Pronation

Complex disturbance in which there are biomechanical abnormalities causing the foot to function improperly. Pronation is a tri-plane motion involving:  (a) internal rotation of the lower leg and talus bone on the sub talar joint; (b) dorisflexion of the foot at the ankle joint; (c) abduction of the forefoot from the midline of the body. 

Cause:

Related to the shape and structure of the bones of the lower extremity and are generally due to hereditary, congenital, traumatic, or infectious causes.

Symptoms:

Pain and fatigue in the arch area of the foot and also in the legs.  Because the foot that has pathologic pronation often has related biomechanical problems, any of the mechanical disturbances (corns, calluses, bunions, ingrown toenails, Tailor bunions, etc) may be considered a symptom of pronation.

Treament:

Various strappings, physical therapy, and orthotics are commonly employed.   Severe cases may require surgical correction.

A painful inflammation of the bottom of the foot between the ball of the foot and the heel.

Cause:

There are several possible causes of plantar fasciitis, including:

• Wearing high heels
• Gaining weight
• Increased walking, standing, or stair-climbing.

If you wear high-heeled shoes, including western-style boots, for long periods of time, the tough, tendonlike tissue of the bottom of your foot can become shorter.  This layer of tissue is called fascia.  Pain occurs when you stretch fascia that has shortened.  This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning.

   If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or stand in shoes with poor heel cushioning.  Normally there is a pad of fatty tissue under your heel bone.  Weight gain might break down this fat pad and cause heel pain.

   Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts.  It can also occur with a change in exercise surface or terrain, or if your shoes are worn out and don’t provide enough cushion for your heels.

   If the arches of your foot are abnormally high or low, you are more likely to develop plantar fasciitis than if your arches are normal.

Symptoms:

The main symptom of plantar fasciitis is heel pain when you walk.  The pain may also present itself in any area of the arch.  You may also feel pain when you stand and possibly even when you are resting.  This pain typically occurs first thing in the morning after you get out of bed, when your foot is placed flat on the floor.  The pain occurs because you are stretching the plantar fascia.  The pain usually lessens with more walking, but you may have it again after periods of rest.

   You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.

Treament:

Rest, ice pack to the heel, prescribe anti-inflammatory, such as aspirin or ibuprofen and stretching.  All these treatments help to decrease pain and inflammation.   Heel cushions worn in both shoes can help.  Orthotics, whether custom or over-the-counter,  may be part of your treatment, as well as the the prevention in the future. 

   If your heel pain is not relieved by the treatments described above, your health care provider may recommend physical therapy.    A splint may be fitted to the calf of your leg and foot, to be worn at night to keep your foot stretched during sleep.  Another possible treatment is injection of cortisone in the heel.  Surgery is rarely necessary.

Prevention:

The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet.  This is especially important when you exercise or walk a lot or stand for a long time on hard surfaces.  Get new athletic shoes before your old shoes stop supporting and cushioning your feet.

You should also:

• Avoid repeated jarring to the heel.
• Maintain a healthy weight.