Definition

Metatarsalgia is a term characterized as pain under the forefoot beneath one of more of the metatarsal heads (the area just before the toes, more commonly referred to as the ball-of-the-foot), regardless of cause. The structures involved can include metatarsal bones, metatarsophalangeal joints, plantar plates, digital nerves, and soft tissues in the immediate area of the first to fifth metatarsal heads.

Cause

This is a common foot disorder with the underlying cause of metatarsalgia being the repetitive transfer of ground forces and plantar pressures to the forefoot during walking or running. This condition can affect anyone but is more common for those older than 60 years of age due to two main factors. The first is that in some individuals, the plantar fat pad atrophies with age and fails to provide the necessary cushioning when walking. Without the cushioning of the fat pad, the nerves of the foot located near the metatarsal heads are more exposed and become scarred from friction. Secondary to the loss of fat pad cushioning, or to the natural morphology of the individual, hyperplasia can occur. At the sites of the metatarsal heads, where tissue has become thin from excessive pressure, calluses evolve, also leading to compression of the nerves. Females are at higher risk than male’s but it is unclear why metatarsalgia is more common for females than males. It is theorised that it may be secondary to wearing tight fitting shoes and high heeled dress shoes, both of which create compression or excessive pressure on the metatarsal heads.

Treatment and Prevention

The first step in its treatment is to determine the cause of the pain. Many facets can be involved including the structure of the bones of your feet. The more common reason is improper fitting footwear. Footwear designed with a high, wide toe area and adequate insole cushioning is ideal for treating metatarsalgia. The high, wide toe area allows the foot to spread out while the insole reduces stress on the ball-of-the-foot. Balance Supports are designed to relieve ball-of-foot pain thanks to the inclusion of a metatarsal pad. They are constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Some companies offer gel metatarsal cushions for relief but they are a very short term solution and don’t address the main issue’s. When Balance Supports are used with proper footwear, you should experience significant relief from the symptoms.

If problem persists, consult a specialist

Definition

Achilles tendinitis is an overuse injury of the Achilles tendon; a band of tissue that connects the calf muscles at the back of the lower leg to your heel bone. It's more common in runners but can also occur in people that are required to remain standing for long periods on hard surfaces, causing high degree's of calf muscle tension to build up over time.

Cause

The development of Achillies tendinopathy is considered to be a multifactorial issue with impact from anatomical differences, biomechanical factors and overuse injuries. Excessive loading of the Achillies tendon during walking or running is considered the main pathological impetus in the development of Achillies pain. During running, as the foot contacts the ground, ground forces are transferred up through the joints and soft tissue structures in order to allow progressive dissipation of the forces being experienced by the body. Forces from the foot are transferred via the ankle to the leg, meaning the Achillies tendon and calf muscles experience higher amounts of force due to their proximity to the foot. This proximity results in loads between six to twelve times a person’s body weight, being placed upon the Achillies tendon every time your foot strikes the ground. The tendon may react to excessive loading placed upon it with either degeneration of the tendon fibres, inflammation of the paratenon sheath, which is known as Achilles paratenonitis, or a combination of both.

Treatment and Prevention

Achillies tendonitis can create chronic degenerative changes deep within the tendon, creating a cycle of injury > pain > partial recovery > re-injury, that can go on for many months.

Prevention is the best approach and the introduction of a Balance Support helps limit heel eversion and subsequent internal rotation of the lower leg. This prevents twisting of the Achilles tendon while walking, one of the main proceeding factors of an Achillies injury. Should you already have an Achillies injury then the same mechanics apply in the recovery; while your physical rehab is provided by an Osteopath/Physio, limiting heel eversion ensures minimal load is being put on the tendon throughout your day, speeding up recovery times.

If problem persists, consult a specialist

Definition

Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body’s insulin to perform its normal everyday functions. Insulin is a substance produced by the pancreas gland that helps process the food we eat and turn it into energy. Diabetes affects approximately 16 million Americans and is classified into 2 different types: Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often linked to heredity causes. Type 2, commonly referred to as adult onset diabetes, is characterized by elevated blood sugars, often in people who are overweight or have not attended to their diet properly. Many complications can be associated with diabetes. Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet. People with diabetes should pay special attention to their feet.

Neuropathy

Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy. Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet. It is very important for diabetics to take the necessary precautions to prevent all foot related injuries. Due to the consequences of neuropathy, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative footcare measures, he or she reduces the risks of serious foot conditions.

Poor Circulation

Diabetes often leads to peripheral vascular disease that inhibits a person’s blood circulation. With this condition, there is a narrowing of the arteries that frequently leads to significantly decreased circulation in the lower part of the legs and the feet. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, causing injuries to heal poorly. Poor circulation can also lead to swelling and dryness of the foot. Preventing foot complications is more critical for the diabetic patient because poor circulation impairs the healing process and can lead to ulcers, infection, and other serious foot conditions.

The selection of an arch support, of any kind, for those suffering from diabetes should only be done in consultation with your specialist

Definition

Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort.

Cause

There are two different classes of heel pain. The first is caused by over-use repetitive stress which causes pain from excessive impact on a specific area of the foot. This condition, often referred to as “heel pain syndrome,” can be triggered by a thin fat pad in the heel area, shoes with heels that are too low or from a sudden increase in activity without sufficient time to adjust to the new activity.

Treatment and Prevention

Heel pain requires a multifactorial approach. On the surface simply having additional cushioning at the heel would seem to be an obvious solution. However, heel cradles, heel cushions and other “shock absorbing” devices change the biomechanics of the body by lifting your foot up from its heel, placing additional loading on the forefoot and creating new problems. These types of solution are only a band-aid for the symptoms and not a true solution. The right footwear is a good starting point, ensuring your heels have sufficient support with a quality insole in your shoe and that the shoe itself is firm enough to support your heel. In addition, a Balance Support, providing medial posting and arch support, helps control the foots movements and will reduce over-pronation, a common biomechanical factor in the development of heel pain. Anti-inflammatorys, ice and, in extreme cases, corticosteroid injections can also be used.

If problem persists, consult a specialist

Definition

The formation of calluses is caused by an accumulation of dead skin cells that harden and thicken over an area of the foot. This callus formation is the body’s defense mechanism to protect the foot against excessive pressure and friction. Calluses are normally found on the ball-of-the-foot, the heel, and/or the inside of the big toe. Some calluses have a deep seated core known as a nucleation. This particular type of callus can be especially painful to pressure. This condition is often referred to as Intractable Plantar Keratosis.

Cause

Calluses develop because of excessive pressure at a specific area of the foot. Some common causes of callus formation are high-heeled dress shoes, shoes that are too small, obesity, abnormalities in the gait cycle (walking motion), flat feet, high arched feet, bony prominences, and the loss of the fat pad on the bottom of the foot.

Treatment and Prevention

Many people try to alleviate the pain caused by calluses by cutting or trimming them with a razor blade or knife. This is not the way to properly treat calluses, unless done by a professional. This is very dangerous and can worsen the condition resulting in unnecessary injuries. Diabetics especially should never try this type of treatment. To relieve the excessive pressure that leads to callus formation, weight should be redistributed equally with the use of an orthotic. An effective orthotic transfers pressure away from the “hot spots” or high pressured areas to allow the callus to heal. The orthotic should be made with materials that absorb shock and shear (friction) forces. Women should also steer away from wearing high-heeled shoes. As always, surgery should be the very last resort.

If problem persists, consult a specialist