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By Dr. Kuvent, June 25, 2010 2:12 pm

“Arch Pain” is a common term used by many to describe symptoms that may occur in the arch of the foot. One of the most common findings in a patient with arch pain is inflammation of the tissues within the midfoot (you know, that portion of the foot further down from the ankle and heel, but closer than the toes). You may know where the arch of the foot is on your own feet, but what is involved in forming this arch? A tight band of tissue called the “plantar fascia” connects the heel bone to the toes, forming the arch. Now, this band of tissue is very important in ensuring that the foot performs as it should mechanically, and it is important in walking because of its role in transferring weight from the heel to the toes with each step. When this arch-forming tissue becomes irritated and inflamed, it causes that infamous “arch pain” and patients may experience severe pain even with the simplest of movements.

Knowing that the plantar fascia is an important structure in forming the arch of the foot should lead you to believe that plantar fasciitis (a commonly used medical term meaning inflammation of the plantar fascia) is the most common cause of arch pain. Symptoms of plantar fasciitis include pain right away in the morning when you first get out of bed or pain with long walks or prolonged periods of standing. If you experience arch pain early in the morning, chances are it is due to the plantar fascia becoming tight while you sleep. Upon waking up and walking to the kitchen for your morning cup of coffee, the plantar fascia is still tight from your slumber and it gets irritated when it stretches out during walking. This in turn makes the already difficult walk (depending on the amount of sleep you get) to the kitchen even more difficult due to intense pain.

The best treatment for plantar fasciitis is often a combination of some simple stretching exercises, anti-inflammatory medications such as Advil, and inserts for your shoes to help support your arches, which reduces the amount of stretching of your plantar fascia. If these conservative treatments aren’t enough to take care of your pain, you should see a podiatrist to discuss other options.

Another cause of arch pain involves collapse of the midfoot, placing excess stress on the arch. This stress affects the plantar fascia, as well as some tendons running along your ach and the joints of the midfoot. Over time, excessive stress on the midfoot joints can result in arthritis.

There is a particular tendon that helps support the arch and prevents it from collapsing. When excess stress is placed on the midfoot, this tendon becomes overstressed, which can result in tearing, inflammation, pain and eventual breakdown of the tendon. This may require therapy, being placed in a cast, or even surgery.

If you are experiencing any of the discussed symptoms of arch pain, make an appointment with your local podiatrist to determine the best course for relieving your pain and making your morning walk to the kitchen easier!

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By Dr. Kuvent, April 2, 2010 8:41 am

          Most people have heard somewhere along the line of rheumatoid arthritis (RA) or osteoarthritis. These conditions have been previously described on this blog and can cause serious pain and damage to the joints of your feet and ankles. However, there are many other arthritic disorders that can also affect the lower extremities which is why a proper podiatric work-up can help to distinguish some of these conditions. Similar to RA, there are three fairly common diseases (along with multiple others) which also demonstrate similar inheritance patterns and tend to affect similar joints. These include Ankylosing spondylitis, Psoriatic arthritis, and Reiter’s syndrome.

          Ankylosing spondylitis, also called Marie-Strümpell’s disease, most often affects males. It typically begins when people are in their 30’s but often times the disease itself is not diagnosed right away because the early signs and symptoms are vague. However, these can include multiple manifestations including eye problems, stomach inflammation, and neurologic deficits. The classic finding, however, is lower back or buttock pain which tends to radiate down the thighs. In the lower extremity, symptoms can occur at the balls of the feet where degeneration and dislocation occurs at the joint. Symptoms may also arise in the heel where pain and inflammation occur at locations where tendons and bones connect.

          Psoriatic arthritis, as you can imagine, is closely associated with psoriasis although there are also other genetic, environmental, and immune system-related factors. The most common presentation involves the joints of the toes and results in widening at the joint space as well as joint destruction, toe swelling, and possible knee involvement. Interestingly, this disease also presents with unique nail changes; specifically the development of many small pits in the nails which may indicate the onset of the disease.

          Reiter’s syndrome is a form of reactive arthritis which occurs in response to an infection elsewhere in the body. The infection in question is usually either a urinary tract infection or a gastro-intestinal infection and thus often follows the contraction of a sexually-transmitted disease or the consumption of contaminated foods. Of course, this disease process includes many systemic signs, but in the lower extremity it exhibits symptoms similar to Psoriatic arthritis and Ankylosing spondylitis including swollen toes, nail changes, and heel pain.

          If you’re experiencing the symptoms of one of these conditions, your local Chandler foot doctor can be especially helpful. For one thing, there is a wide variety of other conditions including gout, RA, osteoarthritis, and lupus among others which will need to be effectively ruled out. Most of these conditions have different radiographic patterns which is helpful in that respect. Furthermore, if one of these conditions is diagnosed, your podiatrist has a huge role to play in the conservative and/or surgical management of your symptoms. Feel free to make an appointment today with any questions.

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By Dr. Kuvent, May 26, 2009 2:03 am

As you can imagine, human feet are incredibly complex and impressive structures. Just think of all the functions that your feet perform every day! Each human foot contains roughly 26 bones and 33 joints. That actually accounts for about a quarter of all the bones in the body! The coordinated movements that we often take for granted require efficient and effective motion between each of those bones and joints. Occasionally, however, some of the bones can develop unions or connections with other bones which can have a big impact on the function and comfort of your feet.

In most circumstances, the connections which reduce or stop motion between bones show up in the middle or hind part of the foot below the ankle. These unions are often bony themselves, but can also be made up of cartilage or fibrous tissue as well. They’re certainly nothing new. Doctors back in the 1700’s first began to describe this condition, and a pre-Colombian Indian skeleton from around 1000 AD even had one!

Unions between bones in the foot may be acquired over time or congenital- showing up in fetuses as early as the first trimester. Some acquired causes may include trauma, arthritis, or even tumors. Either way, they can present in a variety of ways. Patients may experience pain, muscle spasms, decreased motion, or no symptoms at all. Pain is usually localized to the outside top of the foot or the entire rear-foot, and often comes on after activity. Walking over rough surfaces is especially painful. Individuals-especially children-who develop a stiff flatfoot on one side but not the other have a very high chance of having a bony connection in that foot.

Podiatrists perform a number of simple clinical exams as well as radiographic techniques to quickly assess whether an individual has a bony union or not. They’re able to localize the issue and determine the extent of the problem, and of any arthritic changes. After that, a number of conservative measures may be implemented to address the problem. If these measures fail, surgery may be recommended to address the needs of that specific foot.

Physical activity is a critical part of everyone’s healthy lifestyle, and walking should not be painful. If your feet become rigid or uncomfortable, you should have them examined professionally. You’ll be glad you did!

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By Dr. Kuvent, February 12, 2009 10:52 am

Most commonly, heel pain is caused by inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis.
Plantar fasciitis causes stabbing or burning pain that’s usually worse in the morning because the fact that the fascia tightens overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing, increased activities or after getting up from a seated position.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Be alert to; sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot. Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe. Heel pain after long periods of standing or after getting up from a seated position. Heel pain after, but not usually during, exercise Mild swelling in your heel

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

Physical activity overload

Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

Arthritis

Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Faulty foot mechanics

Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia.

Improper shoes

Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.