Our Feet. Our Foundation.

There are 206 bones in the human body… and 25% of them are in the feet!!  It’s clear, then, that your feet are vitally important and why we need to take care of this foundation of every-day life!

There are many common foot problems… and any one of them can turn a great day into a painful day!  PAL is here to help practitioners make some of that pain go away….

So, if you are a patient, please continue reading about some of the more common foot problems you may be experiencing.

If you are a practicing physician, feel free to print these helpful web pages to better educate your patient base!

Call 800.223.2957 or email us to order PAL’s available patient education materials today!

Arch Pain

What is Arch Pain and Strain?

Arch pain, which is often referred to as arch strain, refers to an inflammation or burning sensation at the arch of the foot.

Causes

Arch pain can be caused from many different factors. A common condition called plantar fasciitis is most often the cause of arch pain. The inflammation caused by the plantar fascia being stretched away from the heel can lead to pain in the heel and arch areas. The pain is often extreme in the morning when an individual first gets out of bed or after a prolonged period of rest. A structural imbalance or an injury to the foot is also sometimes the cause of this condition. If this condition is left untreated and strain on the longitudinal arch continues, a bony protrusion called a heel spur may develop. It is important to treat the condition promptly before it worsens.

Prevention and Treatment

Arch pain and strain can be easily treated and is a common foot condition.

Those suffering from arch pain should avoid high-heeled shoes whenever possible. Instead, select footwear with a reasonable heel, soft leather uppers, shock absorbing soles and removable foot insoles.

When the arch pain is pronation-related due to flat feet, an orthotic designed with a medial heel post and proper arch support is recommended for treating the pain. This type of orthotic will control over-pronation, support the arch and provide the necessary relief.

Call 800.223.2957 or email us to know more about which PAL products are best for arch pain!

Arthritis

What is Arthritis?

Arthritis is a disease characterized by inflammation of the cartilage and lining of the body’s joints, and is often accompanied by an increase in fluid in the joints. Inflammation causes redness, warmth, pain and swelling. About 40 million Americans suffer from arthritis, and primary targets for arthritis are people over the age of 50.

Arthritis is a major cause of foot pain because each foot has 33 joints that can become affected by the disease.

Various Forms of Arthritis

Osteoarthritis

The most common type of arthritis, osteoarthritis causes excessive strain and wearing of cartilage in the joints of the foot. Movement becomes very difficult and painful. Pain and swelling worsens while standing or walking, and stiffness usually occurs after periods of rest.

Gout

Another form of arthritis that also leads to foot complications, gout causes excess uric acid crystals to collect in and around the joints of the big toe. The big toe is commonly the focal point due to the stress and pressure placed on the big toe during walking and other weight bearing activities. This often leads to severe pain in the big toe. Men are more likely to develop gouty arthritis than women.

Rheumatoid Arthritis

This can develop at any age, and there is no known cause for this condition. The most crippling form of arthritis, this disease can affect people of all ages. Often causing severe deformities of the joints and associated fatigue of the entire body, rheumatoid arthritis can cause severe forefoot problems such as bunions, hammer toes or claw toes.

Causes

There are many causes of arthritis. Heredity plays a major role, but arthritic symptoms can develop due to many other factors including bacterial and viral infections, prescription and illegal drugs, traumatic injuries, and bowel disorders such as ileitis and colitis.

Forefoot problems such as hammer toes, claw toes, mallet toes, and bunions often develop as a result of arthritis, particularly rheumatoid arthritis. Problems can also develop in the heel and ankle area due to the erosion of the involved joints.

Prevention and Treatment

Conservative, non-surgical treatment of the arthritic foot includes proper footwear, orthotics, and/or forefoot supports.

Arthritic footwear can provide relief in a variety of ways:

  • A high, wide toe box, offering high and wide space in the toe area, allows ample space for the foot.
  • Removable insoles allow for fitting flexibility and the option to insert orthotics if necessary.
  • Rocker soles designed to facilitate walking reduce stress and pain at the ball of the foot.
  • Arthritic footwear should always allow for possible swelling of the foot.
  • Orthotics designed to provide comfort, support and extra cushioning are recommended.
  • Orthotics made with a material called plastazote are often recommended because they mold to the foot to provide customized comfort.
  • Proper footwear and orthotics reduce pressure to provide a comfortable and healthy environment for the foot.
  • Forefoot supports such as gel toe caps, gel toe shields and gel toe straighteners can often provide relief.

Call 800.223.2957 or email us to know more about which PAL products are best for arthritis!

Calluses

What are Calluses?

Callus formations are caused by an accumulation of dead skin cells that harden and thicken over an area of the foot. Callus formation is the body’s defense mechanism to protect the foot against excessive pressure and friction. Calluses are normally found on the ball of the foot, the heel, or the inside of the big toe.

Some calluses have a deep-seated core known as a nucleation. This particular type of callus can be especially painful to pressure. This condition is often known as intractable plantar keratosis.

Causes

Calluses develop due to excessive pressure at a specific area of the foot. Some common causes of callus formation are:

  • High-heeled dress shoes
  • Shoes that are too small
  • Obesity
  • Abnormalities in the gait cycle
  • Flat feet
  • High-arched feet
  • Bony prominences
  • Loss of the fat pad on the bottom of the foot

Prevention and Treatment

Many try to alleviate the pain caused by calluses by cutting or trimming them with a razor blade or knife. This is very dangerous and can worsen the condition and result in unnecessary injuries. Diabetics especially should never try this type of treatment.

To relieve the excessive pressure that leads to callus formation, weight should be redistributed equally with the use of an orthotic.

An effective orthotic will transfer pressure away from the high pressured areas to allow the callused areas to heal. Orthotics should be made with materials that absorb shock and shear friction forces. Women should also avoid from wearing high-heeled shoes.

Call 800.223.2957 or email us to know more about which PAL products are best for calluses!

Diabetic Foot Ulcers

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.

Who Can Get a Diabetic Foot Ulcer?

Anyone who has diabetes can develop a foot ulcer.  Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers.  People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease.  Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

How do Diabetic Foot Ulcers Form?

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes.  Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time.  The nerve damage often can occur without pain and one may not even be aware of the problem.  Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection.  Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing.

What is the Value of Treating a Diabetic Foot Ulcer?

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection and amputation, improving function and quality of life, and reducing health care costs.

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible.  The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

  • Prevention of infection.
  • Taking the pressure off the area, called “off-loading.”
  • Removing dead skin and tissue, called “debridement.”
  • Applying medication or dressings to the ulcer.
  • Managing blood glucose and other health problems.

Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

  • Keep blood glucose levels under tight control.
  • Keep the ulcer clean and bandaged.
  • Cleanse the wound daily, using a wound dressing or bandage.
  • Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.”  Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches.  These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years.  The old thought of “let the air get at it” is now known to be harmful to healing.  We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist.   The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Controlling Blood Glucose

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to accomplish this will enhance healing and reduce the risk of complications.

Surgical Options

A majority of noninfected foot ulcers are treated without surgery; however, when this fails, surgical management may be appropriate.  Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”

Healing Factors

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

How Can a Foot Ulcer be Prevented?

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis.  He or she can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you:

  • Have neuropathy
  • Have poor circulation
  • Have a foot deformity (i.e. bunion, hammer toe)
  • Wear inappropriate shoes
  • Have uncontrolled blood sugar

Reducing additional risk factors, such as smoking, drinking alcohol,  high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks.  Your podiatric physician can  provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day especially between the toes and the sole for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality.  Each time you visit a health care provider, remove your shoes and socks so your feet can be examined.  Any problems that are discovered should be reported to your podiatrist as soon as possible, no matter how “simple” it may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:

  • Lowering blood sugar
  • Appropriate debridement of wounds
  • Treating any infection
  • Reducing friction and pressure
  • Restoring adequate blood flow

The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer.

Call 800.223.2957 or email us to know more about which PAL products are best for the diabetic foot!

Heel Pain

What is Heel Pain?

Heel pain is often the result of faulty biomechanics that place too much stress on the heel bone and the soft tissues that attach to it.

While walking, gait abnormalities are often to blame, stress may also result from injury or bruising incurred while walking, running or jumping on hard surfaces, wearing poorly constructed footwear or being overweight.

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, the heel bone is subject to outside influences that can affect its integrity and ability to keep us on our feet. Heel pain can occur in the front, back, or bottom of the heel.

Causes

Heel pain has two separate categories:

  1. Heel pain syndrome is caused by over-use repetitive stress, which refers to a soreness resulting from too much impact on a specific area of the foot. This condition can be caused by shoes with heels that are too low, a thinned out fat pad in the heel area, or a sudden increase in activity.
  2. Plantar fasciitis, a very common diagnosis of heel pain, is usually caused from a biomechanical problem, such as over-pronation or flat feet. The pain from this condition is often most intense in the morning or after a prolonged period of rest and then subsides as the day progresses.

Prevention and Treatment

When treating heel pain, shock absorption, cushioning and heel elevation are used to transfer pressure away from the heel. This can be accomplished with a heel cup, heel cradle, or an orthotic designed with materials that will absorb shock and shear forces.

When the condition is pronation-related, as is the case with plantar fasciitis, an orthotic with medial posting and sturdy arch support can control pronation and prevent inflammation of the plantar fascia.

Footwear selection is also important when treating heel pain. Shoes with a firm heel counter, proper arch support and appropriate heel height are the ideal choice.

Call 800.223.2957 or email us to know more about which PAL products are best for heel pain!

Metatarsalgia

What is Metatarsalgia?

Metatarsalgia literally means “metatarsal pain” and is a general term used to denote a painful foot condition in the metatarsal region of the foot. The metatarsal region is the area just before the toes, more commonly referred to as the ball of the foot.

Metatarsalgia is a common foot disorder that can affect the bones and joints at the ball of the foot. Pain is often located under the second, third and fourth metatarsal heads, or it can be more isolated at the first metatarsal head, near the big toe.

Causes

It is common to experience acute, recurrent, or chronic pain with metatarsalgia. One or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time.

Pain in the ball of the foot is often caused from improper fitting footwear, instigated most frequently by women’s dress shoes or other restrictive footwear.

Footwear with a narrow toe box or toe area forces the ball-of-foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot.

Participating in high impact activities without proper footwear and/or orthotics can lead to metatarsal pain.

The fat pad in the foot also tends to thin out with age, making many much more susceptible to pain in the ball of the foot.

Prevention and Treatment

Determining the cause of the pain is the first step to correctly treating this condition.

If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe area and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball of the foot.

Unloading pressure to the ball of the foot can be accomplished with a variety of foot care products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. The orthotic is constructed with the pad placed behind the ball of the foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Other products that can provide relief include gel metatarsal cushions and metatarsal bandages. When these products are used with proper footwear, you should experience significant relief.

Call 800.223.2957 or email us to know more about which PAL products are best for metatarsalgia!

Plantar Fasciitis

What is Plantar Fasciitis?

Plantar Fasciitis is an inflammation caused by excessive stretching of the plantar fascia.

The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot. It attaches at the bottom of the heel bone and extends to the forefoot.

Plantar fasciitis occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length. This leads to inflammation, pain, and possibly the growth of a bone spur where the fascia attaches to the heel bone.

Inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

With this condition, the bottom of the foot usually hurts near the inside of the foot where the heel and the arch meet. The pain is often acute first thing in the morning or after a long rest, because the plantar fascia contracts to its original shape while resting. Walking or normal daily activities may cause the pain to lessen or even disappear, but pain often returns after resting or extensive activity.

Causes

Excessive stretching of the plantar fascia leads to inflammation and discomfort and may be caused by:

  • Over-pronation/flat feet, which results in the arch collapsing during weight bearing and the plantar fascia being stretched away from the heel bone (this is the leading cause of this condition)
  • A foot with an unusually high arch
  • A sudden increase in physical activity
  • Excessive weight on the foot, often due to obesity or pregnancy
  • Improperly fitting footwear

Prevention and Treatment

Proper treatment of this condition involves determining what is causing the excessive stretching of the plantar fascia.

When the cause is over-pronation/flat feet, an orthotic with rearfoot posting and longitudinal arch support is effective in allowing the condition to heal.

If you have unusually high arches, cushioning the heel, absorbing shock and wearing proper footwear that will accommodate and comfort the foot.

Other common treatments include stretching exercises, night foot splints, wearing shoes with a cushioned heel to absorb shock or elevating the heel with an heel cradle or heel cup. These in-shoe devices provide extra comfort, cushion the heel and reduce the amount of shock and force placed on the foot during every day activities.

Every time a foot strikes the ground, the plantar fascia is stretched. Pain and strain can be reduced by some simple steps:

  • Avoid running on hard or uneven ground
  • Lose excess weight
  • Wear shoes and orthotics that support your arch to prevent over-stretching of the plantar fascia

Call 800.223.2957 or email us to know more about which PAL products are best for plantar fasciitis!

Shin Splints

What are Shin Splints?

Shin splints are a common complaint, especially among runners and other athletes. Characterized by pain in the front or inside area of the lower leg due to muscle overexertion, the condition usually develops gradually without a history of trauma, and often begins as a dull ache along the front or inside of the shin after running or even walking.

Small bumps and tender areas may become evident adjacent to the shin bone. Pain can become more intense if not addressed, and shin splints should not be left untreated due to the increased risk of developing stress fractures.

Causes

The two types of shin splints are:

  1. Anterior shin splints – located in the front portion of the tibia.
  2. Posterior shin splints – occurring on the inside of the leg along the tibia. Shin splints usually involve small tears in the leg muscles where the muscles are attached to the shin bone.

Shin splints can be caused when the anterior leg muscles are stressed by running on hard surfaces or extensively on the toes, or by sports that involve jumping.

Wearing athletic shoes that are worn out or do not have enough shock absorption can also cause this condition.

Over-pronated flat feet are another factor that can lead to increased stress on the lower leg muscles during exercise.

People with high-arched feet can also experience shin splint discomfort due to poor shock absorption by the foot.

Prevention and Treatment

The best way to prevent shin splints is to stretch and strengthen leg muscles, utilize footwear with proper shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball of the foot. Insoles or orthotics that give arch support for over-pronation are also important.

Treatment includes taking a break from problem-causing exercise until pain subsides. Icing painful areas immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Aspirin or ibuprofen may also help to relieve pain and reduce inflammation.

It is important to avoid training through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electro-stimuli, heat treatments and ultra-sound may provide relief.

Call 800.223.2957 or email us to know more about which PAL products are best for shin splints!

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