Tag Archives: flat feet

What is Plantar Fasciitis?

4 Dec
plantar fasciitis

Kobe Bryant famously suffered with Plantar Fasciitis

Plantar Fasciitis is the leading cause of heel pain. In medicine, the suffix itis refers to irritation or inflammation of an organ, and in this case, to the plantar fascia, a band of tissue which connects your heel bone (calcaneus) to the ball of your foot. Pain can be felt anywhere along this path.

The classic sign of plantar fasciitis comes in the morning, when you step out of bed – a sharp pain in your heel. Gradually, as the tissue warms up and becomes flexible, the pain fades – maybe not completely, but substantially. It may then return if you stand on your feet all day or exercise, especially if you run or exercise strenuously.

What causes the heel pain of plantar fasciitis? When the plantar fascia is constantly stressed, small tears occur in the tissue. The tears make the plantar fascia weaker, less able to do its job of support and shock absorption. This offloading of the work causes stress on the surrounding tissues, which is the actual cause of the pain.

Plantar fasciitis also makes itself known to those who are carrying more body weight than normal, like pregnant women or obese individuals. You might also develop plantar fasciitis if you made a poor choice in shoes and wear a style which doesn’t support your feet correctly. People with flat feet also frequently suffer from plantar fasciitis, as do long distance runners .

Symptoms of Plantar Fasciitis
  • A sharp pain at the back of your heel, sometimes described as “knife-like”
  • Pain is most common with your first few steps in the morning, but may also occur after physical activity, or climbing stairs
  • In most cases, pain increases gradually
  • Usually appears in one foot, but occasionally both
  • Foot may be stiff and difficult to bend
heel pain plantar fasciitis

Click for larger view

The Plantar Fascia acts like a shock absorber for your foot, and also supports your arch. If the plantar fascia receives repetitive stress, such as from exercising on hard surfaces, unsupportive footwear, or too much pressure from weight, small tears form in the tissue. These tears cause irritation in the surrounding tissue, which triggers pain.

If plantar fasciitis is left untreated, the condition may get substantially worse. Knee pain is also frequently reported in patients with plantar fasciitis, due to their change in gait to compensate for the heel pain.

Treatment for Plantar Fasciitis
  • Custom orthotics (not off the shelf) prescribed by your podiatrist
  • Physical therapy
  • Rest, elevate, and ice the heel
  • Over the counter anti inflammatory pain medicine such as Ibuprofen (Advil) or Naproxen (Aleve)
  • Athletic shoes which provide excellent arch support and padding at the heel
  • If exercising, train on soft surfaces instead of hard surfaces
  • If overweight, start a weight management program

If these methods aren’t successful in relieving your pain, your podiatrist may recommend steroid injections, PRP injections, EPAT (shockwave) therapy, Radiofrequency Ablation (RFA), or in extreme cases, surgery.

Help! The Arches In My Feet Are Falling!

6 Aug
adult aquired flat foot

In a normal foot, only the smallest toe is visible when viewed from behind.

A common problem among the elderly and increasingly middle aged patients is collapsing arches, medically known as Adult Acquired Flat Foot Syndrome (AAF), or Posterior Tibial Tendon Dysfunction (PTTD). This is a progressive condition in which the arch of the foot collapses and the bones of the ankle and foot fall out of proper alignment.

A magnitude of foot problems develop as we age and many of these complaints begin about the age of 60. Among the most serious from a biomechanical standpoint is Adult Acquired Flat Foot Syndrome (AAF).  Treated early enough, symptoms can be arrested or at least slowed. Untreated however, AAF becomes an extremely painful condition which ultimately affects the entire body and the patient’s lifestyle, as gait is significantly altered by the out-of-line foot and ankle. This malalignment can create pain, fatigue, and discomfort throughout the entire body.

As we age, many of our muscles, tendons, and ligaments lose their ability to stretch and support our bones.  If you’ve ever discovered an old rubber band in the bottom of a drawer, you’ll get the idea – it’s more likely to snap than stretch. The Posterior Tibial Tendon, which attaches the calf muscle to the bones in the foot, is largely responsible for the support of your foot when walking, and to hold up the arch. With aging, overuse, or trauma, this tendon degenerates and loses its function, along with associated ligaments and joints on the inner side of the ankle and foot. Ligaments are responsible for holding bones in place, and when they fail, bones shift and deformity is the result. The deformity causes malalignment, which leads to more stress and failure of the ligaments, and a slow collapse of the arch which becomes debilitating in its later stages.

AAF is most frequently seen in women, especially those who start out with somewhat flat feet or a pronated (rolls inward) foot. These attributes place extra stress on the soft tissue structures, along with the posterior tibial tendon and the ligaments on the inner side of the foot. Other contributing factors are diabetes, obesity, rheumatoid arthritis, and hypertension. People who play high impact sports may also develop tears in the posterior tibial tendon, eventually leading to AAF.

pttd out of alignment foot ankle

The foot and ankle become malaligned as AAF progresses

Symptoms of PTTD/AAF

The symptoms of posterior tibial tendon deformity change considerably as the condition progresses. Initially, pain may be felt along the tendon’s path on the inside of the foot and ankle. This area may also be red, warm, and swollen. As the arch starts to flatten, in addition to pain, the foot and toes turn outward and the ankle rolls inward. As the arch flattens even more, the pain shifts to the outside of the foot, just below the ankle. Arthritis develops in the foot, and later may develop in the ankle, sometimes causing the ankle joint to lock.

Treatment of PTTD/AAF

Treatment of adult acquired flatfoot depends on the stage of the condition and its severity. Mild cases may only warrant rest, ice, and custom orthotics. Advanced cases may require immobilization, bracing, or even surgery. Early intervention by a podiatric surgeon is key to slowing the progression of PTTD.

At the onset of PTTD, a boot or brace is used to support the arch and relieve strain on the soft tissues, including the tendon. When pain has subsided, custom orthotics are used to reduce the stress on these tissues. However, as the arch has already fallen, the deformity may progress. If pain persists after these conservative measures, surgery to correct the deformity may be recommended.

What is the benefit of custom foot orthotics?

5 Feb

Shoe inserts from a drug store or shoe store are not to be confused with custom made foot orthotics. Most everyone has tried over the counter shoe inserts at some time in their life, and most everyone has been disappointed with them. That’s because there’s no such thing as an “average foot”, so a one-size-fits-all solution for foot pain doesn’t exist.

custom made foot orthoticsOrthotics are custom made shoe inserts. They can only be ordered by a medical professional after an examination of your feet, your gait, your pronation, and an analysis of any pain you may be experiencing. Issues resulting from heel pain, bunions, plantar fasciitis, flat feet, high arches, abnormal biomechanics, or poor lower limb alignment can all be addressed with custom designed orthotics, which can be made to cushion sore areas and correct abnormalities. They can also be very helpful for athletes, especially runners who have recurring problems with their feet.

Orthotics are made from more durable materials than over the counter shoe inserts, and they last for years, not months. Orthotics are custom designed specifically for your foot to improve your running, walking, and balance by supporting the arch, cradling the heel and rotating your foot into a “neutral” position. This support and proper pronation helps the foot function at its maximum level. When your foot is balanced and supported correctly, you’re less prone to ankle or foot injury, knee pain, hip pain, and back pain as well. After all, your entire body is riding on your feet.

For athletes, foot orthotics can help reduce foot stress and fatigue, and may also increase agility. By balancing the foot, shock absorption will improve, diminishing before reaching your limbs.

How do I know if I’ll benefit from custom orthotics?
  • Look at the bottom of your shoes to see if they are worn evenly across the toe or heel area. Even wear-and-tear indicates your gait is normal, but if they wear out too quickly or unevenly, then you may benefit from orthotics
  • Do your feet hurt after being active? How about your ankles, knees, hips, or back?
  • Do you have unusually high arches?
  • Do you have flat feet?
  • Do you have tendonitis, shin splints, hammer toes?
  • Are your legs consistently tired or aching?
  • Do you have diabetic foot problems or a neuroma?
Only a podiatrist can tell if custom made orthotics are right for your feet, but most patients notice an immediate difference in comfort and stability, and their pain is sharply reduced or eliminated.

Causes, Symptoms, and Treatment of Flat Feet (Fallen Arches)

6 Dec
flat feet fallen arches

Typical fallen arch or flat foot

When you take your first baby steps, it’s usually done on flat feet. But as you walk more and develop your foot and ankle muscles, bones and tendons, an arch forms to support your foot. Or at least it’s supposed to.

Read: My child has flat feet – what should I do?

From Web MDSeveral tendons in your foot and lower leg work together to form the arches in your foot. When the tendons all pull the proper amount, then your foot forms a moderate, normal arch. When tendons do not pull together properly, there is little or no arch. This is called flat foot or fallen arch.

For some, the arch never develops and they have flat feet for their entire life, yet suffer no symptoms and need no treatment. This is actually a variation on normal foot type. But for others, the arch forms normally and then falls later in life, usually after the age of 40. In these cases, the arch collapses in one or both feet and the entire sole of the foot comes into contact (completely or nearly so) with the ground. These individuals may suffer pain in the heel, arch, ankle, knees, or back, because the fallen arch alters the alignment of their legs.

The reasons for fallen arches may be due to:

  • Obesityflat feet
  • Faulty biomechanics or aging
  • Damage to the tendons from overuse (stretched or torn)
  • Improper development of muscles and tendons
  • Damage or inflammation of the posterior tibial tendon which connects at your calf muscle, runs along your ankle, and attaches to the middle of your arch
  • Broken or dislocated bones in the foot
  • Rheumatoid arthritis
  • Problems with the nerves
  • Pregnancy
  • Diabetic collapse (charcot foot)

Interestingly, going barefoot is one of the best ways to avoid getting flat feet, as long as you aren’t suffering from any serious foot conditions. In India, a medical study was conducted of children who had grown up wearing shoes compared to those who grew up barefoot. In the barefoot group, the longitudinal arches were generally stronger and higher, with flat feet less common in this group than those who grew up wearing closed-toe shoes.

Symptoms of Flat Feet or Fallen Arches
  • Feet are painful or ache, especially in the arch or heel area
  • Feet are quick to tire
  • Inside bottom of feet may become swollen
  • Ankles may be swollen
  • Standing on toes is difficult
  • Back, knee, ankle, or leg pain
Treatment for Flat Feet
  • Depending on the cause of your fallen arches, your podiatrist may recommend one or a number of the following:
  • Rest, ice and over the counter anti inflammatory medicine (Advil, Aleve) to reduce pain and swelling
  • Stretching exercises / physical therapy
  • Custom made orthotics
  • Custom made shoes, shoe modifications, or braces
  • Steroidal injections to relieve pain and swelling
  • Surgery if necessary to repair tendon, or to make changes to the joints or bones

Why does the top of my foot hurt?

27 Jun

Pain on the top of your foot can be excruciating, making it difficult or impossible to walk even a few steps.

pain in top of foot

Assuming there is no visible injury, and you can’t attribute the pain to falling, twisting your ankle, barefoot running, or dropping furniture on your foot, the cause could be anything from an ingrown toenail to Gout.  A podiatrist would have to do a thorough examination to determine the specific cause, but here are the most common reasons you might have pain in the top of your foot.

Nerve Entrapment

Your shoes have quite an affect on the health of your foot. Shoes that are too tight, including athletic footwear, can cause Nerve Entrapment – also known as a “pinched nerve”. Repeated pressure on one area irritates the nerve and can cause a surprisng amount of pain. Ice, rest, and a change to less constricting footwear should resolve the pain.

Midtarsal fault

The arches in your feet are meant to absorb the shock of running, walking, and standing. When the arches fall and you suffer with flat feet, the tarsal bones can become compressed, which leads to damaged joints, bone spurs, and irritation.  The top of your foot may be slightly swollen, have red spots, and pain will increase with activity. Improper footware is one of the main causes of this condition.

Metatarsal Stress Fracture

Stress on the metatarsal bones (the five long bones in the front of the foot) can cause tiny cracks in the bones. This is a very common injury for athletes, dancers, and those who return to exercising after a long layoff.

Extensor Tendonitis

The Extensor Tendons lie just under the skin on the top of the foot. Their job is to pull the toes up away from the ground, and when they become irritated, the pain can be excruciating and often confused with a fracture. The most frequent cause of this complaint is once again, footwear that’s too tight.

Other reasons for pain in the top of the foot may include

  • Bone spurs
  • Sprain
  • Ganglion Cyst
  • Aging (arthritis)
  • Hammertoes
  • Gout

Pain on the top of the foot could indicate a mild irritation to your nerves or tendons from tight shoes, or a more serious condition. If rest, ice, and over the counter anti-inflammatory medications do not relieve the symptoms, call podiatrists at PA Foot and Ankle Associates for an immediate examination. We will determine the cause of your pain and create a customized treatment plan for you.

My child has flat feet – what should I do?

12 Jun

If your child has flat feet, there may be no need for worry – it could be normal for their age.

my child has flat feet

Many parents become concerned when they notice that their child has flat feet. Depending on the age of your child, it may be nothing to worry about or it may indicate fallen arches, which Podiatrists call pes planus.

When a child is born, their feet are definitely flat – well, more like chubby. That’s because the foot needs to be very flexible while the baby is in the womb. Until a child is about three years old, her foot is made mostly of cartilage and you’ll notice very little change in it’s appearance until her feet are bearing weight – standing, walking, running.

Between the ages of two and three, your child’s foot will start to show it’s true shape as her baby fat and cartilage diminish and the bones become more prominent. Ligaments and tendons start to strengthen at this time as well. Yet, the foot may still look flat. In fact, 90% of two year olds exhibit flat feet, but by the time they’re ten, only 10-15% have flat feet.

When does the arch of the foot form?

The arch of the foot begins to develop between the ages of two and four, as your child walks more and more. Your child is growing, changing posture, and building their muscles, and as they do, the tarsal bones develop in the foot and the connective tissues that bridge the midfoot.  Thus, the arch forms… or doesn’t.

If your child is halfway through their second year and their arch is still not developing, then it’s time to visit East Penn Foot and Ankle Associates for a complete diagnosis of your child’s foot.

A study published in 2009 found that overweight children have a higher incidence of flat feet than children of normal weight. The cause and effect is unclear and it remains to be seen if overweight kids will grow into adulthood with pes planus.

When do I need to worry about my child’s flat feet?

If your child’s feet are still very flat by the time she is eight years old, she will likely complain of aching, fatigue in her legs or arches, and difficulty keeping up with other kids during athletic activities. She may also complain of pain or fatigue in the lower back, hips, knees, or legs due to the compromised mechanics caused by the flatfoot deformity. This is when you should call a podiatrist for a thorough examination of your child’s foot and a course of treatment.

normal foot flat foot compared

Treatment for flat feet

If your child has a mild flatfoot deformity and no symptoms, your podiatrist may simply recommended a yearly check-up to monitor the development of their feet. If your child has a moderate to severe flatfoot deformity and does have significant symptoms in the foot or lower extremity, treatment may include:

  • Supportive shoes
  • In-shoe inserts such as arch padding
  • Functional foot orthotics which limit the abnormal flat arch and stabilize the heel
  • Calf muscle stretching exercises – tight calf muscles may worsen flatfoot deformity and make symptoms worse
  • Surgery in the most extreme cases

The biggest question a physician must answer when examining your child’s feet: Will this child’s flat feet remain stiff and inflexible into adulthood?  Some flat feet remain that way but create no symptoms. Others remain stiff and inflexible, with the loss of inward and outward movement (inversion and eversion). In this case, they can be responsible for quite a bit of discomfort. A podiatrist is expert at spotting inconsistencies in the structure of the foot and is in the best position to ascertain how serious your child’s problem is… or will be.

How can my child avoid getting flat feet?

Here’s some food for thought: Researchers in India found that flat feet were far more prevalent among people who wore footwear before the age of six. Kids who went barefoot for most of their first six years – the formative years for feet – had better developed arches and exhibited flat feet far less often. No other factors had comparable impacts. It may seem counterintuitive to parents, but letting young children run barefoot as often as possible may be the best way to insure that their feet develop properly.

How do I choose the right running shoe?

31 May

How often have you stared at the wall of running shoes in the athletic store and just decided to make no decision at all? Choosing the right shoe for you can be quite confusing without some kind of direction.

But if your shoes are old, if the tread is worn out or if your toes are showing through (don’t laugh, I’ve seen it), it’s definitely time to bite the bullet and spring for new sneaks.

old running shoesNow that we’re nearing the end of spring you should have a pretty good idea if your shoes are up to the task of your running routine. If your ankles, feet, shins, hips, or back are sore after you run, the culprit could very well be your athletic shoes.

When your feet strike the surface you’re running on, it creates energy that should be absorbed by the shoe. A lack of support and shock absorption in the shoe may be responsible for letting that energy move upwards through your body until it dissipates, causing stress on your muscles and joints. That equals soreness and pain.

Poor support, weak tread and lax construction will be the difference between pain/no pain. I can tell you first hand that the difference between running in a cheap shoe and a shoe that is properly fitted for your foot-type is like night and day. Don’t be a cheapskate when it comes to running shoes. A quality, properly fitted shoe will save on pain, discomfort and a trip to a podiatrist or orthopedist.

How do I know what kind of running shoe I need?

A good athletic shoe is designed to fit one of three foot types: Neutral Pronation, Underpronation or Overpronation. Pronation refers to the rolling motion of your foot from heel to toe through foot strike. You can determine your level of pronation by looking at the bottom of your shoes. Most will show wear on the outside of the heel, which is normal. The wear on the forefront is what reveals the pronation.

Here’s how you can tell which kind of foot you have:

Neutral Pronation

Also known as proper pronation, this is when your foot lands on the outside of your heel, moves to the ball of your foot and spreads evenly across the front. This movement is best for pain free running, as the energy is distributed evenly across the foot. If wear on the bottom of your shoe appears uniform across the forefoot, you’re a proper pronator.


People with high arches usually are Underpronators, where the outside of the foot takes most of the shock instead of finishing in the neutral position. If your shoe wear is on the outside, you’re an underpronator.


People with flat feet are usually Overpronators. Here, there is too much rolling from the outside to the inside of the foot. If your shoe wear is on the inside you’re an overpronator.

Check out the shoe advisor from Runners World to find which shoe is right for you.

In the video below, Dr Adam Teichman from PA Foot and Ankle Associates and Chris Schmidt from The Finish Line Running Store talk about how to find the running shoe that’s perfect for you.

P.S.: If you buy a pair of running shoes at The Finish Line, mention Doctor Teichman or East Penn Foot And Ankle Associates and save ten percent!

What Causes Flat Feet?

19 Oct

When you stand up, do your feet completely touch the ground? If you answered yes, then you are missing arches on the inside of your feet, a condition called flat feet. Flat feet are a common condition that occurs when the tissues holding the joints in the foot together are loose.

A person usually develops flat feet during childhood. Children have flat feet because the foot’s arch hasn’t developed yet. As children grow the tissues in their feet tighten and form an arch, usually by the age of two or three years old. By adulthood arches have formed, but in some people the arch may never form completely or may need help in order to correct the condition. Injuries can also be a cause of flat feet as well as the aging process.

Do flat feet cause pain? Not always – having flat feet is typically painless. But it’s not completely uncommon that people with flat feet experience foot pain in the heel or arch area, difficulty standing on tiptoe, or have swelling along the inside of the ankle. Standing for long periods of time, along with achy or tired feet after playing sports may also cause pain. Some back problems can also be attributed to flat feet.

Flat feet can be diagnosed after having a physical exam of your feet, but to help determine the cause, a doctor may ask for x-rays. Treatment for flat feet depends upon the pain and trouble your feet are causing for your everyday activities. If you are not experiencing any pain that’s great, but if you are there are a couple different options. Purchase shoe inserts, although not a cure, shoe inserts can help reduce the symptoms of flat feet and in severe cases, custom orthotics will be needed. Stretching is also an option that can help reduce pain.
Sometimes flat feet can cause problems in your ankles and knees so it’s important to check with your podiatrist about your condition if you are experiencing any pain. Feel free to call our office and we can arrange a date for you to meet with the doctor. (610) 432-9593


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