What Is Progressive Flatfoot? Signs, Causes & Treatment

Another name for progressive flatfoot is Posterior Tibial Tendon Dysfunction. The posterior tibial tendon is found in the calf down to the inside of the ankle to the middle section of the foot. It is responsible for holding up the arch of the foot and gives us support when walking. Progressive flatfoot happens when the tendon becomes inflamed, stretched or torn, causing the arch to collapse.

Not to be confused with plantar fasciitis, which is the inflammation of the plantar fascia, causing the bottom of the foot to hurt and swell. While progressive flatfoot is an injury to the tendon, plantar fasciitis is a strain to the ligament.


Patients with progressive flatfoot will experience pain on the inner side of the ankle. The arch of the foot is now flat and pain gradually develops on the outer side of the ankle as well. Patients may be unable to or experience difficulty in supporting their weight on their toes.


Progressive flatfoot is often caused by trauma to the ankle from sports or outdoor activities such as soccer, running and hiking. The posterior tibial tendon is overstretched, resulting in inflammation. This condition can also happen to patients with an abnormality of the tendon, usually women over the age of 50. Obese and diabetic patients are also at higher risk for this injury.


Treatment is important to prevent chronic pain or even disability. If left unattended, the tendon would stiffen up and it might be difficult to walk or wear shoes. Arthritis would develop in the hind foot and the pain would spread to other parts of the ankle.

Non-Surgical Treatment:

If the condition is mild, patient would be wearing a cast or brace for 6-8 weeks to prevent the foot from weight bearing. At this point, anti-inflammatory drugs and plenty of rest are needed to recover. Patient would need to wear a shoe insert to support the arch after the cast is removed.

Surgical Treatment:

For more severe cases or if the condition does not get better with non-surgical treatment, the doctor would recommend surgery. The surgical procedure may include cleaning away inflamed tissue, changing the alignment of the heel bone, repairing the damaged tendon, recreating the arch of the foot or joining two bones together to stabilize the hind foot.

Age-related Orthopaedic Conditions

Age related orthopaedic conditions frequently decreases the ability to remain mobile, cause discomfort and pain and reduces the ability to lead a quality lifestyle, requiring alterations to daily activities. Ageing is a process which is spontaneous and cannot be avoided. However, age-related problems can be avoided if proper nutrition and care is provided.


Osteoporosis is a skeletal disorder indicated by low bone mass and deterioration of bone tissues. Osteoporosis can be grouped into systemic and local. Local osteoporosis is due to fractures, rheumatoid arthritis, tumours, muscular paralysis or tendon ruptures. Our bone is frequently undergoing remodelling, forming new bone cells in the process. However, osteoporosis causes an imbalance between this bone forming, causing low bone mineral density and poor quality of bones which are easily fractured.


Osteoarthritis is another orthopaedic problem associated with ageing. Degeneration of ligaments and joints can cause arthritis. Patients suffering from arthritis suffer immense pain. They can also have deformed joints and even loss of motion. Osteoarthritis can happen in any synovial joints, but it occurs most often in frequently used parts of the body such as the hands, feet, knee and hips.

Carpal tunnel syndrome

Carpal tunnel syndrome can occur in elderly patients. This is due to the irritation of the median entrapment nerve compressing on the carpal tunnel. Rheumatoid arthritis can trigger carpal tunnel syndrome as well due to the inflammation of the flexor tendons, causing compressive stresses on the carpal tunnel.

Cervical spondylosis

Narrowing of the intervertebral foramina disc can cause irritation at the cervical nerve roots. This is often between the C4/5 vertebrae and can cause stiffness and sensory-motor impairment. Patients can also frequently experience a triad of tenderness over the neck area.

Genu valgum

Genu valgum or knock knee is often due to osteoarthritis in the knee. Osteoarthritis will cause deformation to occur on the knee, causing them to touch each other while straightened, and increasing asymmetrical wear on the cartilages at the medial and lateral joints. Genu valgum will lead to an increase in pain during activities and stiffness.

Plantar Fasciitis

Plantar Fasciitis is a medical condition that affects the feet and it causes extreme pain that is amplified after periods of inactivity. The pain is likened to as being stabbed repeatedly in the feet. The onset of pain is largely due to long periods of immobility of the feet such as a long day of using the computer. As the activities around the leg increases, the pain will decrease.

Degenerative orthopaedic conditions are common in the elderly. However, most of the conditions can be improved through physiotherapy or by leading an active lifestyle, working out the limbs and joints more often. When things get serious, pain relief medication may need to be consumed to maintain the level of pain in a tolerable range.

5 Applications of Shockwave Therapy

Extracorporeal shock wave therapy or more commonly known as Shockwave therapy is a non invasive medical treatment that sends acoustic waves to injured parts of the body with the intent to reduce pain and promote healing. The shockwaves used for Shockwave therapy is similar to those used to break down kidney stone, but it is only at one tenth of the intensity, rendering it rather safe for the body. There are many uses of shockwave therapy and it can be widely applied to treat different injuries. Let’s take a look at some of the common applications of Shockwave Therapy.

Decrease pain

Shockwave therapy promotes hyperaemia which is actually the increase in blood flow to a targeted part of the body. Hyperaemia is the basis of shockwave therapy and the increase in blood flow provides extra energy and loosens up the muscles and path interactions between the actin and myosin. This will reduce muscle tension and decrease pain.

Dispersion of substance P

Substance P is a neuropeptide in the body and it functions as a transmitter and modulator for nerve communication. The main purpose of substance P is to modulate inflammation. Shockwave therapy can efficiently disperse substance P and increase the secretion of histamine. Dispersion of substance P also helps to reduce pain in the affected area and reduce the risk of developing oedema or fluid retention.

Increases collagen production

Collagen is the main protein that is found in the connective tissues throughout the body. It works together with elastin to provide structure and flexibility to the skin. Collagen is also the pre-requisite for any repair mechanism in the body that is due to a damaged ligament structure. Shockwave therapy will help to stimulate collagen production in the deeper layers of the tissues and this is something that you can never achieve just by taking collagen supplements.

Increases metabolism

Shockwave therapy removes nociceptive metabolites and helps to increase oxygen levels in the body and increasing the energy source. It also helps to reduce histamine which is acidic and increases the metabolism rate in the body.

Plantar fasciitis

Shockwave therapy will over stimulate nerves that are responsible for the transmission of pain to the brain, reducing pain immediately. It will also trigger the healing mechanism of the body and increases the formation of blood vessels in the affected area, speeding up the recovery process.

Shockwave therapy is a non-invasive treatment method that can be used for treating soft tissue injuries. Since it is non-invasive, there is minimal downtime and a hospital stay is not required. However, shockwave therapy may be painful for some but it is otherwise tolerable.

5 Home Remedies for Plantar Fasciitis

Plantar Fasciitis is a medical condition which affects the feet. It will cause extreme pain and this pain is more pronounced during the morning when the ligaments and tendons in the feet are not yet warmed up. Many patients describe the pain they experience in the morning as being stabbed repeatedly in the feet. The onset of pain is largely due to long periods of immobility of the feet such as a long day of using the computer. As the activities around the leg increases, the pain will decrease. The most common treatment method is the use of anti-inflammatory medication as well as pain killers to provide pain relief. However, some home remedies can actually work wonders.


Ice is probably the cheapest and one of the most effective home remedies. If you have an ice pack, use it. If not, you can even use frozen peas. Massage the painful area for around 15 minutes, 5 times a day. Ice can help to bring down swelling and reduce inflammation.

Protective arch support insoles

You should purchase insoles that provide arch support and place them in your shoes. It can help to reduce pain and divert away some of the impact to bring relief of pain when you move around. If possible, you should even wear them at home when you move around.


Whenever possible during the day, you should perform stretching exercises targeted at your legs. Exercises that stretch the Achilles tendon and Plantar Fascia will help to increase flexibility and warm the area up, reducing pain.

Massages using creams or oils

If able, you should massage the painful area with pain relief creams or even medicated oils multiple times during the day. Massages with medicated oils will help increase the blood circulation level at the legs and bring pain relief and promote healing.

Foot splints

When you turn in for the day, you should use foot splints to brace the foot, ankle and lower leg. The main purpose of the splint is to provide gradual stretches of the plantar fascia throughout the night, reducing stress levels and reducing pain and inflammation. Since the stretching continues through the night, you will experience lesser pain when you first wake up in the morning.

Plantar Fasciitis is a troublesome and painful leg condition that will cause a lot of discomfort throughout the day and night. It is not good to depend on pain relief medication always and whenever possible, you should substitute the pain relief medication with some home remedies.

Causes of Heel Pain

Heel pain is a very common problem experienced by many and is caused by different reasons. Patients will often suffer pain under the heel or behind the heel. Most of the time, heel pain will disappear on its own with time but in serious cases, they can become chronic problems. There are 26 bones in the human foot and the largest bone is the heel bone. The function of the heel is to provide support and balance the weight of the body. With such immense weight acting on it and various activities such as running and jumping, the heel is at a high risk of injury.

Plantar Fasciitis

Plantar fasciitis is a painful result of the inflammation of the plantar fascia. The plantar fascia links the heel bones to the toes and is responsible for the arch of the boot. Plantar fasciitis can cause immense pain which increases with every additional step you take but once you warm up the leg, the pain will start to go away, coming back again after periods of immobility.

Stress Fracture

As mentioned above, the heel bone is the largest bone in the human foot and stress fractures can occur due to overuse of the heel. Continuous activity on a hard surface can also contribute to stress fractures due to the higher force environment. When the heel bone fractures under stress, it will cause immense pain at the heel region and recovery time is often lengthy.

Heel bursitis

Heel bursitis results from inflammation of the bursa which is located at the back of the heel. It is most commonly occurred when the patient lands on the heels incorrectly, injuring the tendons and bursa. Improper footwear may also contribute to heel bursitis. The pain will normally get worse as the day passes.

Tarsal Tunnel Syndrome

The Tarsal tunnel is located between the bones in the foot and the fibrous tissues in spaces. There is a nerve located at the tarsal tunnel called the posterior tibial nerve and it is protected by bones and tendons. Sudden high impact can cause stress fractures which will result in the posterior tibial nerve being pinched onto, causing pain at the heel and numbness at the region.

Heel pad inflammation

Located under the heel bone is the corpus adiposum which acts as a shock absorber to protect the heel bone. After repeated hard landings on the foot or overuse, inflammation of the corpus adiposum can occur, causing pain and discomfort. In more serious cases, haemorrhaging of the heel pad can happen. At times, simple activities like walking can also be a difficult task.

There are many different causes of heel pain and most of it is caused by overuse and lack of sufficient rest periods. The heel bone is an important part of our body and heel bone pain can restrict us from carrying out daily activities smoothly.

Typical Treatments for Plantar Fasciitis

Have you ever experienced pain that does not go away with time at the bottom of your foot? The cause of this could possibly be Plantar Fasciitis, a condition that affects the bottom of the foot mainly due to inflammation of the fascia. Plantar Fasciitis is often caused by over usage of the Plantar Fascia. People who engage in long distance running without wearing shoes that provide good cushioning and support are much more prone to this.


The first and foremost is to stop whatever is causing the pain and this is usually running. You need to provide sufficient time for the inflammation in the fascia to go away and this can reduce the pain significantly. During this period, you should not engage in any form of sporting activities.

Ice pack

The next step would be to apply ice pack on the painful area. Ice pack will help to reduce the swelling, decrease the pain and help to control inflammation. Make sure that you are applying ice pack and not a warm pack as you should only apply a warm pack before any activities and not after.


Plantar fasciitis taping or simply taping can help to relieve stress and pressure on the plantar fascia ligament as it inhibits movement of the fascia. It can be easily done with athletic tape which is widely available in sporting stores.

Anti-inflammatory medication

Anti-inflammatory medication such as ibuprofen or aspirin can help to reduce inflammatory and reduce pain. If over the counter medication do not help, you may consider getting prescribed medication to relieve the pain.

Shock absorbing heel pads

Heel pads with shock absorbing features are excellent in treating plantar fasciitis. They help to cushion whatever shock that is experienced during walking and running. Heel pads can also help to reduce arch strain which is usually associated with plantar fasciitis.


Stretching exercises can help to reduce the pain significantly in a short period of time. Stretching will also increase the flexibility of the ligaments and increase the muscular strength, allowing it to better support the arch of the foot.

Night splint

During night time, the plantar fascia muscle will contract and tighten, resulting in tremendous pain when you wake up in the morning. The pain will slowly decrease as the day passes as the muscles are stretched. Therefore, wearing a night splint during sleep will prevent the plantar fascia muscle from contracting and tightening, reducing the pain experienced when you wake up in the morning.

There is no one single treatment for plantar fasciitis. Rather, it is a combination of a number of methods all joined together for optimal results. It is important to keep the muscle warm and flexible to reduce the pain.

Common running injuries

Running is an excellent cardiovascular exercise that has good effects on the body. It helps to improve stamina and burn off calories to keep the body in a lean manner. It also increases the good cholesterol level in the body and boost our immune system. However, running is a high impact sport and it is not meant for everyone. Because of their high impact nature, they can cause injuries to the ankles, knees, hip and even the spine. To take advantage of running and not like running take advantage of you, you need to be aware of the common injuries due to running and how are they caused so that you can take the necessary precautions and not fall victim to them.

Runner’s Knee

Patellofemoral pain syndrome or otherwise commonly known as runner’s knee is caused by the irritation of the knee cartilage at the kneecap. It contributes roughly 45% to the overall injuries caused by running. As the duration and intensity of your running increases, the pain will intensify. It is usually caused by using running shoes that are of inferior quality or not meant for running so that the supports are insufficient. The running surface also matters and an uneven one will increase the risk. Insufficient recovery period in between runs also contributes to runner’s knee.

Plantar fasciitis

Plantar fasciitis is a result of inflammation of the tissue located at the bottom of the foot which connects our heel bone to our toes. Runners who have tight achilles tendons are at a higher risk of suffering from this injury. Wearing running shoes with poor support, long distance runners and flat feet runners also have an increased risk. Runners who suffer from plantar fasciitis will have weak and swollen feet and will have difficulty walking around.

Shin splints

Medial tibial stress syndrome or commonly known as shin splints results in sharp pain in the shin area due to inflammation of the tibia. It is normally caused by strenuous activities such as tennis and running. The pain will occur on and off for activities such as tennis and they can also stay throughout the activity such as a long distance run and will eventually result in the runner stopping the run due to the excruciating pain. Running on uneven roads and improper footwear with insufficient support will increase the risk of shin splints.

Above are 3 common running injuries. If you have noticed, all are caused by running on uneven surfaces with improper footwear that provides inadequate support for the foot. If you are having existing problems, the best bet would be to run on a treadmill which provides a constant flat surface. If you wish to run in a natural environment, invest some money in a good pair of running shoes and your feet will thank you for that. After all, spending a hundred dollars on a pair of good running shoes is cheaper than having to spent thousands on your medical bills in the future.

6 Effective Plantar Fasciitis Exercises For Heel Pain

Heel pain or most commonly known as Plantar Fasciitis is a very common foot problem all around the world and many people suffer from it. Luckily, it can be treated with some really simple and inexpensive methods.

Exercise 1

Often people who suffer from plantar fasciitis experiences intense heel pain in the morning when they wake up, and taking the first steps of the day is a painful process to undergo. This is due to the tightening of the plantar fascia during sleep. Stretching the plantar fascia before standing up can have significant results and often reduces the heel pain.

Stretch the foot by flexing it up and down 20 times before standing. Use a towel and pull the heel towards you, stretching the bottom of the foot.

Exercise 2

Stand 6 to 8 meters away from a wall and lean towards it while keeping the knees straight and heel firmly flat on the ground at all times. There will be a slight strain on the calf muscles and you can feel your Achilles tendon starting to tighten up. Holding this position for 15 seconds, repeat it 10 times each set, doing it throughout the day. Thru this exercise, the Achilles tendon and calf muscles can be stronger and much more flexible.

Exercise 3

Place marbles and a cup on the floor. Using only the toes, lift the marbles up one by one and place them into the cup. Repeat the exercise for 10 times, 3 sets each time. This not only stretches the muscles, it also improves the coordination skills of you.

Exercise 4

Place your left leg infront of you and keep it flexed. As you bend your right knee, lean back slightly. You should notice your pelvis tilted forward. Keep the upper body straight and hold the position for 15 seconds, then switch sides. You should be able to feel a strain all the way up the back of the extended leg.

Exercise 5

Standing on the floor barefooted, raise your heels up slowly while using the balls of your feet and toes. Hold the position for 5 seconds and slowly go down again. Repeat this exercise 10 times, 5 sets each.

Exercise 6

Either with or without shoes, move your foot around your ankle drawing a big circle with your big toe in the air. Do it both clockwise and anticlockwise and repeat as many times as you like.