Plantar Fasciitis (heel pain)
The plantar fascia is a dense band of fibrous tissue that originates at the heel and connects to the base of the toes. It stretches and contracts each time the foot is used, and is prone to overuse especially if the arch is not supported by proper footwear. As the fascia micro-tears at its attachment to the heel, it can cause heel spurs, or small areas of calcification at the heel. Effective treatment should include arch support with custom orthotics or off-the-shelf inserts. Other treatment includes stretching the gastrocnemius complex, icing, anti-inflammatory medications, ultrasound, taping methods, night splints and massage.
Metatarsalgia and Neuromas
Interdigital neuromas are the most common referring diagnosis. Nerves between the toes become compressed and inflamed; typically occurring in the 3rd web space but also common in the 2nd web space (Morton’s neuromas). Neuromas can develop secondary to adjacent joint inflammation (ex: sesamoiditis or hallux limitus). Pain is often described as tingling, numbness or shooting pain. Treatment includes metatarsal pads (met cookies) or metatarsal bars incorporated into a custom orthotic with ample arch support, and wider shoes. Metatarsalgia is a generic term referring to forefoot pain which may or may not be caused by a neuroma. The treatment for Metatarsalgia is generally the same style foot orthotics.
IT Band Pain and Other Knee Pain
Pain in the knees can be due to excessive pronation or supination, excess weight, running on an incline, arthritis, prior surgery, overuse, or other reasons. For a cyclist, faulty cleat position, overuse or improper bike fit can cause knee pain. Custom orthotics will help hold the foot in a neutral, supported position which decreases internal rotation of the lower leg thus reducing forces on the knees. IT Band (Iliotibial band) pain is generally caused by excessive rotation of the tibia as a result of excessive pronation. Custom foot orthotics helps control this motion thus reducing discomfort.
Shin splints present as pain along the tibia (shin) which gradually develops over weeks. The medical term for shin splints is periostitis. This means there is inflammation in the Periosteum, a dense membrane composed of fibrous connective tissue that closely wraps the bone. Predisposing factors include training errors, anatomic variations, poor running technique, or poor equipment. A weak or tight Achilles tendon may be involved, as they are the muscles responsible for lifting up the foot. A custom foot orthotic to support the foot and prevent over pronation, along with supportive, shock absorbing shoes are recommended. Treatment also involves rest, ice, stretching and massage.
General arch pain may have a variety of causes including Plantar Fascia strain, midtarsal stress from lack of joint mobility in the ankle or arthritic conditions. Custom foot orthotics effectively treat general arch pain by minimizing motion in the midtarsal joint and supports the arch.
Hip pain can be associated with a leg length difference, hip surgery, tight or strained muscles, arthritis, degenerative joint disease, poor posture or a variety of other causes. If upon evaluation, a leg length difference of ¼” or more is believed to be a cause for this pain, a heel lift can be incorporated into a custom orthotic or may be placed under the foot in the shoe. Leg length difference in excess of ¾” will require a build-up made to the outside of the shoe.
Lower Back Pain
Pain in the lower back can be associated with a leg length difference, excess weight, weak abdominal muscles, tight hamstring muscles, poor posture, arthritis, pinched nerves, injury, herniated discs, or a variety of other conditions. Custom foot orthotics can help ease lower back pain if the pain is associated with poor posture, pronated feet, and/or a leg length discrepancy. Once the feet are supported and aligned properly by a custom orthotic, lower back pain will often disappear.