Depending on what you read around 60-70% of the population suffer from excessive or over pronation, but what determines what is ‘over or excessive’ when referring to pronation, there is no real criteria that says what is considered normal or more importantly abnormal. It is also important to point out that everyone pronates in their normal walking pattern, but its when we pronate to much that there is an issue, which can lead to a pathology with the foot or lower limb.
There is however a variety of theories of foot function:

• Sub-talar joint neutral theory
• Three rockers theory
• Sub-talar joint axis theory
• Tissue stress theory
• Kinetic chain theory

These theories should be applied by your podiatrist when looking at how the foot functions and if there is any pain present, and thus how to combat the pain.

It is possible for the foot to appear normal when sitting down with a clear arch present under the foot, however when you stand the arch becomes reduced, when walking the foot appears to roll inwards, this is what we call ‘over pronation’.

• Many people who ‘over pronate’ never have any issues throughout their lifetime, however some people have problems when they are much older and some people can have injuries at anytime in their life.
• Some examples of painful foot conditions that are present as a result of over pronation are; heel pain, plantar fasciitis, heel spurs, achilles tendonitis/ tendonosis, posterior tibial tendon dysfunction, in addition other parts of the body can also be affected such as knees, hips, lower back, and even the neck.
• There are many other causes of flat feet, these include obesity, pregnancy and or repetitive stress going through the feet, which can cause structures to get damaged.
• Over-pronated feet can also cause a complete loss in arch and become a flat foot.

Over Pronation Treatment and Prevention

• ‘Over pronation’ can be treated conservatively with orthoses/ insoles that depending on your level of ‘over-pronation’ need to be specific to you.
• Footwear should also been taken into consideration with the correct amount of support and cushioning.
• If there is pain with the foot position then the foot position needs to be addressed as well as the pain, therefore the symptoms need to be treated as well as the cause, usually being the foot position.

This is only touching the surface on what over pronation is; If you have any questions about any of the information above then please don’t hesitate to get in touch!!!

The picture below shows where the sesamoids are located and where you would experience pain:

Cause

• The pain usually begins with a mild ache and increases gradually as the aggravating activity is continued, which may progress to an intense throbbing pain. In a lot of cases there is little or no bruising present.
• One of the largest reasons for sesamoiditis is increased activity suddenly, so it might be you have decided its time to get fit and have jumped straight into it, or you have increased the intensity or slightly changed your workout to run or exercise on different surfaces under foot.
• If you have a reduced fatty padding on the balls of your feet, so there is limited shock absorption there
• If you have in-appropriate footwear, in the same way if you have reduced fatty padding, if you dont have a cushioned trainer then that will also contribute to sesamoiditis.
• Finally if you have a high arched foot then a lot of pressure will travel through the ball of your foot.

Sesamoiditis Treatment

• Minor cases of sesamoiditis warrant a strict period of rest, along with the use of a modified orthoses to reduce pressure away from the affected area, a change in footwear may also be warranted.
• Trainers may also be adapted to offload the pressures away from the foot also.
• The big toe may also be strapped up to prevent any force going through it and also prevent the tendons from working which may be inflamed.
• Of course reduce or stop activity.
• Icing the area and using topical anti-inflammatories will also take down any swelling if there is some present
• While the injury is healing women should wear flat shoes to prevent increased pressure going through the foot.
• If the foot has a high arch then this may be needed to be addressed with orthotics
• If none of the above helps the pain then it will be useful to get x-rays done of the affected area to rule out any other bone involvement in the area.

If  you have any questions about any of the information above then please don’t hesitate to get in touch!!!

Plantar fasciitis is a common condition that causes pain on the bottom of your foot, although the pain is usually localised to either the ball of the foot or the middle of the heel, the pain can be anywhere underneath. As can be seen by the picture where pain can be felt anywhere along the red line, but mainly where the dark areas on the diagram are the most painful if you have plantar fasciitis!!

Signs and Symptoms of Plantar Fasciitis!!

So do you think you have plantar fasciitis? Below is a list of positive clinical examinations along side the most common reported signs and symptoms;

• Pain on the undersurface of the foot (usually on the middle of the heel bone, or on the ball off the foot in the middle)
• Pain first thing in the morning and pain after periods of sitting for a long time
• less stiffness and pain after walking around for a while

What causes plantar fasciitis?
It is caused by straining the plantar fascia that supports the arch, repeated strain can cause tiny tears in the plantar fascia that can lead to pain and swelling. It is important to get plantar fasciitis resolved very quickly, obviously because of the pain, but also because if it is left for long periods of time then it can become chronic in nature and be harder to fix than if it merely happened a few days ago. But never fear there are things we can do if it has been there for a long time!!!

Below is a list of the most common causes of plantar fasciitis!!

• your  feet have a tendency to roll in and look like your arch drops, this is known as excessive pronation
• you have high arches
• you have a flat foot
• you have a job that means your on your feet for long periods of time
• you are carrying a few extra pounds
• you wear shoes that have minimal support in terms of a thin sole or slip on shoes, or they are worn out
• you have tight muscles in the calf (back of the leg)

Plantar fasciitis treatment?
If your reading this and you think well I’ve tried a few of these online treatments and nothing is working, it is important to remember that different treatments work well for different people, and no one single treatment works well in isolation. Plantar fasciitis needs to be treated in various different ways to really repair the plantar fascia in as short amount of time as possible.
Here is a few ways to try to repair the plantar fascia…….

• Try and take a break from activity for a while, give your feet a rest
• To reduce the pain and swelling try topical ibuprofen, or icing the under surface of the foot
• Calf’s need to be stretched, in order to feel the benefit of the stretch, it needs to be held for at least 30 seconds (ideally 45 seconds). This needs to be done twice a day
• When you wake up in the morning spend 30 seconds massaging along the length of the heel
• Ideally get a new pair of shoes
• It is also important to see what is going on with the structure of your foot, and see if this will cause you to have plantar fasciitis in the future or other conditions associated with the feet… If you are concerned about this then please don’t hesitate to give me a call and come in.

Hopefully this helps, if you have any questions about any of the information or similarly any other problems associated with your feet then don’t hesitate to get in touch on 01403 276272 or by email jon@bartholomewwayclinic.co.uk

Very fancy name, but what it means is the tendon that comes from the back of the leg and inserts into the foot can sometimes get damaged. It can get damaged anywhere along the course of the tendon, it is a structure that is responsible for supporting the arch, and works very hard during sport and when the foot is in contact with the ground when walking.

The image below highlights not only where the posterior tibial tendon tracks around the ankle and inserts but also where pain and swelling maybe located.

So what are the signs and Symptoms of Posterior Tibial Tendon Dysfunction?

• swelling and pain around the ankle bone and up the middle aspect of the leg
• burning shooting, tingling and stabbing pain, this is due to the thick swollen tendon pushing on the nerve that also tracks around the ankle bone.
• pain will be steadily worsening towards the end of the day
• in more severe cases when the pain has been present for a long time the foot may begin to change shape and flatten
• In some not all of the cases the patient may not be able to go onto their tip toes for extended periods of time.

This tendon has the potential to rupture or tear so if you feel that you are getting pain in this area then don’t hesitate to come in and have a chat

What causes posterior tibial tendon dysfucntion?

• Trauma to the tendon either where it inserts onto the foot or up the leg
• Pathological rupture due to degenerative conditions such as fibromyalgia, lupus or rheumatoid arthritis.
• People who lead a sedentary life then take up sort quickly
• having a foot structure that predisposes to injury
• Being overweight
• unknown cause
• Research shows that being overweight, smoking, having high blood pressure and diabetes makes you very susceptible to PTTD.

How is posterior tibial tendon dysfunction treated?
Treatment differs depending on stage of the pathology, however most patients come into clinic when the pain has only been there for a short time and therefore the treatment consists of

• The usual Rest, Ice, Compression, Elevation
• Immobilising the tendon for a short time, preventing force going through it (this can be done with a orthotic, ankle support, padding and strapping-or usually all of them to get a good quick result
• Orhtotics are designed to raise the arch and offload the tendon and therefore prevent it from being used.

If you have any issues or questions regarding any of the information above, then please don’t hesitate to come in or contact me on 01403 276272

Severs is the most common cause of heel pain in children aged from 7-16 years old, with it more often than not seen in more boys than girls. It usually occurs in children who play a lot of sport is due to an overuse and repetitive micro-rauma of growth plates of the calcaneus in the heel.

Where Severs can cause pain!!

What are the symptoms of severs?

• Pain and tenderness in or around the heel/ heels
• Pain usually after periods of prolonged exercise, e.g. after a game or training session.
• Limping/ Inc difficulty walking
• Gradual onset
• Relived by rest
• Swelling around the heel
• Pain when the ankle is dorsiflexed (pushed back)
• Pain on palpation

What causes severs?

• As it is an overuse injury, it is directly related to children who play a lot of sport,
• The start of a new season
• If the child is overweight
• Children who over pronate (over pronating refers to anyone with a slightly dropped arch)
• In more than half of patients severs occurs in both heels

Severs Disease Treatment?

• R.I.C.E. (Rest Ice Compression Elevation)
• Stretching calfs and hamstrings ideally twice a day morning and night. Hold the stretch for longer than 35 seconds, repeat that 5 times.
• Ibuprofen gel (always read the label following instructions)
• FOOT ORTHOTICS- dependant on the foot structure and usually if the child pronates then foot orthoses would be beneficial, to prevent excessive forces going through the joints and tendons in the heel. Orthoitcs prevent abnormal forces going through the foot.

What can i do to prevent severs?

• Children with severs usually find that in time the pain will go away on its own when there is a break from physical activity or when the bone is finished growing.
• Maintain good flexibility, spend a little bit of extra time stretching after a game or training session
• Avoid running on hard surfaces and try and keep to grass
• Wear good quality fitting shoes with firm support and cushioning and support

If you would like any more information about the information above or you are concerned about your childs foot structure in terms of pronation then don’t hesitate to give me a ring on 01403 276272 or drop me and email on jon@bartholomewwayclinic.co.uk

Signs and Symptoms

• Pain in the heel, especially with walking, running, or when the area is touched
• Tenderness and swelling which might make it difficult to wear certain shoes on the feet.Pain may get worse when rising on the toes (standing on tiptoes)
• Red, warm skin over the back of the heel
• When pressing fingers in both sides of the heel a spongy resistance may be felt.
• Pain may be worse when the ankle is bent upwards, or pain may be worse when you rise on your toes.

At Bartholomew Way Clinic in Horsham we have access to diagnostic ultrasound, as you can see from the image below this is a clear picture of a retrocalcaneal bursitis;

Treatment

As can be seen from the image above the bursa has a thin white line surrounding it. This line shows that the bursa is calcified and hardened and has therefore been there for months even years.

1. Treatment depends on how long the pain has been there and thus how long the bursa has been there.

2. Treatment also depends on whether there is associated tendonitis or tendonosis
1. NB: Tendonitis is acute inflammatory problem and tendonosis is chronic and has been long standing and no longer has an inflammatory process, this is why the treatment differs
3. Treatment also depends where the achilles tendon is damaged, if it is where it inserts into the back of the heel of mid way up the tendon up the leg then this also changes the treatment
4. Treatment also depends on whether there is a partial tear within the achilles tendon, as this will need to be repaired before treatment starts for the retrocalcaneal bursitis.

It is important to point out that everyone is different and they will have a combination of the above pathologies and you all need to be treated differently.

If you have any issues or questions regarding any of the information above. Do you get pain around the back of the heel or in the achilles tendon then please don’t hesitate to come in or contact me on 01403 276272

Bartholomew Way Clinic is in Horsham 

Paddocks Healthcare is in Henfield

We are lucky enough to work in a large multi-disciplinary team as the 4 Podiatrists being

• Charles Tovey
• Mo Hosseini
• Gary Hadley
• Jon Collins

We also have a large number of other health professionalls specialising in;

• Physiotherapy
• Sports Massage Therapy
• Henfield Chriporactic
• and many more

This process can be achieve within a 1.5 hour consultation at Bartholomew Way Clinic in Horsham.

We believe we are unique among podiatry practices in the South East of the UK, in our ability to fit custom casted insoles within such a short period of time.

This means you don’t have to wait for the relief from your new insoles (could be days or weeks from some practices).  Get relief on the same day of your appointment.

Call us on (01403) 276272, to book your appointment now.

Please advise the reception staff that you require an assessment, casting & fitting on the same day.

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