BT, and tap the ground while squatting down on the left side and reaching right arm across the left knee. Push down with left big toe while squatting. This activates the arch of the left foot and strengthens all the stabilizing muscles on the left side of the lower body. Return to starting position. Perform 8 to 10 repetitions on each leg.
Surgical Treatment
Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.
An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.
Overpronation is when there is excessive rotation beyond the optimum level, more specifically involving more than 15 degrees of difference in angle between the plane of the foot and the plane of the leg. It is often linked with flat feet, fallen arches and collapsed arches. When the arches are high, there is not usually sufficient pronation. This is called underpronation or supination.
Causes
For those not familiar with the term pronation, you might be familiar with terms related to shoes and pronation such as ?motion control?, ?stability,? and ?neutral cushioned.? The terms motion control and stability are typically associated with the word ?over-pronation? or a foot that is supposedly pronating too much and needs correction. According to the running shoe industry, ?over-pronation? is a biomechanical affliction evident when the foot and or ankle rolls inward past the vertical line created by your leg when standing.
Symptoms
Common conditions that develop with prolonged overpronation typically include plantar fasciitis, achilles tendonitis, shin splints, posterior tibial stress syndrome and even IT band syndrome. With long term neglect you may see the development of bunyons, foot deformities and early onset of hip and knee arthritis.
Diagnosis
One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space where your arch did not touch the ground).
Non Surgical Treatment
Side Step with Opposite Reach. This exercise is designed to load the "bungee cord system" of the gluteal muscle and its opposite, latissimus dorsi muscle to keep the foot from overpronating. Because the opposite arm swings across the front leg when walking, this exercise creates tension in the muscles all the way from the front foot, across the back of the hips and back, to the fingers of the opposite hand. Movement Directions. Stand with left foot on top of the dome of the BT. (Note: For added balance, the right foot can tap on the ground, if needed). Reach right leg out to the side of the BT, and tap the ground while squatting down on the left side and reaching right arm across the left knee. Push down with left big toe while squatting. This activates the arch of the left foot and strengthens all the stabilizing muscles on the left side of the lower body. Return to starting position. Perform 8 to 10 repetitions on each leg.
Surgical Treatment
Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.
An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.
Physical Rehabilitation And Severs Disease
Overview
This is a condition that is quite often misdiagnosed as growing pains this generally affects boys more than it may affects girls, especially between the ages of 9 and 15. This is a common disease in children that play the following sports. Soccer. Football. Basketball. Hockey. However it is not limited just to these sports, nor is it simply a pre-season type condition related to fitness. Sever?s Disease is common and although it does not sound good there is no need to panic as it is not something you can catch or incurable. Children have a growth plate in the heel bone, which at puberty becomes solid and forms part of the heel, prior to puberty this can cause pain especially if the child?s foot rolls inwards or outwards too much, this can cause increased stress on this growth plate and therefore causes pain.
Causes
One of the most common causes of heel pain in adolescents, Sever's disease is an overuse injury to the growth plate of the calcaneus (heel). It is commonly seen in growing, active children 8-12 years of age. Soccer players, gymnasts, and children who do any sort of running or jumping activity have an increased risk of developing Sever's disease. Occurring in one or both feet, Sever?s disease occurs at the back of the heel (also known as the apophysis or the insertion of the Achilles tendon).
Symptoms
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next morning after sport.
Diagnosis
Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever's disease these x-rays are usually normal. Advanced Sever's disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI's, are not usually required in typical cases of Sever's disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic Severs disease.
Non Surgical Treatment
First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 20 minutes 3 times a day. If your child has a high arch, flat feet or bowed legs, your doctor may recommend orthotics, arch supports or heel cups. Your child should never go barefoot. If your child has severe heel pain, medicines such as acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names. Advil, Motrin, Nuprin) may help.
This is a condition that is quite often misdiagnosed as growing pains this generally affects boys more than it may affects girls, especially between the ages of 9 and 15. This is a common disease in children that play the following sports. Soccer. Football. Basketball. Hockey. However it is not limited just to these sports, nor is it simply a pre-season type condition related to fitness. Sever?s Disease is common and although it does not sound good there is no need to panic as it is not something you can catch or incurable. Children have a growth plate in the heel bone, which at puberty becomes solid and forms part of the heel, prior to puberty this can cause pain especially if the child?s foot rolls inwards or outwards too much, this can cause increased stress on this growth plate and therefore causes pain.
Causes
One of the most common causes of heel pain in adolescents, Sever's disease is an overuse injury to the growth plate of the calcaneus (heel). It is commonly seen in growing, active children 8-12 years of age. Soccer players, gymnasts, and children who do any sort of running or jumping activity have an increased risk of developing Sever's disease. Occurring in one or both feet, Sever?s disease occurs at the back of the heel (also known as the apophysis or the insertion of the Achilles tendon).
Symptoms
Children aged between 8 to 13 years of age can experience Sever?s disease with girls being normally younger and boys slightly older. Sever?s disease normally involves the back of the heel bone becoming painful towards the end of intense or prolonged activity and can remain painful after the activity for a few hours. Severe cases can result in limping and pain that can even remain the next morning after sport.
Diagnosis
Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever's disease these x-rays are usually normal. Advanced Sever's disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI's, are not usually required in typical cases of Sever's disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic Severs disease.
Non Surgical Treatment
First, your child should cut down or stop any activity that causes heel pain. Apply ice to the injured heel for 20 minutes 3 times a day. If your child has a high arch, flat feet or bowed legs, your doctor may recommend orthotics, arch supports or heel cups. Your child should never go barefoot. If your child has severe heel pain, medicines such as acetaminophen (one brand name: Tylenol) or ibuprofen (some brand names. Advil, Motrin, Nuprin) may help.
Will Posterior Tibial Tendon Dysfunction Always Need To Have Surgical Teatments ?
Overview
Posterior tibial tendon insufficiency (also called posterior tibial tendon dysfunction or adult acquired flatfoot) has been named literally after failure of the posterior tibial tendon. However, the condition is caused not only by the progressive failure of the posterior tibial tendon; it is also failure of associated ligaments and joints on the inner side of the ankle and foot. This results in collapse of the arch of the foot, along with the deformity which most often becomes the debilitating problem in its later stages. While at the beginning the common symptom is pain over the tendon in the inner part of the hindfoot and midfoot, later on it is the deformity that can threaten a person?s ability to walk. Just as the tendon degenerates and loses its function, other soft tissue on the same inner side of the foot - namely the ligaments - degenerate and fail. Ligaments are responsible for holding bones in place, and when they fail, bones shift to places where they shouldn?t; deformity is the result. The deformity causes malalignment, leading to more stress and failure of the ligaments. 
Causes
The cause of posterior tibial tendon insufficiency is not completely understood. The condition commonly does not start from one acute trauma but is a process of gradual degeneration of the soft tissues supporting the medial (inner) side of the foot. It is most often associated with a foot that started out somewhat flat or pronated (rolled inward). This type of foot places more stress on the medial soft tissue structures, which include the posterior tibial tendon and ligaments on the inner side of the foot. Children nearly fully grown can end up with flat feet, the majority of which are no problem. However, if the deformity is severe enough it can cause significant functional limitations at that age and later on if soft tissue failure occurs. Also, young adults with normally aligned feet can acutely injure their posterior tibial tendon from a trauma and not develop deformity. The degenerative condition in patients beyond their twenties is different from the acute injuries in young patients or adolescent deformities, where progression of deformity is likely to occur.
Symptoms
Symptoms are minor and may go unnoticed, Pain dominates, rather than deformity. Minor swelling may be visible along the course of the tendon. Pain and swelling along the course of the tendon. Visible decrease in arch height. Aduction of the forefoot on rearfoot. Subluxed tali and navicular joints. Deformation at this point is still flexible. Considerable deformity and weakness. Significant pain. Arthritic changes in the tarsal joints. Deformation at this point is rigid.
Diagnosis
In the early stages of dysfunction of the posterior tibial tendon, most of the discomfort is located medially along the course of the tendon and the patient reports fatigue and aching on the plantar-medial aspect of the foot and ankle. Swelling is common if the dysfunction is associated with tenosynovitis. As dysfunction of the tendon progresses, maximum pain occurs laterally in the sinus tarsi because of impingement of the fibula against the calcaneus. With increasing deformity, patients report that the shape of the foot changes and that it becomes increasingly difficult to wear shoes. Many patients no longer report pain in the medial part of the foot and ankle after a complete rupture of the posterior tibial tendon has occurred; instead, the pain is located laterally. If a fixed deformity has not occurred, the patient may report that standing or walking with the hindfoot slightly inverted alleviates the lateral impingement and relieves the pain in the lateral part of the foot.
Non surgical Treatment
Get treated early. There is no recommended home treatment. While in stage one of the deformity, rest, a cast, and anti-inflammatory therapy can help you find relief. This treatment is followed by creating custom-molded foot orthoses and orthopedic footwear. These customized items are critical in maintaining the stability of the foot and ankle. Once the tendon has stretched and deformity is visible, the chances of success for non-surgical treatment are significantly lower. In a small percentage of patients, total immobilization may arrest the progression of the deformity. A long-term brace known as an ankle foot orthosis is required to keep the deformity from progressing. The Richie Brace, a type of ankle foot orthosis, shows significant success as a treatment for stage two posterior tibial dysfunction. It is a sport-style brace connected to a custom corrected foot orthodic that fits into most lace-up footwear (including athletic shoes). It is also light weight and more cosmetically appealing than traditionally prescribed ankle foot orthosis. The Arizona Brace, California Brace or Gauntlet Brace may also be recommended depending on your needs. 
Surgical Treatment
Although non-surgical treatments can successfully manage the symptoms, they do not correct the underlying problem. It can require a life-long commitment to wearing the brace during periods of increased pain or activity demands. This will lead a majority of patients to choose surgical correction of the deformity, through Reconstructive Surgery. All of the considerations that were extremely important during the evaluation stage become even more important when creating a surgical plan. Generally, a combination of procedures are utilized in the same setting, to allow full correction of the deformity. Many times, this can be performed as a same-day surgery, without need for an overnight hospital stay. However, one or two day hospital admissions can be utilized to help manage the post-operative pain. Although the recovery process can require a significant investment of time, the subsequent decades of improved function and activity level, as well as decreased pain, leads to a substantial return on your investment.
Pain In The Arch Of Foot What Could It Be
Overview
The elastic covering on the sole of the foot--the plantar fascia--runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch. The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while. Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.
Causes
The cause of this condition is too much pressure exerted on the arches, and although common in athletes, the condition can happen because you went hiking or climbing, you were lifting heavy objects, or you simply walked too far too vigorously. Pregnancy places extra strain on the arches because of both the additional body weight and the effect of hormones on muscles and ligaments.
Symptoms
Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.
Diagnosis
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch. An area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle.
Non Surgical Treatment
There is considerable debate about the best treatment option for plantar fasciitis. Some authors suggest all of the 'mainstream' methods of treatment don't actually help at all and can actually make the symptoms worse. However, on the whole, there are several of the most commonly cited treatment options for plantar fasciitis and these are generally accepted throughout the medical community. I would recommend giving these options a try if you haven't already. Rest. This is mainly applicable to the sports people as rest is possible treatment. (For those who cannot rest e.g. people who work on their feet - skip to the other treatment options below). Rest until it is not painful. This is made more difficult as people need to use their feet to perform daily activities but certainly stop sporting activities that are likely to be putting the fascia under excessive stress. Perform Self Micro-Massage (you can watch this video by clicking the link or scrolling further down the page as it's embedded on this lens!) This massage technique is used to break down fibrous tissue and also to stimulate blood flow to the area, both of which encourage healing and reduce pain. There is also a potentially soothing effect on nerve endings which will contribute to pain relief. Ice/Cold Therapy. Particularly useful after spending periods on your feet to reduce the inflammation. Wrap some ice or a bag of frozen peas in a towel and hold against the foot for up to 10 minutes. Repeat until symptoms have resolved. Heat Therapy. Heat therapy can be used (not after activity) to improve blood flow to the area to encourage healing. A heat pack of hot water bottle can be used. 10 minutes is ideal. Careful not to burn yourself. A good taping technique. By taping the foot in a certain way you can limit the movement in the foot and prevent the fascia from over-stretching and gives it a chance to rest and heal. Click on the link for more information on taping techniques. Weight Management. If you are over-weight, any weight you can loose will help to ease the burden on your sore feet and plantar fascia. Orthotic devices (often mis-spelled orthodic) are special insoles that can be used to limit over-pronation (discussed earlier) and control foot function. By preventing the arches flattening excessively, the plantar fascia is not over-stretched to the same extent and this should help with the symptoms and encourage healing. Stretching the calf muscles (again, click this link or scroll to the bottom of the page to watch the embedded video) can help to lengthen these muscles and the Achilles tendon - a risk factor for plantar fasciitis. Stretching of the plantar fascia itself is also encouraged, particularly before getting up the morning (night splints can be used for this effect) and after periods of rest. This can be achieved by placing a towel or band under the ball of the foot and gently pulling upwards until a stretch is felt. Hold for about 15-20 seconds then rest briefly. Repeat 2-3 times. As you can see there are many different treatment options available. Try incorporating some of these in to your daily routine and see what works for you. Regardless of the method the main aim is to prevent the fascia from over-stretching. Medical professionals such as a Podiatrist may decide to make custom orthotics or try ultra-sound therapy. It is likely that anti-inflammatory medications will also be recommended. If you have tried the treatment options and your symptoms persist I'd recommend going to see a medical professional for further advice.
Surgical Treatment
In adults, the most common cause of collapse is due to the posterior tibial tendon tear. In such cases, the tendon must be repaired and a second tendon may be added to the posterior tibial tendon for strength and added support. If the foot is found to be very flat, bone realignment procedures or possible bone fusion procedures may be used to realign the foot. If the calf or Achilles tendon are found to be tight, they may be lengthened to allow better motion at the ankle and less arch strain. The forefoot may also be in a poor position and stabilization of the arch may be necessary to increase forefoot contact to the ground.
Prevention
Warm up properly. This means not only stretching prior to a given athletic event, but a gradual rather than sudden increase in volume and intensity over the course of the training season. A frequent cause of plantar fasciitis is a sudden increase of activity without suitable preparation. Avoid activities that cause pain. Running on steep terrain, excessively hard or soft ground, etc can cause unnatural biomechanical strain to the foot, resulting in pain. This is generally a sign of stress leading to injury and should be curtailed or discontinued. Shoes, arch support. Athletic demands placed on the feet, particularly during running events, are extreme. Injury results when supportive structures in the foot have been taxed beyond their recovery capacity. Full support of the feet in well-fitting footwear reduces the likelihood of injury. Rest and rehabilitation. Probably the most important curative therapy for cases of plantar fasciitis is thorough rest. The injured athlete must be prepared to wait out the necessary healing phase, avoiding temptation to return prematurely to athletic activity.
Stretching Exercises
Massage therapy is a great way to loosen muscles and help improve mobility in in your feet. As many people with foot pain have discovered, tight muscles in your legs or back can lead to tense foot muscles. All those muscles are connected, so tension in your back can cause tension in your legs which can pull the tendons in your feet and cause stiffness and pain. Getting acupuncture or a professional full body massage are probably the best ways to deal with this, but there are also some simple tricks you can do at home to help keep muscles limber. These are great for loosening up and improving circulation, both before and after exercise. Place a tennis ball under the arch of your bare foot and roll it around, stretching the muscles in your foot and promoting blood flow. You can also roll the ball under your calves and upper legs to work out stiffness and knots. If you feel the tennis ball is too easy, try a lacrosse ball for deeper massaging. This is also demonstrated in the exercise video above. Use a foam roller, those big overpriced rolls of foam that are now available in every department and sporting goods store are fantastic for self-massage (why a roll of foam costs $30 is beyond us, but they do work wonders-our advice is to not waste money on the more expensive fancy grooved ones because even the simplest rollers work great). The exercises you can do with foam rollers seem to be endless, and there are literally hundreds of free videos online showing how to use them to massage every part of your body. Here's one we picked out that specifically targets foot and leg muscles related to arches and plantar fasciitis.
The elastic covering on the sole of the foot--the plantar fascia--runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch. The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while. Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.
Causes
The cause of this condition is too much pressure exerted on the arches, and although common in athletes, the condition can happen because you went hiking or climbing, you were lifting heavy objects, or you simply walked too far too vigorously. Pregnancy places extra strain on the arches because of both the additional body weight and the effect of hormones on muscles and ligaments.
Symptoms
Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.
Diagnosis
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch. An area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle.
Non Surgical Treatment
There is considerable debate about the best treatment option for plantar fasciitis. Some authors suggest all of the 'mainstream' methods of treatment don't actually help at all and can actually make the symptoms worse. However, on the whole, there are several of the most commonly cited treatment options for plantar fasciitis and these are generally accepted throughout the medical community. I would recommend giving these options a try if you haven't already. Rest. This is mainly applicable to the sports people as rest is possible treatment. (For those who cannot rest e.g. people who work on their feet - skip to the other treatment options below). Rest until it is not painful. This is made more difficult as people need to use their feet to perform daily activities but certainly stop sporting activities that are likely to be putting the fascia under excessive stress. Perform Self Micro-Massage (you can watch this video by clicking the link or scrolling further down the page as it's embedded on this lens!) This massage technique is used to break down fibrous tissue and also to stimulate blood flow to the area, both of which encourage healing and reduce pain. There is also a potentially soothing effect on nerve endings which will contribute to pain relief. Ice/Cold Therapy. Particularly useful after spending periods on your feet to reduce the inflammation. Wrap some ice or a bag of frozen peas in a towel and hold against the foot for up to 10 minutes. Repeat until symptoms have resolved. Heat Therapy. Heat therapy can be used (not after activity) to improve blood flow to the area to encourage healing. A heat pack of hot water bottle can be used. 10 minutes is ideal. Careful not to burn yourself. A good taping technique. By taping the foot in a certain way you can limit the movement in the foot and prevent the fascia from over-stretching and gives it a chance to rest and heal. Click on the link for more information on taping techniques. Weight Management. If you are over-weight, any weight you can loose will help to ease the burden on your sore feet and plantar fascia. Orthotic devices (often mis-spelled orthodic) are special insoles that can be used to limit over-pronation (discussed earlier) and control foot function. By preventing the arches flattening excessively, the plantar fascia is not over-stretched to the same extent and this should help with the symptoms and encourage healing. Stretching the calf muscles (again, click this link or scroll to the bottom of the page to watch the embedded video) can help to lengthen these muscles and the Achilles tendon - a risk factor for plantar fasciitis. Stretching of the plantar fascia itself is also encouraged, particularly before getting up the morning (night splints can be used for this effect) and after periods of rest. This can be achieved by placing a towel or band under the ball of the foot and gently pulling upwards until a stretch is felt. Hold for about 15-20 seconds then rest briefly. Repeat 2-3 times. As you can see there are many different treatment options available. Try incorporating some of these in to your daily routine and see what works for you. Regardless of the method the main aim is to prevent the fascia from over-stretching. Medical professionals such as a Podiatrist may decide to make custom orthotics or try ultra-sound therapy. It is likely that anti-inflammatory medications will also be recommended. If you have tried the treatment options and your symptoms persist I'd recommend going to see a medical professional for further advice.
Surgical Treatment
In adults, the most common cause of collapse is due to the posterior tibial tendon tear. In such cases, the tendon must be repaired and a second tendon may be added to the posterior tibial tendon for strength and added support. If the foot is found to be very flat, bone realignment procedures or possible bone fusion procedures may be used to realign the foot. If the calf or Achilles tendon are found to be tight, they may be lengthened to allow better motion at the ankle and less arch strain. The forefoot may also be in a poor position and stabilization of the arch may be necessary to increase forefoot contact to the ground.
Prevention
Warm up properly. This means not only stretching prior to a given athletic event, but a gradual rather than sudden increase in volume and intensity over the course of the training season. A frequent cause of plantar fasciitis is a sudden increase of activity without suitable preparation. Avoid activities that cause pain. Running on steep terrain, excessively hard or soft ground, etc can cause unnatural biomechanical strain to the foot, resulting in pain. This is generally a sign of stress leading to injury and should be curtailed or discontinued. Shoes, arch support. Athletic demands placed on the feet, particularly during running events, are extreme. Injury results when supportive structures in the foot have been taxed beyond their recovery capacity. Full support of the feet in well-fitting footwear reduces the likelihood of injury. Rest and rehabilitation. Probably the most important curative therapy for cases of plantar fasciitis is thorough rest. The injured athlete must be prepared to wait out the necessary healing phase, avoiding temptation to return prematurely to athletic activity.
Stretching Exercises
Massage therapy is a great way to loosen muscles and help improve mobility in in your feet. As many people with foot pain have discovered, tight muscles in your legs or back can lead to tense foot muscles. All those muscles are connected, so tension in your back can cause tension in your legs which can pull the tendons in your feet and cause stiffness and pain. Getting acupuncture or a professional full body massage are probably the best ways to deal with this, but there are also some simple tricks you can do at home to help keep muscles limber. These are great for loosening up and improving circulation, both before and after exercise. Place a tennis ball under the arch of your bare foot and roll it around, stretching the muscles in your foot and promoting blood flow. You can also roll the ball under your calves and upper legs to work out stiffness and knots. If you feel the tennis ball is too easy, try a lacrosse ball for deeper massaging. This is also demonstrated in the exercise video above. Use a foam roller, those big overpriced rolls of foam that are now available in every department and sporting goods store are fantastic for self-massage (why a roll of foam costs $30 is beyond us, but they do work wonders-our advice is to not waste money on the more expensive fancy grooved ones because even the simplest rollers work great). The exercises you can do with foam rollers seem to be endless, and there are literally hundreds of free videos online showing how to use them to massage every part of your body. Here's one we picked out that specifically targets foot and leg muscles related to arches and plantar fasciitis.
