The Achilles tendon connects the calf muscles (gastrocnemius and soleus muscles) to the heel bone (calcaneus). This is the strongest tendon in the human body controlling plantar and dorsiflexion of the foot, and storing elastic energy created when a person jumps, runs and walks. Achilles Tendinopathy indicates two possible pathologies: Tendinitis (inflammation of the tendon), and/or Tendinosis (microtears in and around the tendon that are often related to overuse). An orthotic with a deep heel cup and heel lift will limit tension on the Achilles tendon and stabilize the rearfoot.
The Plantar Fascia is the ligament that connects the heel to the forefoot and creates the arch of the foot. Strains and/or small tears of this ligament are one of the most common causes of heel pain and discomfort associated with plantar fasciitis. This pathology is often associated with any of the following issues: over-pronation, walking or standing on hard surfaces for long periods of time, being overweight, and tight calf muscles. Recommended treatment for this pathology is an orthotic that includes a 3mm heel lift designed to take tension off of the plantar fascia, Achilles tendon, and calf muscles, and a deep heel cup for additional stabilization of the rearfoot.
A heel spur is a pointed boney growth on the plantar (bottom) or posterior (back) surface of the heel bone (calcaneus). This is often associated with the inflammation of the plantar fascia and/or the Achilles tendon. Painful heel spurs may be treated using a soft, heavily cushioned orthotic as well as by resting and icing the affected area.
Adult acquired flatfoot is a very common condition in which a healthy, normal arch collapses causing eversion of the heel bone (calcaneus) and abduction of the forefoot. This is commonly caused by PTTD (Posterior Tibial Tendon Dysfunction), but other contributors include arthritis, Charcot deformity, and trauma. Adult acquired flatfoot can be treated using a foot orthotic or brace that supports the fallen arch.
Pediatric flatfoot is characterized by partial or complete collapse of the medial arch and is often associated with an everted heel bone (calcaneus). This pathology can be either symptomatic or asymptomatic. Asymtomatic patients will often require no treatment because the arch will develop as the child grows, usually by the time the child reaches the age of eight, but as early as four years old. Symptomatic patients with pain or low activity levels will often utilize an orthotic that supports the child’s arch and holds the heel bone (calcaneus) in a neutral position. Many healthcare practitioners believe that early intervention can eliminate or reduce foot and gait problems later in life.
Very high arches characterize a Pes Cavus foot. The patients with this pathology will often experience arch and heel pain and, in some cases, have trouble accommodating their high instep in standard shoe gear. This foot type requires
an orthotic that provides support for the entire arch in an effort to distribute pressure over the entire plantar surface of the foot. In addition to arch support, a well-cushioned device will reduce the impact from ambulation in a rigid cavus foot structure.
Pes Planus is the medical term used to describe “flat feet” and is most often associated with over-pronation. A flexible flatfoot will benefit from arch support as well as stabilization of the rearfoot in a neutral position. Custom orthotic devices and proper shoe gear can alleviate most, if not all, pain associated with the flat foot and decrease the risk of future injury associated with over-pronating instability.
The big toe, specifically the first metatarsophalangeal joint (1st MPJ), can become increasingly stiff and immobile over time. This is a result of excessive pressure being placed on the first metatarsal due to over-pronation, overuse, improper shoe gear or in some cases, genetic predisposition. All of these factors can cause cartilage to wear down in the 1st MPJ, which can eventually lead to bone spurs. Hallux Limitus may be treated using an orthotic device that provides arch support and offloads the 1st MPJ.
Hallux Rigidis is a progression of Hallux Limitus in which the big toe becomes rigid or frozen. This condition is very painful especially when the toe is lifted up (dorsally) or pressed down (plantarly). This can be treated non-surgically in some cases using a stiff extension under the big toe in order to limit movement. A custom shoe with a rockered sole may also be utilized to limit pressure placed on the big toe while walking.
Metatarsalgia is an overuse pathology in which the ball of the foot becomes inflamed and painful. Excessive loading or impacting of one or more of the metatarsals is a likely source of the inflammation. The use of an orthotic that offloads the metatarsal heads that are experiencing pain, as well as a cushioned device, can reduce the effects of high impact activities and is an effective treatment of this pathology.
Morton’s Neuroma is a thickening or swelling of the nerve that runs along the interspace of the toes, typically between the third and fourth toes. This causes a sharp or burning pain that usually worsens while walking. Tight-fitting heels and dress shoes have been thought to contribute to the onset of this pathology. Shoe gear with a wider forefoot as well as an orthotic that includes a teardrop shaped pad at the site of the neuroma are often effective in treating this painful pathology. This teardrop shaped neuroma pad helps separate the two metatarsals that are impinging on the neuroma while allowing the nerve to heal.
The sesamoids are very small bones located on the plantar surface of the big toe. Inflammation of these bones can be caused by repeated overuse or trauma associated with abrupt dorsi-flexion of the big toe. This is a difficult bone to heal because pressure is placed on the sesamoid bones with every step. An orthotic designed to offload the big toe and sesamoid bones will give relief by taking pressure off of the painful area and redistributing it throughout the forefoot, allowing the inflammation and/or fracture to heal.
Lateral instability of the ankle is typically caused by trauma to the stabilizing ligaments on the medial and lateral aspects of the ankle. These stretched or torn ligaments allow the ankle to roll outward, which can cause further injury such as ankle fracture, cartilage damage, and arthritis. Stabilization of the ankle joint is the primary treatment of this pathology, which may include an orthotic, brace or in severe cases, surgery.
Commonly called “pigeon-toed,” Intoeing Gait indicates that a person’s feet turn inward while walking. This is somewhat common in children under eight years of age and will often correct itself as the child grows, although, correction of this pathology early on can decrease the rick of over-pronation complications later in life. Intoeing gait can be corrected by using an orthotic shell designed to promote out-toeing and reduce subtalar joint pronation. An Intoeing Gait is often associated with tripping issues and injury. By promoting a more natural gait, the risk of tripping injuries can be greatly reduced.
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