Does Pain In The Foot's Arch Require Surgical Treatments ?

Overview

Plantar fasciitis can be a real pain in the foot. Plantar fasciitis is the medical term for inflammation of the plantar fascia, which is the connective tissue that runs along the bottom of your foot. If you?ve ever had pain in the bottom of your foot with the first few steps out of bed in the morning, you?ve probably had some experience with this painful condition. In active populations, plantar fasciitis is often associated with overuse or a sudden change in activity, and temporarily easing off of activity can be part of the solution. In more sedentary populations, weight gain is usually a major contributor to plantar fasciitis and a weight-loss plan could be of benefit. Whether you?re active or sedentary, however, previous foot injuries, poor arch support, or tight muscles around the foot can all predispose you to plantar fasciitis.

Pain In Arch

Causes

Arch and heel pain is usually the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. This increased stress causes local inflammation and pain. The most common cause of the stress is a condition where the inside arch of the foot flattens more than it should (often known as "over-pronation"). When the arch of the foot flattens, it also gets longer, causing a stretch on the plantar fascia. In response, the heel becomes inflamed where the plantar fascia attaches.

Symptoms

Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).

Diagnosis

In people with flat feet, the instep of the foot comes in contact with the ground when standing. To diagnose the problem, the health care provider will ask you to stand on your toes. If an arch forms,the flat foot is called flexible. You will not need any more tests or treatment. If the arch does not form with toe-standing (called rigid flat feet), or if there is pain, other tests may be needed, including a CT scan to look at the bones in the foot. MRI scan to look at the tendons in the foot. X-ray of the foot.

Non Surgical Treatment

Rest and icing the swollen area are a good way to practice in-home treatment for mild foot arch pains. Anti inflammatory medications can also be applied to the area. It is important to reduce your activity to avoid worsening the arch pain. Wearing shoes that fit properly is important as well. Make sure to use shoes that are designed with adequate arch support to prevent over pronating. When running, avoid uneven surfaces, as this may contribute to your foot arch pain. Also, orthopedic pads or other padded heel cups and devices can be inserted into shoes to provide support and prevent more strain to the foot.

Pain In Arch

Surgical Treatment

The main goal of surgery is to reduce pain and improve function. It may also reduce other injuries such as repeated ankle sprains and broken bones. Surgery may be considered if there is no relief with physical therapy, changes in shoewear and/or changes in activity. Some patients will also have tendon problems, ankle weakness and foot fractures. These patients may require other procedures to address related problems. If you have medical problems that make surgery unsafe, any infections or blood vessel disease, cavus foot surgery may not be appropriate. The surgical procedures involved with the correction of the cavus foot are varied. Theses may include correction of the bony deformity, ankle looseness and the muscle imbalances that cause the deformity. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.

Prevention

Early in the treatment of arch pain, consideration needs to be given to the cause and strategies put in place to prevent it happening again. Advice should be sought on the adequacy of footwear. Stretching exercises should be continued long after the symptoms are gone. Foot orthoses should be used if structural imbalances are present. Activity levels and types of activities (occupational and sporting) need to be considered and modified accordingly.

Stretching Exercises

Calf Raises. Strengthens the tendons in your heels and calf muscles, which support your arch. Raise up on the balls of your feet as high as possible. Slowly lower down. Do three sets of 10 reps. Progress to doing the raises on stairs (with heels hanging off), and then to single-leg raises. Step Stretch. Improves flexibility in your Achilles tendon and calf-when these areas become tight, the arch gets painfully overloaded. Stand at the edge of a step, toes on step, heels hanging off. Lower your heels down, past the step, then raise back up to the start position. Do three sets of 10 reps. Doming. Works the arch muscles and the tibialis posterior (in the calf and foot) to control excess pronation. While standing, press your toes downward into the ground while keeping the heel planted, so that your foot forms an arch (or dome). Release, and do three sets of 10 reps on each foot. Toe Spread and Squeeze. Targets the interossei muscles of the foot, which support the arch. While sitting, loop a small resistance band around your toes. Spread toes; release. Then place a toe separator (used at nail salons) in between toes. Squeeze toes in; release. Do three sets of 10 reps of each exercise on both feet. Towel Curls. Works the toe-flexor muscles that run along your arch to increase overall foot strength. Lay a small hand towel on the floor, and place one foot on the towel. Using just your toes, scrunch the towel toward you, hold, then slowly push the towel away from you back to start position. Do three sets of 10 reps on each foot.

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