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The Top 3 Reasons Why Foot Pain Occurs And How To Fix Foot & Heel Pain For Pain Free Walking & Exercising 2020John Dean, DPTMid-Michigan Physical Therapy SpecialistsThe Top 3 Reasons Why Foot Pain Occurs AND How To Fix Foot & Heel Pain For Pain Free Walking & Exercising!About The Author:John Dean, DPT has been successfully treating individuals with foot pain and lower extremity issues for more than 25 years. He graduated from Ireland’s Trinity College Dublin School of Physiotherapy in 1988 and then earned a Master’s Degree in Orthopedic Physical Therapy in 1990. He subsequently earned his Manual Therapy Certification in 1993 under the guidance of World Renowned Physiotherapist Dr. Stanley Paris. Throughout the years, he has taught at the University of Michigan PT Program and has also taught numerous Physical Therapists how to successfully treat individuals with foot and ankle pain. He is also one of less than 100 Physical Therapists (as of 2018) in the USA that is Board Certified in both Orthopedic and Sports Physical Therapy.Health Advice DisclaimerThe information contained in this report is intended to provide helpful and informative material on the subject addressed. It is not intended to serve as a replacement for professional medical advice. Any use of the information in this report is at the reader’s discretion. The author specifically disclaims any and all liability arising directly or indirectly from the use or application of any information contained in this report. A health care professional should be consulted regarding your specific situation.Copyright Notice:Any unauthorized use, sharing, reproduction or distribution of this report by any means, electronic, mechanical or otherwise is strictly prohibited. No portion of this report maybe reproduced in any manner whatsoever, without the express written consent of the author.Foot Pain IncidenceIt is estimated that 10% of the population will experience foot/ heel pain during the adult life and 83% will be between the ages of 25-65Foot & heel pain, it is roughly estimated accounts for 1-4 million physician visits/yearThere is a high incidence among walkers & runnersAchilles tendinopathy has been reported to occur in 7-9% of runners annually (Carcia et al JOSPT 2010) – with the highest incidence among middle aged malesWhy Foot Pain OccursThere are multiple reasons why a person may experience Foot/ Heel and Ankle Pain which include the following:CharacteristicsPosterior tibialis tendinopathyPain will tend to affect the inner aspect of the foot. This muscle helps provide support to the medial arch of the foot AND helps control pronation & becomes inflamed when overloaded Fat pad atrophyThinning of the fat pad, common in the elderly and more often in women According to 1 study: This may account for 15% of people with heel painFat pad syndromePain, center of the heel & feels like a bruise and maybe due to trauma or excessive heel strikeSystemic arthritic conditionsHeel pain maybe present in conjunction with pain elsewhere, as well as other symptomsCalcaneal (heel) bone spurWhich may occur in response to PL (Flat feet)Calcaneal stress fracture Pain w/activity (Positive squeeze test) Achilles TendinopathyPain is typically experienced above the heelLow Back Condition w/Nerve involvementEspecially S1 nerve weaknessPelvic asymmetry / SIJ dysfunctionCausing a functional leg length differenceHip (gluteal medius) abduction weaknessCausing abnormal mechanics + ? overpronationPlantar Fasciitis MOST COMMON REASON for FOOT PAIN Ankle sprains & strains Typically the result of ‘rolling’ the ankle, withOuter aspect of the ankle most commonly affected. Note: Without comprehensive rehab. the chances of a 2nd injury increase > 700%Bunions/ Big Toe StiffnessBecomes symptomatic 2nd to an abnormal gaitMetatarsalgiaPain typically noted in the ball of the footFoot & Ankle fracturesSite dependent on the injury sustained.while it is possible if you have sought medical advice for a shoulder condition or undergone testing that you may have been informed that the reason for your pain is one of the reasons listed.At Mid-Michigan Physical Therapy Specialists, we have successfully treated individuals with all of these foot and ankle problems, as well as following surgical corrections, reconstructions & joint replacements. In this report, we are going to share with you some key details about the 3 most common reasons for foot pain and these account for a high percentage of people with foot pain.Reason #1 The Achilles TendonThis is the largest and strongest tendon in the body. It is formed by the 2 principal muscles of the calf ( the gastrocnemius and the soleus) as the distal portions of these muscles merge, while the tendon then inserts into the base of the calcaneus ( heel bone). It is a structure that is very prone to injury, due to it’s poor blood supply. An acute injury of the Achilles tendon involves inflammation of the tendon and is referred to as a tendinitis ( commonly sharp localized pain is noted ) while if the injury is more longstanding (chronic) a degenerative process is present and it is referred to as a tendinosis (often associated with a dull pain, which gets worse w/activity)What Is The Role or Function of The Achilles Tendon / Calf Muscles?Walking : The calf muscles (via the achilles tendon) exert a force on the foot causing it plantar flex, which aids in the propulsion phase of the gait cycle ( ie push off)Running: If the runner is a ‘Heel Striker’ the calf muscles ( via the achilles tendon) work in a similar manner as the walker, however the force is considerably GREATER!If the runner’s is a ‘Mid / forefoot’ runner, peak calf muscle activity ( confirmed by EMG) ( ie greatest stress on the achilles tendon) occurs at initial contact as the muscle works eccentrically to a) decelerate ankle dorsiflexion and b) decelerate subtalar pronationWhy does the achilles tendon get injuredIf tensile forces on the achilles tendon become too great, it becomes over loaded and the achilles tendon tissues are strained (while small tears may also develop) and the tendon becomes inflamed!Reason #2The Plantar FasciaWhat & Where is it AND What does it DO? It is described as thick connective tissue (sometimesdescribed as a web like ligament) that is attached to your calcaneus (heel bone) and then runs along the bottom of your foot to attach to the ( head of) your metatarsal bones, which are the bones between each toe and the bonesof the midfoot, while it is described as shock absorbing bow string that helps to support the arch of the foot!Why does it get injured (Plantar Fasciitis)?Similar to the achilles tendon, if tension or stress on the plantar fascia becomes too great (ie it’s over loaded) the plantar fascia becomes strained (while small tears may develop) and the fascia becomes inflamed!Reason #3Posterior Tibialis TendinopathyThe posterior tibialis muscle /tendon helps provide support to the medial arch of the foot and helps to control pronation ( the degree and rate the foot tends to roll inwards) When overloaded, it can become inflamed and painful, while pain will usually be experienced along the inner aspect of the foot. It is commonly associated with people who walk or run for exercise, while poor footwear can be a major contributing factor.I hope you found this information helpful, while on the next few pages you will learn some strategies to help reduce your foot pain, regardless of the reason for your pain.10 Foot & Ankle Pain Smartest Self Treatment Strategies ( w/guidance)First :Avoid The No. 1 & No.2 Biggest Mistakes You Can Make: Ignoring or Masking The Problem! Then:Rest ! (ugh!) Tendons have a low metabolic rate/ poor blood supply which results in slower healing after injury. This is why initial rest is so important. If the person does not eliminate or at least reduce the aggravating stimulus, a tendon will be in a perpetual state of breakdown and attempted but failed healing!Activity modification (weightbearing) To help foot and ankle problems heal and to enable pain to subside, simply reducing the amount of time on your feet can helpEquipment: The importance of correct footwear cannot be stressed enough. Many people wear their shoes long after they should have been replaced, whereby the shoe offers little or no shoe absorption/ cushioning.It is recommended ( when you are trying to overcome a foot problem) to go to a running store and be fitted for a shoe, that specifically suited to your foot and YES you may have to pay over $100 for the right shoe- but it will be worth it!The importance of Sub Talar Neutral : This is the position whereby the foot is neither in a position of pronation nor supination – while it is (arguably) the optimal position of the foot and ankle to generate the most power during the propulsive phase of walking (or running) while placing the least overall stress on the achilles tendon & plantar fascia.If the foot is in an over pronated position, the alignment of the bones and joints of foot result in increased mobility / decreased stability of the foot, which in turn places increased stress on the soft tissues of the foot ( i.e. the Plantar fascia) while in contrast if the foot is in a supinated position, the alignment of the bones and joints of foot result in a rigid foot, which reduces shock absorption and will lead to injury!The ideal shoe for you ‘should’ put your foot in a neutral position ( ie neither pronated or supinated) when the foot is flat on the ground during the gait cycle.Adjust your training and/or walking and/or running formSpecific to the achilles tendons & the plantar fascia - increasing your cadence, reduces your contact time with the ground and this in turn reduces the strain on these structures – while focusing on your foot facing backwards immediately following heel off will help with this !Weight loss ( if applicable)There is a direct correlation between foot pain and a person’s Body Mass Index (BMI) – especially if it is above 30.0 and in turn, if this is the case weight reduction will help to reduce the stress on your feet and enable you to be more active.Reduce inflammation by icingWhen the tendons of the foot become over strained, inflammation ensues and soon after the person will experience pain. While will not address the biomechanical factors that led to the problem, it will help to reduce the inflammation that is present and in turn reduce the person’s foot pain, enabling them to walk with greater ease. It is recommended that you apply ice to the affected tendons for 10-15 minutes as often asa 3-4 times/ day.Taping There are a no. of ways that your foot can be taped to reduce stresses on the foot, facilitate healing and help reduce painImprove your flexibility, if applicableThis can be best accomplished using a combination of massage ( or self- massage using a massage stick) calf and foot stretching and for plantar fascia, the use of a Strasburg sockImprove calf & foot strengthIncluding exercises to improve foot strength and the posterior tibialis muscle.‘Hands On’ Physical Therapy: There is no faster proven effective way to reduce foot pain than working with a Physical Therapy knowledgeable in ‘Hands On’ Manual Therapy, who can also provide you with an individualized exercise program (specific for your condition and age) which should include a foot & lower extremity stretching regimen and also a foot & ankle strengthening program, which will not only help you in the short term, but thru ‘out your life. (Please note, this form of Physical Therapy for the shoulder is NOT typically provided in a PT hospital setting nor in a Corporate PT facility!)ConclusionSo, here you have several things you can do to help you TODAY to relieve foot pain, while there’s obviously so much more we can do to help you with your foot and ankle issues, but if you start by using these various practices throughout the day, you should notice a reduction in pain.If and when you are ready to consider starting a program of ‘Hands On’ Physical Therapy for your condition, you can either call Mid-Michigan PT Specialists (517-545-3200) to schedule a FREE Consultation with one of our Clinical Team or you may email me directly (jtdean@) to inquire if a program of Physical Therapy is the right choice for you or with any other questions that you may have. Thank you.Wishing the best of health,John Dean, DPTCo-Owner Mid Michigan PT Specialists PS. We commonly have FREE Foot & Ankle Workshops scheduled thru’out the year, so if you’d like to learn more about foot & ankle issues and get your individual questions answered, please call us today to inquire when our next workshop is being held and how to register.(517-545-3200)A Sample Of Foot & Ankle SuccessesFor months, whenever I would try to go for a walk, both my ankles and feet would start to hurt after only 15-20 minutes and it was quite frustrating. I 1st attended one of John’s workshops on foot & ankle pain to learn more about my condition and after just a few weeks of therapy on my feet and ankles, I was back walking painfree and I am now able to rejoin my wife for walks in the evening. Plus, the daily stretching program I learned to do, really helps! - Brian SuszkoWhen I first came to see John a few years ago, I could hardly walk. At the time, I was having severe foot and ankle pain – as I had had both ankles replaced. With his help and guidance, I made a great recovery and he even got me back biking. This year, my ankles started to stiffen back up again and some of my foot pain returned – again making it painful to walk. So, I returned to PT and once again received outstanding care, while with John’s help my foot pain was reduced to a level that has allowed me to get back to many of my regular activities. Jeff McNallyIf We Can Help Brian & Jeff, We Can Certainly Help YOU ................
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