Eastern Ontario and Québec’s source for foot pain relief
Foot Clinic CDP has 30 clinics throughout Eastern Ontario and Québec to relieve your foot ailments. If you experience foot pain associated with plantar fasciitis and heel spurs (heel and arch pain), metatarsalgia and Morton’s neuroma, bunions and hammer toes, Achilles tendonitis and Flat feet or would like to learn more about our clinic, Foot Clinic CDP will help pinpoint the source of your ailments and find the correct treatment. With the help of high-tech Footmaxx™ tools, our expert will be able to cure your ailments. Schedule an appointment now at your nearest Foot Clinic CDP.
Foot Pain – Common foot disorders or foot problems
Plantar Fasciitis – Heel Spur Pain
What is Plantar Fasciitis?
Plantar Fasciitis is a painful foot condition. The plantar fascia, a long, thick tissue that stabilizes the arch of the foot, pulls on the periosteum located at the calcaneus, thereby causing it to be inflamed. It starts from the plantar area of the calcaneus, all the way to the metatarsal heads, and onto the proximal phalanges that form a fibrous sheath in every toe.
Most patients with Plantar Fasciitis complain of severe heel pain originating at the hind foot, usually felt when they try to walk a few steps in the morning, or after a period of rest. When the foot adjusts to the resumption of activity after rest, the pain usually decreases but may return after standing for a long time or after prolonged sitting.
What Causes Plantar Fasciitis?
The plantar fascia is the shock absorber that supports the foot’s arch. When tension is applied on this bowstring and becomes too much to bear, it can result in small tears. Repeated stretching and tearing may irritate or cause it to become inflamed.
The weakest part of the plantar fascia is the fibrous membrane that covers the bone of the calcaneus (periosteum) and is vulnerable to pain. Repeated twisting of the plantar fascia pulls the periosteum from the calcaneus results in inflammation and pain and when this happens frequently, the calcaneus slowly grows to try to attach itself to the plantar fascia. The resulting bone growth is called a heel spur. At night, the fascia’s fibers try to heal with a new fiber. In the morning, as the individual puts weight on the foot, renewed tearing could occur, resulting in extreme pain.
How to treat Plantar Fasciitis
Methods of treatment depend on the severity and nature of the symptoms. Pain from over-pronation and repeated torquing of the plantar fascia would require more rigid orthotic devices to provide stability to the foot and stop the torquing. If pain occurs in the central part of the plantar fascia, strong rear foot control is required from orthotic devices. Because over-pronation is the cause of the problem, orthotics is necessary for controlling pronation and elongation of the arch. Patients may improve by 20-25% every 2 weeks and recover completely within 2-3 months.
Achilles Tendonitis Origin & Symptoms
What is Achilles Tendonitis?
“Achilles” originates from Greek Mythology. This is a foot condition involving the Achilles tendon wherein it becomes inflamed at or near its area of insertion or the posterior area of the calcaneus, which results in pain. It is the longest and the strongest of all the tendons in the body and has no blood vessels, thereby making healing slow. The Achilles tendon is located in the lower third of the tibia’s posterior aspect. There are two muscles that join together to form this tendon – the gastroc-nemius muscle and the soleus. The Achilles tendon functions as an anti-pronator.
An individual with Achilles tendonitis experiences severe throbbing or burning pain originating from the latter aspect of the heel which worsens with passive dorsiflexion or plantarflexion, for instance, putting weight on the toes.
What causes Achilles Tendonitis?
The most common causes of this condition are over-pronation and extreme stress on the tendon. The risk factors for Achilles tendonitis include tight heel cords, foot deformities due to misalignment, and recent changes in level of activity or footwear. During normal gait, the femur and the tibia rotate in harmony, internally while pronating and externally in supination. In the case of an individual who over-pronates, the tibia is locked by the saddle joint in the talus, continually rotating internally beyond the contact phase as the femur rotates externally in midstance. The gastroc-nemius muscle attaches itself to the femur and externally rotates while the Soleus muscle attaches to the tibia and fibula and internally rotates in pronation. The femur’s and tibia’s counter rotation results in a shearing force to the Achilles tendon and twists it at its weakest point, causing it to become inflamed. When inflammation occurs, it has a tendency to be chronic since the tendon is avascular, meaning, without any blood vessels.
Treatment for Achilles Tendonitis
It is important to relieve stress as a first step. Treatment includes ice application and changes to level of activity. Stretching and strengthening exercises help to rehabilitate the gastroc-nemius complex. An individual would immediately notice a difference when wearing a heeled shoe as compared to a flat ground. It is advisable to wear orthotics to maintain proper alignment and control the movement of the talus in order to eliminate the stress on the Achilles tendon. When the tendon is tight, an extra heel lift in addition to orthotics can help. Recovery is generally gradual and occurs over a period of several months.
Bunions : Causes and Treatment (Hallux Valgus)
What is a bunion?
Bunions develop from medial deviations and inflammation of the big toe’s metatarsophalangeal joint (MTP). The joint’s capsule becomes displaced, thickens and enlarges while the joint’s cartilage becomes damaged. Bunions can be mild, moderate, or severe. While they are not hereditary in nature, the tendency to over-pronate can be inherited, and causes bunions.
When there is sustained pressure on the medial aspect of the 1st MTP joint, it can result in thickening of the bursa and medial capsule, leading to a severe valgus deformity of the big toe. Normally, toe-off happens at the big toe’s plantar surface. During over-pronation, the propulsion phase of stance takes off from the medial aspect of the big toe’s phalanges rather than the plantar surface. This action pushes the joint out and causes the joint’s capsule to stretch. This stretching and tearing action of the joint capsule, together with the wear and tear it causes to the cartilage, results in pain.
What is the treatment for bunions?
The primary problem is over-pronation. Orthotics is highly recommended and gradual recovery will occur over several months. While orthotics won’t change the toe’s deformity, it will stop further progression and may also arrest the pain. Severe cases of bunions require surgery to correct the deformity but unless the over-pronation is corrected, it can develop again. Orthotics is necessary since the root cause is over-pronation.
Shin Splints : Complications and Treatment
What is a shin splint?
A medial shin splint is a condition wherein the tibia’s periosteum becomes damaged when pulled away by the tibialis posterior muscle that is overstressed. An anterior shin splint is a condition wherein flow of the blood becomes obstructed by the anterior compartment because of hypertrophy from overstress.
Common symptoms of shin splints
Medial shin splints cause a dull ache along the tibia’s medial side. With the onset of pain, any type of activity will make it worse.
With anterior shin splints, patients experience a dull ache along the tibia’s anterior side. This may require emergency medical treatment as there would be insufficient blood flow which could result in neurosis and muscle gangrene in the anterior compartment.
How do shin splints develop?
Shin splints develop over time as a result of constant pounding and stress on the bones, joints and muscles of the lower leg. Irritation and inflammation occurs which causes pain. For medial shin splints, the tibialis posterior muscle is plantar flexed and the foot is inverted because of the insertion on the foot’s medial aspect. In the case of individuals who over-pronate, the tibialis posterior’s tendon stretches and is pulled excessively, affecting the weakest portion in the tibia’s periosteum. Chronic inflammation and pain result from small pain fibers of the periosteum being torn away.
On the other hand, anterior shin splints develop when the tibialis anterior muscle is dorsiflexed and the foot is inverted as it functions like an anti-pronator because of its insertion on the first metatarsal’s base and the medial aspect. In over-pronation, the muscle fibers found in the tibialis anterior muscle must work to counter the excess pronation. This action causes the tibialis anterior compartment to become swollen. Since constriction develops in the anterior compartment, the inflamed tibialis anterior causes blood flow to be obstructed, thereby resulting in extreme pain from insufficient oxygen supply (ischemia). This complication can be dire and may require immediate surgical intervention. Angina is an example of ischemia.
How are shin splints treated?
Medial and anterior shin splints, depending on the gravity of the symptoms, may be treated with standard care for acute conditions, limitation of activity and orthotic therapy to correct the over-pronation and arrest the falling of the foot into an excessively medial position. This also facilitates proper timing and function of the foot to reduce the stress placed on the tibialis anterior.
Morton’s Neuroma : Pain Relief and Treatment
Morton’s Neuroma is a painful foot condition affecting the ball of the foot, usually in the area between the third and fourth toes. It has been likened to the sensation of standing with a pebble in the shoe or a fold in one’s sock.
Pain is usually in the 3rd interspace but can also be felt in the 2nd, 4th and 1st interspaces. There can also be burning sensation in the interspace that would radiate to the other digits. Patients also report tingling sensations, numbness and loss of sensation in the toes.
What causes Morton’s Neuroma?
During over-pronation, pivoting of the 3rd and 4th metatarsals may result in a shearing force. The force between these digits entraps the digital nerve, causing it to become inflamed and painful. Abnormal subtalar and midtarsal joint pronation also results in excess metatarsal transverse plane movement. As the 1st, 2nd and 3rd metatarsals work as a single unit, while the 4th and 5th metatarsals function as another unit, significant movement in the 3rd and 4th metatarsals cause nerve irritation between them. Pain is caused by inflammation.
How is Morton’s Neuroma Treated?
Patients experience temporary relief from pain when the affected interspace is massaged. Symptoms of Morton’s Neuroma can also be reduced by controlling the abnormal transverse plane movement of the foot. The prescription of orthotics diminishes the excess transverse plane rotation of the medial and lateral foot columns which also reduce the inflammation and pain from the neuroma. In case a patient fails to respond to orthotics, a neuroma pad can be added to further diminish the transverse plane metatarsal motion and compression. If neuromas are present in other interspaces, these can be treated with functional foot orthotics for controlling abnormal foot function during propulsion. A patient may feel pain relief after several weeks and recover completely in 2-3 months, or up to 12 months, depending on the severity of the condition.
Causes and Cure for Iliotibial Band Syndrome (Iliotibial Band Friction Syndrome)
What is Iliotibial Band Syndrome?
The Iliotibial band can be found from the hip to the lateral side of the tibia’s proximal end. It works to resist the tibia’s internal rotation and to keep the leg stable. When the Iliotibial band becomes stretched and twisted, with the distal end rubbing across the femur’s lateral side, the Iliotibial band syndrome develops. This condition is also referred to as “iliotibial band friction syndrome”.
Individuals with this condition suffer pain on the knee’s lateral side that often goes all the way to the thigh and the hip.
What causes Iliotibial band Syndrome?
The most common cause of this condition is overstress placed on the Iliotibial band. In normal gait, the femur and tibia uniformly rotate, internally and externally. In the case of a person who over-pronates, the tibia becomes locked by the saddle joint into the talus and continues with its internal rotation long after the end of the contact phase. During the midstance phase, the femur also rotates externally with the pelvis. The counter rotation of the tibia and femur resulting from this action places a shearing force to the twisted tibio ilial band. The distal end of the band rubs and becomes inflamed by the femur’s lateral condyle.
What is the cure for Iliotibial Band Syndrome?
It helps to massage and stretch the surrounding muscles to reduce tightness. Ice application eases the inflammation. Because abnormal pronation is the primary cause of this condition, a patient must be prescribed with functional orthoses for correction of the extended pronation and reduce the counter rotation by the tibia and the femur. This will help alleviate the stress to the iliotibial band.
Dropped Metatarsal Head – Causes and Treatment Options
What is a dropped metatarsal head?
This is a condition wherein the metatarsal bone, generally the 2nd metatarsal), appears lower than the rest at the distal end.
Many patients with this condition feel pain and sensation that is similar to walking on a pebble. A callus usually forms under the head of a dropped metatarsal.
Common Causes of a Dropped Metatarsal Head
This is a prevalent condition that is strictly hereditary in nature. Another contributing factor would be over-pronation since abnormal weight distribution of an excessively pronated foot tends to put a lot of weight on the second metatarsal.
How is this condition treated?
The use of orthotics redistributes the pressure on the dropped metatarsal head. The addition of a metatarsal pad proximal to the affected metatarsal helps to reduce pain and pressure.
Common Causes and Symptoms of Metatarsalgia
Metatarsalgia is pain experienced in the metatarsals due to inflammation in the ball of the foot. It is generally known to be an overuse injury frequently from sports. Individuals suffer pain or tenderness in the foot’s plantar surface or in the metatarsal joints.
Common Causes of Metatarsalgia
Metatarsalgia usually develops due to abnormal weight distribution associated with abnormal pronation. It can be due to one factor or a combination of factors such as intense training, stress fractures, badly-fitting shoes, foot deformity, excessive weight, or Morton’s Neuroma.
How is Metatarsalgia treated?
A patient would be prescribed an orthotics to correct the abnormal pronation so that weight will be evenly distributed along the foot’s plantar surface. If it can be worn with shoes, a metatarsal bar helps to off-load the metatarsal heads to reduce pain underneath the metatarsal heads.
Piriformis Syndrome: Causes, Pain Relief and Cure
What is Piriformis Syndrome?
When the Piriformis muscle irritates the sciatic nerve, pain develops in the buttocks and goes down to the leg, following the sciatic nerve’s path. Patients experience an annoying pain in the buttocks that gets worse when sitting, walking or squatting. In a relaxed position, the affected leg becomes externally rotated.
What causes Piriformis Syndrome?
The Piriformis is a band-like muscle in the pelvis region. It originates from the sacrum and extends to the outer part of the hip, attached to the femur’s lateral side. It works by rotating laterally and extending to the hip’s joint. The roots of the sciatic nerve innervate this muscle. A compression of the sciatic nerve gives rise to various symptoms including pain, numbness, and a feeling of weakness in the buttocks and the legs.
When the leg is externally rotated over a long period of time, for instance, during a long drive, the Piriformis muscle may shorten. If the femur continues its internal rotation as a result of extended pronation or faulty foot mechanics, this muscle works overtime and may become enlarged. If the leg is straightened, like while walking, the sciatic nerve is compressed by the muscle.
Cure for Piriformis Syndrome
Sitting or other activities may trigger pain. You can avoid these positions and get sufficient rest. Ice application and heat are useful for pain relief. Exercises and stretches may be recommended by a physical therapist or orthopedist to resolve the compression of the sciatic nerve. Anti-inflammatory medications, corticosteroid injections and muscle relaxants may also be prescribed. Surgery may be recommended for severe or non-responsive cases.
Flat Feet (Fallen Arches) – Causes, Symptoms and Treatment
How do you know you have flat feet? You can test whether you have flat feet by checking the inside of the feet when you stand up and the sole of your feet is touching the floor. If the inside of your feet is flat, you have flat feet or fallen arches. Individuals with normal arches usually have an upward curve in the middle of the foot.
In young children, it is quite common to have flat feet which could later develop arches as they grow older (flexible flat feet). Some cases can develop in adults (acquired adult flatfoot). Adult acquired flatfoot is a progressive condition that occurs over time.
What causes flat feet?
There are a number of factors that cause flat feet in adults. These include:
- Congenital abnormality
- Torn or stretched tendons
- Damaged or inflamed posterior tibial tendon
- Bone dislocation or breakage
- Rheumatoid arthritis and other health conditions
- Nerve conditions
Aging, pregnancy, obesity and diabetes are other factors that could increase the risk for developing flat feet.
When to seek treatment for Flat Feet
Many people with flat feet encounter no problems like pain or discomfort. For some individuals, they may feel pain in the feet especially in the heel and arch area, swelling of the inside of the bottom of the feet, foot fatigue, pain in the back or leg, and difficulty with movement like standing on one’s toes.
If you experience some of these symptoms, it is best to see a qualified health practitioner.
Heel Pain and Heel Spurs
Heel pain is often concentrated on the back of the heel or its underside. Pain in the underside is generally the result of Plantar Fasciitis, a painful foot condition. When the pain is felt at the back of the heel, it could be Achilles tendinitis. While heel pain is not usually serious or life-threatening, it does prevent or limit normal activity like physical exercise.
Common Causes of Heel Pain
There are many causes of heel pain but the most common is Plantar Fasciitis. Patients with Plantar Fasciitis experience heel pain which can be exacerbated by the development of a bony growth called heel spur. Heel spurs are actually calcium deposits on the underside of the heel. They are frequently caused by foot muscle or ligament strain, stretching of the plantar fascia and repeat tears on the membrane which covers the bone in the heel. Many athletes develop heel spurs due to extensive running and jumping.
It should be noted that heel spurs can be asymptomatic. Patients with painful heel spurs generally suffer from Plantar Fasciitis, a condition wherein the plantar fascia tissue connecting the heel bone to the ball of the foot becomes inflamed.
How to treat Heel Pain from Heel Spurs
Unlike in other foot conditions, heel pain due to plantar fasciitis and heel spurs do not go away with rest. After sleep or rest, pain could become worse because the plantar fascia elongates and pulls the heel. Pain may diminish after walking but could recur after a long period of resting or sitting.
There are non-surgical methods of treatment for heel spur or plantar fasciitis pain. Over the counter medications may relieve pain and in some cases, corticosteroid injections may be prescribed to relieve inflammation.
Functional orthotic devices can also be prescribed to correct the causes of heel and arch pain due to biomechanical issues.
While majority of patients recover with conservative treatments within 9 to 12 months, some cases may require surgical intervention for pain relief and restoration of mobility. Heel spur removal or plantar fascia release are the most popular surgical techniques but are only recommended as a last resort.
Knee Pain : Common Causes and Treatment Methods
Knee pain could be due to a physical injury, overuse, or a health condition such as arthritis. Appropriate treatment varies depending on the cause of the knee pain. Some of the symptoms of a knee injury are swelling, stiffness and pain.
What could be causing your knee pain?
Injuries can affect the tendons surrounding the knee joint, the bursae, the ligaments and cartilage, and the bones that form the joint. The knee joint is complex in design and since it is active in bearing weight, it is prone to injury.
Trauma may also cause injury to the knee’s ligaments. An injured knee ligament can be painful during rest and become swollen and warm. Pain may increase if you try to bend the knee or bear weight with the knee or while walking.
A torn meniscus could occur due to shearing forces to the knee with sharp or rapid movement such as in sports. The risk is higher with aging and cartilage degeneration. Multiple tears can be present. An individual with a meniscus tear could experience popping sensation when moving the knee. It is also accompanied by swelling and sensations of warmth.
Knee pain could also be caused by diseases affecting the knee joint, and the tissues and bones around the knees. Rheumatic diseases and immune diseases of the various joints and tissues commonly affect the knee joint.
Knee Pain Diagnosis and Treatment
Arthritis treatment is generally based on the type of arthritis (osteoarthritis, gout or rheumatoid arthritis). Knee bursitis can be treated with icing, anti-inflammatory medications and immobilization. Severe knee trauma due to vehicular accidents and bone fractures could be serious injuries that require surgical repair. It is important to see a doctor for proper diagnosis and treatment of knee pain.
Ankle Pain can be due to a sprain or fracture but could also be caused by other factors such as ankle instability, infection, and poor structural alignment of the foot or leg, health conditions such as tendonitis, gout, arthritis and tarsal tunnel syndrome (nerve compression). Accompanying symptoms of ankle pain include swelling, redness, warmth and stiffness.
A patient would experience pain in the inside or outside of the ankle. Mild cases generally respond to self care but it could take time to improve. For severe cases of ankle pain, a doctor must do the diagnosis especially if it is after an injury.
Common Causes of Ankle Pain
Some of the most common causes of ankle pain are:
- Achilles tendinitis
- Achilles tendon rupture
- Bone spurs
- Broken foot or ankle
- Avulsion fracture
- Tarsal tunnel syndrome
Treatment of Ankle Pain
Initial methods of treatment are conservative and include icing, rest, elevation, immobilization and anti-inflammatory medications. The best person to diagnose and prescribe treatment for ankle pain would be a foot and ankle surgeon.
Cavus Foot (High Arches)
Cavus foot condition means having abnormally high arch. Due to this high arch, too much weight is put on the ball of the foot and the heel while walking or standing. The condition can develop in one or both feet and could occur at any age.
Causes of Cavus Foot
Neurological disorders or medical conditions such as cerebral palsy, muscular dystrophy, stroke, spina bifida, polio and Charcot Marie Tooth disease, could cause a cavus foot. Other cases may be due to an inherited abnormality in foot structure.
It is important to get an accurate diagnosis because the cause would dictate the proper course of treatment. High arches that are due to neurological or other medical conditions could worsen.
Cavus Foot Symptoms
Some of the symptoms of cavus foot include:
- Hammertoes or claw toes
- Calluses in the heel, ball, or side of the foot
- Pain while walking or standing
- Foot instability because of inward tilting of the heel that could lead to an ankle sprain
Treatment Methods for Cavus Foot
Conservative treatment for cavus foot includes:
- Custom Orthotic devices
- Shoe modifications
In the event that conservative treatments fail to relieve pain or improve stability, surgical treatment may be considered to reduce pain and enhance the foot’s weakness.