Plantar Pain (Plantalgias)
Plantalgias refer to conditions and disorders affecting the sole of the foot and the midfoot region. These types of pain can quickly become very disabling and significantly impact a patient's daily activities. Unlike metatarsalgia, plantar pain is often aggravated by wearing flat shoes, which can increase stress on the structures of the arch and sole of the foot.
Plantar Fasciitis
Plantar fasciitis is the most common cause of plantar foot pain treated in podiatry. It is an inflammation of the plantar fascia, a thick band of tissue that supports the arch of the foot. The condition is usually caused by excessive tension within the calf muscles, Achilles tendon, and plantar fascia, collectively known as the Suro-Achilles-Calcaneo-Plantar (SACP) System.
This excessive strain may result from flat feet, excessive pronation, or high-arched feet. The plantar fascia plays an essential role in supporting the foot and helping to propel the body during walking.
Custom foot orthoses help reduce tension on the plantar fascia by supporting the arch and improving foot mechanics, often with the addition of a heel lift to decrease strain on the SACP system.
Posterior Tibial Tendinopathy
The posterior tibial muscle is one of the main stabilizers of the foot. Its tendon inserts on the navicular bone on the inside of the foot and plays a key role in supporting the arch and controlling foot motion during walking.
When the arch collapses, as seen in flat feet or excessive pronation (valgus foot), the posterior tibial tendon is subjected to excessive strain, which can lead to inflammation and degeneration. Pain is typically felt along the course of the tendon behind and below the inner ankle or at its insertion on the navicular bone.
Custom foot orthoses help by supporting the arch and improving foot alignment, reducing the workload on the posterior tibial tendon and relieving symptoms.
Tarsal Coalition (Synostosis of the Tarsus)
Tarsal coalition is an abnormal fusion between one or more bones of the tarsus. This fusion may initially be fibrous or cartilaginous before becoming bony. The resulting osseous bridges cause significant stiffness of the foot and painful muscle contractures, particularly of the peroneal muscles. It often leads to a flatfoot deformity, known as a rigid flatfoot.
Custom orthoses aim to reduce muscular strain by unloading painful areas and recruiting remaining mobile joints. However, they cannot correct the fixed structural deformity caused by the bony fusion. In severe cases, treatment may include immobilization in a cast, medication for muscle relaxation, or surgical resection of the bony bridges.