Knee Pain

What causes it?

Knee pain is a very common complaint and has many different causes. Some of the more common diagnoses that are given include: arthritis, ligament injury or tear, cartilage (meniscus) tear, patellar tendonitis, patellofemoral pain syndrome and bursitis.

All of these conditions involve pain in one or both knees. Some are a result of direct trauma or injury, and some can be the result of long standing wear and tear. Some involve pain that is made worse by squatting, kneeling, sitting with the knees bent, and rising after long periods of sitting.

Is my knee pain related to my feet?

Feet are the foundation for every step taken, and play a key role in absorbing the shock being placed on the body every day. Problems with foot function can have repercussions that are felt all the way up the body’s lower kinetic chain which include the knees, hips and low back.

Excessive pronation (or flattening of the arches) is the biomechanical problem most often cited as being associated with lower limb pain or injury. When the arches raise and lower (which is a normal part of walking) the bones of the leg and thigh rotate inwards and outwards. When there is foot dysfunction, such as pronation or flattening of the arches, this rotation of the leg bones can become excessive – leading to increased stress on the knees, pelvis, and low back. If knee pain is notably worse in different shoes, or when walking in bare feet creates knee pain. This may be an indication that the feet are contributing to the knee pain.

How is it treated?

Treatment for knee pain is as varied as the number of causes. It is very important that the cause of your symptoms is understood before undergoing treatment for knee pain. Here are some of the more common treatments:

Anti-Inflammatory Agents:

These may include ice and oral anti-inflammatory medications. These may provide some temporary relief from the pain of inflammation, but are usually not helpful in addressing the underlying cause of the condition. Resting your knees may also be helpful in reducing inflammation.

Exercises and Stretches:

Many of the muscles in the thigh and calf interact at the knee joint. Keeping these muscles and tendons loose and mobile can decrease stresses around the knee. Increasing the strength of muscles that have be¬come weak can sometimes play a role in recovery. Regardless of the type of treatment being received, a good stretching and strengthening protocol can help get better results.

Injections:

Depending on the cause of knee pain, this intervention may be considered. Cortisone is a very powerful medication used to decrease inflammation in the knee joint. Talk to a doctor about the risks and benefits of this treatment.

Surgery:

In cases of severe injury or in cases that do not respond to conservative measures, a doctor may recommend surgery. Surgery can often repair torn or damaged tissues. As with other treatments, the reason why the tissues were damaged in the first place should be considered. If considering surgery, talk to more than one doctor carefully about the benefits and risks.

Custom Foot Orthotics:

Custom made CBAS foot orthotics can address knee pain that is, at least partially, caused by poor biomechanical problems of the feet, specifically excessive pronation or flattening of the arches.

CBAS unlike typical custom orthotics, are designed to help restore proper arch height and function of an individual foot, determined by a unique way of capturing an impression of the arch with the foot arranged in an optimal position, then completely supporting it. Only allowing the arch to flex accurately at a calibrated rate. The CBAS orthotic is the only calibrated custom orthotic that is designed with an individual’s body weight, foot flexibility, and activity level in mind, creating true biomechanical shock absorption. This restoration of proper foot function takes the abnormal joint positions and stresses off of the knee minimizing harmful compressive forces that cause knee injury therefore allowing the affected tissues to heal and normal joint function to be restored. In this way the CBAS custom orthotics not only help with the body’s posture of the lower kinetic chain, but it may provide the difference for long-term success in the management of knee pain.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.

Shin Splints

What is it?

Tibialis Anterior and / or Tibialis Posterior tendonitis or “shin splints” generally refers to pain anywhere along the shinbone (tibia) between the knee and the ankle. It occurs as a result of damage and inflammation of the tendons and muscles that run up the shin. Shin splints are commonly seen in runners and athletes. Signs and symptoms may include pain along the front inside edge of the shin. Pain may also exist on the inner back side of the leg. The area may be tender to the touch and in some cases can become red and swollen. The pain of shin splints may be able to be reproduced by pointing the foot and toes down, but it is mostly aggravated by activity and exercise. A doctor may consider an x-ray to rule out stress fractures and other conditions.

How did I get it?

The primary cause of shin splints is the overuse of the involved muscle and tendon. This can happen with an increase in exercise levels, repetitive movements as in running and other stresses to the lower leg such as hard or changing running surfaces. Another major contributor to shin splints is over-pronation or arch flattening. The muscles in your leg that are primarily involved are the tibialis anterior and tibialis posterior muscles. These muscles help support the arch. When your arch flattens these muscles can become overworked and start to break down causing pain and inflammation.

How is it treated?

The initial goal in the relieving the symptoms of shin splints is to reduce the inflammation and any symptoms of pain that may be present. The next step is to address the underlying cause of the symptoms associated with shin splints.

Exercise:

Stretching and strengthening exercises are aimed at lengthening and strengthening muscles in your lower leg to take the stress off your shins. Exercises that make your muscles stronger are usually effective in prevention of a recurrence once your shin splints have healed.

Anti-Inflammatory Agents:

These may include ice and oral anti-inflammatory medications. Ice can be applied directly to the painful areas of your shin. A compressive elastic bandage can be helpful if there is any swelling. These may provide some temporary relief from the pain of inflammation, but are not helpful in addressing the underlying causes of your condition.

Rest and Avoidance:

Rest is often recommended to reduce inflammation and swelling. You may be advised to decrease your training time or distance until your shins have a chance to heal. You may also be advised to avoid activities such as running and try biking or swimming until your shin can heal. It is important to remember that although rest may decrease your pain temporarily, it does not address the reason why you have shin splints.

Surgery:

In very rare cases that do not respond to conservative measures, surgery may be considered to repair muscles and tendons that are severely damaged.

Custom Foot Orthotics:

Custom Biomechanical Arch Supports called CBA's can help alleviate Shin Splints by addressing the root cause associated with Shin Splints. CBA's restore arch height and function of an individual foot by completely supporting it, only allowing the arch to flex accurately at a calibrated rate. By restoring arch height and function then completely supporting the arch will effectively help the shin splints by

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.

Morton’s Neuroma

What is it?

Morton’s Neuroma is a common foot problem consisting of a benign tumor-like enlargement of a nerve at the ball of the foot. It is usually located between the third and fourth toes, occasionally between the second and third. This condition is not a true tumor but rather a thickening of the tissue around the nerve.

Symptoms of a Morton’s Neuroma include sharp pain, burning sensation and even a lack of feeling in the area. It is usually worsened by walking and excess pressure on the ball of the foot. This is a soft tissue deformity and will not show up on x-ray. Diagnosis is made by eliciting pain in the area between the toes with pressure on the nerve. Sometimes an increased gap or space (“the daylight sign”) between the third and fourth toes exists. Moving the toes in certain directions may also cause a clicking sensation as the enlarged nerve slides under a nearby ligament.

How did I get it?

A neuroma is formed by irritation and rubbing of the nerve, similar to the way a callus is formed on the skin from excessive rubbing or pressure. The nerve “skin” gradually thickens to protect itself, forming a benign tumor. When the arch of the foot collapses, it can cause excess force to shift away from the big toe and onto the smaller bones of the forefoot. These smaller bones are not designed to handle the excess loads, so the force tends to break down the tissues under them, including the nerves running between them to the toes. As the nerve thickens to protect itself, it occupies more space and is more easily rubbed. Eventually, the nerve gets so big that it is sensitive to every step and it can even spread the toes, called “the daylight sign” since you can see light between the toes, as pictured above. Shoe wear that is too tight in the toe area, high heels that place additional pressure on the forefoot, and an increase in activity are also thought to exacerbate the pain of a Morton’s Neuroma.

How is it treated?

The initial goal in the relieving the symptoms of Morton’s Neuroma is to unload the excess pressure on the ball of the foot and any symptoms of pain that may be present. The next step is to address the underlying cause of the symptoms associated with Morton’s Neuroma.

Anti-Inflammatory Agents:

Cortisone can be injected into the area to control inflammation and pain. This may be helpful in reducing the pain temporarily but does not address the cause of the symptoms. Overuse of injected steroids can result in side effects such as weight gain and increased blood pressure and can interfere with proper healing, which is why patients only receive a limited number of injections.

Surgery:

In cases that do not respond to conservative measures, a doctor may recommend surgery. The surgery is thought to be very successful in reducing the pain of a Morton’s Neuroma but is a last resort as it comes with risks. The surgery involves the removal of both the tumor and some of the nerve. This often causes permanent numbness in the affected toes. The nerve will grow back slowly over time. If the underlying cause of the original problem is not treated, the nerve will become a “stump neuroma” which is often more painful than the first one. If considering surgery, talk to more than one doctor carefully about the benefits and risks.

Custom Foot Orthotics:

Custom made CBAS foot orthotics will address Morton’s neuroma by restoring arch height and function. This will effectively help restore proper weight distribution over the first metatarsophalangeal joint (the big toe) and ensure the forces being passed through the forefoot are not excessive, removing abnormal pressures that cause the nerve to thicken. The nerve can then heal and shrink back to normal size. When this is done the cause of Morton’s neuroma is being addressed rather than just the symptoms.

CBAS unlike typical custom orthotics, are designed to help restore proper arch height and function of an individual foot, determined by a unique way of capturing an impression of the arch with the foot arranged in an optimal position, then completely supporting it, only allowing the arch to flex accurately at a calibrated rate. The CBAS orthotic is the only calibrated custom orthotic that is designed with an individual’s body weight, foot flexibility, and activity level in mind, creating true biomechanical shock absorption. This truly restores proper foot function so that abnormal joint positions and stresses can be reversed allowing affected tissues to heal and normal joint function to be restored. In this way the CBAS custom orthotics provide the best option for both the primary therapy and preventative care in helping relieve the symptoms associated with Morton’s Neuroma.

What help can I expect to get from CBAS orthotics?

With a proper diagnosis along with a well-rounded management plan including CBAS othotics, the forecast is excellent. It’s not unusual get over 90% of the cases to respond favorably to proper orthotic management if addressed early enough.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.

Metatarsalgia

What is it?

Metatarsalgia is a term used to describe a painful foot condition in the area just before the small toes (more commonly referred to as the ball of the foot). The condition is characterized by pain and inflammation on the sole in the region of the metatarsal heads, which are the ends of the long bones in the foot. The joint capsule or tendons may also be inflamed.

The pain is generally aggravated by putting pressure (as in walking) through the ball of your foot. Metatarsalgia can affect anyone who spends significant time on their feet and frequently affects runners and other athletes who participate in high-impact sports. Although generally not considered a serious condition, the pain can sideline a person whether an Olympic athlete or a weekend warrior.

Besides pain on the ball of the foot, other symptoms can include numbness and tingling in the toes, sharp pain that worsens when the feet are flexed, and feeling like there is a bruise in the foot or the feeling of walking on a stone.

How did I get it?

Metatarsalgia forms when too much weight is shifted to the 2nd, 3rd, and 4th metatarsal heads (ball of the foot) during walking or running, where excessive pronation (or flattening of the foot) being the major contributor to these improper forces. When the arch of the foot collapses, it can cause excess force to shift away from the big toe and onto the smaller bones of the forefoot. These smaller bones are not designed to take such repetitive excess loads, so they may inflame as in any overuse injury.

Other contributing factors can include: an increase in activity or training, excess weight, length of time one must be on their feet in a day, and poorly fitted or constructed shoes.

How is it treated?

The initial goal in the relieving the symptoms of metatarsalgia is to unload the excess pressure exerted on the ball of the foot and any symptoms of pain that may be present. The next step is to address the underlying cause of the symptoms associated with metatarsalgia.

Anti-Inflammatory Agents:

These may include ice and oral anti-inflammatory medications. These may provide some temporary relief from the pain of inflammation, but are not helpful in addressing the underlying cause of the condition.

Exercises:

A regular calf stretching routine should be a part of any treatment regimen. Increasing the length of the calf muscles is a very important part of any treatment. Tightness in this muscle group can cause excess pronation (arch drop).

Footwear:

Advice that focuses on taking the pressure off the metatarsals should also be followed. Unloading the pressure on the ball of the foot with a reduced heel height shoe should be helpful.

Injections:

Depending on the cause of the metatarsal pain, this intervention may be considered. It involves the injection of a medication that blocks the transmission of pain through the nerves of the foot. Risks include permanent numbness in areas of the foot so be sure to discuss the indications and risks for this treatment with a doctor.

Surgery:

In cases that do not respond to conservative measures, a doctor may recommend surgery. This may include realigning the bones of the feet. Parts of the bone may be removed and ligaments or tendons may be cut in an effort to reduce weight bearing on the metatarsal heads. If considering surgery, talk to more than one doctor carefully about the benefits and risks.

Custom Foot Orthotics:

Custom made CBAS foot orthotics will address metatarsalgia by restoring arch height and function. This will effectively help restore proper weight distribution over the first metatarsophalangeal joint (the big toe) and ensure the forces being passed through the 2nd, 3rd, and 4th metatarsal heads (ball of the foot) are not excessive. When this is done the cause of metatarsalgia is being addressed rather than just the symptoms.

CBAS unlike typical custom orthotics; are designed to help restore proper arch height and function of an individual foot, determined by a unique way of capturing an impression of the arch with the foot arranged in an optimal position, then completely supporting it; only allowing the arch to flex accurately at a calibrated rate. The CBAS orthotic is the only calibrated custom orthotic that is designed with an individual’s body weight, foot flexibility, and activity level in mind, creating true biomechanical shock absorption. This truly restores proper foot function so that abnormal joint positions and stresses can be reversed allowing affected tissues to heal and normal joint function to be restored. In this way the CBAS custom orthotics provide the best option for both the primary therapy and preventative care in helping relieve the symptoms associated with metarsalgia.

What help can I expect to get from CBAS orthotics?

With a proper diagnosis along with a well-rounded management plan including CBAS othotics, the forecast is excellent. It’s not unusual get a 50-70% relief in the first month, 70-90% the second month and 90-100% the third.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.

Bunions

What is it?

A bunion is a bony bump located at the base of the big toe. Hallux abducto valgus is the medical term used to describe the position of the big toe, and is generally used together with the term bunion that describes the enlarged joint. Bunions are one of the most common big toe problems contributing to foot pain.

Symptoms of a bunion include red­ness, swelling or pain at the base of the big toe. Initially a bunion may present itself as non-painful de­viation of the big toe towards the others. As the big toe pro­gresses towards the others a limited range of motion of the big toe can occur along with cal­luses, corns and deformities of the other toes.

How did I get it?

A bunion forms as a result of improper forces being passed through the first metatarsophalangeal joint (the big toe) during walking or running, where excessive pronation (or flattening of the foot) is the major contributor to these improper forces. When the arch of the foot collapses, the smaller bones of the forefoot become underutilized. The big toe is designed to bear the majority of the force created when the forefoot is loaded during walking; however, if it receives a strain that is excessive then the first metatarsal head is literally pushed away from the other metatarsals, creating a deviation of the big toe.

Bunions are not inherited, but they can run in families. What can be inherited is a foot type, and some foot types are more prone to bunion formation than others.

How is it treated?

The initial goal of bunion treatment is to unload excess pressure on the bunion and any symptoms of pain that may be present. Followed by addressing the underlying cause of the bunion.

Footwear Modifications:

Correct fitting shoes are essential to addressing the pain from a bun­ion that may be caused by rubbing against the inside of the shoe. Corns and calluses should be treated as well. Felt padding can be used to buffer the bunion bump against the shoe. Padding can also be placed in be­tween the big toe and the second toe that may lessen some of the pain. Keep in mind that these options can help relieve the symptoms, but do not address the cause of bunion formation.

Exercises and Splints:

Exercises can be performed that may help keep the joint mobile. A night splint can be worn to try and prevent a loss of mobility. Night splints are more effective when used with younger people who still have considerable mobility in their joints.

Surgery:

The type of surgery varies with the type and severity of the bunion. Often a doctor will take an x-ray to measure how much deformi­ty has occurred. Surgery is often indicated in moderate to severe bunions and bunions that do not respond to conservative measures.

Surgery is often done on an outpatient basis. The most common type of surgery involves re­aligning the bones of the first metatarsophalangeal joint (the joint between the big toe and first metatarsal head). Ligaments and tendons may be tightened and the bony protrusion of the bunion may be shaved away. If a bunion requires surgery, it is crucial that the cause of the prob­lem is also addressed. Failure to do this may result in additional surgery when the bunion returns in a few years. If considering surgery, talk to more than one doc­tor carefully about the benefits and risks.

Custom Foot Orthotics:

Custom made CBAS foot orthotics will address a bunion by restoring arch height and function. This will effectively help ensure the forces being passed through the first metatarsophalangeal joint (big toe joint) are not excessive. When this is done the cause of the bunion is being addressed rather than just the symptoms.

CBAS, unlike typical custom orthot­ics, are the only calibrated custom orthotics designed with an individual’s body weight, foot flexibility, and activity level in mind, thus creating true biomechanical shock absorption. By restoring proper foot function abnormal joint posi­tions and stresses can be reversed allowing affected tissues to heal and normal joint function to be restored.

It is common to achieve bunion arrest or rever­sal with CBAS custom orthotics especially in mild to moderate cases. Even in severe cases, CBAS have been indicated to help restore proper function to the foot. The time to symptom reso­lution varies with the type, severity and cause of the condition. The age and mobility of the joints in the foot are also a factor in symptom relief. Using CBAS custom orthotics is critical for avoiding re-occurrence of the bunion af­ter surgery as well.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.

Plantar Fasciitis

What is it?

Plantar Fasciitis (pronounced plan-tar fash-ee-eye-tis) is a common cause of heel and foot pain in adults. “Plantar” means the bottom of the foot; “fascia” is a type of connective tissue, and “itis” means “inflammation”. The classic symptoms of plantar fasciitis include heel pain that is usually most severe first thing in the morning. This condition is characterized by inflamma­tion at the insertion point of the plantar fascia on the heel bone. Plantar fascia is a layer of tough fibrous tissue that runs along the bottom of your foot and supports the arch. This is one of the longest and strongest ligaments in the body. As the plantar fascia pulls on the heel, the body will respond by lay­ing down more bone in the area. This can be seen on an x-ray and is known as a heel spur.

How did I get it?

Common contributors to this condition in­clude: progressive flattening of the arches over time (primary reason), lack of flexibility in the calf muscles, changes in activity levels, over­use, and weight gain. When the arch drops, the plantar fascia begins to tear away from its inser­tion at the heel. When this happens over a long period of time, it can overcome the body’s abil­ity to repair itself.

How is it treated?

The initial goal in the relieving the symptoms of plantar fasciitis is to reduce the inflammation of the fascia and any symptoms of pain that may be present. The next step is to address the underlying cause of the symptoms associated with plantar fasciitis.

Exercises:

To lessen the pull at the heel stretching exercises that are aimed at lengthening the plantar fascia will help. A regular calf stretching routine should be a part of any treatment regimen. Increasing the length of the calf muscles is a very im­portant part of any treatment. Tightness in this muscle group can cause excess pronation (arch drop).

Anti-Inflammatory Agents:

These may in­clude ice and oral anti-inflammatory medica­tions. These may provide some temporary re­lief from the pain of inflammation, but are not helpful in addressing the underlying cause of the condition.

Night Splints:

A night splint is a device worn at night to help prevent contraction of the plantar fascia and to maintain calf flexibility. This will usually lessen the “first step in the morning” pain and relieve symp­toms temporarily. They can be uncomfortable to wear for some, but generally provide some relief.

Corticosteroid Injections:

This involves the in­jection of a steroid directly into the heel and site of inflammation. Usually reserved for intractable or difficult cases, this may provide more relief than oral anti-inflammatory medications. Talk to more than one doctor about the indications and risks for this treatment.

Extracorporeal Shock Wave Therapy:

A high or low frequency sound wave is delivered to the area in an attempt to speed the healing process. Usually 1 to 3 treatments are required, and de­pending on the intensity of the sound wave an anesthetic may be used. The outcomes of this treatment are unproven and discussing the risks with more than one doctor is recommended.

Surgery:

In cases that do not respond to conser­vative measures, surgical release of the plantar fascia may be a consideration. Cutting the plantar fascia will lessen the pull on the heel, but may have long term consequences including further flattening of the arch (since the plantar fascia con­tributes about 30% to the stability of the arch).

Custom Foot Orthotics:

Custom made CBAS foot orthotics will address plantar fasciitis by restoring arch height and function then completely supporting the arch. This will effectively help the plantar fascia being pulled on excessively, and tearing away from its inser­tion at the heel. When this is done the cause of plantar fasciitis is being addressed rather than just the symptoms.

CBAS unlike typical custom orthot­ics, are designed to help restore proper arch height and function of an individual foot, determined by a unique way of capturing an impression of the arch with the foot arranged in an optimal position, then completely supporting it. Only allowing the arch to flex accurately at a calibrated rate. The CBAS orthotic is the only calibrated custom orthotic that is designed with an individual’s body weight, foot flexibility, and activity level in mind, creating true biomechanical shock absorption. This truly restores proper foot function so that abnormal joint posi­tions and stresses can be reversed allowing affected tissues to heal and normal joint function to be restored. In this way the CBAS custom orthotics provide the best option for both the primary therapy and preventative care in helping relieve the symptoms associated with plantar fasciitis.

With a proper diagnosis along with a well-rounded management plan including CBAS othotics, the forecast is excellent. It’s not unusual get a 50-70% relief in the first month, 70-90% the second month and 90-100% the third. Regular orthotic use can insure that the problem does not return.

If left alone plantar fasciitis can take from 6 to 18 months to heal, and symptoms can reoccur on various occasions, even before the last flair up has completely dissipated. Interfering with the ability to work and activities.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.