CODG Blog

Plantar Fasciitis, also known as heel pain syndrome, can cause mild, moderate and even severe pain of the heel and/or the arch of the foot.  The plantar fascia is band of tissue that starts at the heel and blends into the tissues around the ball of the foot.  When there is excess tension around the plantar fascia, it may get inflamed and irritated.

Signs and Symptoms- Often with plantar fasciitis, there is a gradual increase in pain at the heel and sometimes into the inside arch of the foot.  The pain will be worse first thing in the morning when getting out of bed and then after resting during the day.  Sometimes the pain can continue all of the time.  It may be in one or both feet.  If an x-ray is taken, there may be a spur on the heel bone.  Plantar fasciitis can cause significant pain.

Treatment- Since plantar fasciitis can be caused by many factors all together, there are many things that should be done to treat it and since it often takes a long time to seek treatment, it may take sometime to cure.  See your doctor for a proper diagnosis and to rule out other possible underlying medical conditions.

• Proper footwear - A good supportive pair of running shoes or molded sandals should be worn at all times - NO BAREFOOT
• Biomechanical assessment to see if foot orthoses (or orthotics) are necessary
• Roll your foot over a frozen bottle of water to ice the area (make sure to protect the skin from frostbite and do not do this if you have loss of sensation in the feet)
• Daily exercises to stretch the calf muscle - must be gentle and slow - hold 30-60 seconds several times a day
• Sometimes your doctor will prescribe medication
• A night-splint  will hold the foot into a position to stretch out the Achilles tendon
• Physiotherapy may be necessary for ultrasound, proper stretching and other modalities

 Since plantar fasciitis is affected by so many factors and often develops over time, many factors and some time are involved in resolving it.  See your doctor and follow the instructions carefully!

We often have parents coming in for an appointment with their children wanting foot orthoses or insoles for "flat feet".  The big question is: Do children need foot orthoses? 

In everything that we do, we need to make sure that each situation and each person is assessed properly to determine if there is any treatment that should be provided.  Children are often hard to treat - they do not always act and perform the same as adults or even adolescents and it is difficult for them to verbalize their complaints (if they do at all).  The first line of treating a child with flat feet is to visit the physician for a good diagnosis and to rule out any possible underlying medical conditions.  The child can then be assessed by a Certified Orthotist where a complete history, a physical examination and a gait examination would be performed. 

In some cases, foot orthosesare beneficial and advised for young children and in some cases, we watch and monitor the child's growth and development.  It is important to remember that as a child grows and develops, they do go through a range of body alignments that are completely normal.  For example, very young children look like thay have completely flat feet due to the normal amount of fatty tissue in the feet - once the child grows a little, the feet thin out and do not look as flat. 

As a parent, the best thing to do is remain observant, listen to the children and educate yourself about the condition of your child.  Physicians, therapists and Certified Orthotists are all excellent resources for parents to use and learn from.  If you are concerned, have your child assessed and like any medical intervention, foot orthoses can and should be used but only when appropriate and only by qualified healthcare providers such as a Certified Orthotist in collaboration with a medical doctor.

The final answer: Sometimes!

Pain in the joint of the big toe is quite common and can be caused by many things including gout, arthritis and injuries.  The main thing that often makes the joint more painful is increased movement in the joint by bending the joint upwards (dorsiflexing).  The unfortunate thing about big toe and dorsiflexing is that in order to walk, we need to dorsiflex the big toe joint.  As we walk, we go from having the foot flat on the ground to a position of "push-off" where the heel lifts off the ground and the toes push down.  We need the push-off to propel us forward.

The question is: "How do we get an efficient push-off without dorsiflexing the big toe joint as much?"  Here are some solutions which can be used individually or altogether, depending on your case.

1. Foot Orthoses

With the pain in the big toe joint, sometimes the foot rolls in too much (over-pronates), and then puts too much pressure on the toe.  If that is the case, a custom made foot orthosis (orthotic) will help to prevent excess pressure at the big toe and elevate the joint to reduce the amount of dorsiflexion required in walking. 

2. Rockered Sole

If the alignment of the foot is good but there is still pain, a rockered sole will help to reduce the amount of bending at the toe.  A rockered sole works like the bottom of a rocking chair - the shoe and the foot roll along rather than bending.  Most running shoes have a rockered sole and many new types of "exercise shoes" such as the MBT have a rockered sole.    The rockered sole can also be added to the bottom of most shoes.  It is very effective at reducing excess force at the big toe and is often used in combination with a custom made foot orthosis.                        

                                                                    MBT Tunisha

3. Sole Stiffener

If the rockered sole and the custom made foot orthosis is not enough to control pain the big toe joint, the third option is a sole stiffner.  By adding a piece of stiff material into the shoe, under the orthosis or to the sole of the shoe, there is a reduction of motion at the big toe which will also help to reduce pain.

As always with any medical condition, it is important to discuss your concerns with your physician and obtain a proper diagnosis.  Once it is known what is wrong, it is always easier to treat!              

Diabetes Mellitus affects more than two million people in Canada and many of them have complications that affect the feet.  The level of complications vary widely, and therefore the treatment options are highly variable as well.  The one thing that all people with Diabetes Mellitus must remember is: "Check your Feet Everyday!"  What do you check for? Red marks, pressure areas, blisters, cuts - anything that is not normal.  See your health care provider if you are not sure.

The reason that checking your feet is so important is that diabetes can lead to Diabetic Neuropathy where the sensation in the feet is altered and eventually a person with diabetes can lose all sensation.  The loss of sensation along with other complications of diabetes can allow what normally would be a small callous become a life threatening ulcer.  Prevention is the most important tool we have to protect your feet and here are some of the things that may be used to help you.

Foot Orthoses - custom made insoles made from plaster impressions of your feet to distribute pressure more evenly to help reduce callouses

Orthopaedic or comfort shoes - Shoes must fit properly and accommodate all foot deformities in length, width and depth (see Buying and Fitting Shoes Guidelines).  The shoes offer protection for the feet from outside dangers as well as providing a stable base of support for the feet and help redistribute pressure.

Offloading Boot - For those people who have diabetic ulcers, it is essential to offload or remove pressure from the area.  Several different types of boots are available, such as an AirCast, to help redistribute pressure and change the gait to allow the ulcer to heal.

Charcot Restraint Orthotic Walker (CROW) or custom ankle foot orthosis (AFO) - many different types of braces are designed and used to further offload pressure from the ulcerated area or the Charcot ankle.  The CROW is a boot like brace that reduces pressure in the foot area and stabilizes the ankle.

For more information and pictures, please check:

http://www.slideshare.net/CODG/orthotic-management-of-the-diabetic-foot-v21

For more information from the Canadian Diabtes Association please check:

http://www.diabetes.ca/about-diabetes/living/complications/foot-care/