Foot Pain & Plantar Fascitis

How do our arches become weakened and flatten out?

40 or 50 years ago there was a lot more soft ground then there is today. The present day is filled with development and urbanization which surrounds us in a world of concrete and hard floors. With soft ground there is a relative hardness but it is a lot more absorbent and gives when we walk on it as opposed to walking on concrete which does not give. Over the years constant repetition and wear and tear eventually began to take a toll on the muscles, tendons, and ligaments around the arch and the feet. When there is a weakening of these structures the bones that make up the arch become unlocked from each other and the feet become too flexible or overpronate (too much flexibility to the inside or medial side of the arch, the heels will usually kick or evert to the outside). This process leads to over 35 different symptoms and diagnosis, everything from plantar fasciitis, bunions, shin splints, foot, heel, knee, and low back pain. Using orthotics will help to post and support the medial arch while redistributing weight evenly across the foot and repositioning the foot, ankle, knee, hip, and low back into a neutral position. Almost 80-85% of the U.S. population has some degree of slight to severe overpronation and flexible arches.

With that being said only a small percent of the population has a high rigid arch or oversuppinate. This foot presentation is more biomechanically correct, maintaining a neutral position for the feet, ankle, knees, hips, and low back. But maintaining that neutral position does have its disadvantages, this individual puts a greater distribution of weight on the forefoot and on the heel. Since they have a very high ridged arch they lose a tremendous amount of shock absorption in the ankle. This individual would benefit from orthotics because it will redistribute weight more evenly across the foot and give a lot more shock absorption.

Orthotic Types

There are 3 different types of inserts and orthotics that exist, all which are designed and function differently.

1. Cushion Insert. Probably the most commonly known insert that you can find in all of the grocery stores, drug stores, and large retail stores. Usually these look and give the appearance that they will indeed give relief and comfort to your feet but are usually generically designed. These types of inserts use gel and thick cushioning which might give some temporary relief but will not give long term support.

2. Ridged Custom Orthotics. This orthotic is far superior to a cushion insert usually cast from a health related expert using plaster or a foam mold. The advantage of casting the orthotic is that it is customized to each individual’s foot mechanics; however, this orthotic tends to be too rigid and very bulky. The rigid orthotic does not allow any movement or flexibility during walking. Keeping the foot supportive is key in helping to control overpronation and healing many aches and pains but our foot was meant to have some motion and flexibility during walking to aid in shock absorption. A lot of times these orthotics are very bulky which limit the types of shoes that can be worn with them.

3. Semi Flexible/Ridged Orthotics. Biomechanical gait scan analysis determines both statically and dynamically. This advanced analysis can detect split second abnormal foot function not seen with the naked eye. Mapping anatomical relationships of the foot allows for a contoured and custom-made prescription orthotic to support and align the foot. This orthotic is specifically designed using memory thermoplastic to allow a small amount of flexibility allowing natural physiologic shock absorption. There are a variety of different types of additions and modifications that can be customized to each orthotic to fit any foot type or any shoe.

Common Misconceptions

How do my feet affect my knees, hips, low back, and neck? Your feet have a direct impact on the rest of your body. Like the foundation of a house, your feet support the weight of everything above them. When a small problem develops in your feet, subtle changes in the way you walk will cause a chain reaction of changes in your posture and walking mechanics. These changes can put stress on your joints higher up in your body, and lead to more serious problems over the years. Customized orthotics helps to rebalance your feet, reducing pain and discomfort by enhancing your body’s natural movements.

A common misconception is that everybody thinks they have a high arch. Our foot is designed to actually have an arch; it is the foundation for our feet and is a weight bearing structure for our entire body. What actually is commonly seen is a flattened or weakened arch which at one point was higher and a lot more rigid. Due to constant forces and stresses placed on the foot and surrounding structures it slowly weakens over time becoming more flexible. Arch height is measured 2 ways: weight bearing and non-weight bearing. Weight bearing is a more sensitive and accurate test and will give you more information than non-weight bearing.

Running sneakers actually are one of the best things for your feet are true. This is especially true if recovering from an injury (plantar fasciitis, heel spurs, heel pain, bunions, shin splints, knee hip, and low back pain). However getting fitted for the proper sneaker is key. There are 3 different types of sneakers all which are designed for different foot types (Motion Control offers a lot of stability for very flat feet and severe overpronators, Stability sneakers also offer support for mild to moderate overpronators, Neutral cushion sneakers for a high ridged arch to give a lot more cushion and shock absorption). Everybody’s feet are shaped and sized a little bit differently so what sneakers may fit and work well for one person may not fit and work for somebody else. There is also a clog made by Dansko which is a very supportive shoe that is a little more dresser and very supportive for your arch.

You are not a runner and only use your sneakers for walking. Again running sneakers are the most structured and supportive sneakers on the market. More so than some walking and cross-training sneakers. Walking and running biomechanically have the same motion. Both use the same forward motion and the feet tend to react very similarly whether walking or running.

Remember when walking you add 1-2 times your body weight, when running you add 3-5 times your body weight. Therefore if a sneaker is supportive and cushioned enough to run in then it is good enough to walk in.

Another common misconception is that in earlier years your feet may have always measured the same size but, recently you find that your feet grew and have become longer and increased in size. Your foot really isn’t growing at all but your arch has been slowly weakening and flattening out over the years from constant pounding and wearing unsupportive footwear, gaining weight, and hormonal changes during pregnancy with females. This process allows ligamentous soft tissues to become flexible and stretched pushing your toes forward giving you longer feet but they are not really growing.

Sneakers are updated and slightly changed every year to eighteen months. With this in mind if you find a pair that really fits you well then buy a second pair. If you wait until the next time you need sneakers the same pair will no longer be available.

You don’t like the look of running sneakers. Well granite some running sneakers may need to tone down the colors but they are the best thing for your feet. The design of running sneakers isn’t just the flashy style, they actually are methodically designed and each overlay of a different colored piece has a functional purpose to support and lock your foot in place.

Everybody should wear orthotics. This statement is somewhat true due to the fact that nearly 80-85% of the U.S. population has weakened arches and 5-10% has high rigid arches. That leaves only a small percentage left that actually have mechanically neutral and supportive arches.

New Balance is not the only good sneaker available. New Balance is a good company but there are many others out there. When buying sneakers many different styles and brands should be tried on. The fit of the sneaker is far more important than the brand. These sneakers should feel snug but not too tight and most importantly instantly feel comfortable. In addition to New Balance, Asics, Brooks, and Saucony are very good brands that put a lot of research into their footwear instead of advertising and marketing like some other large company’s.

You should wear your shoes in the house, is also true. It is polite and customary to remove our shoes when entering the house but again we want to support our arch as much as possible.

Going barefoot inside means we subject our foot to the same stresses on hard wood and tiled floors that we do on concrete. Having an inside the house pair of shoes or sneakers to change into is an easy solution. Granite they should also be supportive and structured.

FOOT FACTS

• 􀀀25% of the bones in your body are in your feet. 26 bones make up each foot.

• 􀀀The average person takes 8,000 to 10,000 steps every day.

• 􀀀The average person will walk over 100,000 miles in their lifetime, or more than 4 trips around the world.

• 􀀀Women have four times as many foot problems as men (pregnancies and fancy non supportive footwear are some causes)

• 􀀀 More than 75% of people will experience foot problems in their lifetime.

New Orthotic Adjusting Process

Now that you have your new orthotics you want to take it slow. It took your feet and arches many years to get to their present condition so it will take anywhere from 10-14 days for your body to fully adjust to the orthotics. The reason being wearing your new orthotics is to support your arch which will change your weight distribution and the biomechanics of your foot while using different stabilizing muscles in your legs. Wearing your orthotics too much too soon can cause muscle soreness and may feel uncomfortable. Everybody is different, some can wear them for a full day with no problems while others are more sensitive and need a more gradual transition into them. For the best results on the first and second day wear them for only an hour or two and let your body adjust while getting a feel for them. On the third day, we begin to increase the wear time for two to three hours. Continue to increase the wear time throughout the next 10-14 days until you're wearing them for a full day without any discomfort. If you start to feel some soreness then cut back to wearing them for only a few hours a day until your body heals and adjusts.

Dr. Kevin M. Nightingale 154 Plaza Dr. Williamsville NY 14221 716-204-0784

www.nightingalechiropractic.com