Orthotics 4 Foot and leg Pain

Perhaps no other condition in the foot, ankle or leg has more indications for an orthotic than plantarfasciitis.  This condition and its slightly worse condition of heel spur, may be the number one reason why people will try some sort of arch support.

Plantarfasciitis as the name implies is an inflammation of the plantarfascial ligament that occurs on the bottom of the foot.  If you were to bend your big toe upwards with one hand and place the other hand on the bottom of your foot, you will more than likely feel a long hard cord extending from your heel to the ball of your foot.  That is the plantarfascial ligament.

There are actually three bands that make up this ligament, but plantarfasciitis usually affects what is known as the medial and central bands, meaning this condition will rarely cause pain on the bottom-lateral (outside) portion of your foot.heel spur

Why mention heel spur in this article?  A heel spur represents a calcification of the plantarfascial ligament where it attaches into the heel bone (calcaneus).  It is thought this calcification occurs from chronic inflammation of the ligament where it attaches into the heel bone.  The importance here is that when talking about an orthotic for heel pain, if there is a heel spur then it needs to be accounted for.  A heel spur is a projection of bone over growth which occurs on the bottom of the heel, so if that spur is allowed to hit the walking surface, it could add to the pain that one is experiencing.  The blue arrow points to the heel spur which as noted occurs on the bottom of the heel.

So, what is the purpose of the plantarfascial ligament?  This ligament essentially acts as a "bowstring" to maintain the congruity of the arch.  Looking at the picture below you will notice the triangle. The lower portion of the triangle represents the plantarfascial ligament going from the heel to the ball of the foot.  The two upper lines represent the arch of the foot.  The more the arch attempts to collapse during gait, the more tension that is placed on the plantarfascial ligament.  Once the ligament ends up over strained, it becomes inflamed, usually at the heel, but certainly can also occur anywhere along its course and you end up with plantarfasciitis.

arch collapse and plantarfasciitisCollapsing of the arch to some degree is a normal component of gait.  However, in other instances the over collapsing of the arch can be caused by various outside factors.  Some of these factors include poor shoe selection where the shoes one is wearing are way to flimsy and do not help support the foot, so the plantarfascial ligament has to work harder.  Additonally, being overweight obviously puts additional stress on the feet and this too may cause plantarfasciitis.

Athletics may also be a factor in the formation of plantarfasciitis.  Obviously, an activity such as running will force the plantarfascial ligament to overstretch far more frequently than walking, plus the force with which the foot hits the ground may also play a role in this type of pain.

A persons occupation may also play a role in the formation of plantarfasciitis.  Someone who does a lot of walking during the course of the day, or even someone who stands all day, but stands on hard concrete type floors will be candidates for plantarfasciitis.

Some people have a shortened heel cord (achilles tendon).  This will tend to aggravate plantarfasciitis as many experts consider the plantarfascial ligament to be an actually extension of the achilles tendon.

Lastly, some people develop plantarfasciitis for no apparent reason.  In any event, most doctors who treat this condition usually have a protocol that they incorporate based on the severity and length of time someone has been suffering from this pain.  In todays world we foot specialists make a distinction between acute plantarfasciitis and chronic pain which is known as plantarfasciosis.  Again, it is beyond the scope of this article to explain the differences other than to state that an orthotic can be used in either situation.

If your plantarfasciitis is an acute problem perhaps from wearing a flimsy pair of shoes, an anti-inflammatory medication and some ice may be all you need.  But, if your pain does not resolve the first thing you need to do is find out if you actually have plantarfasciitis and not some other condition that may mimic the condition.

Once you know you actually have plantarfasciitis and perhaps even a heel spur then you need to consider an orthotic.

                   how does an orthotic help plantarfasciitis?

I think most of you reading this article will know the answer to this and that is an orthotic supports the plantarfascial ligament so that when the foot is over collapsing, for whatever reason, the plantarfascial ligament does not over stretch.  The less strain on the ligament, the less inflammation that occurs.

In my practice, orthotic therapy is the central part of treatment for any plantarfasciitis except perhaps acute plantarfasciitis of a couple of days duration.  But even in those cases if I see a situation that may lead to an ongoing problem like obesity or an excessively flat foot, I may recommend an orthotic simply because I can see the problem recurring. 

There is certainly no shortage of treatments out there for plantarfasciitis and there are a lot of claims being made on how certain treatments cure 80 to 100 percent of all cases of plantarfasciitis.  Well, this condition is like any other medical condition and where one treatment may work great for one person, it may have absolutely no effect on the next person.

Having said that, I have always felt that unless you adequately support the plantarfascial ligament and keep it from over stretching, than any other treatment you may try will have a decreased potential for success simply because without support, every step you take just continues to re-inflame the ligament.

In many instances simply wearing an orthotic, assuming a properly supported orthotic may be all that is necessary.  Most people who come in to my office complaining of this type of pain have already tried some sort of store bought device ranging from a heel cushion all the way to some kind of arch support and in most cases will tell my that they had some degree of relief, but not the kind of relief that they were hoping for.  This tells me that a properly fitted orthotic will probably be very beneficial to them.

Assuming you actually have plantarfasciitis and not another condition, you may certainly try a store bought arch support.  Whether it actually helps you depends on a number of factors most important of which is the ability of the device to adequately support the ligament and the ability of the arch support to cushion the heel.

If that works, great, but if not you will need to consider something more professional.  Even though I use both medical grade off the shelf orthotics and prescription orthotics, I tend to find for plantarfasciitis, the medical grade off the shelf seem to work in the majority of patients where I prescribe them.  The only exceptions may be in people that are excessively over weight or those that have a heel spur.

When a heel spur is present, in order to keep pressure off the spur, the heel portion of the orthotic may have to be accommodated, meaning a cut-out needs to be created around the spot where the spur hits the ground.  In creating this cut-out, we are able to alleviate the pain from the bony spur hitting the walking surface.  As far as I know, this accommodation can only be had in a prescription orthotic.


ORTHOTIC RATING:

store bought arch support if the device cushions the heel and has some degree of arch support could be helpful

medical grade off the shelf orthotic would be indicated for this problem in most foot structures except perhaps people with very high arches

prescription orthotic very effective in all foot types but the average person will probably do fine in a medical grade off the shelf orthotic unless they have a very high arch or have a diagnosed heel spur.


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MEDICAL GRADE ORTHOTICS

best buy in pre-made orthotics for sneakers, work boot and casual lace shoes

KLM SuperStep Orthotic    

best buy in pre-made orthotics for womens flats, low heel pumps and mens dress shoes

Redithotics 3/4

medical grade off the shelf childrens orthotics because kids outgrow orthotics so quickly

childrens orthotics



Copyright © 2013. All Rights Reserved.Marc Mitnick DPM