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Coping With Arch Pain

Overview
One of the most common foot maladies people suffer from is plantar fasciitis. This condition arises when undue stress is placed on the ligament in your foot that supports your arch, the “plantar fascia”. When that ligament is overworked it leads to the classic symptoms of heel and arch pain which worsens when you get up to walk after periods of rest. This isn’t the kind of pain you experience after being on your feet all day at work or walking around Disneyland with your kids. The pain from plantar fasciitis is often intense and debilitating. It is also surprisingly common. Two million Americans suffer from plantar fasciitis every year and 10 percent of the population will experience it in their lifetime. It has become recognized as one of the most chronic and, often times, most difficult foot problems to treat.


Causes
Sprains, strains, bruises, and fractures may be the result of a single stress or a combination of stresses to the foot. A blunt-force injury such as someone stepping on your foot may result not only in a bruise (contusion), but also in damage to the primary and secondary structures of the foot. Many of the muscles of the lower leg and foot attach on or near the arch. Injured or tight muscles may lead to incorrect biomechanics and in turn cause arch pain. Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma, which can result in a stress fracture. A sprain of the arch occurs when the ligaments which hold the bones together are overstretched and the fibers tear. The muscles of the foot may be strained by overstretching, overuse, overloading, bruising, or being cut by stepping on a sharp object. Arthritis of the arch joints may also occur if the foot is subjected to repetitive movements that stress the arch.


Symptoms
Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.


Diagnosis
To come to a correct diagnosis, your podiatrist will examine your foot by using his or her fingers to look for a lump or stone bruise in the ball of your foot. He or she will examine your foot to look for deformities such as high or low arches, or to see if you have hammertoes. He or she may use x-rays, MRIs (magnetic resource imaging), and CT scans to rule out fractures and damage to ligaments, tendons, and other surrounding tissues. Your doctor will also inquire about your daily activities, symptoms, medical history, and family history. If you spend a lot of time running or jumping, you may be at a higher risk for pain in the bottom of your foot. These diagnostic tests will help your doctor come to a proper diagnosis and create an appropriate treatment plan.


Non Surgical Treatment
Once the severity and cause of arch and foot pain is determined, a course of corrective and rehabilitative actions can be started. Therapists may use machines and manual therapies to reduce pain and increase circulation to the area to promote healing. Maintenance of fitness levels via modification of activity may be prescribed. Substitute activities that may aggravate the pain and soreness with other activities; for instance, running causes the body to have multiple impacts with the ground, but the use of bicycling, elliptical trainers, step machines, swimming, or ski machines eliminates impact and allows you to continue to maintain and improve your fitness levels. Take medications to help reduce pain and inflammation. Follow up with your doctor until you are better.


Surgical Treatment
In adults, the most common cause of collapse is due to the posterior tibial tendon tear. In such cases, the tendon must be repaired and a second tendon may be added to the posterior tibial tendon for strength and added support. If the foot is found to be very flat, bone realignment procedures or possible bone fusion procedures may be used to realign the foot. If the calf or Achilles tendon are found to be tight, they may be lengthened to allow better motion at the ankle and less arch strain. The forefoot may also be in a poor position and stabilization of the arch may be necessary to increase forefoot contact to the ground.


Prevention
People who run regularly should replace shoes every six months, more frequently if an avid runner. Avoid running or stepping on uneven surfaces. Try to be careful on rocky terrain or hills with loose gravel. Holes, tree stumps and roots are problems if you are trail running. If you have problems with the lower legs, a dirt road is softer than asphalt, which is softer than concrete. Try to pick a good surface if possible. However, if you’re racing, be sure to train on the surface you’ll eventually run on. Be careful running too many hills. Running uphill is a great workout, but make sure you gradually build this up to avoid injuries. Be careful when running downhill too fast, which can often lead to more injuries than running uphills. Prevent recurrent injuries. Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries.


Stretching Exercises
Strengthening exercises. Below are two simple strength exercises to help condition the muscles, tendons and joints around the foot and ankle. Plantar Rolling. Place a small tin can or tennis ball under the arch of the affected foot. Slowly move the foot back and forth allowing the tin can or tennis ball to roll around under the arch. This activity will help to stretch, strengthen and massage the affected area. Toe Walking. Stand upright in bare feet and rise up onto the toes and front of the foot. Balance in this position and walk forward in slow, small steps. Maintain an upright, balanced posture, staying as high as possible with each step. Complete three sets of the exercise, with a short break in between sets, for a total of 20 meters.

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