Over-pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person’s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, potentially causing severe discomfort and leading to other foot problems.
Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding additional stress to other parts of the foot. Therefore over-pronation can often lead to a case of Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. People with flat feet often do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.
Overpronation can lead to injuries and pain in the foot, ankle, knee, or hip. Overpronation puts extra stress on all the bones in the feet. The repeated stress on the knees, shins, thighs, and pelvis puts additional stress on the muscles, tendons, and ligaments of the lower leg. This can put the knee, hip, and back out of alignment, and it can become very painful.
Your healthcare provider will ask about your symptoms, medical history, and activities and examine your feet. Your provider may watch you walk or run. Check the motion of your feet when they strike the ground. Look at your athletic shoes to see if they show an abnormal pattern of wear.
Non Surgical Treatment
Flat feet and fallen arches can be treated effectively by wearing an orthotic insert in your shoes. Orthotics can be custom-made and prescribed by your foot specialist (podiatrist), or you can use a so called pre-made foot orthotic. Most people do not require expensive custom-made orthotics to combat excess pronation, unless they have a specific medical foot condition. Footlogics orthotic insoles were developed to correct excess pronation, thereby providing sustainable, long-lasting pain relief to many aches and pains in a natural way. Footlogics Comfort, Casual and Sports are products which promote excellent biomechanical control of the foot.
Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.
An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% – 100%, depending on manufacturer.
Sever’s Disease is not a disease in the sense of an infection or other chronic pathology but is an injury/irritation of a growth plate. The Calcaneal growth plate or growth plate in the heel bone has attachments from the achilles tendon and the plantar fascia. Pull from either or both of these structures can cause enough motion within the apophysis or growth plate space to create irritation and inflammation which can be quite painful and limiting. This can start when the growth plate is still wide open but is more often seen as the growth plate starts to close further limiting its ability to move with the traction of soft tissue attachments. It was believed by Sever that fractures within the growth plate were the source of the discomfort. When looking at a growth plate that has started to close it can appear to be fragmented into 2 or 3 pieces. It has since been proven that this is the normal appearance of a closing growth plate.
Inflammation occurs at the insertion of the achilles tendon into the back of the heel due to a number of reasons. One or several of the following may cause the initiation of Sever?s disease. Rapid growth spurt. Tight calf muscles. Change in footwear (soccer boots / athletic shoes no heel). Excessive rolling in of feet. Poor warm up routine. Remember this condition usually settles as the growth plate fuses within 6-12 months.
Some of the common symptoms of Sever’s disease are pain in one or both heels with running and walking. The pain is originates from the point of the heel where the tendo-achilles inserts into the heel bone. Heel pain that goes away when resting. Swollen heel. Calf muscle stiffness first thing in the morning.
This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever’s disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever’s disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever’s disease.
Non Surgical Treatment
Cold packs: Apply ice or cold packs to the back of the heels for around 15 minutes after any physical activity, including walking.
Shoe inserts: Small heel inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons. This will only be required in the short term.
Medication: Pain-relieving medication may help in extreme cases, but should always be combined with other treatment and following consultation with your doctor).
Anti-inflammatory creams: Also an effective management tool.
Splinting or casting: In severe cases, it may be necessary to immobilise the lower leg using a splint or cast, but this is rare.
Time: Generally the pain will ease in one to two weeks, although there may be flare-ups from time to time.
Correction of any biomechanical issues: A physiotherapist can identify and discuss any biomechanical issues that may cause or worsen the condition.
Education: Education on how to self-manage the symptoms and flare-ups of Sever?s disease is an essential part of the treatment.
One of the most important things to know about Sever’s disease is that, with proper care, the condition usually goes away within 2 weeks to 2 months and does not cause any problems later in life. The sooner Sever’s disease is addressed, the quicker recovery is. Most kids can return to physical activity without any trouble once the pain and other symptoms go away. Although Sever’s disease generally heals quickly, it can recur if long-term measures are not taken to protect the heel during a child’s growing years. One of the most important is to make sure that kids wear proper shoes. Good quality, well-fitting shoes with shock-absorbent (padded) soles help to reduce pressure on the heel. The doctor may also recommend shoes with open backs, such as sandals or clogs, that do not rub on the back of the heel. Shoes that are heavy or have high heels should be avoided. Other preventive measures include continued stretching exercises and icing of the affected heel after activity.