The arch of the foot is made from a complex series of bones tendons and ligaments. According to podiatric practice there is only one important arch of the foot on the medial side. The height of the arch varies and having a flat foot or high arched foot is inherited. The arch acts to dissipate forces and store energy within the foot. Most young children have flat feet and this is because the arch has fatty tissue overlying it. Normally an arch appears after the age of 5-6 years. Even if you remain flat footed this might be normal for you and your family. Just because the arch is low does not mean that any treatment is required. Many world class athletes have flat feet. If the arch is painful or the arch of one foot suddenly drops then investigation and treatment may be required. The arch might drop acutely due to a tear in a tendon or the movement of a bone within the arch. A scan and X Ray may be indicated and treatment ranging from insoles to surgery may be required. If you have a high arched foot this is likely to have been inherited. In extreme form this can cause pain in the ball of the foot and is often associated with a tight Achilles tendon and a tendency to walk on the outside of your foot. In most people there are no symptoms and in others there may pain along the arch and pain on the outside of your ankle. Both these foot types are often mild and require no treatment, but if symptoms occur a full bio-mechanical examination will often reveal a mechanical cause to your pain. Often the treatment may be simple stretches and orthoses.
The most common acquired flat foot in adults is due to Posterior Tibial Tendon Dysfunction. This develops with repetitive stress on the main supporting tendon of the arch over a long period of time. As the body ages, ligaments and muscles can weaken, leaving the job of supporting the arch all to this tendon. The tendon cannot hold all the weight for long, and it gradually gives out, leading to a progressively lower arch. This form of flat foot is often accompanied by pain radiating behind the ankle, consistent with the course of the posterior tibial tendon. Compounding matters is the fact that the human foot was not originally designed to withstand the types of terrain and forces it is subjected to today. Nowhere in nature do you see the flat hard surfaces that we so commonly walk on in present times. Walking on this type of surface continuously puts unnatural stress on the arch. The fact that the average American is overweight does not help the arch much either-obesity is a leading cause of flat feet as the arch collapses under the excessive bodyweight. Furthermore, the average life span has increased dramatically in the last century, meaning that not only does the arch deal with heavy weight on hard flat ground, but also must now do so for longer periods of time. These are all reasons to take extra care of our feet now in order to prevent problems later.
Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. The condition is diagnosed with the classic symptoms of pain well focused deep in the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking. Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. It is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
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.
Cavus foot is caused in part by an over-pull of one of the lateral ankle muscles. A release of this tendon can be performed on the outside of the ankle. Additionally, a transfer of this tendon can be performed to help in correcting deformity of the ankle joint. Often patients will have a tightness of their gastrocnemius muscle, one of the main muscles in the calf. This can increase the deformity or prevent a correction from working. It is addressed with a lengthening of a part of the calf muscle or Achilles tendon. This is often performed through one or more small cuts in the back of the leg or ankle. Finally, the plantar fascia may be tight. The plantar fascia is a cord-like structure that runs from the heel to the front part of the foot. Partial or complete plantar fascia release may be done.
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.
Plantar Fasciitis stretches can be incorporated into a comprehensive treatment regime which may involve: ice, heel wedge support, taping, massage, muscle strengthening, orthotic inserts for shoes, topical anti inflammatory gel or oral medication and/or corticosteroid injections. If you suspect you may have Plantar Fasciitis seek accurate diagnosis and treatment from a health professional to ensure a correct diagnosis and reduce the likelihood of developing chronic foot pain. Treatment interventions may be provided by your Physical Therapist, Podiatrist and/or doctor.