COMMON FOREFOOT PROBLEMS

• Do you suffer from forefoot pain and don't know why or what to do about it?
• Do you wonder why your toes are curling or why you have callouses?
  

This post is going to be a crash course in what forefoot problems you may be causing and what you can do about it. Whether you're athletic, on your feet alot at work, or just walking around the house, most people experience some form of pain in the front of the foot at some point in time. I'll try to go over as many causes of these problems as I can in one blog. If I don't get to them all and you think you may have something other than what's listed, feel free to give me a call to discuss it. Also, if there is a solution to any one of these ailments you didn't see, please e-mail me so that I can add it.

Athletic Forefoot Problems
Most athletic forefoot problems are gait related. You're putting an inordinate amount of pressure on your feet, and if that pressure isn't on just the right spots of your feet it'll probably cause injuries pretty quick.
Stress fractures: Generally a "prick" sensation when you put any weight on it. The little bones in the front of the foot and the narrow bones through the mid foot are very susceptible to stress fractures if misused.
Forefoot callouses: 1) If they're like a ridge on the toes, usually caused by wearing shoes with the wrong toe shape for your foot. The average person tends not to look at shoe shape when buying athletic shoes. Take out the shoe liner, put it on the floor, and stand on it. If any part of your foot overlaps the side of the liner, then it's the wrong shape for your foot. There are many shoe lasts (which is what creates the shape of the shoe). If you visit a professional shoe-fitting facility, they'll help you determine what lasts will work best for you. 2) If they're on the ball of your foot, then they're caused from excessive pressure. That usually means that you've been bearing too much weight on the front of your feet. The heel is meant to bear weight, not the toes. Do not run on the front of your feet unless you're in an actual race. The average person does themselves a great injustice by not heel striking properly during athletic activities. If you're in a sport like tennis that force more forefoot pressure, then you'll have to be careful to use a shoe built specifically for tennis AND putting a support inside of the shoe that helps to distribute pressure more evenly across the foot to prevent stress fractures and ankle sprains.

Other Forefoot Problems
Callouses
Cause: The combination of moisture and friction/pressure. So you're feet are trying to protect themselves against poor gait and bad shoes.
Medical solutions: none besides cutting them off periodically
Non-medical solutions: See a pedorthist at the Denver Foot Solutions about evaluating your footwear and gait. Depending on what cause is determined, the treatment will vary. An easy way to cut down on moisture and friction is switching from a cotton sock to a moisture-wick sock.

Numbness/Tingling/Burning
Cause: Usually nerves. If your heel is elevated higher than your forefoot, the likelihood is that you're pinching the nerves between your toes from being shoved into the end of the shoes. This also happens if your shoes are too narrow in the toe box, or if you've developed a slouchy posture. If left untreated can develop into a Morton's neuroma, which is a thickening of the nerve in the area of pinching.
Medical solutions: Cortisone shot
Non-medical solutions: Orthotics; wide/deep toe-box shoes; flat sole shoes or rocker sole shoes; Metatarsal pads/bars

Hammer Toe
Definition/cause: The interphalangeal joint of toe is bent upwards causing rubbing on the top of the joint from pressure of shoes. Cause is usually from the arch of your foot not operating properly. When the arch isn't working right, the tendons and muscles on the top of the foot try to compensate. They're not designed to take over the duties of the bottom of the foot, so they tighten up and pull back on the toes. This causes the joints to bend. If left untreated the joints begin to lose range of motion and become rigid. If you can catch them before they become rigid, it is more likely reversible than if you let them become rigid.
Medical solutions: surgery/pins
Non-medical solutions: If the hammer toe is still Flexible: Hammer toe splint, deep toe box shoes, Custom Bio mechanical Arch Support (CBAS), metatarsal pads/bars.
If the hammer toe is Rigid: Hammer toe crest, deep toe box shoes, Custom Bio mechanical Arch Support (CBAS), metatarsal pads/bars.

Claw Toe/Mallet Toe
Definition/cause: Toes are bent under to look like claws. Again, the cause is arch related. Cause is usually from the arch of your foot not operating properly. When the arch isn't working right, the tendons and muscles on the top of the foot try to compensate. They're not designed to take over the duties of the bottom of the foot, so they tighten up and pull back on the toes. This causes the joints to bend. If left untreated the joints begin to lose range of motion and become rigid. If you can catch them before they become rigid, it is more likely reversible than if you let them become rigid. Sometimes the cause is congenital in cases of Charcot Marie Tooth and other such rigid foot deformities.
Medical solutions: surgery/pins
Non-medical solutions: Custom Bio mechanical Arch Support (CBAS), Metatarsal pads/bars, Wide/deep toe box shoes

Morton’s Neuroma
Definition/cause: Tissue buildup around pinched nerve usually located between the 2nd & 3rd or 3rd & 4th bones in the ball of the foot, causing shooting pains and numbness. Some of the causes are from wearing shoes too narrow for your foot shape, wearing shoes that have an elevated heel, running on the balls of your feet, and having a slouched posture.
Medical solutions: cortisone shot
Non-medical solutions: Wide/deep toe box shoes; Rocker-sole shoes; Met pads/bars; Arch Supports

Metatarsalgia
Definition: General term for undiagnosed forefoot pain
Medical solutions: padding
Non-medical solutions: Wide/deep toe box shoes, Metatarsal bars/pads, Custom Bio mechanical Arch Supports, Rocker-sole shoes, socks with additional padding on the soles.

Dropped Metatarsal Head
Definition/cause: One or more metatarsal bone(S) of forefoot are dropped or set lower than the others. Sometimes structural, sometimes developed from excessive flexibility/pressure, and collapse of the arch.
Medical solutions: Reconstruction; excavation
Non-medical solutions: Excavation of shoes or orthotics, wide/deep toe box shoes, Rocker-sole shoes, Metatarsal pads/bars

Bunion / Tailor’s Bunion
Definition/cause: Big toe (bunion) or little toe (tailor's bunion) joint is enlarged or dislocated; usually develops osteo-arthritis, and heavy callousing around joint; may develop bone spurs if untreated. Cause can be either from poor foot bio mechanics, poorly fit shoes, or hereditary. And just because your parents had bunions doesn't make it hereditary. Chances are that you have the same feet as your parents, therefore just as predisposed to getting the same foot-neglect deformities. Hereditary bunions usually look much different than developed bunions.
Medical solutions: Fusion of joint; removal of bone
Non-medical solutions: Custom Bio mechanical Arch Supports (CBAS), wide/deep toe box shoes, shoes without any elevation in the heel or Rocker-sole shoes to take pressure off forefoot, stretch pockets in shoes for bunions, metatarsal bars/pads

Arthritis - Rheumatoid
Definition/cause: The body’s immune system attacks the joints, causing inflammation
Medical solutions: Inflammation management, pain management, possible surgery
Non-medical solutions: Nonrestrictive footwear with structure and shock absorption, Custom Bio mechanical Arch Support (CBAS) to take pressure off joints and balance bone structure, possibly try Rocker-sole shoes for shock absorption and increased circulation factor depending on pain level

Arthritis - Osteoarthritis
Definition/cause: The cartilage of the joints is worn away from overuse, stress, or misalignment.
Medical solutions: Pain management, possible surgery to fuse or replace joints
Non-medical solutions: Nonrestrictive footwear with structure and shock absorption, Custom Bio mechanical Arch Supports (CBAS) to take pressure off joints and balance bone structure, possibly try Rocker-sole shoes for shock absorption and increased circulation factor depending on pain level.

Gout
Definition/cause: Crystal-like Uric acid buildup in joints, usually the big toe causing pain when joint bends. It can be a form of arthritis or dietary related. You want to contact the doctor if your big toe is swollen, red, and tender to the touch to have gout diagnosed and treated as soon as possible.
Medical solutions: Dietary, Medications
Non-medical solutions: Limit range of motion in irritated joint, flat-sole shoe or negative-heel shoes, Consult a nutrition expert

The Custom Orthotics that the Denver Foot Solutions store fit are usually the best solution for the more common forefoot conditions:
Our custom orthotics help Denver residents to….
· Distribute weight evenly across the foot to reduce and eliminate pain
· Improve balance and stability
· Improve posture and align knees, hips, and back to remove pain
· Keep bunions and other foot conditions from getting worse
· Absorb shock from walking/running on hard surfaces
· Help with shin splints and other sports injuries
· Maximize athletic performance

*In some cases medical attention is imperative for both diagnosis and treatment. If there is a combination of discoloration and swelling, you should consult the doctor right away. Most of the other conditions are treatable by non-medical solutions without a diagnosis being necessary. Working with a Pedorthist who specializes in preventative foot care is my first recommendation for the more common foot ailments. The Pedorthist will send you to the doctor if there are signs of necessary medical care, or if the ailment is unresponsive to treatment.*

WHY DO MY FEET HURT?

Are you tired of having sore feet only four hours into your work day? Are your feet restricting your lifestyle? Do you feel like you've wasted an awful lot of money on shoes that hurt your feet?

Are you sick of shoe shopping only for your feet to be miserable… again?

You don’t have to be!

I’ve heard it all before, “I’m just getting older.” Hog-wash! Sore feet aren’t from age. They’re from abuse. The good news is that you don’t have to go another week with sore feet if you’re going to finish reading this article and listen closely. I’m going to tell you a few secrets.

Secret 1: Everyone’s feet are different. Feet are NOT generic. Shoes ARE generic.

What this means is that you probably just need a little bit more information about your feet so that you can find the right shoes for YOU, specifically. See a shoe-fitter at the Foot Solutions store. It’ll take maybe an hour or two of your day, and you’ll stop wasting money on shoes that hurt!

Secret 2: Shoes that are good for you are NOT always ugly. Sure, some are… but there are a lot of shoes that are very good for you that aren’t unattractive. You probably will not find super fashionista shoes that are “good” for you. But there are flip-flop alternatives and dress shoes that are designed to be pretty darn good for you. Remember, it’s about finding the right shoes for your specific feet, not your specific outfit! If you have to have a few basic-looking shoes in your closet for work, it’s not the end of the world.

Secret 3: Any shoe is ok to wear as long as you’re wearing them for the purpose they were designed for.

- Flip-flops: Pool/Water activities, Sand/Grass activities

- Crocs: Gardening… that’s it!!

- Dress shoes: 2-4 hours of light standing, special occasions

- Running shoes: Nike/Addidas/Avia/Reebok/Mizuno/etc – ONLY for soft-surface running (i.e. taking a jog on gravel or dirt or grass). Aetrex/Brooks/Saucony/New Balance 900 series and up – More of an all surface athletic shoe. Be careful about athletic shoes that you’re using them for the activity they were built for (i.e. don’t wear a running shoe for walking, or a running shoe for aerobics)

Secret 4: Only YOU really notice how ugly your feet/shoes are. Trust me, NO ONE cares about your feet/shoes the way that you think they do. Media has led us to believe that we must be super aware of our outfits. No one really cares, look around you! Besides, what’s more important? That your body is healthy and strong, or that you don’t “offend” someone you don’t even know by wearing ugly shoes? For real! You can’t be that shallow! I have gals who refuse to wear sandals because they have toe deformities, but the truth is that no one else really notices. All they’re doing is making themselves uncomfortable and insecure. Hold your head up high and don’t find self-esteem from what the media says you should look like.

To conclude, your feet do not have to hurt or ache. Come see someone who can help you figure out how to protect your feet and body from discomfort and the damages that occur from walking on hard, flat surfaces. They can help you learn how to find good shoes and explain why your feet hurt. Don’t wait until your feet are disfigured and injured to take care of them. If you can keep your feet looking nice AND operative correctly, then you’ll save yourself a lot of stress and pain AND money in the long run.

The Denver/Lowry Foot Solutions store is on Quebec street just North of Alameda and just South of 6^th street. It’s right next door to The Delectable Egg. We’ll see you there.

Chung Shi and Masai Barefoot Technology (MBT)

You’ve probably heard about them in an ad or from a friend. “They’re like magic. They’ll melt your cellulite and make your body feel really good.” Not all these claims are necessarily accurate, but the fact is that people LOVE Mbts and Chung Shis. I’d say their best advertising is through the people who wear them and have had results they’re happy with.
Now, let me explain some of the differences between the two, pros and cons, and some important key factors to consider before you buy them.

Q: What are the differences between MBT and Chung Shi biomechanically?
A: MBT began distribution in 1996. Chung Shi was developed later. Both began as medical equipment for physical therapists and pre/post surgical therapy. As research on the product progressed, more benefits were recognized.
Mbts slowly teach your body how to stand/walk appropriately. It takes time, but isn’t terribly aggressive or difficult to adjust to. They’re quite soft in the soles, which initially makes them feel like you’re walking on clouds.
Chung Shi shoes are an aggressive approach to gait correction. It forces the body to stand and walk correctly. They’re more rigid and stabile for more control and durability.
They’re both designed to counteract the detrimental effects of walking on hard flat surfaces your whole life. The body breaks down when forced to be on such harsh surfaces regularly. Not to mention the awful footwear that is standard in the US. This Biomechanical Technology was developed as a long-term preventative/corrective solution to muscle atrophy and poor gait. So far, being quite successful across the board.

Q: What are the main benefits of the Swiss Masai and Chung Shi?
A: These shoes are designed to over time, tone and shape the body, activate neglected muscles, improve posture and gait, help with shock absorption, and help with various discomforts and medical conditions both pre and post operation.

Q: Who cannot wear the MBT and Chung Shi?
A: It varies per person. If you have concerns about wearing these shoes with your condition, PLEASE ask your doctor or therapist. Tendonitis is usually a condition that has a pretty good bet of a negative response from these shoes, but there aren’t a lot of definites. There are no guarantees. Many people have amazing results medically/physically from these technologies, but even people with the same conditions can react differently to it.


Some Pros and Cons

MBT
Pros : Cons

Softer soles : Instability medially/laterally, which may mean you’ll need an arch support in addition to the shoe. Because of the softness and instability, they’re only to be used on hard flat surfaces.

Build muscles around the major joints so as to ward off cartilage wear and give the body a natural shock absorption : Some major injuries and/or surgeries can interfere with the ability to tolerate muscle use

Generally an easier break-in because of softer sole and more mild transition : The soles are more sensitive to water and chemicals causing them to break down more quickly BUT can be resoled.

Chung Shi
Pros : Cons

More stability in the sole which is designed to help control gait : More rigid and aggressive; can seem quite uncomfortable at first. BUT this sensation usually dissipates within minutes of walking in the shoe, as your muscles and feet get a little more used to the idea of the SHOE controlling your gait.

The rigid sole is very durable and isn’t sensitive to water like the MBT. They’re a multi-surface shoe : Cannot be resoled as of yet.

Build muscles around the major joints so as to ward off cartilage wear and give the body a natural shock absorption : Some major injuries and/or surgeries can interfere with the ability to tolerate muscle use.

Some things to be aware of before buying: Not everyone can wear these shoes. If you have a chronic medical condition, I’d recommend asking a medical professional before making your decision about these products.
They’re also a special fitting shoe. You need to be properly sized in the style of your choice as there isn’t consistency of fit between styles. Depending on the last and uppers, you may be several difference sizes.
Also make sure you are properly trained/informed on the dos and don’ts of MBT/Chung Shi use. There are things you may need to know for specific activities you wish to use them for.
**Most Importantly!! You may also need to wear arch supports in these shoes as with any other shoe. There is “more” control in the Chung Shi arch than the MBT, but that doesn’t mean that it’s ENOUGH. You need to be properly evaluated for poor alignment in your feet or you may end up with more irritation and discomfort than before you tried the shoes. Very important. A Pedorthist can evaluate your gait at the Denver, Colorado Foot Solutions store in the Lowry Town Center.

To sum up, You should be evaluated at your local Foot Solutions store to see if you are a good candidate for either the Swiss Masai Barefoot Technology or the Chung Shis. They’re both Great products that promote better health throughout the body.

Topic: SOCKS

You wouldn’t think it matters very much what type of sock you wear or what it’s made of. People usually think of sock as disposable clothing, therefore it doesn’t make sense to spend a lot of money on them, right? Especially when you can get them in packs of 6 for ten bucks.
Socks can serve many purposes, and can dramatically improve your comfort level when you have the right one per the activity/footwear.

MATERIALS –
Myth: Cotton socks are the best.
Truth: Not unless you’re allergic to microfiber and/or wool materials.

Cotton is only breathable when it’s exposed. If you’re enclosing it into a shoe, or trapping it between your foot and the ground/shoe sole, it is no longer breathable.
Cotton naturally absorbs moisture. The average foot puts out ½ pint of body oils in a day. Much more if you’re active.
The socks will absorb this moisture, and then what? It holds the moisture against your foot. The socks start losing their shape because they’re wet, and you keep having to pull at them as they’re sliding down your leg and bunching up in your shoe. Now you start to get blisters and corns, which are the result of the combination of moisture and pressure/friction. The other downfall to cotton is that, because of the moisture it holds, it starts to break your shoes down pretty fast.
Now you wouldn’t think that synthetics would be any better. Nylon blends and Rayon blends aren’t very good. Microfiber/Acrylic is the best material for socks, with marino wool coming in second. Microfiber and Wool grabs the moisture that your foot puts out and shoves it out towards the shoe. Get into a really good brand like Thorlo, Smartwool, Feetures, Aetrex. These socks will outlast all your other socks, plus they hold their shape without fail. They’ll cost you a little more money, but they’re worth every cent. You can find some of these brands at the Foot Solutions stores. The Denver location can order in whatever styles you desire in each brand.

ACTIVITY -
A lot of socks come in padding levels. Some are specifically designed to pad the spots on the feet that are affected by the activity that you’re doing. There are socks for Skiing, Hiking, Running, Walking, Golfing, Fishing, Snowboarding, Basketball, Tennis, Dress and many other activities. The brands I’m thinking of that have the most variety are Smartwool and Thorlo.

CONDITIONS -
There are even socks for medical conditions, like Diabetes. These socks are always microfiber blends, in order to keep the feet dry and blister free. They are also designed without seams, and usually with more built-in padding to protect the bottoms of the feet. The best Diabetic socks come in low-compression styles, or even ultra-low compression for the wider calf. Low compression socks are knit a lot more loosely, so that they don’t leave ridges in your feet or legs like most other socks do. It’s very important not to wear things that fit tightly when you are a Diabetic. That is, with the exception of your doctor stating otherwise.
Another condition or two that is affected by socks is Toe Fungus or Athletes foot. The moisture that you get from your feet every day feeds the bacteria and fungus growing under your nails and between your toes. You need the moisture control that wicking socks provide, and you should definitely not be in a synthetically made shoe either. All-leather uppers and/or mesh will allow the trapped moisture escape.

Synthetic socks will also help with temperature control with your feet if you have poor circulation and have cold feet all the time, or if you have sweaty stinky feet no matter what you do.

TIP -
A tip for fighting moisture in your shoes is to put some cedar balls/shoe trees in them when you take them off at night. Wear an entirely different pair of shoes the next day and let the cedar sit in your shoes for the whole day. By the following day, your shoes will be nice and dry, and the cedar balls/shoe trees will have absorbed a great deal of foot odors, moisture, and bacteria growing in your shoes (which is the natural result of normal wear). This, in addition to wearing Microfiber or Wool socks, will make a huge difference to the shoes preservation.

In a nut shell, materials that hold moisture are bad for the skin on your feet, your socks, and your shoes. Find the socks that most suite your lifestyle and enjoy your new sock-induced foot health.

Bunions

Topic: Bunions

Look at your feet. Now wiggle your big toe. The joint that you’re using is VERY important. You use it every time that you stand, and every time that you walk.
The problem is that if you’re walking on flat surfaces and have any flexibility at all, you’re likely to develop bunions. The cause is biomechanical.
That’s not to say that some people aren’t born with bunions, but the majority of bunions can be traced back to poor foot biomechanics and poor environment (flat surfaces). Sometimes it’s the choice of footwear.

None of us were born to walk on hard, flat surfaces, rather on soft, unstable surfaces like grass, sand, dirt, rocks. The biomechanics of the feet will not function properly on hard, flat surfaces. They simply can’t. There is a reason your feet are in pain.
Over time, our foot structure breaks down little by little from walking improperly. Bunions are generally formed from these malfunctions in your gait. The arch falls and the forefoot turns towards the outside of the shoe, the joint of the big toe gets torqued
and swells. Sometimes it actually comes out of joint. Sometimes you get bone spurs on the edge of the joint that are extremely painful when you bend the toe. Sometimes the joint just looks really big and pushes against your shoe.
What you need to do for bunions? Well… depends. You can’t fight hereditary bunions very effectively. But there is hope for correction or partial correction with biomechanically developed bunions.

Biomechanically developed bunions are divided into two categories: Flexible and Rigid. With flexible bunions you can still move your big toe from right to left easily. Many people wearing a biomechanical arch support have seen reduction in their bunion deformity. This device is called a Custom Biomechanical Arch Support. This type of orthotic changes the bad biomechanics of your gait, so long as you haven’t had surgical procedures that restrict your function from fully returning. It may LOOk like all the other plastic orthotics out there, but it IS NOT similar in the way they function. There are a few facilities in Denver, Colorado who carry this product.

This device may or may not be helpful for those of you who have Rheumatoid Arthritis, I will point out. The orthotics may need to be worn with a rigid carbon plate underneath the orthotic to keep from irritating the inflammation in the great toe joint.

Some people with rigid bunion deformities have also seen some decrease in their bunions with the use of a biomechanical orthotic device. The only other option being to have them surgically removed, orthotics are worth trying first. It takes time, as bunions don't develop overnight, they will not dissipate overnight either.

Q: Should I explore surgery for my bunions?
A: Not as a first option. Your shoes can be made to accommodate your bunions, biomechanical orthotics will help offload pressure and maybe even cause some correction, and/or bunion splints for daytime/nightime.
Surgery should be reserved as a last option for the feet. Opperating on your feet is like taking parts off a car. It'll never function the way it's designed to. It can even stop you dead in your tracks. I've seen alot of foot damage CAUSED from foot and ankle surgeries.

Q: Why do so many people’s bunions return after having them surgically removed?
A: What happens is that people have their bunions removed, but then get right back into their old lifestyle, their old shoes, their old habits. You can’t expect a different result the second time around. It’s cause and effect.


Q: Will ANY orthotic help with my bunions?
A: Yes and no. Most orthotics are accommodative, meaning that they restrict foot movement and prevent worsening of foot conditions. Better than nothing, yes. But definitely not going to help you as much as a biomechanical/functional arch support. Accommodative orthotics support the status quo.
Whether or not your bunions bother you, they are a sign that your feet are not functioning properly. The key is to target the CAUSE of what is creating the foot problem, and work on THAT. Bunion splints, gel pads, and toe separators are all the equivalent of a band-aid. Not going to fix anything. They just mask the boo-boo.



Cross-over deformity: This usually happens when the first toe joint is pushed so far over by the bunion that the 2nd toe has no where else to go but over the first. If this becomes rigid (can’t pull the 2nd toe straight manually) it will probably have to be surgically repaired, an undesirable circumstance.



To sum-up: Unless your bunions are hereditary (you'll know if you have hereditary bunions, not if your parents had them, but if you've had them since you were in your early teens), bunions are the result of bad foot biomechanics.
If you don’t have them, be glad. If you do have them, I suggest having your feet checked for biomechanical malfunctions, and review non-surgical solutions before surgery.
Make sure that your shoes have a roomy toe box when you’re going to be on your feet a lot.
If you have ANY pressure from your shoe on the bunion, or if your bunion is red and inflammed on the outside, then you should have a pocket stretched into your shoe to accommodate.

As always, it is important to have your individual feet evaluated for solutions specific to your body type. What works for one person may not work for another. There are very few solutions for bunion deformities, though. If left untreated, they can get pretty big and ugly and interfer significantly with your gait. Compensation problems can result.



Please write me with questions and comments. The discussion of certain products or techniques is welcomed.

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It is not appropriate nor appreciated to post the web address of other businesses on this website. If you feel there are other solutions or products that are beneficial that I havn't mentioned, please write an e-mail to my business e-mail for me to review before it is posted. Thank you.

**THE “OUCH!! MY HEELS ARE KILLING ME!!” SYNDROM**

WHAT IS IT? Plantar Fasciitis is a micro-tear in the Plantar Fascia, usually at the point where it connects to the heel bone. The Plantar Fascia is the very strong tissue that connects to several bones just behind your toes, and stretches across the entire bottom of your foot attaching to the heel bone (ie. See picture above). The Plantar Fascia is pulled taut each time that you put weight on it, and can become overworked and overstretched. Plantar Fasciitis describes tears that occur in the Plantar Fascia. It IS an injury and should be treated as such.

· Plantar (bottom)
· Fascia (tissue that stretches across the entire bottom of foot, attached to the heel bone and the metatarsal bones of the forefoot, and aids in walking and standing)
· -Itis (inflammation)

I see it every day, and it’s no wonder with the type of footwear people are wearing. Flip-flops and Crocs are on the rise. People wear dress shoes for eight hour shifts almost every single day, without the consideration of how much foot damage is just over the horizon for them.

You’ve probably heard of Plantar Fasciitis. It’s becoming more and more common, even among teenagers.
Some people get it as soon as their foot structure is finished developing, and others get it seventy+ years later. It all seems to depend on foot flexibility and lifestyle.










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CAUSE:

If you understand the cause of Plantar Fasciitis, it’s easy to understand what must be done to both prevent and heal it.
The Plantar Fascia is the connective tissue that extends across the entire bottom of the foot. It is a crucial part of the foot.
Depending on how flexible your feet are, over time the Plantar Fascia becomes lengthened and stretched to the max. Once it gets to that point, it doesn’t take much for it to tear. One morning you’ll step out of bed and think you’ve stepped on a nail, or you step off the side of the curb and feel a sharp sting. Once this initial tear has occurred, it very easily reoccurs with almost any amount of stress put on the feet… i.e. walking, running, or even just every day chores. You’re going to have a really rough time getting rid of Plantar Fasciitis if you’re up and down ladders all day. But other than that, if you are willing to make a few changes in your footwear and lifestyle, it shouldn’t be too difficult to get under control.

You wouldn’t think that walking is so stressful on the feet. If you are walking or standing on flat, hard surfaces (tile, hardwood, pavement, sidewalk, even carpeting) you are putting a lot of unneeded stress on the feet and obstructing the natural biomechanics of the body. The feet (no matter what your arch height) are designed to walk on natural, uneven surfaces (dirt, rocks, sand, grass).
Your body is like a car. Can you imagine driving a Camry through the woods? It’d break down pretty quick, because it’s not designed to operate in that environment. The same way, your body isn’t designed for hard-flat surfaces.

It doesn’t take a doctor to understand that when you mess with the function of the body that a large variety of things start going wrong. A large number of knee, hip and back problems are associated with improper gait and poor foot function. Poor posture is almost always associated with the feet and ankles. With that said, when you restore function to the body, it has a tendency to snap back. That is, so long as you havn’t had an injury or surgery that prevents you from reaching full function again. Going back to the car analogy… If you start to fuse parts of a car, or even worse, take parts off… that car will never run the same again. Can’t.

So, ideally your prescription would read “Move to the beach, relax, and get plenty of fluids.” Not likely, right?! They more likely read “Custom Orthotics, stable footwear, and calf stretches.” Hopefully you don’t have a doctor whose first suggestion is surgery. There are very good, and very successful, NON-surgical procedures for Plantar Fasciitis.
My experience is that THE RIGHT ARCH SUPPORT for YOUR body and foot type, in combination with LOTS OF CALF STRETCHES is the most successful treatment for Plantar Fasciitis, along with many other foot and joint disorders. The right arch support will provide your body better alignment, which affects all your joints.
To sum up, what causes PF is lack of support, a hard-flat environment, and mooshy-soft-cheap footwear.
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TREATMENTS:

There are varieties of solutions for Heel pain:

• Heel Lifts - Not recommended for more than 2 weeks. A very short-term solution. If worn more than a couple of weeks, it will cause your Achilles tendon to become shorter, which will in turn tug even harder on the plantar fascia and become inflamed again.
  
  


• Heel Cups - Also a short-term solution. If built into an arch support device, very effective, though.
  




• Stretches – Keeping the Achilles loose and long are key to preventing and healing Plantar Fasciitis statistically. A variety of calf-muscle stretches are provided below.












• Night Splints – A boot-like device that is worn while you sleep in order to keep the Achilles from shortening during the night.








• Ice - You can find various products to freeze and roll your feet over to help decrease the inflammation.






• Higher heeled shoes – Obviously a worse-case scenario. If you REALLY want to shorten your calf-muscles and throw your entire alignment off, help yourself to some heels.




• Accommodative Arch Supports – A good idea, but ultimately not a long-term solution, either. Accommodative orthotics are rigid and do not allow the foot muscles and tendons the normal movement they need in order to stay strong and fit. You DO want to restrict your foot from over-stretching, but if you restrict your foot biomechanics TOO much, the muscles and tendons with shorten and weaken. It’s the fine line between not-enough and too-much support.





• Functional Arch Supports – Now THIS is the best solution by far, because it supports the foot, but also allows the foot to function at its best. There is some flexibility in the orthotic, but not too much. If you can get the ones that are calibrated to your body weight and foot flexibility you'll be getting an upbeatable orthotic to date.
  
  



• ESWT (shock wave therapy) - Ask your doctor about this option.
  
  



• Supportive footwear -
  *Your shoes
  should not bend
  anywhere past the
  ball of the shoe*
  
  
  




• 
  




• The Most effective solution? The combination of Function Orthotics, calf stretches, and supportive footwear. Orthotics, because ultimately collapsing arches are the cause of PF. Calf-stretches, because short calves will cause PF to reoccur. Supportive footwear, because you need to be wearing a shoe that will hold up against the hard, flat surfaces you’re walking on from day to day.
  
  
  Some treatments work more often than others, but no ONE treatment works for everyone. Healing can be up to double the amount of time you felt the original injury.
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**I love this picture. It's the best way to describe what happens to our bodies when the feet don't function properly. Your feet are your foundation. Your feet can't function properly on hard, flat surfaces. So, they begin to break down. Once that happens, the whole body starts to collapse. The answer is to do the best you can to rebuild the foundation, hence realigning the body/house. Shoes represent the beams propped against the side of the house. Still not quite enough, but does make some difference. The bricks represent an arch support. We can't cut off our feet and replace the foundation... but supports will keep it from getting worse, and helping reverse the reversible damage.**

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STRETCHES:


*You must hold these stretches for 45-60 seconds each stretch.

Do not bounce on the stretch.

Hold it nice and snug for the full 45-60 count.

Do the stretches as often as possible until you’re past the severe stages of Plantar Fasciitis. After that, continue to stretch, but it’s ok to cut back a little. Any time you feel any stress on your feet, though, stop and stretch.


*Drop your heels off the stair until you feel the calf pulled taut.
Hold stretch 45-60 seconds.



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Questions and Answers

Q: Do I have to stop working out?
A: If it includes running or long amounts of walking, then YES until your feet have had time to heal a bit. Remember, this is an injury and inflammation. Once you get into your arch supports AND have had at least a few weeks of recovery, then start back into your exercise routine slowly.

Q: How long does it take to recover from Plantar Fasciitis?
A: How long have you had PF? Now take that time and divide it in two. That’s USUALLY how long it takes to recover from Plantar Fasciitis, IF you are doing your part.

Q: What’s a good shoe for Plantar Fasciitis?
A: Try the MBT or Chung Shi shoe. They are designed to lengthen and strengthen the calf muscles and the Plantar Fascia. In combination with the right arch support, these shoes will help to restore function to the body by giving you better posture, increasing your circulation, and increasing muscle activity throughout the body. This type of technology shoe is one of the best long-term ways of preventing Plantar Fasciitis as well as a myriad of other medical problems. Other than these shoes, you need to get OUT of your Crocs and flip flops and dress shoes. Get INTO a shoe that you can’t twist in half. It needs to have structure! That doesn’t mean that it’s going to be hard as a rock. Get your feet evaluated somewhere like a Foot Solutions, and they’ll help you get into a comfortable, structured shoe that will also suit your lifestyle needs.

Q: Once the pain goes away can I go back to wearing my old shoes, stop wearing my arch supports, and discontinue the stretches?
A: Absolutely NOT. Once this injury/inflammation has occurred, you can expect that when you go back to your old habits that it will come back. I’ve worked with people who’ve been struggling with PF for ten years! There’s no need for that. You MUST continue to take care of yourself. And unless you’re walking barefoot in the woods every day – all day, then you have to stay in your arch supports and supportive footwear.

Q: Can I go barefoot, even if it’s just around the house?
A: If you’re going to be on the beach or walking through the park… sure. If you’re going to be at home on your carpeted, hardwood floors… nope. You should NEVER go barefoot on flat surfaces. It might feel ok at the time, but it will only make the injury worse in the long run, and create more problems elsewhere. Remember, flat surfaces stress the feet, even when in a mooshy shoe like Crocs or flip-flops. Which is just as bad, if not worse, than going barefoot.











Q: What if I have a heel spur? Should I have surgery?
A: Please listen to your doctor. I would at least try wearing the right arch support and doing plenty of stretches before I’d recommend surgery. The MBT/Chung Shi shoes have also provided a great deal of positive results with bone spurs, from my experience. Because of the function restored to the foot (in combination with the right arch support), and the increase of blood circulation, some people have had bone spurs both relieved and reabsorbed. Like I said, Restore function to the body and it tends to heal itself.

IN CONCLUSION, the results vary case-by-case. You need to have your feet completely evaluated (gait analysis, pressure scan, foot palpation, flexibility test, footwear examination, etc). And be careful to do your OWN research. If you just trust that the sales associate or Doctor working with you knows everything, then you are going to end up spending a lot of unnecessary money. How many people have had orthotics made that didn’t work? Almost 99% of orthotics made don’t work, because they’re not put on the correct foot. There are a lot of orthotics out there; you just need to make sure that you get the right one for YOU. No ONE product works for everyone.


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Quotes: From Scott Roberts via HeelSpurs.com

**There are so many good quotes from this website I can't include them all. This guy was suffering from heel pain and started this website to help others learn about heel pain. He's not a doctor, but sometimes the most informed people are those who suffer from the condition.**

"Patients often report that the pain "moves around." The pain can be mild or debilitating. It can last a few months, become permanent, or come and go every few months or years for the rest of a patient's life with no obvious explanation.

Every year, about 1% of the population seeks medical help for this condition (one company claims it's 2.5%).

The heel may hurt when it strikes the ground, but plantar fasciitis is not caused by the heel striking the ground.

Some patients begin walking on the front of their foot because of heel pain. This may help if they have something other than plantar fasciitis, but if they have plantar fasciitis, walking on the forefoot causes more tension in the plantar fascia (which pulls more on the heel) and it can make their condition worse.

Unfortunately, it can take 12 to 36 hours after harmful activity before the pain increases, so it is not usually obvious what activity is causing an increase in pain. For example, a runner may not know if it was a recent change in shoes or changing to a terrain with hills that is causing an increase pain. But since a lack of flexibility in the calf muscles and/or excess weight are the causes of most cases, it is not usually a particular activity that can be blamed.

Despite the claims of various product manufacturers, there is no cure-all. Different treatments help different people. Patients need to be active in their treatment. Experimenting with several different treatments is often necessary before finding those that help. As in exercising and working out, actively finding a way to enjoy the daily routine that is beneficial to your feet is crucial for continued improvement. Applying ice, stretching, and taping are not inherently enjoyable, and it is not always obvious that they are helping.

The pain usually increases gradually over weeks or months before help is sought, and improvement is usually just as slow. Patients often have to be patient. Setbacks are the norm in dealing with plantar fasciitis, and simply preventing the daily minor injuries is just as important as preventing the less frequent big injuries.

A portion of a patient's lifestyle (excessive running or standing, over-eating, inactivity, or inflexible shoes) has often caused the pain, and it is that portion of their lifestyle that has to change. Desk jobs are unnatural and a very recent development, so they are probably a major cause by way of atrophy (desk jobs prevent the feet and legs from being naturally flexible and strong). Frequent stretching before walking should be emphasized for those with desk jobs."

"Trying to "walk through the pain" can cause a mild case to become long-term and debilitating."

"So, many doctors appear to use the phrases "heel spur" and "plantar fasciitis" interchangeably. Plantar fasciitis and heel spur syndrome are "waste basket" diseases: if there is pain in the heel or bottom area of the foot and the doctor has ruled out other causes, then it may be called "plantar fasciitis" or "heel spurs." This is not a completely unfortunate situation because many of the treatments for plantar fasciitis will help many different causes of heel and arch pain. "

"Out of the 1st 2,655 responses to the survey, 46% had had heel pain for over a year. The pain can range from mild to debilitating. In some cases, patients report having to quit work and crawl to get around the house. If there is little success after 9 to 12 months of proper conservative treatment, patients are often advised to have surgery. A podiatrist emailed to say that the presence of a bone spur increases the chances that surgey is required. Surgery fails 2% to 35% of the time, depending on which journal article is quoted. Some doctors may have a failure rate greater than 50%. A failed surgery can ruin the patient's ability to walk for at least a year. Some surgeries reported as "successful" by the doctor may decrease a patient's ability to walk for up to a year. Those who delay seeing a doctor, have heel spurs in both feet, or are overweight are more likely to have the condition for a long time. It is important for the patient to be active in their treatment."

"Probably the number one cause of plantar fasciitis is lack of flexibility in the calf muscles. A journal article reports that people with inflexible calf muscles are 23 times more likely to get it."

"See "Risk Factors for Plantar Fasciitis: A Matched Case-Control Study" J Bone Joint Surg Am. 2003 Jul;85-A(7):1338.
Results: Individuals with 0° of dorsiflexion had an odds ratio of 23.3 (95% confidence interval, 4.3 to 124.4) when compared with the referent group of individuals who had >10° of ankle dorsiflexion. Individuals who had a body-mass index of >30 kg/m 2 had an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6) when compared with the referent group of individuals who had a body-mass index of 25 kg/m 2 . Individuals who reported that they spent the majority of their workday on their feet had an odds ratio of 3.6 (95% confidence interval, 1.3 to 10.1) when compared with the referent group of those who did not. "

If you have any questions, please feel free to e-mail me. BethJensenCPED@yahoo.com
To reiterate, I’m not a doctor. I am a Board Certified Pedorthist, trained in foot biomechanics, foot conditions and disorders, and some preventative non-surgical foot care treatments. My goal is to point to some products and services that I personally believe are helpful and effective, and to provide some focused education about foot conditions and treaments.

What is a CPED?

A Certified Pedorthist, or C. Ped. is a specialist in using footwear - which includes shoes, shoe modifications, foot orthosis and other pedorthic devises - to solve problems in, or related to, the foot and lower limb.

Description - Wikipedia

Primarily, a C.Ped will select, make and/or modify footwear and foot control devices to help people maintain or regain as much mobility as possible or to optimize their lower extremity biomechanics. Their scope of practice is typically defined in layperson's terms as the ankle and below.

When ability to walk is affected, everything that surrounds or touches a foot - whether it is foot orthoses (commonly known as orthotics or arch supports), shoes, boots, slippers, sandals, socks, hosiery, night splints, bandages, braces, partial-foot prosthetics, or other devices - interacts with a foot. That makes footwear a crucial part of a recommended treatment plan.

Most often, it is Certified Pedorthists, not Podiatrists (or D.P.M.s), who create foot orthotics, whether custom-molded, or pre-molded. A Podiatrist will often take an image of the foot by means of a plaster cast, foam mold, or computer scanned image. He or she will then make recommendations for changes to that image, and send the mold to a lab where the Pedorthist produces the final product.

Becoming a C.Ped. requires completing the educational requirements approved by the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) and passing a written credentialing exam. Efforts are currently underway to establish an A.A. degree in Pedorthics, and are expected to be set by 2010. Source: Wikipedia