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All The Things You Want To Find Out Concerning Arch Pain

Overview
Plantar fasciitis continues to be widely used for the clinical syndrome of undersurface heel pain. However, the use of ‘itis’ denotes an inflammatory disorder. This is a misnomer as the pathology is not the result of excessive inflammation. Pathological changes are degenerative (but partially reversible) in nature, probably due to repetitive trauma. The plantar fascia is a thick, fibrous band of connective tissue. Its origin is the medial plantar tubercle of the calcaneum. It runs along the sole of the foot like a fan, being attached at its other end to the base of each of the toes. It is a tough, resilient structure that has a number of critical functions during running and walking. It stabilises the metatarsal joints during impact with the ground. It acts as a shock absorber for the entire leg. It forms the longitudinal arch of the foot and helps to lift the arch to prepare it for the ‘take-off’ phase of the gait cycle.


Causes
A common cause of foot arch pain is a stress fracture. They tend to occur from repeated overloading of one of the foot bones from activities such as jumping and running especially if you have suddenly increased your activity level. The breaks in the bone may be small but they can be extremely painful. Stress fractures of the metatarsal bones or the navicular can cause anything from mild to severe foot arch pain. The Tibialis Posterior muscle plays a very important role in supporting the medial arch of the foot. Posterior Tibial Tendonitis can occur either through repetitive use e.g. high impact sports such as soccer or tennis, or from an injury e.g. a fall. This causes the tendon to become inflamed or even torn, resulting in pain on bottom of foot. This pain usually gets worse with activity or when standing for long periods. If the problem persists, the inner side of the foot (known as the medial longitudinal arch of the foot) gradually collapses down, causing flat feet. A simple test for this condition is to stand on one leg and rise up onto your tiptoes. If you cannot, it indicates a problem with the Posterior Tibial tendon. Treatment usually consists of rest, ice, exercises, orthotics and physical therapy.


Symptoms
Intense heel pain, especially first thing in the morning and after a long day. Difficulty walking or standing for long periods without pain. Generally, the sharp pain associated with plantar fasciitis is localized to the heel, but it can spread forward along the arch of the foot and back into the Achilles tendon. While severe cases can result in chronic pain that lasts all day, the most common flare ups occur first thing in the morning, making those first steps out of bed a form of torture, and in the evening after having spent a day on your feet. Overpronation (a foot that naturally turns too far inward), high arches, and flat feet (fallen arches) can all cause similar arch pain. In these cases, however, the pain is more likely to continue throughout the day rather than being worst in the morning.


Diagnosis
The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries. Taking your workout shoes to the exam may also provide valuable information to the medical practitioner. Both feet will be physically and visually examined by the medical practitioner. The foot and arch will be touched and manipulated possibly with a lot of pressure and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch.


Non Surgical Treatment
An orthotic arch support, specially molded to fit your foot, may be part of your treatment. These supports can be particularly helpful if you have flat feet or high arches. You can tell if that is what is needed when short-term taping decreases your heel pain.


Surgical Treatment
Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot, meaning you will be on crutches for two months. The bottom line is: Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.


Stretching Exercises
Easy Beginner Version. Start with your bare foot on a flat surface, toes spread out. Place a penny under the ball of your foot and the end of a pen under the middle of your arch (sticking out from the inside of your foot). Activate your arch by flexing your arch muscle. You should feel the muscles on the ball of your foot pushing down on the penny, but your arch shouldn’t be pushing down on the pen. These tools help you (1) avoid rolling your foot and (2) avoid pressing down with your toes (as an extra tip, you can slide a business card under your toes before doing the exercise-when you activate your arch, you should be able to slide the business card out easily with your fingers). Do your best to keep your toes relaxed. Advanced Version. Once you’re ready to move on, you can try this advanced version. It builds on the above exercise to incorporate full body twisting and balance, helping you to maintain proper arches while you move. Using the same ideas from above, stand on a flat surface in your bare feet with a penny under the ball of your foot and the end of a pen under your arch. This time, stand with your back a few inches away form a wall or a door. Lift your other leg (the one without the penny or pen) and stand on one foot. Use the wall for balance, if necessary. Lift one arm and stretch it across your body until you touch the wall or door on the opposite side, maintaining a straight back. Keep your foot straight and your arch on the penny but above the pen. Your arch will want to follow the movement and roll off, but you will need to activate it to stay stable during the movement. Lift your other arm and stretch it across the opposite side of your body, still keeping your arch in place.

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