Commonly Treated Conditions

Metatarsalgia is a generic term for pain or discomfort in the forefoot (the ball of the foot). Generally, metatarsalgia is attributed to a drop or collapse of the metatarsal arch. The arch flattens and the bone ends move closer together causing the soft tissue to be pinched or trapped between the bones. With every step, the arch rises and falls causing repeated stress in the area.

Metatarsalgia can readily be treated with orthotics to alleviate pressure in the area and "create" a metatarsal arch. It is also important to decrease the pressure on the ball of the foot by lowering heel height and having a flexible ankle joint.

How Would Foot Orthotics Help?

Custom made foot orthotics are designed to correct or control biomechanic inefficiencies in the feet, legs or joints. Orthotics can help to support the dropped metatarsal arch and reduce the pressure in the ball of the foot. Orthotics also control excessive movement of the foot and ankle joints, reduce pronation and provide cushioning to protect the feet.

Associated Metatarsal Conditions

• Neuromas: Neuromas commonly occur when the metatarsal arch drops and pinches a nerve between the bones. The nerve becomes inflamed and the nerve tunnel becomes crowded. This causes tingling and numbness into the toes. Neuromas are most often located between the first and second or the third and fourth metatarsals.Neuromas
• Sesamoiditis: Sesamoiditis is the inflammation of the soft tissue surrounding the seed-like sesamoid bones in the ball of the foot under the big toe. This area becomes inflamed under pressure and can cause a shifting of the sesamoids. The irritation is very localized and is pressure sensitive.
• Exposed Bone Ends: The dropped metatarsal arch exposes the bone ends on the bottom of the foot and creates a pressure area (and often a callous) under the second, third and/or fourth toes. This can lead to skin breakdown, especially in diabetics and arthritics.

Symptoms of Metatarsalgia

• Pain at the ball of the foot during weight bearing activities
• Tingling/Numbness in toes
• Sharp or shooting pain in toes
• Aggravated when dorsiflexing toes
• Callousing under 2/3/4th toes

What Causes it?

• Shortened heel cord range (calf muscles are too tight)
• Change in shoe heel height
• Prolonged use of improper footwear i.e. high heels, cowboy boots
• Muscle imbalance
• Strained arches - excessive pronation or supination

Treatment Options

• Orthotics - the most effective, permanent way to treat and to avoid re-injury
• Stretching - decreases the likelihood of recurrence.
• Shoes - the correct choice of shoes can be effective treatment for padding and protecting heel
• Rest
• Anti-inflammatory medicine - cortisone injection or oral anti inflammatory medication to relieve symptoms, but may not address source of problem
• Physical Therapy - Ultra sound/ Electrical Stimulation/ Paraffin/Deep Heat/Whirlpool

Supination is the opposite motion of pronation. It allows the foot to be a more stable, rigid structure for when we push off on our next step. The foot naturally supinates during the toe-off stage (when the heel first lift off the ground until the end of the step) to provide more leverage and to help roll off the toes.

The plantar fascia is a tight ligament that stretches along the bottom of the foot from the heel bone to the ball of the foot. Plantar fasciitis occurs when this connective tissue inflames and small fibres begin to tear away from the heel bone.

Often, the body responds by depositing calcium in an attempt to "glue" the detached ligament fibers back on to the heel. Heel spurs, or calcaneal spurs, can develop if the fascia is continuously under tension. These heel spurs can be re-absorbed by the body (or become asymptomatic) when the tension is released.

Symptoms

severe pain on the bottom of the heel after rest (rising from bed or sitting)
pulling your 'toes towards your nose' exacerbates the symptoms
firm pressure with the thumb elicits a deep tender spot, often over the medial tubercle of the calcaneus (heel bone)

What Causes it?

• abnormal motion of the foot called excessive pronation or supination
• a shortened Achilles tendon/ calf muscle
• traumatic injury
• excessive, prolonged pressure through the foot (obesity, heavy lifting)
• long, rigid and elevated arches
• changes in shoes, activity level, terrain

Treatment Options

• Orthotics - the most effective, permanent way to treat and to avoid re-injury
• Stretching - decreases the likelihood of recurrence.
• Shoes - the correct choice of shoes can be effective treatment for padding and protecting heel
• Rest
• Anti-inflammatory medicine - cortisone injection or oral anti inflammatory medication to relieve symptoms, but may not address source of problem
• Physical Therapy - Ultra sound/ Electrical Stimulation/ Paraffin/Deep Heat/Whirlpool

Giving your injured foot a hand!

Give your foot a rest. Fasciitis is, after all, an overuse injury. If you've just started to get a tender spot, you may get over it in a few weeks. If you've had pain for a while, don't expect an overnight recovery. It can take 6 weeks or longer to get better. Cut down or cut out running and extended walking to rest the foot, or try other forms of exercise. Simply varying your workout with a less foot-dependent sport (e.g. swimming or cycling) might be all you need in the early stages of fasciitis.

Non-steriodal anti-inflammatory (e.g. acetominophen or aspirin) can help reduce inflammation thereby decreasing pain. Massage the painful area with ice. This is another good way to reduce inflammation. Once or twice a day for no more than 20 minutes at a time should be sufficient. Stretch your calf muscles. Crazy as it sounds, this works! The calf muscles/Achilles tendon complex runs from the bottom of the heel to the back of your knee. A tight heel cord pulls the heel bone up and back, stressing the fascia. A relaxed tendon and calf muscles puts less strain on the injury. Wear shoes with a moderate heel height. We recommend a heel height of 1/2" to 3/4". A lower heel height tightens the Achilles tendon and causes more pull on the plantar fascia. This will help handle the symptoms but will not fix the problem.

In simple terms pronation is the flattening out of the arch when the foot strikes the ground. Normally, the foot will pronate to absorb shock when the heel hits the ground, and to assist in balance during mid-stance.