Recently a 13 year old non-athlete came to our clinic complaining of left sided foot/arch pain the occurs if he is on his feet for extended periods of time and he wears non-supportive shoes such as flip flops or VANS. We asked him the typical questions that someone with plantar fasciitis would answer “Yes” to—
“Does it hurt in the morning when you get out of bed”?
“Does it hurt if you have been sitting for an extended period of time then get up to walk”?
“If it does hurt in the morning or after sitting does it warm up rather quickly and become less tight and/or painful”?
He answered “no” to all of the above questions suggesting he was not suffering from plantar fasciitis.
Next we measured the height of his medial arches while he was sitting and then again while he was standing. This measurement is known as the “Navicular Drop” measurement. The average Navicular drop is 3-5 mm. His measured 10 mm on his right side and 14 mm on his left (the side of pain). We then had him stand on a heat sensitive pressure board so that we could get a visual of his arch heights and also access him for heel or calcaneal eversion as opposed to dropped arches.
His left arch was noticeably lower than his right and he did appear to be suffering from calcaneal eversion.
During this inspection I noticed his right hip was higher than his left suggesting he might have an anatomical leg length discrepancy.
I had him lay on his back and measured his legs from his hips to his ankles on both sides. His left leg measured 87 cm and his right measured 88 cm making the right leg 1 cm longer than the left.
Anatomical leg length discrepancies can cause foot, knee, hip and back pain and can even cause functional scoliosis of the spine. Because he is 13 I won’t intervene yet to correct his leg length difference…..his body may very well do that on its own. However, I will measure him once a year to make sure it is not getting more severe and if it starts causing him more problems I will correct his difference by making a full length lift for his shorter side (left).
We determined that due to his leg length difference (Right long) he was “listing” to his left side putting more % of his body weight on his left foot resulting in the pain he is experiencing. We chose an off the shelf orthotic that has a deep calcaneal/heel cup which will reduce his calcaneal eversion. The insole also has an aggressive medial arch which will help support and raise his collapsed left arch and help even out his weight distribution.
We then instructed the patient on self care techniques like arch muscle strengthening exercises, self massage using a foot roller and stretching techniques for his arches.
The patient was scheduled for a follow up appointment so that we may customize his new orthotics by either raising or lowering the medial arch and providing either more or less support for his heel/calcaneus based on his feedback regarding his symptoms and comfort of the orthotic. In order for orthotics to be effective the patient must wear them. They will only wear them if they are comfortable. For this reason it is not unusual to modify orthotics in order to “dial them in” for each unique person.
If you have a foot, knee, hip or lower back issue and think it could be due to your orthotics or lack of orthotics please schedule an appointment with our clinic. You can email: Dr Allen@sdri.net / Call (858)268-8525 or Text (858) 322-8581.