Does Arch Pain Need Surgery Treatment ?
Overview
Plantar Fasciitis is an inflammatory process that occurs in the plantar fascia, usually at the insertion to the heel bone (calcaneus). It has been reported that 10% of the worldwide population will suffer from this condition at some point in their lives. The inflammatory process is thought to occur due to repeated trauma to the plantar fascia as it is over-stretched. In other words, the burden on the foot is too great for the plantar fascia to maintain the foot arch and therefore the arch 'collapses' or 'falls' slightly more than it should, thus over-stretching the fascia. This causes damage (micro-tears) in the plantar fascia which triggers the inflammatory response, causing pain. In the vast majority of cases this process occurs at the origin of the plantar fascia at the heel bone.
Causes
In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition. Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin. Obesity. Very high arch. Repetitive impact activity (running/sports). New or increased activity.Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.
Symptoms
Arch pain may have a variety of different causes. Proper evaluation and diagnosis of arch pain is essential in planning treatment. A good general guideline is to compare the injured side to the uninjured side. Injury may present itself as a distinguishable lump, a gap felt at that location, or a "crunchy" feeling on that spot caused by inflammation. The type, causes, and severity of pain are also good indicators of the severity of the injury.
Diagnosis
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.
Non Surgical Treatment
In mild cases patients would benefit from custom made semi rigid full length custom made foot orthoses fitted into appropriate supportive footwear, preferably with laces or a velcro straps. In more severe cases patients may require a custom made Arizona lace up ankle brace or a posterior shell Ankle Foot Orthosis. These offer significantly more control and support than the foot orthoses. In severe cases surgery may be required to repair the tibialis posterior tendon and realign the foot and ankle, or fuse the subtalar joint. It is important to note there are many risks involved in having surgery and these must be considered prior to going ahead.
Surgical Treatment
If pain or foot damage is severe, your doctor may recommend surgery. Procedures may include the following. Fusing foot or ankle bones together (arthrodesis). Removing bones or bony growths also called spurs (excision). Cutting or changing the shape of the bone (osteotomy). Cleaning the tendons' protective coverings (synovectomy). Adding tendon from other parts of your body to tendons in your foot to help balance the "pull" of the tendons and form an arch (tendon transfer). Grafting bone to your foot to make the arch rise more naturally (lateral column lengthening).
Prevention
Arch pain occurs when the plantar fascia becomes worn down due to constant strain or excessive exercising. This may be caused by increasing your running or hiking mileage too fast, wearing inadequate footwear, lack of stretching, running on steep hills, standing on your feet for too long and abnormal anatomy such as flat foot. Stretching is an important exercise that should not be overlooked because the tightness or lack of tightness of the joints in the foot can also cause pain in the arch.
Stretching Exercises
Try these simple stretches to assist with relieving pain in your arches. (Note: Stretch slowly and gently. You should feel a moderate pull on the muscle and tendon but no pain. If these stretches are painful, stop and seek further advice from a health professional). STRETCH ONE. Stand at arm?s length from a wall with one foot in front of the other, forward knee bent. Keeping your back leg straight and back heel on the floor, lean into the wall until you feel a stretch in your calf. STRETCH TWO. This time, bend your back leg slightly, and lean into the wall. You should feel a stretch in the lower part of your calf. Hold each stretch for 20 seconds and repeat on each leg, a few times daily.
Plantar Fasciitis is an inflammatory process that occurs in the plantar fascia, usually at the insertion to the heel bone (calcaneus). It has been reported that 10% of the worldwide population will suffer from this condition at some point in their lives. The inflammatory process is thought to occur due to repeated trauma to the plantar fascia as it is over-stretched. In other words, the burden on the foot is too great for the plantar fascia to maintain the foot arch and therefore the arch 'collapses' or 'falls' slightly more than it should, thus over-stretching the fascia. This causes damage (micro-tears) in the plantar fascia which triggers the inflammatory response, causing pain. In the vast majority of cases this process occurs at the origin of the plantar fascia at the heel bone.
Causes
In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition. Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin. Obesity. Very high arch. Repetitive impact activity (running/sports). New or increased activity.Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.
Symptoms
Arch pain may have a variety of different causes. Proper evaluation and diagnosis of arch pain is essential in planning treatment. A good general guideline is to compare the injured side to the uninjured side. Injury may present itself as a distinguishable lump, a gap felt at that location, or a "crunchy" feeling on that spot caused by inflammation. The type, causes, and severity of pain are also good indicators of the severity of the injury.
Diagnosis
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.
Non Surgical Treatment
In mild cases patients would benefit from custom made semi rigid full length custom made foot orthoses fitted into appropriate supportive footwear, preferably with laces or a velcro straps. In more severe cases patients may require a custom made Arizona lace up ankle brace or a posterior shell Ankle Foot Orthosis. These offer significantly more control and support than the foot orthoses. In severe cases surgery may be required to repair the tibialis posterior tendon and realign the foot and ankle, or fuse the subtalar joint. It is important to note there are many risks involved in having surgery and these must be considered prior to going ahead.
Surgical Treatment
If pain or foot damage is severe, your doctor may recommend surgery. Procedures may include the following. Fusing foot or ankle bones together (arthrodesis). Removing bones or bony growths also called spurs (excision). Cutting or changing the shape of the bone (osteotomy). Cleaning the tendons' protective coverings (synovectomy). Adding tendon from other parts of your body to tendons in your foot to help balance the "pull" of the tendons and form an arch (tendon transfer). Grafting bone to your foot to make the arch rise more naturally (lateral column lengthening).
Prevention
Arch pain occurs when the plantar fascia becomes worn down due to constant strain or excessive exercising. This may be caused by increasing your running or hiking mileage too fast, wearing inadequate footwear, lack of stretching, running on steep hills, standing on your feet for too long and abnormal anatomy such as flat foot. Stretching is an important exercise that should not be overlooked because the tightness or lack of tightness of the joints in the foot can also cause pain in the arch.
Stretching Exercises
Try these simple stretches to assist with relieving pain in your arches. (Note: Stretch slowly and gently. You should feel a moderate pull on the muscle and tendon but no pain. If these stretches are painful, stop and seek further advice from a health professional). STRETCH ONE. Stand at arm?s length from a wall with one foot in front of the other, forward knee bent. Keeping your back leg straight and back heel on the floor, lean into the wall until you feel a stretch in your calf. STRETCH TWO. This time, bend your back leg slightly, and lean into the wall. You should feel a stretch in the lower part of your calf. Hold each stretch for 20 seconds and repeat on each leg, a few times daily.
