Areas of Pain

(Conditions that Pro‑Nation Orthotics can be used for)

Foot Arch Pain and Heel Pain

This pain generally arises from a common foot pathology usually known as plantar fasciitis although it has other more specific names which indicate the source(s) of the pathology e.g. plantar fasciosis or plantar fasciopathy. The plantar fascia is a thick band of soft tissue under the skin on the bottom of your foot, made primarily of the protein collagen, that runs from your heel to the base of all your toes. It has an important function in correctly directing the ground reaction forces that travel through your foot when walking, supporting your foot’s arch structure and facilitating an efficient push off whilst walking and running.

Up to 1 in 10 people in the UK will suffer from this problem over their lifetime and this condition forms up to 40% of all podiatry referrals. People who are:

overweight or obese i.e. have a BMI score of 25 and above
aged between 40 – 60 years
standing for long periods

are at risk of developing this pain, which generally builds over a period of time, then is worse first thing in the morning and towards the end of the day. Excessive pronation has been closely linked to the exacerbation of plantar fasciitis, if the rolling in movement of the foot continues when it should have ceased then this can sprain the plantar fascia and increase the traction at its attachment on the heel bone.

Arch pain can also arise from cramping or straining within the muscle that runs along this area, called muscle abductor hallucis. This muscle helps to align your big toe in a straight direction so that it can function more efficiently.

There are many other causes of heel pain, including:

prolonged compression and bruising arising from walking and standing for long periods in hard soled shoes
arthritis and fractures in the heel bone (called the calcaneus)
sometimes from entrapment of the nerve that supplies sensation detection in the skin around the heel (tarsal tunnel syndrome)
splinters from walking barefoot

Ankle Pain

Commonly pain in this area is as a result of a sprain (a stretch, twist or tear) in the ligaments that support the ankle joint, especially the ligaments on the outside of the ankle joint. Ligaments are thick areas of soft tissue (made from mainly the proteins collagen and elastin) that hold bony joints together. Sudden change in movement direction, twisting or landing awkwardly can cause a sprain. Excessive pronation within the feet can lead to general joint instability and overuse of the ligaments that support the ankle joint, particularly on the inside of the ankle joint (the deltoid ligament).

Pain in the ankle joint can also be caused by arthritis within the joint or a fracture to the bones that form the joint i.e. the talus (the uppermost bone within the foot), the tibia and the fibula (the 2 bones of the leg).

Knee Pain

There are 2 joints that form the knee joint, one between the femur (thigh bone) and the tibia and one between the knee cap (called the patella) and the femur. Often the most common causes of knee pain are strains to the muscles surrounding the knee and sprains to the ligaments holding the joints together. These can result from doing too much activity too soon. Often contributing to these injuries is excessive pronation within the foot. The inward rolling of the foot and the subsequent over internal (inward) rolling of the leg and thigh can, over a period of time, create thigh muscle weakness and consequent misalignment of the knee cap (commonly called anterior knee pain) as it glides on the femur. This type of pain often gets worse on activity where the knee is straightened (extended) bearing bodyweight or is bent (flexed) for long periods e.g. climbing stairs or walking downhill.

Other causes of knee pain are:

Tearing of the shock absorbing cartilages that line the joint between the femur and tibia called the menisci
Osteoarthritis (degeneration of the joint surfaces) commonly between the knee cap and the femur and mainly in older people. Another type of arthritis that affects the knee is gout, where crystals of a waste product (uric acid) build up in the joint creating intense pain. Also rarer forms of arthritis, such as haemarthrosis (bleeding into the joint resulting from internal injury or from taking the medication Warfarin) and septic arthritis can occur
Sprains or tears to the internal joint ligaments called the cruciate ligaments as they are arranged like a cross inside the knee joint, or to the ligaments at the sides of the knee, the co-lateral ligaments
Tendon sprains and inflammation (tendonitis) of the tendon that joins the knee cap to the tibia (leg bone)

Hip Pain

The most common cause of hip pain results from osteoarthritis where there is damage to the cartilage that lines the bone surfaces in the hip joint.

Other causes of pain in the hip joint area are fractures or damage to a thick band of fascia called the ilio-tibial band (ITB) which runs along the outside of the thigh and helps, in part, to stabilise your pelvis on your thigh. The ITB can often be damaged from rapid changes to the level of activity undertaken, if muscles in your pelvis become weak (especially gluteus medius) and if you run on journeys where your lower limbs are forced to turn inwards a lot e.g. on slopes of pavements or roads. Continual turning in of the lower limbs can force the movement of pronation in the feet to become excessive, which in turn may contribute to the ITB pain at the hip (and sometimes at the knee joint).

Back Pain

Back pain is very common in the general population and there are numerous causes. Excessive sub-talar joint pronation within the foot has been linked to exacerbating lower back pain through the increase of lumbar flexion (bending forward) from prolonged lower limb internal rotation i.e. turning inwards. Prolonged lumbar flexion can lead to compression in the cartilage discs that separate the bones (vertebrae) in your spine. Also without a good push off from your foot, which excessive pronation can result in by limiting how much your big toe bends, muscles in your back and pelvis have to work harder to start your leg to swing forward. The harder work done by these muscles can create rotation in the vertebrae on which they attach and create friction in the cartilage discs.