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Pain In Heel And Arch Of Foot After Running

Overview
Plantar fasciitis continues to be widely used for the clinical syndrome of undersurface heel pain. However, the use of ‘itis’ denotes an inflammatory disorder. This is a misnomer as the pathology is not the result of excessive inflammation. Pathological changes are degenerative (but partially reversible) in nature, probably due to repetitive trauma. The plantar fascia is a thick, fibrous band of connective tissue. Its origin is the medial plantar tubercle of the calcaneum. It runs along the sole of the foot like a fan, being attached at its other end to the base of each of the toes. It is a tough, resilient structure that has a number of critical functions during running and walking. It stabilises the metatarsal joints during impact with the ground. It acts as a shock absorber for the entire leg. It forms the longitudinal arch of the foot and helps to lift the arch to prepare it for the ‘take-off’ phase of the gait cycle.


Causes
There are several reasons why arch pain develops. Sometimes it?s due to a condition known as plantar fasciitis, in which the plantar fascia (the band of tissue that runs along the bottom of your foot from your heel to your toes) becomes inflamed after excessive stress. Heel pain results from this inflammation. Sometimes the pain is due to extensive time spent on your feet. Many people feel pain on the arch of their feet after a long workday, while others overuse their feet exercising or playing sports. A foot deformity, such as hammertoe or clubfoot, can also cause this pain. Medical conditions such as diabetes or obesity can put additional stress on your feet, thereby causing arch pain. Your footwear is also important. Shoes should support all parts of your foot, especially the bottom. This is very important if you spend excessive time on your feet, if your obese, if your pregnant, or if you engage in sport-related activities. Injuries to any of the twenty-six bones, thirty-three joints and over 100 muscles, tendons and ligaments in the feet can also cause arch pain. Because the foot is such a complex structure, it?s important to see a podiatrist at the first sign of symptoms.


Symptoms
Symptoms include pain which is often described as a burning pain radiating into the arch of the foot, heel and sometimes the toes. Pins and needles or numbness may be felt in the sole of the foot. Pain may be worse when running or when standing for long periods of time and often worse at night. The area under the medial malleolus on the inside of the ankle may be tender to touch.


Diagnosis
The diagnosis of high arch (cavus) foot deformity or Charcot Marie Tooth disease can be made by an orthopedic surgeon in the office. Evaluation includes a thorough history and physical examination as well as imaging studies such as X-rays. The orthopedic surgeon will look at the overall shape, flexibility, and strength of a patient?s foot and ankle to help determine the best treatment. Nerve tests may occasionally need to be performed to help confirm the diagnosis.


Non Surgical Treatment
The most effective treatment for foot arch pain and strain is to use an arch support. The arch support sits under the foot and stops the arch of the foot from collapsing, thereby preventing the stretch of the arch pad which causes pain and discomfort. Wearing an arch support in slippers or house shoes can also prevent pain in the mornings when discomfort it most common and severe. Arch supports usually relieve symptoms within a few days.


Surgical Treatment
The soft tissue surgeries usually would include a lengthening of the Achilles tendon, releasing of the plantar fascia as well as tendon transfers. These procedures are usually done in conjunction with bony procedures such as calcaneal osteotomies (to lower the heel bone and get it more under the leg itself), as well as metatarsal osteotomies. These procedures usually involve either cutting or fusion of the bones, and placement of fixation devices to allow the bones to heal. Healing time is usually at least 6-8 weeks and usually the patient must be non-weight bearing during the healing process. These types of surgical corrections are usually reserved for the more difficult, painful and deformed feet. They can require more surgeries down the line. These procedures are usually the last resort after all other modes of treatment have been exhausted (except in children where it is usually best to treat the deformity early). There are many different degrees of high arched feet and these procedures should be left for the more extreme cases. These cases usually require a very high degree of surgical skill and should only be done by those who frequently perform these types of cases.


Prevention
Maintain a healthy weight, Use insoles to support your arches, Limit how often you wear high heels, Use proper shoes, especially when exercising to evenly distribute weight through your foot.


Stretching Exercises
Start in an L-Sit position. (If you?re hips and hamstrings are tight sit up on a box or phone book to be able to achieve a tall back position. You can even sit on a box with your back supported against a wall!) Keeping the legs straight, but not locked, reach both heels out away from your body to ?Flex? the ankles. Try to avoid pulling back with the toes to flex. Keep the toes relaxed and lead from the heel to hinge the foot into the flexed position. Hold the flexed foot and breathe. Take 3-5 breaths and see if you can reach farther through the heel to deepen the flex on each exhale. To transition to the pointed position, begin by pointing the foot to move the ankles as far as possible in the other direction. Once the ankles have reached their endpoint, use the muscles along the sole of the foot to point the toes. Inhale to continue lengthening out through the top of the foot, exhale to deepen the contraction under the sole of the foot to point the toes. Take 3-5 breaths. Then release the toes, and begin reaching out through the heel to hinge the ankle into the flexed position to repeat the exercise. Continue to flex and the point for 5-10 repetitions.

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