Foot Pain, need help

[Energon]

I am severly flat footed and that was causing a lot of problems particularly due to the endless hours spent on my feet, running around etc.

I hence invested a lot of money to get orthotic insoles to help build arches. I had no problems wearing the insoles for the first few months but now, my right foot has really started to hurt to the point where I have limp around. I feel a lot of pain on the mesial aspect of the bottom of the foot (arch portion) and on the lateral aspect of the top of the foot near the ankle. I also feel numbness in my foot at times.

The problem is, the company I bought the orthotic stuff from did not have me evaluated by a physician or a podiatrist. However, now I am getting a little worried and was wondering what I should do.

Who do you guys think I should go to? A foot & ankle orthopod? or a DPM? Also, for some of you residents out there, how common is something like this?

Thanx for any input

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[DPTATC]

I am severly flat footed and that was causing a lot of problems particularly due to the endless hours spent on my feet, running around etc.

I hence invested a lot of money to get orthotic insoles to help build arches. I had no problems wearing the insoles for the first few months but now, my right foot has really started to hurt to the point where I have limp around. I feel a lot of pain on the mesial aspect of the bottom of the foot (arch portion) and on the lateral aspect of the top of the foot near the ankle. I also feel numbness in my foot at times.

The problem is, the company I bought the orthotic stuff from did not have me evaluated by a physician or a podiatrist. However, now I am getting a little worried and was wondering what I should do.

Who do you guys think I should go to? A foot & ankle orthopod? or a DPM? Also, for some of you residents out there, how common is something like this?

Thanx for any input

PT perspective: Often orthotics are made that simply hold the arch up and completely prevent functional pronation. I think there are better ways to control arch height. If your orthotics have a high medial longitudinal arch, that may be the direct cause of your new symptoms.

analogy: Lets say you have a garden with a stone fence to keep the critters out. Because you don't want to lift the tiller over the wall, you hire a mason and build an arch out of stone so that you can make a gate. After several years, the keystone of the arch begins to fall down. You COULD simply put a post beneath the keystone and prevent it from falling, but then you would eliminate the functionality of your archway. OR you could reinforce each side of the archway and then the keystone could not fall.

In my 14 years of experience, I have found that rearfoot and/or forefoot posts are more effective in controlling arch motion. Your arch needs to go down when you are at mid stance and re-supinate as you push off to propel yourself. If the arch is controlled by simply putting a bunch of stuff beneath it, your plantar fascia will have to bend up and over the "stuff". This will not really eliminate the problem.

Have your foot evaluated by someone who works with athletes and looks at a lot of feet. Obviously, I prefer a PT who looks at feet all of the time. measurements that they should take include measurement of rearfoot and forefoot varus. The amount of posting will be determined based upon those measurements. Also, tight calf muscles will limit dorsiflexion in the talo crural joint and require too much dorsiflexion at the midtarsal joint. That causes the arch to flatten out more and loads the plantar fascia excessively.

The right orthotics are like magic. It sounds like you don't have them.

Good luck.

 

[Energon]

Thanx dude, I wasn't even aware PT's handle foot pain. However, from what i understand, I cant go directly to a PT and seek tx, I have to go thru an orthopod or podiatrist first.... is that true?

Also, do you think steroid injections are going to be administered if I indeed have plantar fasciitis?

I apologize in advance for sounding stupid, unfortunately my specialty happens to be the other end of the body.

 

[DPTATC]

Thanx dude, I wasn't even aware PT's handle foot pain. However, from what i understand, I cant go directly to a PT and seek tx, I have to go thru an orthopod or podiatrist first.... is that true?

Also, do you think steroid injections are going to be administered if I indeed have plantar fasciitis?

I apologize in advance for sounding stupid, unfortunately my specialty happens to be the other end of the body.

You can refer yourself to PT or call the doc you see for regular things. It doesn't have to be an orthopod or podiatrist. In fact, 37 states allow direct access to PT by law, but most insurance companies require a referral. Steroid injections are sometimes helpful but it is usually not a solution. You have to stop causing the inflammation. Once you have done that and if it still hurts, then try the injection (unless you are miserable, then it can sometimes buy you some painfree days, it doesn't always work though)

My first step with a PF patient is to tape their arches. Most ortho PTs and nearly all athletic trainers will know how to do it. Most DPMs do as well but they are sometimes harder to get in to see. Often the arch tape will be incredibly helpful (again, not the solution probably but will buy you time without that needle which, I understand, is not a fun injection to receive).

 

[diabeticfootdr]

I am severly flat footed and that was causing a lot of problems particularly due to the endless hours spent on my feet, running around etc.

There is only so much you can do conservatively for flatfeet. It sounds like you're developing pain from compensation, and the numbness you're experiencing could be worrisome, perhaps caused by traction on the tibial nerve or dysfunction and enlargement of the posterior tibial tendon in the tarsal tunnel compressing on the nerve.

Perhaps you're coming to an impass where you require reconstruction, usually a calcaneal osteotomy and shifting the posterior part medially, in addition to a few other things like tendon balancing or medial column fusion.

Check out the recent clinical practice guideline for adult flatfoot disorders . . .
Lee MS, et al., Clinical Practice Guideline; Adult Flatfoot Panel. Diagnosis and Treatment of Adult Flatfoot. J Foot Ankle Surg 2005; Mar-Apr 44(2):78-113

That should give you a good idea if surgery is indicated for you.

LCR