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.