Various pains

Hallux Valgus

  • The angle between the big toe and the connected tibia is >15 degrees
  • Female > Male (5 times easier than men!)

Cause

  • Genetic/family history (main cause)
  • Acquired factors: often wearing shoes with high heel and narrowing toe box. It makes the big toe under stress and resulting in deformation.
  • Flat foot sequelae: The inner side of the foot is stressed, It cause the big toe to press outward.

Affect

  • Appearance. More difficult to buy shoes because of the bunion. A wider forefoot shoes must be chosen to reduce friction.
  • Poor balance, affecting walking posture and easier to fatigue
  • Bunion with pain
  • Forefoot pain and sputum appear
  • Caused the deformation of the second toe and even cause corns.

Treatment

  • Footwear with wide toe box
  • Toe Separation Gel (off-the-shelf/customised)
  • If there is a flat foot: Wear an arch pad / custom insole
  • If the deformity is serious, even affecting daily life: Surgery correction is recomened

Low back pain

  • Cause

    According to statistics, Low Back Pain is one of the most common diseases. Eight out of ten adults have had varying degrees of low back pain. There are many causes of lower back pain, including spinal shift, interspinous ligament sprain, degenerative arthritis, disc herniation, and so on. However, some of the lower back pain are closely related to the foot problems. The biomechanics of the human body is quite strange. The body is like a building skyscraper. The unstable foundation will effect the upper structure of the building naturally.

     

    flat feet/Pronated foot (Flat Foot / Pronated Foot)

    The problem of flat feet and pronated feet is usually accompanied by hindfoot eversion. During walking, the foot invert (the inner arch is sunken) and cause the calf rotate inward. Since the ligaments that stabilize the knee joint are quite tough, it cause the thighs rotated inwardly. The pelvis then naturally rotates inward and forward in order to reduce excessive muscle pull around the thigh. At this point, the Psoas major muscle will be pulled. When the foot is lifted out of the second step, the psoas muscles will contract and pull back the inner thighs on the right track. (Fig. 1) The more severe the flat foot, the more the waist and the muscles are pulled and feel more tired, resulting in a lower back pain.

     

    Leg length discrepancy (uneven leg) (Leg Length Discrepancy)

    Leg length discrepancy can divided in structural (different bone lengths between sides of the lower limbs) and functional (the length of the lower limbs is the same but the muscles or joints on both sides are not balanced). When walking with structural length discrepancy, the pelvis is tilted downward at the short leg side. In order to maintain the center of gravity of the body, the ludratus lumborum muscle on the side of the long leg which is located on the side of the waist, connect between 12th rib and pelvis will have long-term contraction. The excessive fatigue of the waist muscles will cause low back pain. (Fig. 2) When the longer side of the foot touches the ground, the foot increases the internal rotation (foot pronated) and maintains a flat foot state to reduce the length of the "long foot". According to the study, this can be reduced by about 6 mm. Thereby, reducing the pelvic imbalance. However, as same as flat feet, it causes strain of the psoas muscle.

     

    Wearing high heel shoes

    Many women in Hong Kong love to wear high-heeled shoes. When walking with high-heeled shoes (especially with heels higher than 2 inches), the human body is like standing down a slope and leans and moves forward. (Figure 3) In order to maintain the body balance, the Quadricep in front of the thigh and the muscle behind the calf (Calf muscle) contract to keep the lower limbs balanced. The upper part of the body will conduct compensated movement and the lower back muscles remain in a contracted state for a long time. In order to make the center of gravity backward and does not fall forward, the contraction of the lower back muscles makes the woman's back tired and feels like broken. In addition, the lumbar vertebrae joints are under long-term compression, causing joint strain; lumbar nerves may also be stressed and stimulated. It may cause severe pain in the lower back and even lower limb pain and paralysis.

Flat foot / Pronated foot

Introduction

One foot is composed of 26 bones, the number of bones in one foot has accounted for 1/4 of the total number of bones in the body! The shape of the arch is maintained by bones, ligaments and muscles, etc. The main function of the foot arch is to help boost the body and improve the efficiency of energy use. The flat foot means that the inner arch of the foot is completely sunken.Duck feet"

According to statistics, about 20-30% of the population have flat foot, If the height of the arch is low but not completely depressed, We call it "Pronated foot" These type of feet account for about 40% of the population.

People who usually have flat feet or pronated feet often have a hindfoot valgus phenomenon, The heel bone is inclined inward, and the angle is generally proportional to the severity of the flat foot.

  • Flat feet have three different categories: Non-flexible flat feet, Flexible flat feet and fat feet.
  • Non-flexible flat foot – It refers to the congenital abnormal skeletal structure of the foot, which means the shape of the flat foot is non flexible. No matter how to twist the joint of non flexible flat feet in a non weight bearing situation, the arch can not be Formed. The arch support insole may not be suitable for this type of flat feet. Surgical treatment may be a more appropriate option.
  • Flexible flat foot – It is the most common flat feet type (about 80-90% of people with this type of flat feet). This type of flat foot is due to the abnormal relaxation of the ligament inside the foot, and the strength of the muscle over the arch is not enough, resulting in different degrees of internal arch sag, but the arch can be formed at non-weight bearing or flexed big toe.
  • Fat foot – This type of the flat foot is common in children below aged. Because the fat layer on the sole of the foot is thick at this stage, it often covers the arch of the foot and forming a pseudo-flat foot phenomenon.

Cause

  • According to our clinical experience, Over 50% flat feet are caused by family genetic issue. Sometimes it may not be inherited by the parents and the intergenerational inheritance (the grandparents passed this to the grandchildren) will also be the case. On the other hand, the proportion of acquired causes has increased more and more in these years. The material and nutritional level in the society has increased. This generation of children lacked of exercise and become overweight easily. The proportion of overweight increase significantly, resulting in more children got the deformation of foot structure. It is because the foot can't tolerate the excess pressure from the overweight body and coupled with the lack of exercise on the plantar muscles. Those issues causes the arch to sag and form an acquired flat foot.
  • The flat foot has a chain effect on the entire human body structure. If the inner arch is too low, it will cause the foot structure to "excessively" rotate and lead the "excessive" internal rotation of the humerus, femurs and patella. When the foot is off the ground, the bone is still in the inner rotation stage. It cannot be turned outwards with the patella, which puts pressure on the knee joint. Various injuries will be caused by long time strain.
  • The damage caused by flat feet is generally strained, including knee degeneration and low back pain. The regular exercise (for example: long-distance running) and occupation which need longtime standing and walking (disciplined forces, retail, etc.). will increase the loading on the foot. If you have flat feet, the excessive pulling force of the plantar fascia and muscles can easily lead to chain sequelae such as plantar fasciitis, pain in the arch and inflammation of the calf muscles. Because joint degeneration is a gradual process, some people with flat feet will not feel pain. However, after a period of time, the damage of the joint and tendon will reach a certain level. Then, pain or inflammation, etc. will gradually appear. It will be much difficult to deal with at this stage.
  • Children with flat feet are less painful. Young children aged 4 – 6 may have a tendency to fall and unwilling to walk. For the older children, they may be tire easily and lack of balance. If parents encounter children who have such problems, it is recommended to deal with them as soon as possible.

Treatment for flat feet

  1. Exercise
  • Since the flat foot is caused by the weakness of the foot plantar muscles, some simple muscle exercises can increase the load capacity of the foot during walking;

          Grasping toe exercise

  • 1.Grab the object with toes (waves, towels, etc.) 2.Lift it for 5-10 seconds, then put it down, 3.Repeating 5 times for each foot;

          Standing with toes

  • 1.Stand with the toe 2.Stay for about 5 seconds, followed by normal standing 3.Repeat 10 times
  • Rope skipping, playing basketball, etc.

2. Insole

  • Arch supported insole or custom made insole prescribed by Orthotists should be used to effectively support the depressed arch. The treatment purpose is to improve foot posture during walking and running, reduce the abnormal movement of the ankle joint and prevent strain or pain.
  • If you have flat feet, proper treatment should be done as soon as possible. A good quality of life can't without a healthy foot.

Heel pain

Cause

include: Degenerative fat layerBone spurandPlantar Fasciitisetc. The treatment of each cause is also different, so it is important to understand the symptoms of pain.

  • Fat layer under calcaneusis a human natural shock absorber. Since we have known how to walk, When we touch the ground, we need to withstand the shock of our own weight. After long term using, the heel will slowly squash like a sponge and lose some of the shock absorption function. It cause the other vulnerable tissues of the foot to withstand excessive shocks and due to injury. In general, If people often use the flat shoe or need to stand up for long time, they have more chances to have a heel pain.

 

  • Bone spurrefers to the the formation of calcified tissue by heel bone hyperplasia . If the position of the spur located around the nerve bundle, the heel pain occurs during walking.

 

  • Part of the heel spur is caused byPlantar Fasciitis. The fascia is a fibrous tissue that extends from the heel to the toes. It is an important part of the foot arch which helps to adjust the height of the arch during walking to perform labor-saving. Unfortunately, people with flat feet, frequent walking, and athletes are more likely to suffer from plantar fascia injuries, especially at the heel side which is the initial contact point of the plantar fascia. Once the tissue in this part is injured without healing, the injured part will form a heel spur.

 

  • The typical symptom of plantar fasciitis is including heel pain when you wake up in the morning or sit for a long time and then get up. The pain will subside after walking for a while, but some pains come again when you continuous to walk.

 

Treatment

  • To find out the problem of heel pain, the symptoms of pain, and the shape of the foot should be studied.

 

  • If plantar fasciitis is caused by flat feet, arch support should be used for reducing the the stretching of the plantar fascia, thereby relieving pain. If the pain is more serious or there is obvious deformation on the foot shape, the custom insole is more effective for the patient.

Common foot pain in pregnant women

Introduction

Many pregnant woman have lower limb problems. Common symptoms are as follows:

  • The size of the foot becomes larger
  • Swelling of lower limbs, easy to get tired and cramped
  • Varicose veins

 

During pregnancy, the physiological changes will gradually increase. Including the slowing of the blood circulation of the body, especially the blood vessels of the lower leg and lower limbs are oppressed due to the enlargement of the fetus and the uterus. It causing blood hard to circulate and caused edema. The problem of the soles of the feet is more serious, and it is even prone to fatigue and pain in the calf muscles, resulting in cramps and varicose veins.

 

In addition, the fetus absorbs extra calcium during pregnancy to develop bones and teeth, so the mother will lose a lot of calcium during pregnancy. The lack of calcium causes the nerve transmission information function can not function effectively and caused cramps.

 

Prevention

To prevent pregnant women from cramping and reducing swelling of the lower limbs, there are some methods:

 

  1. Often doing lower limb exercises and calf stretching
    Lower limb exercises help to relax the tension muscles and maintain a good blood circulation. It is also recommended to do more stretching exercise to prevent fatigue of the calf muscle.
  2. Soaking warm water and massage
    You can use a plate of warm water, soak the calf position for 15-20 minutes, or use warm water for bath. They both can increase blood circulation of the calf. With massaging the calf muscle, the effect is more ideal.
  3. Improve sleeping position
    As the fetus growing, the main blood vessels will easily be pressed by the fetus if you sleep with supine lying. It is recommended to sleep in a side position.
  4. Wearing elastic compression socks
    If mother has edema or varicose veins, wearing elastic compression stockings can eliminate edema and prevent varicose veins and cramps.
  5. Choose the right shoes and insoles
    As mothers gain more than ten kilograms during pregnancy, the burden on their feet will increase during walking. In addition, the plantar ligament will loosen due to weight and form a flat foot. In the selection of shoes, there should be a sole anti-slip design with broaden the forefoot for easy forefoot flexion. The shoe also should be easy to wear. The insole should have a suitable inner arch support to stabilize the step.

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