Overview



The medical term for fallen arches is pes planus. Pes planus can occur from birth and is not always a medical problem (pathologic). It can also occur over time from degeneration of the cartilage and ligaments that support the arch of the foot. It is especially important for persons with pes planus that is caused by degeneration to use comfortable footwear.

Causes

You can have a tendency towards fallen arches from birth. Up through the toddler stage, it is common to have flat feet. Throughout childhood, arches tend to normally develop. For reasons not well understood, however, in some cases the feet stay flat and the arch never forms. In many cases this abnormality does not cause symptoms or require any treatment. In other cases, it is due to a condition called tarsal coalition. This occurs when some of the foot bones fuse.

Symptoms

Fallen arches symptoms may include the following. Being unable to slip fingers underneath arches. Inwards rolling of foot and ankle when running. Knee problems due to lack of support from feet.

Diagnosis

There are a few simple ways to assess your foot type, and most include making an imprint of your footprint. The classic way is to stand on a hard floor surface with wet feet to make a wet foot print. Look at the narrowest part of your footprint, which should be between your heel and ball of your foot. If the print of your foot in this part is less than 10% of the width of the widest part then you are likely to have high arches. more than 10% but less than 25% then your foot profile is probably normal, more than 25% or even the widest part, then you have flat feet.

arch supports for high arches

Non Surgical Treatment

Physiotherapists will carry out a detailed biomechanical assessment of your feet and lower limb. Once the causes have been identified a number of treatment methods may be used to help relieve pain and restore function in the feet including the use of custom made orthotics to support the foot and offload the areas which are painful, strengthening exercises for weakened muscles and tendons in the arch, and massage and mobilisation techniques to help mobilise stiff tissue and joints in the foot.

Surgical Treatment



Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.

Overview

Neuromuscular. Muscle imbalance causing different pull on pelvis (anterior superior Ilium or posterior inferior ilium). Muscle tightness/shortness especially piriformis (which lead to an external rotation of the femur thus shortening of the leg) and QL (raising ipsilateral iliac crest). Genu recurvatum, valgus, varus. Asymmetrical fallen arches or over pronation. Polio, Cerebral palsy. Trauma. Fracture. Injury epiphyseal plate. Iatrogenic (such as hip or knee surgery). Idiopathic. Hip disorder (such Legg-Perthes-Calve? or Slipped capital femoral epiphysis). Advanced degenerative changes.

Causes

Some children are born with absence or underdeveloped bones in the lower limbs e.g., congenital hemimelia. Others have a condition called hemihypertrophy that causes one side of the body to grow faster than the other. Sometimes, increased blood flow to one limb (as in a hemangioma or blood vessel tumor) stimulates growth to the limb. In other cases, injury or infection involving the epiphyseal plate (growth plate) of the femur or tibia inhibits or stops altogether the growth of the bone. Fractures healing in an overlapped position, even if the epiphyseal plate is not involved, can also cause limb length discrepancy. Neuromuscular problems like polio can also cause profound discrepancies, but thankfully, uncommon. Lastly, Wilms? tumor of the kidney in a child can cause hypertrophy of the lower limb on the same side. It is therefore important in a young child with hemihypertrophy to have an abdominal ultrasound exam done to rule out Wilms? tumor. It is important to distinguish true leg length discrepancy from apparent leg length discrepancy. Apparent discrepancy is due to an instability of the hip, that allows the proximal femur to migrate proximally, or due to an adduction or abduction contracture of the hip that causes pelvic obliquity, so that one hip is higher than the other. When the patient stands, it gives the impression of leg length discrepancy, when the problem is actually in the hip.

Symptoms

The symptoms of limb deformity can range from a mild difference in the appearance of a leg or arm to major loss of function of the use of an extremity. For instance, you may notice that your child has a significant limp. If there is deformity in the extremity, the patient may develop arthritis as he or she gets older, especially if the lower extremities are involved. Patients often present due to the appearance of the extremity (it looks different from the other side).

Diagnosis

The evaluation of leg length discrepancy typically involves sequential x-rays to measure the exact discrepancy, while following its progression. In addition, an x-ray of the wrist allows us to more carefully age your child. Skeletal age and chronological age do not necessarily equal each other and frequently a child's bone age will be significantly different than his or her stated age. Your child's physician can establish a treatment plan once all the facts are known: the bone age, the exact amount of discrepancy, and the cause, if it can be identified.

Non Surgical Treatment

The non-surgical intervention is mainly usedfor the functional and environmental types of leg length discrepancies. It is also applied to the mild category of limb length inequality. Non-surgical intervention consists of stretching the muscles of the lower extremity. This is individually different, whereby the M. Tensor Fascia latae, the adductors, the hamstring muscles, M. piriformis and M. Iliopsoas are stretched. In this non-surgical intervention belongs also the use of shoe lifts. These shoe lifts consists of either a shoe insert (up to 10-20mm of correction), or building up the sole of the shoe on the shorter leg (up to 30-60mm of correction). This lift therapy should be implemented gradually in small increments. Several studies have examined the treatment of low back pain patients with LLD with shoe lifts. Gofton obtained good results: the patients experienced major or complete pain relief that lasted upon follow-up ranging from 3 to 11 years. Helliwell also observed patients whereby 44% experienced complete pain relief, and 45% had moderate or substantial pain relief. Friberg found that 157 (of 211) patients with LBP, treated with shoe lifts, were symprom-free after a mean follow-up of 18 months.



leg length discrepancy exercises

Surgical Treatment

The bone is lengthened by surgically applying an external fixation device to the leg. The external fixator, a scaffold-like frame, is connected to the bone with wires, pins, or both. A small crack is made in the bone and the frame creates tension when the patient or family member turns its dial. This is done several times each day. The lengthening process begins approximately five to 10 days after surgery. The bone may lengthen 1 millimeter per day, or approximately 1 inch per month. Lengthening may be slower in a bone that was previously injured. It may also be slower if the leg was operated on before. Bones in patients with potential blood vessel abnormalities, such as cigarette smokers, may also need to be lengthened more slowly. The external fixator is worn until the bone is strong enough to support the patient safely. This usually takes about three months for each inch. Factors such as age, health, smoking and participation in rehabilitation can affect the amount of time needed.

Overview



Plantar fasciitis is an inflammation of the long band of connective tissue running from the heel to the ball of the foot. The plantar fascia acts like a bowstring and supports the arch and several muscles inside the foot. When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment on the heel. This results in inflammation and pain with standing and walking and sometimes at rest.

Causes

Many things can cause heel pain. Most commonly seen at our Troy, MI office are heel spurs, which are small growths on the heel bone. Heel pain can be caused from heavy activities and increased weight that put extra pressure on feet. Dr. Weinert often treats heel pain in athletes, runners and women who are pregnant. There are other cases where Dr. Weinert has related a patient?s heel pain to arthritis, stress fractures, fractures, bone tumors, cysts, achilles tendonitis and Haglund's deformity. The main cause of heel pain is usually a biomechanical problem in the foot and it?s, in a nutshell, having a foot out of alignment. There are numerous conditions. One of the most prevalent is called talotarsal dislocation syndrome. What that is in lay terms is you?ve just got a misalignment of your ankle on your heel and as you bear weight you?re getting a collapse of the ankle on the heel causing the foot to be out of alignment. So the plantar fascia, bones, joints, and ligaments receive constant stress. This stress occurs at the point where the plantar fascia (the major tissue that connects your toes to your heel) meets the heel. Many patients explain the pain as being in the middle of the inside of the heel. As a patient bears weight, they get the collapse of the foot and that ligament pulls. And if you think of a rubber band constantly getting pulled on that area of the insertion on the heel, you eventually start getting some micro tears in that ligament and causing inflammation and pain specifically right there in middle area of the heel. Plantar fasciitis is also a common source of heel pain. The plantar fascia, a band of tissue that runs from your heel to your toes, can become strained and inflamed due to overuse and wear and tear. This band of tissue can only withstand so much pressure and when it gives way, the pain can be severe and requires immediate and effective treatment.

Symptoms

The most common complaint is pain and stiffness in the bottom of the heel. Heel pain may be sharp or dull, and it may develop slowly over time or suddenly after intense activity. The pain is typically worse in the morning, when taking your first steps of the day. After standing or sitting for a while. When climbing stairs.

Diagnosis

A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric long-term solution to his problem.

Non Surgical Treatment

Rest until there is no more pain. This is the most important element of treatment as continuing to walk or run on the injured foot will not allow the injury to heal. Wear soft trainers with lots of cushioning or pad the heel of shoes with shock absorbing insoles or heel pads. These should be worn in both shoes, even if only one heel is bruised. Wearing a raise in only one shoe causes a leg length difference which can cause other problems. Replace running shoes if they are old. A running shoe is designed to last for around 400 miles of running. After this the mid soles are weakened through use.

Surgical Treatment

Only a relatively few cases of heel pain require surgery. If required, surgery is usually for the removal of a spur, but also may involve release of the plantar fascia, removal of a bursa, or a removal of a neuroma or other soft-tissue growth.

heel spur shoes

Prevention



Wear properly fitting shoes. Place insoles or inserts in your shoes to help control abnormal foot motion. Maintain a healthy weight. Exercise and do foot stretches as they have been shown to decrease the incidence of heel pain.

Overview

Morton?s neuroma is a swollen nerve in the distal portion of the foot. The enlarged portion of the nerve represents scarring within the plantar nerve that occurs after chronic compression and/or repetitive injury. This may come about when the toes are squeezed together for too long, as can occur with the chronic use of high heels. The nerve that runs between your toes will swell and thicken. This can cause pain when walking. The symptoms of Morton?s neuroma can include burning pain in the foot, the feeling of a lump inside your foot, pain between the third and fourth toes typically but it can occur between other toes.

Causes

The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.

Symptoms

Episodes of pain are intermittent. Patients may experience 2 attacks in a week and then none for a year. Recurrences are variable and tend to become more frequent. Between attacks, no symptoms or physical signs occur. Two neuromas coexist on the same foot about 2-3% of the time. Other diagnoses should be considered when 2 or more areas of tenderness are present.

Diagnosis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a Morton's neuroma. Investigations such as an X-ray, ultrasound, MRI, CT scan or bone scan may sometimes be used to assist with diagnosis, assess the severity of the injury and rule out other conditions.

Non Surgical Treatment

The most important factor in the treatment of Morton's neuroma is changing footwear. Sometimes a cushioned dome pad can be worn inside the shoe and this helps spread the metatarsal heads and decrease pressure on the nerve. There are other products that can be worn between the toes with certain types of shoes or when the client is barefoot. These toe spacers will help reverse biomechanical patterns that aggravate the nerve compression. Massage can be helpful, but should not be performed with deep pressure between the metatarsal heads. Additional pressure in this region can aggravate the nerve compression and prolong the pathology.

Surgical Treatment

Surgery for neuroma most often involves removing affected nerve in the ball of the foot. An incision is made on the top of the foot and the nerve is carefully removed. Surgeon must remove the nerve far enough back so that the nerve doesn?t continue to become impinged at the ball of the foot. Alternatitvely, another type of surgery involves releasing a tight ligament that encases the nerve. Recovery after Morton?s neuroma (neurectomy) surgery is generally quick. Typically patients are walking on the operated foot in a post-surgical shoe for 2 - 4 weeks, depending on healing. Return to shoes is 2-6 weeks after the surgery. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.

There are actually not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital means that you are born with it. One leg is structurally shorter compared to the other. Through developmental periods of aging, the brain senses the step pattern and recognizes some variance. The body typically adapts by tilting one shoulder over to the "short" side. A difference of less than a quarter inch is not grossly abnormal, require Shoe Lifts to compensate and usually does not have a profound effect over a lifetime.



Leg length inequality goes largely undiagnosed on a daily basis, however this issue is very easily fixed, and can eliminate numerous instances of back pain.

Treatment for leg length inequality usually consists of Shoe Lifts. These are typically low cost, typically costing less than twenty dollars, compared to a custom orthotic of $200 if not more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Upper back pain is the most prevalent health problem affecting people today. Around 80 million people experience back pain at some stage in their life. It is a problem that costs companies vast amounts of money yearly because of time lost and productivity. Innovative and better treatment methods are constantly sought after in the hope of minimizing the economical impact this issue causes.



People from all corners of the world experience foot ache due to leg length discrepancy. In most of these situations Shoe Lifts can be of very helpful. The lifts are capable of reducing any pain and discomfort in the feet. Shoe Lifts are recommended by countless professional orthopaedic physicians.

To be able to support the body in a well-balanced fashion, your feet have a very important role to play. In spite of that, it's often the most overlooked zone of the human body. Many people have flat-feet meaning there is unequal force placed on the feet. This causes other areas of the body like knees, ankles and backs to be impacted too. Shoe Lifts guarantee that appropriate posture and balance are restored.

There are actually two unique variations of leg length discrepancies, congenital and acquired. Congenital implies that you are born with it. One leg is structurally shorter than the other. As a result of developmental stages of aging, the human brain picks up on the step pattern and recognizes some difference. The body usually adapts by dipping one shoulder to the "short" side. A difference of under a quarter inch is not really excessive, require Shoe Lifts to compensate and usually doesn't have a serious effect over a lifetime.



Leg length inequality goes largely undiagnosed on a daily basis, yet this condition is easily remedied, and can reduce quite a few cases of lumbar pain.

Therapy for leg length inequality usually involves Shoe Lifts. Most are affordable, usually costing below twenty dollars, in comparison to a custom orthotic of $200 plus. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Lower back pain is easily the most prevalent ailment impacting people today. Around 80 million men and women experience back pain at some point in their life. It is a problem which costs businesses millions of dollars every year on account of time lost and output. New and better treatment solutions are constantly sought after in the hope of decreasing the economical influence this issue causes.



Men and women from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In a lot of these situations Shoe Lifts are usually of very beneficial. The lifts are capable of reducing any pain in the feet. Shoe Lifts are recommended by countless skilled orthopaedic doctors.

So that you can support the body in a balanced manner, your feet have a significant task to play. Inspite of that, it can be the most overlooked zone in the human body. Some people have flat-feet meaning there may be unequal force exerted on the feet. This will cause other parts of the body including knees, ankles and backs to be impacted too. Shoe Lifts guarantee that suitable posture and balance are restored.

There are not one but two different kinds of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is structurally shorter in comparison to the other. Through developmental stages of aging, the human brain senses the stride pattern and recognizes some variation. The body usually adapts by dipping one shoulder to the "short" side. A difference of less than a quarter inch isn't really excessive, demand Shoe Lifts to compensate and usually doesn't have a serious effect over a lifetime.



Leg length inequality goes largely undiagnosed on a daily basis, yet this condition is very easily remedied, and can eradicate many incidents of chronic back pain.

Therapy for leg length inequality typically involves Shoe Lifts . These are generally low cost, commonly priced at less than twenty dollars, compared to a custom orthotic of $200 and up. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Mid back pain is the most common condition impacting people today. Around 80 million people are affected by back pain at some point in their life. It is a problem that costs businesses huge amounts of money annually on account of lost time and production. Innovative and better treatment methods are continually sought after in the hope of reducing the economical influence this issue causes.



Men and women from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In most of these cases Shoe Lifts are usually of beneficial. The lifts are capable of alleviating any discomfort and pain in the feet. Shoe Lifts are recommended by many specialist orthopaedic doctors.

So that they can support the body in a well balanced manner, your feet have got a significant task to play. Irrespective of that, it is sometimes the most overlooked area in the human body. Many people have flat-feet meaning there may be unequal force placed on the feet. This will cause other areas of the body like knees, ankles and backs to be affected too. Shoe Lifts make sure that ideal posture and balance are restored.

There are actually two different kinds of leg length discrepancies, congenital and acquired. Congenital means that you are born with it. One leg is structurally shorter in comparison to the other. As a result of developmental stages of aging, the human brain picks up on the step pattern and identifies some variation. Our bodies usually adapts by dipping one shoulder to the "short" side. A difference of less than a quarter inch isn't grossly uncommon, does not need Shoe Lifts to compensate and commonly does not have a profound effect over a lifetime.



Leg length inequality goes mainly undiagnosed on a daily basis, yet this problem is easily remedied, and can eliminate numerous cases of chronic back pain.

Therapy for leg length inequality commonly involves Shoe Lifts. These are generally affordable, often costing under twenty dollars, in comparison to a custom orthotic of $200 or even more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Back ache is easily the most widespread health problem afflicting men and women today. Around 80 million men and women suffer from back pain at some point in their life. It's a problem which costs businesses millions yearly as a result of lost time and output. Innovative and more effective treatment solutions are continually sought after in the hope of decreasing the economic impact this condition causes.



Men and women from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In these types of situations Shoe Lifts are usually of very beneficial. The lifts are capable of decreasing any pain in the feet. Shoe Lifts are recommended by numerous skilled orthopaedic doctors.

So that you can support the body in a well-balanced manner, your feet have got a crucial task to play. Irrespective of that, it's often the most overlooked region of the body. Many people have flat-feet meaning there is unequal force placed on the feet. This causes other parts of the body like knees, ankles and backs to be affected too. Shoe Lifts guarantee that correct posture and balance are restored.