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Working With Pain In The Arch

Overview
The arch of the foot is formed by the tarsal and metatarsal bones and is strengthened by ligaments and tendons that enable the foot to correctly support the weight of the body. The underside of the foot is made up of four layers of muscle tissue as well as a length of thick connective tissue called the plantar fascia, which supports the arch. If the surrounding muscles weaken, the plantar fascia will drop and the arch will collapse. If the arch collapses, the whole foot touches the ground, which is known as pes planus or flat feet. Flat feet affect about 15 per cent of Britons. Although usually genetic, the condition may be exacerbated or triggered by poorly fitted shoes or conditions such as arthritis and pregnancy, when sudden changes in shape and weight can alter the body’s centre of gravity leading to a weakening of the arches.


Causes
In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition. Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin. Obesity. Very high arch. Repetitive impact activity (running/sports). New or increased activity.Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.


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
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.


Non Surgical Treatment
Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle, eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in some cases severely limiting athletic ability.


Surgical Treatment
Patients with adult acquired flatfoot are advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot, meaning you will be on crutches for two months. The bottom line is: Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.


Stretching Exercises
People with flexible feet who develop fallen arches may benefit from foot strengthening exercises, notes the Nicholas Institute of Sports Medicine and Athletic Trauma. Standing on a towel in bare feet and grasping the material with the toes is an easy foot-strengthening exercise that can be done at home. Standing on one leg while arching and releasing the foot may also prove useful. Doctors may prescribe gentle stretching exercises for the foot and ankle tendons.

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