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Certified Pedorthist

What Causes Heel Spurs & How To Treat Them

April 27, 2020 by Target Therapeutics Leave a Comment

active man running and jumping with a heel spur

A heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. On an X-ray, a heel spur can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as “heel spur syndrome.” Although heel spurs are often painless, they can cause heel pain.

active man running and jumping with a heel spur

What is a Heel Spur? 

Heel spurs are a common source of heel pain. Heel spurs are a bony growth attached to your heel bone (calcaneus) and grow into your foot arch.

What Causes a Heel Spur?

A heel spur is caused by chronic plantar fasciitis.

Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. Your plantar fascia acts as a passive limitation to the over flattening of your arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis.

When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. These bone formations are known as heel spurs.

What are the Symptoms of a Heel Spur?

You’ll typically first notice early heel spur pain under your heel in the morning or after resting. Your heel pain will be worse with the first steps and improves with activity as it warms up.

feet man runner running on snow forest trail

How Does a Heel Spur Progress?

As your heel spur grows, the pain will be present more often.

How is a Heel Spur Diagnosed?

Heel spurs and plantar fasciitis is usually diagnosed based on your symptoms, history and clinical examination.

X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur.

Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.

Pregnant woman massaging her swollen foot sitting on bed

Risk Factors for Heel Spurs

You are more likely to develop plantar fasciitis and heel spurs if you are:

Active

Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. running, ballet dancing and aerobics.

Overweight or Obese

Carrying around extra weight increases the strain and stress on your plantar fascia.

Pregnant

The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation.

On your feet A lot

Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses.

Flat Feet or High Foot Arches

Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.

Middle-Aged or Older

With ageing, the arch of your foot may begin to sag, putting extra stress on the plantar fascia.

Wearing shoes with poor support.

 

Weak Foot Arch Muscles.

Muscle fatigue allows your plantar fascia to overstress and cause injury.

Arthritis.

Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Diabetes.

Although doctors don’t know why plantar fasciitis occurs more often in people with diabetes.

an obese woman works out in the gym

Heel Spur Prognosis

The good news is that heel spur pain is rarely permanent. Plantar fasciitis, the main cause of a heel spur, is reversible and very successfully treated. Over 90 percent of people with plantar fasciitis or heel spurs improve significantly with physiotherapy treatment. While you may continue to see a heel spur on Xray, once you settle the inflammation adjacent to your heel spur, the heel pain will resolve.

Heel Spur Treatment

Due to poor foot biomechanics being the primary cause of your plantar fasciitis it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development of a heel spur.

Our Certified Pedorthist is an expert in foot assessment and its dynamic biomechanical correction who is an expert in the prescription on passive foot devices such as orthotics.

Active foot stabilization exercises are an excellent long-term solution to prevent and control heel spurs and plantar fasciitis.

Ultimately, biomechanical correction is the aim. Foot intrinsic muscle strengthening (including tibialis posterior and peroneus longus) and calf (gastrocnemius and soleus) stretches are almost always required.

Cases of moderate to severe biomechanical deformity should be referred for physiotherapy or podiatric assessment to prevent chronic recurrence. NSAID’s and corticosteroid injection is most effective when combined with biomechanical correction.

Mechanical treatment that involves taping and orthoses has been shown to be more effective than either anti-inflammatories or accommodative modalities.

Plantar fascia night splints essentially overstretch the plantar fascia, which may provide you with some short-term relief, but ultimately elongates your passive arch structures. The medium and long-term benefits make no sense of this rationale. On the contrary, permanent elongation will predispose you to flatter arches and more likelihood of recurrent heel pain. Based on this we do NOT currently recommend plantar fascia night splints in most instances.

Two women stretching feet before jogging

What Happens If You Do Nothing?

Left untreated, heel spurs grow larger and usually become excessively painful. For more specific advice about your heel spur or plantar fasciitis call our clinic

 

Make an appointment with our Certified Pedorthist today.

Filed Under: Certified Pedorthist

What To Do About Your Flat Feet

March 9, 2020 by Target Therapeutics Leave a Comment

Female feet on yoga mat at home

Female feet on yoga mat at home

What are Flat Feet?

Pes planus or flat feet is a postural deformity relating to the collapse or flattening of the medial longitudinal arch. It can also be referred to as hyperpronation or overpronation. Although there are varying degrees of collapse, people are still able to live completely pain-free with flat feet.

What Causes Flat Feet?

This condition can be congenital (e.g. from birth) or acquired (e.g. adults, increased exposure to weight-bearing).

Congenital flat feet occur when someone is born with or predisposed to having a more flexible midfoot region resulting in pronation or collapsing of the arch. Ethnicity is an important factor surrounding flat feet, with the condition being more likely in certain indigenous cultures.

Acquired flat feet are caused by a loss of active (e.g. intrinsic foot and ankle stabilizers) or passive support (ligamentous laxity, hypermobile joints) during dynamic weight-bearing activities. Muscular insufficiency in the ankle and arch stabilizers are the most common etiological factor for flat feet.

How Do Flat Feet Progress?

Flat feet progress slowly as you increase your feet’s exposure to weight-bearing activities. The two most common progressions from flat feet are foot deformities and bony stress injuries.

In the active person, hyperpronation alters the load transference up through the leg and can cause stress responses such as shin splints and in the worst case, stress fractures.

At the opposite end, the bones through your foot are also exposed to altered loads potentially causing a bunion. As seen in the image, the midfoot pronation and collapse of the arch change the line of force to the outside of the first metatarsal (from green to red), creating the bony protrusion. As the head of the metatarsal is forced out, the rest of the big toe is forced inwards further accentuating the bunion.

How are Flat Feet Diagnosed?

Your Certified Pedorthist will observe you conducting numerous single leg tasks in order to investigate your overall dynamic control, from your foot and ankle to your hips. This will include activities that challenge your strength, endurance, proprioception, and balance. Integrated into the entire kinetic chain, the main focus will be identifying any active insufficiencies through your arch and its’ respective stabilizers.

In some cases, a weight-bearing Xray may be ordered in order to investigate the integrity and dynamic control of the specific joints of the arch under stress and load.

Woman feet running on road closeup on shoe

Flat Feet Treatment

Treatment can vary largely considering the broad etiological factors. Below is a range of treatment directions focussing primarily on improving the active stabilization of the foot and ankle to endeavour to correct the flat feet deformity.

Restore Intrinsic Muscle Control and Foot Arch Biomechanics

Your foot arch is dynamically controlled via important intrinsic plantar muscles, which may be weak or have poor endurance. These foot muscles have a vital role in dynamically stabilizing the base of your foot plus preventing overpronation of the midfoot and loading through your plantar fascia.

Dynamic Foot Posture Exercises

Any deficiencies will be an important component of your rehabilitation. Your physiotherapist is an expert in the assessment and correction of your dynamic foot control. They will be able to help you to restore your normal foot biomechanics and provide you with foot stabilization exercises to alleviate any deficiencies.

Custom Orthotics

After your biomechanical assessment, you may be recommended a soft temporary orthotic to help provide protection and relief through over-loaded structures. If your physiotherapist deems an orthotic will be of benefit for long-term use, a referral to your local podiatrist for a specialized orthotic may be recommended. The good news is that most flat feet sufferers will not need permanent passive arch support such as an orthotic.

At Target Therapeutics, our Certified Pedorthist can make sure you get the best possible custom orthotics.

Restore Normal Calf & Leg Muscle Control

You may find it difficult to comprehend, but all of your leg (calf, thigh and hip) muscles play an important role in controlling your ankle position and foot arch mechanics. Your physiotherapist will assess your leg muscle function and provide you with the necessary treatment or exercises to correct any ankle, knee or hip stabilizer insufficiency. Ask your physiotherapist for more specific advice.

Footwear Analysis

Sometimes it is poorly designed footwear that can predispose you to acquire flat feet or an associated injury. If you do suffer pain or discomfort that is impacting your active lifestyle, you should seek the professional advice of your healthcare practitioner to assist your ability to determine the best footwear for your feet.

Do you suffer from flat feet? You’re not alone. There are many possible solutions that can help you immensely.

 

Filed Under: Certified Pedorthist, Remedies, Running

Custom Orthotics vs. Store Bought Orthotics

January 16, 2020 by Target Therapeutics Leave a Comment

When weighing the options between a pair of custom orthotics vs. a pair of store-bought orthotics there are a number of things to consider.

The Pedorthic Association of Canada defines store-bought orthotics or over the counter foot orthotics as “mass-produced devices that are not unique to any person”.

Custom orthotics are defined as “an internal foot appliance which is manufactured from a three-dimensional image of the foot, and made from raw materials. Custom orthotics can accommodate bony deformities, and/or modify the movement pattern of the foot and lower limb”.

Store-Bought Orthotics

Store-bought orthotics are made with lower quality materials and are not very supportive through the arch.

Advantage: for a person with a lack of padding on their feet (i.e. fat pad dystropohy) or a person with normal feet who spends a lot of time standing or walking on hard surfaces, may find that a cushion may be all that is necessary.

Disadvantage: Materials break down faster than the higher quality materials used in custom orthotics.

Store-bought orthotics are made for an “average” foot shape and may not be ideal for all people.

Advantage: these orthotics provide a small amount of support for the average shaped foot.
Disadvantage: If the patient’s foot is not the same or similar to the shape of the store-bought orthotic then the level of comfort and support will be minimal if any is achieved at all.

Store-bought orthotics tend to be less expensive.

Advantage: They are less expensive which can be a good thing.

Disadvantage: Insurance companies will NOT cover the costs associated with store-bought orthotics and due to the wear and tear to the materials used, replacement is usually required every 3 to 6 months which is much more often than custom orthotics.

Custom Orthotics

Custom orthotics provide a large number of design options with respect to materials used so that the orthotic can be designed exactly to your needs.

This allows for a customized fit, feel and design for each individual and for the types of shoes that they wear. We can take into account the person’s foot, biomechanical control needs, the type of shoe the custom orthotic will need to fit into, the persons’ activities and any material allergies or discomfort the patient may have.

Custom orthotics tend to be more expensive.

Disadvantage: It is recognized that custom orthotics do have a rather large upfront cost

Advantage: When custom orthotics are made by a properly licensed professional, insurance companies will cover a portion, if not the entire cost, of the custom orthotics.

Key Factors to Consider:

Durability: The “lifespan” of store-bought orthotics are shorter than custom orthotics due to wear and tear on the materials used.

Cost: Custom orthotics are much more expensive however some or all of the costs are covered by most extended insurance policies and custom orthotics last much longer.

Time Sensitive: Custom orthotics require time to be manufactured and there is a 2-3 week time period from the examination to dispensation. In moments of urgency, store-bought orthotics can help with immediate relief.

Biomechanical / Motion Control: custom orthotics can be designed with exact specificity to suit your needs. These features are not available in off the shelf orthotics.

For further questions give us a call and we would be happy to answer any questions that you may have.

Filed Under: Certified Pedorthist, Health, Running, Sports Medicine

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