Footworks Orthotics

Plantar-fasciitis is a seriously annoying, long lasting painful condition of the big ligament that passes along the sole of your foot - It will persist unless the daily cycle of night time healing and repeated damage through daily walking is interrupted.
Classically this is caused by tightness/rigidity of the Achilles/plantar-fascia complex and is massively exacerbated by rolling or flat foot posture.  This condition rarely occurs in athletic individuals with loose, supple or well toned legs.
The plantar-fascia connects the bottom of your heel bone to the front of your foot, your Achilles tendon attaches directly into the opposite surface of your heel bone and directly affects the state of the plantar-fascia- hence why I’ll keep going on about Achilles and calf tightness.

Untreated this condition will rarely resolve itself within 9 months - Sometimes lasting for years.

I have tried to list the main options for you to consider.  Basically you need to do as many of these things as often and as regularly as possible - bear in mind that if you do nothing it’s  not likely to go away by itself.

Orthotic Insoles
Wear insoles - always - as it aids the control of the movement of your feet through the day, protecting your feet from excessive shearing and stretching movement on the plantar-fascia.  An incorporated slight heel raise also benefits by further reducing the tension of your calves.

Stretching
Stretch your legs, especially your calves and hamstrings every morning before walking and regularly through the day (to try to get some extra length in your calves and Achilles) - While we sleep our muscles and ligaments shorten and the foot is pulled into a relaxed posture with the toes pointing down - this period of rest allows the body to try to heal the affected area and it does this by laying down scar tissue that, is put under too much tension when we force our feet into a 90 degree position as we haul ourselves out of bed in the morning thus causing the newly formed scar tissue to tear/rip away causing extreme pain.  This pain lasts for only the first few steps and soon subsides as we continue to walk.  Passive stretching prepares our muscles and the fascia for the onslaught ahead.  Contact your P.T. for advice about dynamic stretching to maximise the effect of  your stretches.

See http://www.grangephysio.com/exercises for walk through stretching guides.

Massage
Book yourself in for a sports massage twice a week initially to help reduce the stiffness and rigidity in your legs and feet.  Tightness in muscles and the resulting reductions in ranges of movement in your joints transfers huge tension to the plantar-fascia compounding the problem.  A good massage will hurt and find muscles you thought you never had.  We look after our cars better than we look after our bodies - keep up a regular monthly massage to keep supple.

Don’t forget to drink lots of water after your massage.

Therapeutic Ultrasound

High frequency vibrations focused on the affected area helps by gently breaking down the scar tissue that untreated can delay healing.

Contact you Physiotherapist for advice on this treatment.

Shoes
Avoid very flat low heeled shoes and flip-flops as the low heel forces the achilles and plantar-fascia to be under increased tension.  Avoid walking barefoot - always wear slippers around the house with a good heel.  Wear day shoes with a slightly more than average heel height to reduce the tension in your achilles.  Try fit - flops (girls) or MBT shoes for improved cushioning at heel and smooth roll over the toes.

Look for soles with cushioned heels as hard soles create jarring and heel pain.  Try Fit-flops as an alternative to flip-flops.

Night time stretches
There are a variety of devices that you can wear to keep your feet in a stretched position through the night.  They unfortunately look like snowboarding boots with the front missing, but they work very effectively to hold your foot in a stretched toes up position, keeping the plantar-fascia in tension, allowing it to heal in a way that is less inclined to tear when you stand on your feet.

Contact me directly if you think that this may benefit you.

Exercise
Don’t bother exercising unless you have warmed up and stretched really well before hand.  Swimming is Ok as you swim with your toes pointing down, but take care stepping out of the pool - take time to sit on the side and do a few passive stretches before walking.

Remember to stretch after exercise.

Other options:
Cortizone injection to reduce the acute inflammation (really painful injection but normally takes pain away for 3-4 months)

Rest
If you can afford to lie on your back and let the kids do all your work then your feet will heal beautifully in about 8 weeks and you will forget how horrendously painful this awful condition is!

I suffer intermittently from a strong nerve pain in the middle toe of my left foot.  Do you think you could be of help to me in this.
Thank you,

Hi

This sounds like a Morton’s Neuroma.

Classically this is an extremely severe shooting nerve pain stimulated by squeezing up from the base of your foot in the space between between the 2nd and 3rd or 3rd and 4th toes quite close to the ball of your foot.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage. The nerve gets squeezed by the adjacent bones during walking, creating astonishing levels of pain and is, unfortunately, quite common.

In the clinic, a positive indication to a Morton’s Neuroma is that I have to scrape you off the ceiling after doing this!

What Causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities - bunions, hammer toes or v.flat feet are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.

Treatment
1st option
Icepack to reduce swelling and inflammation  -  avoid narrow fronted shoes  -  change your activity to stop the over-loading at your toes

2nd
Orthotics -  often highly successful
Insoles to spread the transverse arch (across ball of foot) creating as much space as possible between the bones of your foot where the restriction or crimping has occurred and reduce the mechanical trigger.
Improving the bio-mechanics of your gait keeps your foot in the best position during walking -controlling the trigger and allowing the nerve inflamation to subside
Ensure shoes are wide at the fore-foot and do not squeeze and restrict the ball of your foot.  It may be worth having them stretched slightly to give more space - NB trainers/running shoes are normally very wide over the forepart.

3rd
cortizone injection to reduce swelling and inflammation

4th - and normally the very last option!
Surgery to chop out a chronically damaged nerve

hope this helps

“I’ve started running on the treadmill at my gym recently and am finding that a lot of skin is peeling from the soles of my feet. This has now become pretty painful and is upsetting my exercise regime.
What can I do to stop this?”

There are basically 2 reasons for this but normally it’s a combination  of both.

Fungal infection- athletes foot loves warm sweaty environments  causing softening of the skin and peeling. This is typically more
irritating than annoying and easily treated with non prescription  creams.

Skin shear- normally causes hard skin or blisters and is not normally  problematic but can, when severe or combined with a moist environment   result in large slabs of skin separating from the bottom surface  of the foot normally at the heel or under the ball of the foot,  especially the big toe. This can be seriously painful as the exposed skin/tissue is extremely raw.

Skin shear and hard skin / callus development is a sign that foot  movement is excessive and that the foot pressures are unusual.  Good fitted Orthotic insoles will resolve this.

Check shoe fit, look for skin peeling between the toes.  Change socks  regularly to keep feet dry.

Contact me if you would like an appt to discuss  further.

David wrote:
“I have orthotic insoles that were made for me about 3 years ago.  They are hard
orthotics.  I have now started getting knee pain, lower back pain,inner thigh
tightness and calf tightness.  What do I do?”

Reply:
Sounds nasty!

What you describe sounds postural as opposed to muscular.  Ie muscular problems you can normally stretch out or get physio to improve specific muscle group function.  Postural variances tend to be caused by joint mal-alignment and includes multiple joints as you describe, but unfortunately you frequently see a blend of both situations.

There are probably only 2 options to consider

1.Your feet have changed (worsened) and your insoles do not fit you or give you the same support they once did.

2.You don’t actually need insoles and they are proving counter productive and are affecting other parts of your body

I suspect by the description of your symptoms that it is the former.
Typically, excessive flattening of the foot (pronation)  causes internal rotation of the knee which in turn internally rotates the hip causing an anterior tilt of the pelvis, obviously more dramatic if both feet do the same thing.

Rigid orthoses can cause quite a severe change to your gait and posture.  They work in the same way as softer ones but apply a much greater correction to your feet.  It may be worth sourcing some semi-rigid ones that work dynamically with your feet, providing a more balanced gait by not restricting the natural movement of your feet.

NB - calf tightness is an occupational hazard of growing older, keep up hamstring, gastroc and soleus stretches before and after activity to keep tightness at bay.

Hope this helps

“I have Morton’s Neuroma and need advice on how I can live with it  comfortably. I had  a cortisone injection in November, it relieved the acute pain but I still have noticeable discomfort.  Is there anything that can help minimise the pain?”

A Morton’s Neuroma is a really irritating problem that typically causes extremely severe pain in the web space between either the 2nd and 3rd or 3rd and 4th toes.

The Neuroma or enlarged nerve becomes compressed during walking giving rise to surprisingly high levels of localised pain.  The Jury is still out in determining the cause of nerve inflammation, but flat-foot posture or wearing higher heeled shoes can exacerbate this problem by decreasing the space between the bones or metatarsals and squeezing on the nerve.

Resolving this issue is complex and needs to be tackled on many fronts.

• Shoes - avoid higher heeled shoes or ones with thin bendy soles that do not protect the feet.
• Insoles do help by correcting any unwanted deviations of the foot that may cause  compaction of the fore-foot and by elevating the transverse arch (across your forefoot from side to side) allowing the bones of your foot to spread apart and bring a gasp of relief to the troubled nerve.
• as Expected - Rest and relief to allow the nerve inflammation to reduce.