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From The Foot
In the third edition of Healthy Times, we covered bunion, tired aching leg
and knee pain (patello-femoral syndrome), which can be a result of over-
To Lower Back Part 2
pronation. In this edition, you will read more about over-pronation related
common conditions such as Metatarsalgia (Ball of foot pain), Achilles’ ten-
By Dr. Lam from California Foot
donitis, Ilio-tibial band syndrome (Outside knee & hip pain), Tibial Stress
and Ankle Medical Center
Syndrome (Shin Splints) and Lower Back Pain.
Metatarsalgia (Ball of foot pain)
Treatment:
Orthotics control the internal rotation of the tibia and furthermore the rotation
Metatarsalgia is usually described as a "burning and sometimes sharp pain in the
on the knee and hip joint. Thereby, it can reduce tractional and frictional forces
ball of the foot". This is usually aggravated when walking barefoot or on hard
on the ilio-tibial band. Additional treatments include ice therapy, strengthening
surfaces. Sometimes patients may describe the pain as a lump underneath the
and stretching of the ilio-tibial band.
ball of the foot. Applying pressure to the plantar surface of the metatarsal heads
may elicit pain.
Cause:
Lumbo-Sacral Pain (Lower back pain)
When a foot is pronated excessively, there is a progressive weakening of the soft
It is a dull ache and stiffness in the lumbar region. Standing for long periods or
tissue structures. In the forefoot, as this occurs the metatarsals plantarflex and
sitting in the same position may worsen the pain.
rotate. This results in shearing forces on these foot structures. After a period of
time the foot may experience nerve damage or callosities.
Cause:
Bilateral excess pronation internally rotates the tibial and femoral shafts which
Treatment:
can lead to anterior tilt of the pelvis and a forward shift of the body's center of
gravity, resulting in increased lordotic curvature and compensatory muscular
Custom orthotics can prevent plantar-flexion and shearing of the metatarsal
tightness of the lumbo-sacral region. The upper body (Thoracic Region) com-
shafts. Balancing the weight distribution over metatarsal bones helps remove
monly develops a secondary kyphotic curvature. Unilateral excess subtalar joint
excess weight and friction which commonly causes the callus and burning sen-
pronation lowers the vertical distance of the foot to the ground, therefore creat-
sation. Treatments also include icing and appropriate footwear such as shoes
ing a functional short leg, causing hip mal-alignment.
with deep roomy toe box.
Treatment:
Achilles’ Tendonitis
Custom orthotics control internal rotation of the tibial and femoral shafts, there-
by limiting anterior pelvic tilt and secondary muscular tightness of the lumbo-
It is an inflammation of Achilles’ tendon, commonly found in athletes.
sacral region. Proper exercises also play an important role of treatment.
Symptoms include sharp, nagging pain above the heel. Limited ankle flexibility
1. Strengthening of the abdominal muscles - 'safe' sit-ups (lift head and shoulders
and inflammation over the affected area are often present.
off the ground whilst keeping the neck straight and eyes focused on ceiling)
2. Press-ups: like push-ups, however the legs and pelvis stay flat on the ground
Cause:
3. Hamstring and lumbo-sacral stretches
It commonly occurs from shearing and tractional forces placed on the Achilles
tendon above the heel. When the foot accelerates into an excessively pronated The above treatment options serve as a general guideline only. Every case should
position, the heel bone everts which causes an increase in medial Achilles’ ten- have their individualized treatment plan. One should consult their foot and
don traction resulting in transverse shearing. ankle specialists if further evaluation and/or management are needed.
Treatment:
Dr. Lam can be contacted at California Foot and Ankle Medical Center at 2525 0611.
Custom orthotics can reduce medial Achilles’ tendon traction, therefore helping
to alleviate the problem. Proper Achilles’ stretch, ice therapy (15 minutes, 3
times a day) and rest from exercise are also important.
Tibial Stress Syndrome (Shin Splints)
It is an inflammation of soft tissues along the tibia. The patient will complain of
tightness/tenderness and sometimes throbbing pain along the border of the tibia
that comes on with a specific activity (especially running & walking long dis-
tances) and often settles upon resting. Often, it will start like a dull ache but
quickly becomes sharper and more aggravated.
Cause:
There are two types of tibial stress: anterior and posterior. Anterior tibial stress is
often experienced by new runners or walkers when pain occurs in the anterior
muscles of the shin during exercise. Posterior shin splints (medial tibial pain) are
a more chronic condition occurring along the inside edge of the tibia and gen-
erally occurs with over-use related sports.
Both conditions are related to excess stretching of soft tissue structures along the
shin bones (tibia and fibula). Excessive pronation and internal tibial rotation
increase the medial tractional forces upon the deep flexors and extensors of the
leg. This is a common factor in muscular overuse conditions and commonly
exhibits secondary periosteal swelling due to tractional forces placed upon the
soft tissue structures on the tibia and fibula.
Other causes of shin splints include stress fracture of the tibia and tendonitis of
the muscles that cross the ankle and compartment syndrome.
Treatment:
Custom orthotics assists reduction of internal tibial rotation and reduces medial
tractional forces upon anterior tibialis and posterior tibialis muscles. Additional
treatments include ice therapy (15 minutes, 3 times a day), rest from exercise,
deep tissue massage, stretching and strengthening of tibial muscles.
Ilio-tibial Band Syndrome (Outside knee & hip pain)
It is a common overuse injury in athletes caused by abnormal friction & torsion
of the ilio-tibial band over the knee and hip joints. It is a gradual but rather
severe pain on the outside knee joint and less commonly on the outside hip sec-
tion. Sometimes, simply walking up or down stairs may aggravate this condition.
The pain usually subsides immediately upon rest but reoccurs with activity.
Cause:
Excess pronation causes excess internal tibial rotation which effectively causes
the ilio-tibial band to shear over the lateral femoral condyle, resulting in friction,
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tightness and secondary inflammation.
(852) 2771 1920
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