Overview



Flat feet are a usually painless condition where the arches on the inside of your feet are completely collapsed arches so that the entire sole of your feet touch the floor when standing. Flat feet can develop after an injury to the foot, such as a ligament, tendon or muscle tear, or as a result of arthritis or they may develop because the condition runs in the family. People with flat feet often complain of their feet rolling inwards when walking or a feeling of their foot collapsing.

Causes

There are many reasons why flat feet develop. Here?s a look at some of the most common causes. Genetics, weak arches, injury, arthritis, diabetes, age, wear and tear on feet, tibialis posterior (ruptured tendon). Nervous system or muscle diseases such as cerebral palsy. Weakness and tightness of other muscles and tendons higher up in the lower extremity. The way our arches form depends on several factors. Our feet are complex structures that comprise twenty-six bones, thirty-three joints, and more than 100 muscles, tendons, and ligaments each. Each foot forms two arches. The arch that runs from the heel to the toe is known as the longitudinal arch, while the one that runs the width is known as the transverse arch. Ligaments (fibrous tissues) give our arches their shape and hold our bones together. The plantar fascia (the long, strong band of connective tissue that runs along the sole of your foot) and muscles add secondary support. There are also foot pads that absorb impact and assist with weight-bearing functions. How these things intertwine and work together determines the formation of our arches. A structural abnormality or injury to one of these components can result in flatfoot.

Symptoms

Flat feet may not cause any symptoms at all. Rigid flat feet may cause pain, calluses, blisters, or skin redness on the inner side of the foot. A stiff foot, weakness or numbness of the foot, Rapid wearing out of shoes-worn shoes lean in toward each other. Difficulty or pain with activities like running-in the foot, knee or hip.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.

pes planus radiology

Non Surgical Treatment

Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch-supporting insert in the shoe) can bring relief. With the increased interest in running, many shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring because they correct for the abnormality. Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet. For tarsal coalition, treatment starts with rest and possibly a cast. If this fails to improve the pain, surgery may be necessary. For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces. In more advanced cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints of the foot into a corrected position. Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.

Surgical Treatment



Rarely does the physician use surgery to correct a foot that is congenitally flat, which typically does not cause pain. If the patient has a fallen arch that is painful, though, the foot and ankle physicians at Midwest Orthopaedics at Rush may perform surgery to reconstruct the tendon and "lift up" the fallen arch. This requires a combination of tendon re-routing procedures, ligament repairs, and bone cutting or fusion procedures.

Prevention

Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.

Overview

Leg length discrepancy (LLD) affects about 70% of the general population, and can be either structural - when the difference occurs in bone structures - or functional, because of mechanical changes at the lower limbs. The discrepancy can be also classified by its magnitude into mild, intermediate, or severe. Mild LLD has been particularly associated with stress fracture, low back pain and osteoarthritis, and when the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these orthopaedic changes may appear early and severely. The aim of this study was to analyze and compare ground reaction force (GRF) during gait in runners with and without mild LLD. Results showed that subjects with mild LLD of 0.5 to 2.0 cm presented higher values of minimum vertical GRF (0.57 ? 0.07 BW) at the shorter limb compared to the longer limb (0.56 ? 0.08 BW) Therefore, subjects with mild LLD adopt compensatory mechanisms that cause additional overloads to the musculoskeletal system in order to promote a symmetrical gait pattern as showed by the values of absolute symmetric index of vertical and horizontal GRF variables.

Causes

An anatomical short leg is due to several orthopedic or medical condition mechanisms. Often, one leg simply stops growing before the other one does and is called ?congenital?. We often see mother-daughters or father-sons who exhibit virtually the same degree of shortness on the same side. Often it is not known why this occurs, but it seems to account for approximately 25% of the population demonstrating a true LLD. Other causes of a true LLD include trauma or broken bones, surgical repair, joint replacement, radiation exposure, tumors or Legg-Calves-Perthes disease.

Symptoms

LLD do not have any pain or discomfort directly associated with the difference of one leg over the other leg. However, LLD will place stress on joints throughout the skeletal structure of the body and create discomfort as a byproduct of the LLD. Just as it is normal for your feet to vary slightly in size, a mild difference in leg length is normal, too. A more pronounced LLD, however, can create abnormalities when walking or running and adversely affect healthy balance and posture. Symptoms include a slight limp. Walking can even become stressful, requiring more effort and energy. Sometimes knee pain, hip pain and lower back pain develop. Foot mechanics are also affected causing a variety of complications in the foot, not the least, over pronating, metatarsalgia, bunions, hammer toes, instep pain, posterior tibial tendonitis, and many more.

Diagnosis

A qualified musculoskeletal expert will first take a medical history and conduct a physical exam. Other tests may include X-rays, MRI, or CT scan to diagnose the root cause.

Non Surgical Treatment

Structural leg length discrepancy can be treated with a heel lift in the shorter leg?s shoe, if the leg length is greater than 5 mm. The use and size of the heel lift is determined by a physical therapist based on how much lift is needed to restore proper lumbopelvic biomechanics. In certain cases, surgical intervention may be needed to either shorten or lengthen the limb. An important component to any surgical procedure to correct leg length discrepancies is physical therapy. Physical therapy helps to stretch muscles and maintain joint flexibility, which is essential in the healing process. For a functional leg length discrepancy no heel lift is required, but proper manual therapy techniques and specific therapeutic exercise is needed to treat and normalize pelvic and lower extremity compensations. The number of treatments needed to hold the pelvis in a symmetrical position is different for each patient based on their presentation and biomechanical dysfunctions in their lower back, pelvis, hip, knee, and foot/ankle. If you have pain in your lower back or lower extremity and possibly a length discrepancy; the two symptoms could be related. A good place to start would be a physical therapy evaluation to determine whether you have a leg length discrepancy and if it could be contributing to your lower back pain, hip pain, knee pain, or leg pain.



increase height quickly

Surgical Treatment

Surgeries to lengthen a leg are generally only performed when there is a difference in leg length of greater than four centimeters. These types of surgeries can be more difficult and have more complications, such as infections, delayed healing, dislocations, and high blood pressure. In a several step process, bone lengthening surgeries involve cutting a bone in two in order to allow new bone growth to occur. After the bone is cut, a special apparatus is worn with pins that will pull the bone apart at approximately one millimeter per day. This causes osteogenesis, or new bone growth, in between the cut bone segments. A cast or brace may be required for several months after surgery to allow the new bone growth to harden and provide extra support.

Overview



The most common cause of heel pain is plantar fasciitis which is commonly referred to as a heel spur. Plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes. Plantar fasciitis is a condition in which the plantar fascia is inflamed. This condition can be very painful and cause a considerable amount of suffering.

Causes

Near the inflamed plantar fascia attachment, but not in it, some extra bone may form, producing a small "spur". In fact, it is a shelf of bone, not a sharp spur. These "heel spurs" are commoner in people with plantar fascitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain.

Symptoms

The primary symptom is pain in the heel area that varies in severity and location. The pain is commonly intense when getting out of bed or a chair. The pain often lessens when walking.

Diagnosis

The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Non Surgical Treatment

Once diagnosed, treatment for plantar fasciitis may include one or more of the following: advice on footwear, in particular use of arch-supportive footwear; avoid walking barefoot; stretching exercises, shoe modifications such as heel pads, taping and strapping, anti-inflammatories and orthotic devices to correct abnormal foot mechanics. Injection therapy with corticosteroids is only advisable if all the conservative treatment methods mentioned above have been exhausted due to undesired effects implicated with steroid infusion in the heels.

Surgical Treatment

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

Where is a heel spur located?

Prevention



Wear properly fitting shoes. Place insoles or inserts in your shoes to help control abnormal foot motion. Maintain a healthy weight. Exercise and do foot stretches as they have been shown to decrease the incidence of heel pain.

Overview

Morton?s Neuroma is a pathological condition of the common digital nerve in the foot, most frequently between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (scar) tissue and the nerve fibres eventually deteriorate.This condition is named for the American surgeon, Thomas George Morton (1835-1903), who first recognised the condition in 1876. Incidentally his father was the dentist who discovered the anaesthetics; initially Nitrous oxide, the very gas used today in cryosurgery for the condition his son lent his name to? Morton?s neuroma.

Causes

Poorly fitted footwear can be a cause. Shoes that have a tight and narrow toe box can cause the never to become entrapped causing the pain. High heeled shoes abnormally place the metatarsals under extreme pressure which can cause Morton?s Neuroma. In cases of abnormal pronation, there can be significant motion between the 3rd and 4th metatarsals which can cause an irritation to the nerve that runs between them. This inflammation causes the pain.

Symptoms

Morton's neuroma can cause a very painful burning or sharp pain in your foot that feels worse when you walk. It may feel like a small lump inside the ball of your foot. It is usually between the third and fourth toes, but it can also be between other toes.

Diagnosis

The diagnosis of interdigital neuroma is usually made by physical examination and review of the patient's medical history.MRI ad High Definition Ultrasound examination may be useful to confirm the diagnoses however they may still not be 100% reliable. The commonest reason for this is de to natural substances present in between the metatarsal heads and between the fat pad and the intermetatarsal ligament. These natural substances i.e. bursa, fat, capsular thickening and even bony growths, can all be a factor in the impingement process and may need to be surgically cleared.

Non Surgical Treatment

Once a diagnosis is obtained, it is essential to begin treatment immediately. Your podiatric physician will advise you on the most effective means. If caught early enough, good foot care, shoes that fit properly, and/or orthoses may eliminate the need for any further intervention. Other conservative measures might include oral non-steroidal anti-inflammatory medication (NSAIDS), physical therapy, ultrasound or other non-invasive measures. If that doesn?t work, your podiatric physician might use injectable steroids, and/or a local anesthetic around the neuroma to reduce inflammation and pain. Many patients report relief after these measures are taken.

Surgical Treatment

Surgery. This is the last and most permanent course of action. This surgery is used as a last resort as it often comes with a series of side affects including the risk of making the pain worse. This surgery can be performed by Orthopedic surgeons as well as Podiatric surgeons.

There are actually two different types of leg length discrepancies, congenital and acquired. Congenital implies you are born with it. One leg is anatomically shorter compared to the other. As a result of developmental periods of aging, the human brain picks up on the walking pattern and recognizes some variance. The human body typically adapts by dipping one shoulder over to the "short" side. A difference of under a quarter inch isn't very excessive, demand Shoe Lifts to compensate and mostly won't have a profound effect over a lifetime.



Leg length inequality goes mainly undiscovered on a daily basis, yet this issue is very easily corrected, and can reduce a number of incidents of lower back pain.

Therapy for leg length inequality usually involves Shoe Lifts. These are generally low cost, frequently costing under twenty dollars, in comparison to a custom orthotic of $200 or more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Lumbar pain is the most prevalent health problem affecting people today. Around 80 million men and women suffer from back pain at some stage in their life. It's a problem which costs companies millions of dollars annually due to time lost and productivity. Innovative and more effective treatment solutions are constantly sought after in the hope of lowering economic influence this issue causes.



People from all corners of the earth suffer from foot ache as a result of leg length discrepancy. In these situations Shoe Lifts can be of very helpful. The lifts are capable of easing any discomfort and pain in the feet. Shoe Lifts are recommended by numerous skilled orthopaedic physicians.

So as to support the body in a balanced fashion, your feet have a significant part to play. Despite that, it is sometimes the most neglected area in the body. Many people have flat-feet which means there may be unequal force exerted on the feet. This causes other areas of the body including knees, ankles and backs to be impacted too. Shoe Lifts guarantee that correct posture and balance are restored.

There are actually not one but two different kinds of leg length discrepancies, congenital and acquired. Congenital implies that you are born with it. One leg is structurally shorter than the other. As a result of developmental stages of aging, the brain senses the walking pattern and identifies some variation. The entire body typically adapts by tilting one shoulder over to the "short" side. A difference of less than a quarter inch isn't grossly abnormal, require Shoe Lifts to compensate and normally won't have a serious effect over a lifetime.



Leg length inequality goes typically undiagnosed on a daily basis, yet this condition is simply fixed, and can eliminate numerous cases of lower back pain.

Treatment for leg length inequality commonly consists of Shoe Lifts . These are low cost, often priced at below twenty dollars, in comparison to a custom orthotic of $200 or maybe more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Upper back pain is the most common ailment impacting men and women today. Around 80 million people suffer from back pain at some point in their life. It is a problem that costs companies millions each year because of lost time and production. Fresh and better treatment solutions are constantly sought after in the hope of reducing the economical impact this issue causes.



People from all corners of the earth suffer the pain of foot ache as a result of leg length discrepancy. In most of these cases Shoe Lifts can be of very beneficial. The lifts are capable of easing any pain and discomfort in the feet. Shoe Lifts are recommended by countless expert orthopaedic physicians.

So as to support the human body in a healthy and balanced manner, the feet have a significant job to play. Inspite of that, it is often the most neglected zone in the body. Some people have flat-feet which means there may be unequal force placed on the feet. This causes other parts of the body such as knees, ankles and backs to be affected too. Shoe Lifts make sure that appropriate posture and balance are restored.

There are two different types of leg length discrepancies, congenital and acquired. Congenital indicates you are born with it. One leg is anatomically shorter than the other. As a result of developmental stages of aging, the human brain senses the step pattern and identifies some variance. Your body usually adapts by dipping one shoulder over to the "short" side. A difference of less than a quarter inch isn't very abnormal, doesn't need Shoe Lifts to compensate and typically does not have a serious effect over a lifetime.



Leg length inequality goes largely undiscovered on a daily basis, yet this condition is easily remedied, and can reduce many instances of upper back pain.

Therapy for leg length inequality commonly involves Shoe Lifts. These are typically very reasonably priced, ordinarily costing below twenty dollars, in comparison to a custom orthotic of $200 if not more. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Chronic back pain is the most widespread health problem affecting men and women today. Over 80 million men and women are affected by back pain at some point in their life. It's a problem which costs companies vast amounts of money yearly because of lost time and production. Innovative and more effective treatment methods are continually sought after in the hope of lowering economic influence this condition causes.



Men and women from all corners of the earth suffer the pain of foot ache as a result of leg length discrepancy. In a lot of these cases Shoe Lifts can be of worthwhile. The lifts are capable of easing any discomfort and pain in the feet. Shoe Lifts are recommended by many experienced orthopaedic practitioners".

So that you can support the body in a well balanced fashion, the feet have got a significant role to play. Despite that, it is sometimes the most overlooked zone of the human body. Some people have flat-feet which means there is unequal force placed on the feet. This will cause other body parts such as knees, ankles and backs to be affected too. Shoe Lifts guarantee that the right posture and balance are restored.

There are not one but two different types of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter in comparison to the other. Through developmental phases of aging, the brain senses the stride pattern and recognizes some variance. The human body typically adapts by tilting one shoulder over to the "short" side. A difference of under a quarter inch is not blatantly uncommon, demand Shoe Lifts to compensate and commonly doesn't have a profound effect over a lifetime.



Leg length inequality goes mainly undiagnosed on a daily basis, however this problem is easily corrected, and can eradicate a number of instances of chronic back pain.

Therapy for leg length inequality usually consists of Shoe Lifts. These are affordable, commonly costing less than twenty dollars, compared to a custom orthotic of $200 or even more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Mid back pain is the most widespread health problem impacting people today. Around 80 million men and women experience back pain at some point in their life. It's a problem which costs businesses huge amounts of money each year as a result of lost time and output. New and more effective treatment solutions are constantly sought after in the hope of minimizing the economical influence this issue causes.



Men and women from all corners of the earth experience foot ache as a result of leg length discrepancy. In these situations Shoe Lifts are usually of beneficial. The lifts are capable of easing any pain in the feet. Shoe Lifts are recommended by many professional orthopaedic doctors.

So that they can support the body in a balanced fashion, feet have got a critical function to play. In spite of that, it can be the most overlooked area of the human body. Some people have flat-feet meaning there may be unequal force exerted on the feet. This will cause other areas of the body including knees, ankles and backs to be affected too. Shoe Lifts ensure that appropriate posture and balance are restored.