Category Archives for "foot pain"

Foot Pain – Heather Camenzind

Heather: So we had a warm stretch here in Vancouver, and it pretty much felt like summer. And the client came in the week after just saying, Oh, the bottom of their foot, like along the arch was really sore. And after talking to them about like what had changed, a very common question that I asked with foot pain is, have you changed your footwear recently or any changes there?

And it turns out that with the warm weather they had transitioned from wearing like more of like a running shoe or more supportive shoe to just a basic flip-flop, like the ones with the foam. Very very standard kind of flip flops that you see. And that can contribute to their pain that they're having. So that's what we're here to talk about today. 

Mark: So is that a function of just kind of transitioning too quickly into changing the footwear? 

Heather: Yeah, exactly. It can be a shock to the foot. If you think about what your foot is doing when it's in a running shoe, there is actually a little bit of a heel lift. So your heel is elevated within the shoe. So your foot gets used to that position. And also just the forces and the pressures that are going through your foot get used to that. And then when you transitioned to something like a flip-flop or just being in your bare feet more outside, your feet aren't strong enough.

They're used to being in this very compressive shoe, this very supportive shoe, and then you walk around and your foot can splay more with the flip-flop or even just in your bare feet and your feet aren't ready for it. As well as then the heel is no longer elevated, it's quite flat. So that puts a lot more strain on your calf and in through the bottom of your foot. 

Mark: So I have some other questions about that, but let's talk about how do you diagnose what's going on? And then what's the treatment protocol.

Heather: Yeah, so it always starts with a detailed history. So like I said, with this person, we found out kind of that something had recently changed in their life. And then you go into more of the, we call it an ergonomic assessment. So we watch how they walk and we watch how they stand, and then we do like a manual assessment. So we get our hands on the foot and we test out muscle length, some muscle strength, and then also just the joint mobility. So in the foot there's so many little bones and how are they all moving and how do they move within one another?

And sometimes there's something stiff, but often it's something that's a little bit tight. And one of the common things we see is calf tightness. And that's what this person presented with, this calf tightness. 

Mark: So is that just then prescribing some stretching exercises or is there more, do you pull out the needles?

Heather: Yes, we can pull up the needles and we can do something called IMS. And so that can be very useful in releasing that tension, especially something in this case where it was something very acute. We can often mitigate that pain in one or two sessions quite quickly for the person, with something like IMS. But also then we can just do some manual release like massage in through the foot and stretching, and then following up with some home exercises for this person. 

Mark: So foot pain, I'm sure it's something not just switching from winter footwear to summer footwear, but what about shoes breaking down?

Heather: Absolutely. So shoes can become, they do, they break down. The rubber, especially in running shoes, they break down, you can see that maybe you flip your shoe over and you look at the bottom and you look at the wear pattern on it that you've worn down more, maybe more, a part of a heel or more part of, one part of the shoe than the other, or just the rigidity within the shoe.

You take the shoe and you kind of like bend it and you should have, not all shoes, but some shoes, most shoes have some rigidity to them a little bit. And some of you can just kind of like fold up. And if we're used to going from a more rigid shoe or your shoes and slowly breaking down, sometimes you can detect that.

I myself know when it's a new time I run a lot. I know it's time for a new pair of running shoes. My knees start to hurt. When I run, I get new running shoes and the pain goes away. It's one of those like telltale signs for myself. That I know it's time that my shoes and the cushioning and my shoes are broken down.

Mark: Yeah. I've learned for myself now with how much I walk, that it's three months. I got to change them every three months. They're toast. 

Heather: Yep. Yeah. Yeah. It depends on everybody. They kind of people, they kind of figure it out. They know yep, it's that time. They walk that certain distance in that time. Or they run that certain distance or something and it's time for the new pair. And it's unfortunate sometimes the shoe looks really good still. Like it still looks, it still looks brand new, but it's just, it's lost that cushion. 

Mark: Yeah, my wife was complaining about how her feet were sore. We went for a walk the other day and her shoes are a year old, only oh they're only a year old, they still, there was nothing there. Tissue paper. What about barefoot running? Barefoot shoes, all that kind of stuff. What's your experience with that? 

Heather: There's definitely a time and a place for them. They're not for everybody. But the thing with barefoot shoes and barefoot running is that we have to transition to it slowly. So we can't just go from wearing our traditional running shoe to something that's very minimalist with like a zero drop or something like that. You have to ease yourself into it. So it's kind of like any training program. I encourage people, say, okay, you have to train yourself up. So you start with maybe 10 minutes of running in your minimalist shoe. And then you could even increase that distance or the time, and you have to train your foot and your body. It's not just your foot, but it's actually training the whole way up the chain that your body needs to adjust to that. There's nothing wrong with them. People just often transition to them way too fast. And that's where we see breakdown or injuries happen. 

Mark: So you mentioned how, you know, when it's time to change your shoes, cause you get knee pain running. How much do your feet being properly supported, affect the rest of your body and how can that show up? How have you seen that show up for people? 

Heather: It's very common. You think about our feet support us. We're often kind of abuse our feet. We don't really pay much attention to them, but they're what hold us up all day. Our feet are working so hard and they're brilliant in how they're designed to support us.

But there's lots of things that can go wrong in the foot. Often we get weaker in the foot. And a lot of people see these flat feet, that means their arch has collapsed. And then you see that transition up the chain in that you see then there's more pressure on the inside of their foot, which then puts more pressure on the inside of their knees. And then up into the hips and into the low back, you see these shifts that people do within their bodies to compensate for those changes within their foot. 

Mark: Any quick exercises that you would recommend that people use to maybe strengthen their feet a little bit.

Heather: Yeah, so strengthening and stretching. Common stretches I give for any foot person, any foot injury is a calf stretch. So most people know it's like the good lunge stretch, stretching with your knees straight, and then also bending your knee a little bit in that position. And the other stretching or soft tissue release that I often recommend is just ball rolling on the bottom of your foot.

And the way you recommend people do that is thinking about rolling from your heel and then roll the ball along, kind of pretend this is your foot, you roll from your heel along the line to your big toe. And then you go back and then roll along the line to your second toe and go back and then to your third toe and go back. And it gets all the different muscles and lines along your foot. Rather than just kind of, most people just kind of roll in the middle and we want to get all these different lines. 

In terms of strengthening, there's many different ways you can strengthen the foot. One is just doing a really gentle calf raise and focusing on coming up square on your foot. A lot of times we curl our foot or our ankles turn out and learning how to come up. Where on the foot. So you're across the whole, all the toes are equal. All the way to cross your toes as equal is really important. And that's actually quite hard when you get people to control it slowly on the way up. And then that get them to control it slowly on the way down. Is really nice functional strengthening for the ankle and the whole foot. 

Mark: If you've got some foot pain and you want relief. Go see Heather at Insync Physio, you can book online at insyncphysio.com. She's in the Cambie Street office. Or you can call them (604) 566-9716. Get in there. Get ready for summer. It's gonna happen. It will. Thanks Heather.

Heather: Bye.

Heel Pain – Achilles Tendinopathy Isometric Holds

Start with one foot halfway off a step. Maintain your foot in a neutral position and hold this position for 10 seconds.

Relax your foot. Perform this exercise for 3 sets of 10 repetitions.

This is a great exercise in the acute or early stages of Achilles tendinopathy, a condition involving the overuse of the Achilles tendon. 

Heel Pain – Achilles Tendinopathy Eccentric Heel Drops

Start standing with both feet halfway off a step. Push through both of your big toes to lift your heels up as high as possible.

Remove the unaffected leg, and then slowly lower down the affected foot into full range below the level of the step. Bring back the unaffected leg and push through both feet once again, repeating the exercise.

Perform this exercise for 3 sets of 10 repetitions.

This is a great exercise in the later stages of Achilles tendinopathy which is a condition involving the overuse of the Achilles tendon. 

Foot and Heel Pain – Low Dye Tape Support

So anchor strips. So you want to make sure that you're not at the metatarsal. Okay, so stay off of the MTP area on that part. 

Below the head you mean? 

Yeah below the head of the metatarsal. And you're going to apply with no tension, and you can leave a gap there. So you didn't do a couple strips, but because Lisa's got a bit of a smaller foot, like with yours, maybe I'll do like two strips right. And so for you, remember, you want to make sure you over lap by half, right? 

Yep. 

Okay. So I normally like to go a little bit thinner than this. I usually do like thirds. So I'm going to get you to turn over on your tummy, with your leg hanging off. Okay. So...

I know it's hard, but just be careful with that.

Okay. So...

Do you wanna switch spots.

Alright. So if they're getting pain in through here, you want to support that. So there's a few different ways of doing it. You can vary it up depending on how they feel. Make sure you start off with anchor strip here in the inside. So you want to eventually overlap by half as well. So if you're using the small strips, then you've got to be careful with that.

So you want to start off sort of more right on the medial aspect. And make sure that you don't put too much pressure in through here. You're not cranking. So that's important, because otherwise it's going to get really uncomfortable for her right. And don't go too high. If you go too high, then it all starts to rub under this area, which will be uncomfortable.

So you want to stay right on the calcaneus here. And so you want to also go right to the lateral side as well. So you can do that or you can come in, depending on if she's getting a little bit more sort of pain down through here, to support that a little more. You can do a little teardrop. So really important that this, so what I just did there, you don't want to do, because I'm also talking through this, right, you want to be able to not let it wrinkle. Okay, so that's the first strip. I always go medial lateral, medial lateral, medial lateral. Okay. Sometimes three strips on each side may add too much discomfort onto here. So sometimes I'll go maybe three and two or just two and two.

What if you just do an X?

You can do that too. Yep.

Just go from that side to that side. Just one variation is what you're showing.

Yeah. So you can even just go straight across, so you can just do like a U. Or so with the X, see how it causes the X so you can do that's where I'm supporting in through here a little bit more.

Why would you choose one over the other?

Just depending on what's going on from the ... oh yeah I can get a lot of pain in through there. Then you can support that, that area a little more there, or if it's more immediately then I'll and go that way a little more. Okay. So if that's what I choose and I'm just going to keep repeating that. And so the reason why I started more immediately is because I'm going to go more towards the plantar area. So here I'm going by a half, and then I'm actually overlapping the whole thing and then coming overlapping by half again. Okay. Like that. Sorry that's a  U strip. So this is where it gets a little tricky.. 

When is just the U strip beneficial?

It will support the bottom part more. So if you get a lot of like, tightness in through here, it'll support this area more, right.

More that the X?

Yeah. I mean, they're both really good. Sometimes this can really just give you a lot more support just in the whole heel too, right. And the strain off of here. So laterally. So I'd probably just go two strips with her and then, you know, if she's like, Oh yeah, you know, I do get a little more here, then I can do one strip or next strip, one cross strip, and then one U strip. Just be really careful, you don't hold again. And then, we need you to turn back on your back please.

Okay so because I also want to make sure you remember how I said it supinates a little bit, so I want to go this way. Just so that way, it just helps to bring it back into a little bit less supination, right. So that's the anchor strip. Now here I can also go, I'm just to cover that up, because remember we talked about last week, you want to avoid windows, right? So this has a little bit of a window there, that might be a little bit uncomfortable and sometimes we're like, Oh no, I don't want that up there because it'd be uncomfortable to your individual, right? 

So you can go all the way up, or then you're like, Oh yeah, that's, so you can leave it there and just close it there. That's okay because these windows aren't as bad. Okay. It's the windows that are up in through here because how she moves, that doesn't really move right. So that's not going to be a big issue. But I like to cover it up sometimes, but sometimes they'll be like, Oh, that's uncomfortable. I like to put an extra one on.

I’m going to get you to stand on the table with only like 10%, so stand on the table with most of the weight on that leg or on your knee is actually fine. And then you can just relax… So basically, what we’re going to do when I ask you, you're going to press down as hard as you can. Press down as hard as you can. Okay. And once she's got that a hundred percent weight bearing, then we close it off, right. So that way that gives it that breathability and that sort of flex. Ok a 100% and it closes the anchor strip. And a 100%, there you go.

What is Flat Foot?

When you look at a foot, there is typically a gap underneath the inner part of the foot when you stand. This is your arch. This arch provides the spring in your step, and allows body weight to be more efficiently distributed across your feet and legs. The structure of the arch can also determine a person’s gait. People with flat foot will have something known as a fallen arch, where they have either no arch in their feet or an arch that is very low to the ground. A common cause of flat feet includes genetics, as this is a trait that can be passed on from parents through genes. Having weak arches, or a foot/ankle injury can also lead to a flat foot. Flat foot can also come with age, as well as many other factors.

If you’re looking at your feet right now and discover that your arch is low or absent, you don’t need to worry. Flat foot only needs treatment if it causes discomfort, or leads to pain in another part of the body. Many people seem to have a low arch or no arch without ever experiencing any pain. 

Exercises to manage symptoms of flat feet include:
Heel Stretches

  • Keep one leg forward and the other behind you
  • Press both heels firmly into the floor, while keeping your spine straight
  • Bend into the front leg and push yourself against a wall with your arm to feel a stretch in the back leg and Achilles tendon.
  • Hold this position for 30 seconds and repeat on each side. 

Golf Ball Roll

  • Sit on a chair with a tennis or golf ball under your foot
  • Sit straight while you roll the ball under your foot, focusing on the arch
  • Repeat for 1-2 minutes.

Towel Curls

  • Sit in a chair with a towel under your feet
  • Push your heels into the floor and curl your toes to scrunch up the towel
  • Hold this for a few seconds and release. 

Other methods to treat flat feet include orthotic devices, motion control shoes, or going to physical therapy to correct flat feet, in the case that it is a result of injury or poor form.

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Turf Toe Injuries/MTP Sprain

What are Turf Toe Injuries? 
Commonly reported as a sports-related injury, turf toe refers to a condition where there is damage to structures around the big toe caused by hyperextension (bending the toe back too far) (McCormick & Anderson, 2010). Pushing forcefully off the big toe, as people do when they begin to run or jump, places repeated stress on the metatarsophalangeal joints (MTP) around this area. Sports that involve frequent stopping, starting, and sudden changes of direction (e.g. basketball, soccer, etc.) can be a main cause of turf toe. 

Symptoms of turf toe include pain when extending the big toe, or bearing weight upon it, a “popping” feeling in the foot when the injury occurs, swelling and inflammation, as well as instability and limited movement of the big toe. According to a report by McCormick & Anderson (2010), most turf toe injuries are mild and do not require surgical treatment, however in more severe cases, surgical procedures may be necessary. 

Doctors grade turf toe injuries from 1 to 3 depending on the extent of damage to the MTP joint, sesamoids, and surrounding tissues, ligaments, and tendons (McCormick & Anderson, 2010). 

Grade 1: Plantar complex is stretched, leading to tenderness and swelling 

Grade 2: Partial tearing of the plantar complex, resulting in tenderness, swelling, and bruising. Movement is restricted

Grade 3: Plantar complex is torn, leading to severe tenderness, swelling and bruising. The toe is very painful and difficult to move. 

Prevention?

  • Wearing flexible footwear while running on artificial turf, or other hard surfaces
  • Wearing shoes with better support, to stop the toe from bending excessively when a person pushes off of it
  • A physical or sport therapist can work with individuals to correct an problems with their gait, which could enhance their techniques while playing sports
  • Performing exercises and stretches such as the following, to improve body alignment (Jenn, 2016):
    • Shin Dorsiflexor Release
      • Find a stable, firm surface roughly at knee height
      • Place a tennis ball under the front of the shin and kneel onto it
      • Move the ball along the sore spots to target the entire muscle
      • Perform on each leg for 3-5 minutes
    • Soleus Release
      • Sit on the ground with your lower calf on top of a tennis ball or foam roller
      • Place the other leg over the one being released to add pressure
      • Roll yourself up and down over the ball, focusing on the tender spots
    • Big toe mobilization with movement 
      • Stand with one foot in front of you, and one behind, with the weight on the front foot
      • Anchor a resistance band attached to your front foot to a chair behind you
      • Rock your front knee forward as far as you can without raising your heel, pushing your knee outward
      • Repeat for 3 sets of 10

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Jenn, F. (2016). Podiatrist-recommended turf toe exercises for athletes. Retrieved from https://healingfeet.com/sports-injury-2/podiatrist-recommended-turf-toe-exercises-athletes

McCormick, J., & Anderson, R.B. (2010). Rehabilitation following turf toe injury and plantar plate repair. Clinical Sports Medicine. 29(2). doi:10.1017/j.csm.2009.12.010

Heel Spurs

What is a Heel Spur?
Being the largest of the 26 bones in the foot, the calcaneus, or the heel bone, absorbs a majority of the weight of the body. A heel spur is a bony growth that forms on the bottom or back of the heel bone (“Heel Spur”, 2005). Heel spurs are often related to a condition called plantar fasciitis, however it’s important to not get the two mixed up. A heel spur is a bony projection that occurs from the bottom of the heel along the plantar fascia, whereas plantar fasciitis is caused by an inflammatory process where the plantar fasciitis attaches to the heel due to an abnormal force being placed on it. It is important to differentiate between the two since plantar fasciitis will subside on its own over a period of time, whereas a heel spur will be there permanently, unless surgery is required.

Symptoms of heel spurs can include pain, inflammation or swelling at the front of your heel (“Heel Spur”, 2005). The symptoms can spread to the arch of your foot, and a small bony protrusion may be eventually visible. However, only about 50% of people with heel spurs experience pain from them or even see a change in the soft tissue or bones surrounding the heel. Therefore, heel spurs are often discovered only through X-rays and other tests done for foot ailments.

Prevention?
Heel spurs can be prevented by minimizing wear and tear
· Wear well-fitting shoes with arch support and shock-absorbent soles
· Avoid exercises that involve jumping or repeated stress on hard surfaces, such as pavement or concrete
· Avoid prolonged walking downhill or rocky or uneven surfaces
· Warm up with calf and foot stretches before exercising
  · 1-Legged Squat

  · Wall  Squat On Exercise Ball

  · 1-leg bridges with thera-band isometric
  · Strengthening Ankle Stabilizer Muscles

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Heel spur. (2005). Postgraduate medicine 118(1). doi:10.3810/pgm.2005.07.1689

Plantar Fasciitis

Causes
Plantar fasciitis may be the most common cause of heel or bottom of foot pain. It is common among runners and athletes due to the repetitive stress on the feet with running, sprinting and jumping. It may also occur after wearing footwear with inadequate support, or when you have a change in daily tasks (e.g. starting a new job where you’re on your feet most of the day when you were previously at a desk job with mostly sitting). It may also be a side effect of tight calf muscles or Achilles tendon as this would create greater pull on the heel bone. Wearing high heel shoes can be a factor in the development of plantar fasciitis. Those with either particularly high arches or particularly flat feet may also be at greater risk for developing plantar fasciitis. Whatever the case may be, the repeated stress and strain on the plantar fascia causes an inflammation of the fascia itself.

Symptoms
Pain in the heel or bottom of the foot is the major symptom of plantar fasciitis. It is pain that is usually localized to one spot and is tender to the touch. Pain is likely worse in the morning after the first few steps out bed and eases up as the day goes on. It is important to note here that if the pain is excruciating and you cannot put weight on your foot, it is a good idea to seek out an x-ray or doctor’s assessment to rule out stress fracture. If you are able to bear weight and walking makes it better, it may be more likely that are you are dealing with plantar fasciitis. 
Treatment
Treatment is likely to include exercises to loosen the calf muscle and stretch out the plantar fascia. Something simple such as flexing and pointing the feet a number of times before getting out of bed can help.
In the image above, the patient is shown stretching the bottom of the foot. This is done by flexing the foot (and stretching the Achilles tendon) and also flexing the toes. By flexing the toes, this creates a deeper stretch along the bottom of the foot. Anything that stretches out the calf muscles is also a good idea. If stretching alone is just not cutting it, try using a foam roller to roll out your calf muscles and a golf ball or foot roller (which can be found at many dance shops) to help ease the tension on the heel bone (i.e. the calcaneous). You can also see your massage therapist to have them work on that tension.
If you usually wear high heels, try wearing ballet flats or a lower heel until pain subsides. If your shoes are worn out, invest in a more supportive pair. Or if new shoes aren’t in the budget, try using an arch support from the drugstore in your old shoes and see if it makes a difference. Use ice on your heels at the end of the day to try to decrease inflammation. And as usual, come see your physio or RMT for more specific recommendations because being on aching feet all day is not fun.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Plantar Fasciitis Release Technique

Plantar Fasciitis

The name may sound mysterious, the experience isn’t. Millions of people undergo any number of the following on a daily basis: a pain in their heel the moment their foot hits the ground in the morning; tenderness in the heel and arch area; pain in the heel or arch area after taking the first few steps following a long period of sitting; discomfort and throbbing in the heel and arch area after long periods of standing.

What It Is

Plantar fasciitis is painful inflammation of the heel and bottom surface of the foot. It is generally caused by overstretching of the fibrous tissue (fascia) that connects the heel to the forefoot.

Breaking the injury cycle requires an overall approach, examining critical elements such as postural alignment, biomechanics, musculoskeletal balance, correct footwear and training.

In addition to working on larger corrections in your posture, stride, strength and flexibility, here are a few specific tools to help you get on your road to recovery:

Reset It

Bend the knee of your exercising leg. Place your hands under your metatarsal heads and toes. Flex your top arch and toes toward you. Move until your natural end range of motion. Gently assist with your hand as you continue to move. Return to start position. Exhale as you flex your toes and arch toward you. Inhale as you return to start position. Repeat for two sets of 8-10 repetitions.

Stabilize It

Assume the same starting position as your “reset” exercise–bending the knee of your exercising leg. Place your hands under your metatarsal heads and toes. Extend your toes and top arch toward the ground. Resist with a gentle pressure with your hand resting on the top of your foot. Exhale as you move. Inhale as you return to start position. Repeat for two sets of 8-10 repetitions. Increase resistance with your hand as you get stronger and your body adapts and adjusts to the exercise.

Release It

While seated, cross your affected leg over your opposite thigh or bend your knee. Using your thumb or fingers start applying a very gentle pressure between the inside of your heel and inside anklebone. Because your fascia may already be inflamed, go slowly, allowing your thumb or fingers to be taken into the distorted tissue. You can use a muscle salve or a more adhesive substance for a better grip. Take the time to allow the micro bundles of your facial fibers to unwind at their own pace.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Tips for Living with High Foot Arches

High foot arches are surprisingly common, but they can create problems for people who do not know how to best live with them or perhaps do not even realize that they have high arches. High foot arches do not support the body properly and tend to place excess pressure on the pelvis, which can eventually result in postural problems. High arches can be the result of a congenital abnormality, trauma, or sometimes even a neurological disorder.

Do I have high arches?

If you have any concerns about your feet, then a visit to your local podiatrist is always a good idea. Your podiatrist will be able to determine if you need a particular type of shoe , over-the-counter insert, or custom orthotic to support your foot. An easy way to check whether you have high arches is to look at your footprint any time you are in bare feet. If your footprint shows a curved, narrow print with only a thin strip connecting the heel and ball of the foot, then you probably have high arches.

What are the common problems resulting from high arches?

The biggest problem for people with high arches is that their foot tends to supinate, or roll outwards, while walking or running. This can lead to pain while walking or running as the high arches are not supporting the body correctly; the side of the foot makes contact with the ground first and normal pronation does not occur. If you are not sure whether your foot supinates when you walk you only need to take a look at a pair of shoes that you have worn for a while. If your shoes have more wear on the outside than on the inner edge of the shoe, then you know that your feet roll outwards as you walk.

If you do have this problem, there are a few things you can do to make your life easier:

  • Try to maintain your ideal body weight. Being overweight can cause problems for anyone but as high arches do not support the body properly supported the problem is worse for those with this condition.
  • Buy stable shoes with good arch support. The pain you experience after walking or running can be reduced by distributing your body weight evenly – cushioning your feet with arch supports will help to spread out the weight.
  • If none of these options help to relieve the pain you experience then it may be helpful to purchase an orthotic insert to address your issue.
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.