Plantar fasciitis

Plantar fasciitis is caused by inflammation of the thick shock absorbing fibrous tissue under the foot and is one of the most common causes of heel pain. Prolonged loading that exceeds the tissue tolerance causes microtrauma within the fascia leading to irritation and/or inflammation eventually resulting in pain. Plantar fasciitis often arises without obvious cause.

Symptoms- Pain is usually described as stabbing under the sole of the foot or at the heel and is usually worse in the morning or after periods of inactivity. The pain is usually worse after exercise, not during it.

Causes/ Risk factors- Being within the age of 40 and 60, participating in certain types of exercise (long-distance running, ballistic jumping activities, ballet dancing and aerobic dance), having poor foot mechanics or footwear (flip flops), obesity and certain occupations (individuals who stand on hard ground for extended periods of time can accelerate damage their plantar fascia. Activity/ sports specific exercises, activity modification, general conditioning (strength/ cardiovascular training) and help reduce risk factors associated with this condition.

Prevention- Identifying the root cause of the injury will generally guide the treatment plan. Manual release techniques and instrumented assisted soft tissue therapy help to break up scar tissue and can help increase blood flow thus tissue oxygenation increasing the rate of tissue recovery. Acupuncture, chiropractic care and photobiomodulation/laser therapy can also help to promote healing and minimize barriers to recovery. Ensuring that the alignment of the foot, ankle, knee and hip is optimized can also help reduce stress.

Treatment options- For immediate self-care of a sprain, try the R.I.C.E. approach — rest, ice, compression, elevation.

What’s next?- Continued specific rehabilitation protocols, orthotics and activity modifications and continued maintenance care can help decrease the risk of re-injury, as well as, can also minimize the risk of barriers to recovery.

Bunions

Bunions are bumps that occur either at the outside or inside of the foot near the toes. Bump on the inside of the feet are usually reffered to as standard Bunions or hallux valgus while bumps occurring on the outside of the feet are referred to as Tailor’s Bunion.

Symptoms- A visible bump on the side of your big toe may be a bunion. These conditions can cause pain with prolonged standing and walking and may lead to inflammation and irritation of the inside and outside toes and forefoot.  An individual with a bunion may also present with the following symptoms: tenderness on or around the big toe, callus or corn on the bone below the big toe and difficulty moving the big toe.

Causes/ Risk factors- Wearing tight or narrow shoes can cause bunions to develop. Tight shoes put pressure on the metatarsophalangeal joint (MTP), which is where the bone of the foot meets the bone of the big toe.Bunions may be the result of the foot structure you inherited, and tight- or ill-fitting shoes. Wearing improper footwear, family history of bunions and some diseases may increase the likelihood of developing a bunion. Women in general are more likely to have bunions due to increased pressures from narrow footwear.

Treatmemt options- Activity modification and wearing proper footwear is the first line of defence against bunions. Orthotics can help limit the progression of bunions, reduce pain associated with the condition and in some cases help reverse the bunion process. Other treatment approaches may also help manage the discomfort associated with the condition.

Heel spur

Heel spurs are bony bumps that occur at the calcaneus (heel bone). The two most common locations to have heel spurs are at the underside of the foot near the heel where the plantar fascia attaches and where the achilles tendon attaches at the back of the heel. It can also be associated with secondary conditions such as plantar fasciitis and achilles tendinopathies to name a few.

Symptoms- Heel spurs can be painless but can also cause significant pain and dysfunction. Many people describe the pain of heel spurs as a stabbing or dull that is worse with walking after periods of immobility. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it.

Causes/ Risk factors- Repeated overuse injuries leads to inflammation of the foot’s supportive structure. This chronic inflammation leads to calcium deposits at ligament attachment points resulting in bony bumps. Wearing well-fitting, supportive and appropriate shoes for any given activity, as well as warming up, doing stretching exercises before each activity and pacing yourself can help reduce the risk of suffering from heel spurs.

Treatment options-  Treatment focus to decrease the pain and inflammation associated with this condition. Exercises, instrument assisted soft tissue therapy, acupuncture, custom-made orthotics, and other treatments approaches may be implemented to help manage this condition. If conservative treatments fail, surgery may be necessary.

Claw/ Mallet/ Hammer toe

Toes can sometimes end up in strange positions and orientations. The most common presentations are called Claw, Mallet and Hammer toes.

Symptoms- The condition may or may not cause pain and discomfort depending on the severity and associated local inflammation caused by the condition. Limited range of motion of the toes may also occur.

Causes/ Risk factors- In most cases it is not fully understood why these occur. These often occur suddenly and may even be apparent at birth. Genes, arthritis, toe injuries, wearing tight footwear or other foot problems like high arches or bunions can influence these conditions. They can sometimes be indicators of more serious medical conditions like rheumatoid arthritis, diabetes, or cerebral palsy to name a few.

Treatment options- Wearing proper footwear shoes, orthotics, cushions, splints, pads and certain exercises may help your symptoms. Other treatments options including laser/ photobiomodulation therapy among others may help manage associated symptoms of these conditions.

Gout

Gout is a condition that generally causes sudden, severe pain at the big toe.

Symptoms- It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness at a joint. This commonly occurs at the base of the big toe, but can occur anywhere in the body. Attacks usually occur suddenly.You may experience gout that comes and goes or develop more chronic gout over time that may damage your joints.

Cause/ Risk factors- Happens as a result of too much uric acid in your body. Those that eat diets rich in meat and seafood, drink beverages sweetened with fruit sugar (fructose), comsume alcohol, are obese, take certain medication, have had previous surgery, have a family history of gout, that have certain medical conditions, as well as men between 40 and 50 years old and postmenopausal women are all at increased risk of suffering from gout.

Treatment options- Managing the above factors are the primary approach to treatment. Although we cannot address the causes of the condition, local symptomatic relief has been achieved in a variety of patients at the RL Clinic with the help of laser/ photobiomodulation therapy.

Stone bruise/ Metatarsalgia

The term stone bruise is often used interchangeably with metatarsalgia and is described as pain under the forefoot and fees as though a stone is in your shoe. Conditions that are oten confused with stone bruises are plantar fasciitis, sesamoiditis, stress fractures, heel spurs and Morton’s neuromas.

Symptoms- The area between your toes and arch may feel tingly or numb, sharply painful, or like you have a pebble in your shoe. Symptoms may generally improve on their own.

Cause/ Risk factors- The most common cause is an impact injury to the bottom of your foot. Poor-fitting shoes, high-impact exercise, underlying biomechanical conditions of the feet or lower limbs, obesity and other medical conditions may contribute to this condition.

Treatment options- Resting your feet, ice, and avoiding aggravating factors (uncomfortable footwear/ walking barefoot/ not wearing heels) will help manage the inflamation. Orthotics can help correct biomechanical anomalies often resulting in a resolution of symptoms within a short period of time. Laser/ photobiomodulation therapy can also help manage the inflammation associated with the condition leading to symptomatic relief.

Flat foot

Flat feet (pes planus) is a common postural deformity in which the arches of the foot collapse.

Symptoms- Flat feet are usually painless. However, some people may experience foot pain (heel/ arch area), pain that worsens with activity and swelling along the inside of the ankle. Due to the biomechanical changes that occur with flatfeet, they can also contribute to problems in your ankles, knees, hips and low back.

Causes/ Risk factors- Flatfeet can occur when the arches don’t develop during childhood and is often thought to be a genetic condition. In other cases, flatfeet develop after an injury, as a result of cumulative stress applied on the feet (years of ad footwear) or from the simple wear-and-tear stresses of age.

Treatment options- Flat feet usually only require treatment if they are problematic. If they are giving you grief orthotics can help correct the arch minimizing biomechanical impact related to the condition. Foot strengthening and coordination exercises can also help.

Morton’s neuroma

Morton’s neuroma is characterized as either pain or numbness that generally occurs between the 3rd/ 4th toes.

Symptoms- This can cause a sharp, burning pain or numbness and tingling at the ball of your foot and at the area between the toes. Feeling as if you’re standing on a pebble in your shoe is common wiht this condition. Typically, no observable sign are related to this condition.

Cause/ Risk factors- Tissue thickens around the interdigital nerve(s) in the ball of your foot between your arch and toes. This usually occurs secondary to repetitive mechanical irritation of the area. High-heeled shoes, high impact sports (running/ jumping), foot or gait abnormalities and wearing tight footwear have been linked to the development of Morton’s neuroma.

Treatment options-  Switching shoes or resting your feet is generally the primary approach to treatments. If the condition doesn’t improve, orthotics, other supportive devices, physical therapy and/or laser/photobiomodulation therapy might be warranted.

Sesamoiditis

Sesamoids are small bones that tendons use as pulleys in the feet. These ensure proper functioning of our feet by guiding tendons and allowing them to transmit muscle forces. Sesamoiditis is an inflammation of these bones that causes pain.

Symtoms- Pain usually occurs under the great toe at the ball of the foot. Pain may come on gradually or may develop suddenly in the case of an acute trauma (fracture). You may experience pain with walking/standing and difficulty bending and straightening the great toe. Swelling and bruising may be present.

Causes- Sesamoiditis occurs when the sesamoids are injured or inflamed. Particular activities like ballet or playing catcher in baseball where the foot is held in compromised positions or is subject to repetitive stress such as running is often associated with these conditions.

Treatment options- Begin by limiting any aggravting activities, rest and ice the sole of your feet and wear soft-soled, low-heeled shoes and make sure to avoid activities that put your weight on the balls of the feet. If symptoms persist orthotics or a brace may be used to support the area and limit stress. Laser/ photobiomodulation therapy and other treatment approaches may be able to limit the stress and therefore reduce the inflammation at the area.

Diabetic neuropathy

Diabetic neuropathy occurs when unregulated high blood sugar causes nerve damage. A common site to experience this is at the feet.

Symptoms- Usually, symptoms develop gradually and often patients do not notice anything is wrong until significant nerve damage has occurred. As the disease progresses patients may experience tingling, pins and needles or other changes in sensitivity at the feet, as well as problems with walking.

Causes/ Risk factors- Uncontrolled High blood sugar weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients leading to nerve damage. Other than being diabetic, smoking, being overweight and having kidney disease can also increase your risks of suffering from a diabetic neuropathy.

Treatment options- If you have diabetes, you should see your medical doctor right away if you develop these symptoms as they can sometimes lead to complications such as infection and injury. Maintaining adequate blood sugar levels helps reduce the risk of diabetic neuropathy is paramount in managing this type of condition. Various sources of information offer advice on this topic (e.g. Diabetes Canada.ca)

At the RL Clinic we do not manage diabetes directly but we can help manage certain complications associated with diabetes neuropathies.

Other conditions

Ankle sprains/ strains- One can sprain/ strain any joint/ muscle in the foot. The most common ankle sprains are lateral ankle sprain (the ankle rolls inward) but medial ankle sprains (ankle rolls outward) and high ankle sprains (foot gets forcibly pushed upward) are also common. For more information please see our page relating to sprains and strains.

Fracture/ stress fractures- Fractures can occur anywhere in the foot and ankle. This can happen as a result of a fall or sudden impact or after repeated stress is applied to a bone leading (running) to a stress fracture. Please see our page relating to fractures for more information

Osteoarthritis (OA)- Commonly affect the big toe but can occur at any joint of the foot and ankle. Please see our page relating to Osteoarthritis (OA) for more information.

Other types of arthritis, inflammatory conditions, autoimmune conditions, as well as other disease can lead to foot pain and dysfunctions that may be addressed.