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Plantar fasciitis typically presents as pain in the heel (mostly on the inside fron of the heel) or in the arch foot. The classic description from patients is that the pain is worst when first getting out of the bed in the morning and then eases when walking a few steps. However, once up and about the issue returns when getting up to walk when sitting down.
It commonly presents in adults and is often related to stesses and strains from activity. Through time the plantar fascia becomes injured through wear and tear and eventually leads to what some people feel is an extremely debilitating heel pain or arch pain.
Foot biomechanical issues are very often a contributary factor and need to be considered as part of any treatment programme
The plantar fascia is like a huge elastic band running from your heel bone (calcaneus) along the bottom of your foot and up to your toes. The plantar fascia is one of the main stabilising structures in the foot when walking or running. Biomechanical issues put extra stress on the plantar fascia and through time can become inflamed and painful. Plantar fasciitis is extremely common, and effects a large percentage of the population at some point in their lives.
If you experience any of the issues described above it is very important that you seek qualified professional advice from an Orthotist or Podiatrist around how you should manage this issue. In extreme cases plantar fasciitis can develop and become more stubborn. Plantar fasciitis is in essence a soft tissue problem, but left untreated can develop into a heel spur, which is much more difficult to treat.
Our biomechanical assessment clinic in Hamilton (near Glasgow) can help you with advice and treatment for plantar fasciitis.
Within the clinic we will confirm the diganosis for you and also assess and advise how we could help address the pain and discomfort caused by Plantar fasciitis.
Pain at the forefoot (or front of the foot) can be caused be due to a number of different issues and conditions. A few of these conditions will be described below such as:
Pain at the forefoot generally underneath the foot in the area of the joints of the toes. It can be across all joints or on one single area of the forefoot. The pain is worsened when either in barefoot or in shoes with a slight heel, due to the lack of cushioning in appropriate shoes. In basic terms, metatarsalgia is caused by excessive point loading of an area, often due to an alignment or biomechanical issues.
Involves pain and numbness in the areas between the 2nd-3rd or 3rd-4th toes. The cause of a Morton's neuroma is related to nerve impingement which leads to pain and numbness in this area.
Commonly known as bunions. In this condition the big toe joint is often inflamed and painful. The big toe is deviated to varying degrees towards the 2nd toe with the 1st MTP joint more pronounced. There are a number of reasons for hallux valgus such as Overpronation and Bio Mechanics.
Issues with the motion of the 1st toe and it is reduced impacting on it's ability to move upwards (dorsiflex) when walking. The big toe has an extremely important function in walking to aid in stability and propulsion when pushing off from one foot to the next. When the foot cannot do this either due to arthriitis or poor foot biomechanics compensatory movements take place. This is likely to cause secondary issues.
Over pronation, hyper pronation or "flat feet" are all terms used for feet that give the appearance of rolling in excessively.
Pronation is often assumed to be a bad thing and regularly will be suggested that it should always be prevented. However, during walking and running it is quite normal for the foot when first hitting the ground (shock absorption phase) for the foot to pronate or roll inwards slightly.
Pronation is only normally an issue if this rolling in is excessive and the patient is complaining of symptoms often related to over pronation, such as: Arch or Heel Pain, Toe Joint Pain, Shin Splints or Knee Pain
Under pronation, supinated or the high arched type foot are all terms used for feet that give the appearance of rolling outward onto the outside edge of the foot.
The under pronated foot, high arched or supinated foot is a little more unusual in comparison to the supinated foot. It is generally a "stiif" foot and often patients have less movement around some of the key joints that allow the foot to work normally.
The high arched foot often has too little shock absorption as the foot does not pronate or roll in (normally to absorb the shock on impact) as it should when first making contact with the ground in walking or running.
The high arched foot oftem means that less of the foot is in contact with the ground, meaning some areas of the foot take more pressure than normal. the conditions relating to the high arched foot are often similar in nature to those in the over pronating foot, simple due to the altered biomechanics both conditions cause.
Metatarsalgia is pain at the font of the foot and is directly related to how weight is taken through the forefoot.
A specific forefoot pain that specifically relates to the pain underneath the big toe joint related to 2 small bones in this area. It is felt when the 1st toe is loaded usually when the foot is preparing to push off onto the other foot.
It is often present in females who wear high heeled shoes or when the 1st toe is over loaded repeatedly. Biomechanical issues which involve loading the inside of the foot excessively such as over pronation and also in the high arched or cavus type foot.
A secondary problem which is present usually underneath the 2nd toe joint (Metatarsophalengeal joint). Often when patients have other issues such as bunions or over pronation it affects the biomechanics of the foot.
The over pronated foot loads the 1st toe earlier and more than is normal which displaces on weightearing. The 2nd toe however cannot displace and is then left to take excessive load causing pain and discomfort. In the longer term it is common to see hard skin underneath the 2nd/3rd toe joints.
To treat transfer metatatarsalgia it is important to treat he underlying biomechanical issue by using orthotics (insoles) to control the foot when walking or running.
Tight Achilles Tendon
Limits the movement at the ankle and ultimately how the foot would work in stance phase (while your foot is on the ground).
As the movement is limited at the ankle other joints in the foot and ankle try to compensate usually by increased pronation. The problem with this compensation is that this alter how the foot takes load. This in turn can lead to metatarsalgia due to the increase in load of the foot.
To treat the foot with a tight Achilles tendon and secondary metatarsalgia. Stretching of the tendon to elongate the calf muscles is required. Orthotics to offload the painful area and to correct the altered biomechanics would be required.
occurs where the structures underneath the foot (plantar structures) are tight. As a result of this tightness, the arch is often stiff and possibly higher than normal. A forefoot equinus is often seen in the under pronating or high arched foot.
A forefoot equinus happens where the back of the foot (hind foot) and the forefoot are misaligned due to the tightness in the plantar fascia. When looking from the side (sagittal plane) the forefoot sits lower than the hindfoot (see image).
As a result of this foot position the foot takes weight over a smaller area than normal meaning pressure under the front and the back of the foot is increased, leadin to metatarsalgia. Orthotics would be used to re-distribute pressure across the foot more evenly.
In extreme cases plantar fasciitis can develop and become more stubborn. Plantar fasciitis is in essence a soft tissue problem, but left untreated can develop into a heel spur, which is much more difficult to treat.
Where the foot rolls in excessively and causes issues around how weight is taken through the foot and how it functions. (See "Flat Feet" for more information.)
Where the foot rolls in less than is normal and is closely related to the issues described above in the forefoot equinus section. Often the high arched foot requires more cushioning as this is lost in the stiff under pronating foot. (See "High Arches" for more information)
Shin splints is an over use injury which relates to muscles in your legs working harder than they are able to do. This results in them becoming strained, inflamed and in more chronic situations can lead to stress fractures in you tibia (lower leg bone) if untreated.
There are 2 main areas where people experience shin splints. Both of which can be extremely painful during and after running and can feel like the tibia itself is sore due to the pulling from the muscles which originate in this area. Or alternatively, the muscle belly on the outside of the lower leg
There are a wide variety of issues that can result in knee or thigh pain. Some of which relate to isses with wear and tear or conditions such as arthritis, but also relating to imbalances or alignment issues causing pain on activity.
Often patients report no ongoing history of knee pain but pain starts when they increase their activity e.g. running or walking more. Pain in particular areas of the leg can be related to different problems.
Pain after walking or running can be caused by a number of conditions and factors.
We recommend you book a biomechanical assessment to get to the bottom of the source of this pain.