November 24, 2009

Plantar Fasciitis…or not

“I started getting a pain on the bottom of my foot near the heal but I’m not sure if it’s actually Plantar Fasciitis. I’ve been doing a lot of trail running (at night)and my feet (and ankles) take some abuse. I’ve twisted them, banged them, over-flexed them, etc..My problem foot is weak, especially when I rotate inward or point my toes. Kicking a soccer ball would hurt, for instance. This pain would be more towards the top of my foot, right where it attaches to the leg. I can walk, even run with it with hardly any pain…until I twist my ankle or land on a rock on the bottom of my foot.

I don’t want to panic and think it’s PF, but I’m not sure what to do for treatment. Any ideas would be helpful.”

Steve

Steve, it seems like you are describing two different problems – on one hand, the pain under the foot near the heel sounds a lot like plantar fasciitis to me and then the pain on the top of the foot, like the pain you describe while kicking a ball sounds like it could be related to your ankle or the talo-crural joint or possibly an old high ankle sprain.

plantar fascia irritated

If it is your ankle joint, then you can have a qualified physical therapist perform a distraction manipulation of the ankle which would allow the Talus to re-seat and that in turn should resolve the pain on the top of your foot that occurs when you load the foot in to plantar flexion.

x-ray talocrural joint

OK? Good luck!

July 14, 2009

The Case for Barefoot Running

As an orthopedic physical therapist who builds custom orthotics and provides custom orthotic therapy, one might be surprised that I am also an advocate of barefoot running.

I believe that running around barefoot forces the foot into an ideal posture for running unlike the sophisticated running shoes on the market today that allow and even encourage   running.rearfoot strike

The runner who is a “heavy striker” is a great candidate for barefoot running. While there have not been many studies examining the benefits of barefoot running compared to shod running, the fact is that there is a lower incidence of chronic injuries associated with barefoot running. In fact, an article in Sports Science notes that “running barefoot is associated with a substantially lower prevalence of acute injuries of the ankle and chronic injuries of the lower leg in developing countries”.

The heel strike is a normal    part of the normal gait cycle in walking, but in running, it is preferable to be a mid-foot striker rather than a rear foot striker.  Heel strikers are “puling themselves along” while mid foot and fore foot  strikers are “pushing themselves along”.  I encourage heavy plodders to try to run on their toes in order to move the strike toward the forefoot. In contrast, look at this image and see both the body posture of the runner and how by leaning forward his strike is naturally more underneath him, and as such, is naturally more of a forefoot or even mid foot strike. forefoot strike

I have found that one of the best ways to do this is to run barefoot. By running barefoot, there is a tendency to stay off the heel because excessive heel strike is actually painful, which should tell us something about the way the foot is designed. Remember, there is good evidence from at least a couple of world class runners, that barefoot running does not interfere with performance and, it may be argued, that barefoot running might even enhance performance.

I also want to promote a great new shoe to assist one in their barefoot running efforts. The Vibram Five Finger Classic Water Shoe, shown below is a really useful way to get into barefoot running so that as one does so the risk of injury to the sole of the foot is minimized.

Vibram Five Finger Classic Water Shoe

Vibram Five Finger Classic Water Shoe

The shoe is available at REI for example, and costs about $75.00. Pretty good value. The people I know who are wearing the shoe are very impressed with the feeling they have about the shoe and how it gets them onto their toes during their runs.

So the take away is this: If you are having trouble as a runner with chronic injuries, or if you are a really heavy striker and you can hear your self running, or if you describe yourself as a really “heavy” runner, then you might be a really good candidate for barefoot running to help you re-educate yourself to be more of a forefoot or even a mid-foot striker.  If you go in this direction, then the Vibram Five Finger Classic Water Shoe might be a good solution for you.

December 8, 2008

My Foot Still Hurts After Months, What Gives??


Plantar Fasciitis causes really painful feet, especially in the bottom of the foot near the heel. I agree that it can be difficult to treat, and so I am going to share my “secrets”.

First of all, lets establish that you actually have plantar fasciitis:
- You experience persistent pain under the foot that is worse in the morning, worse with every step.
- If you press near the heel under the foot, it HURTS
- You do better with heavy boots, or at least with stiff soled shoes
- You have had only marginal relief with NSAID’s

OK, so this is how I treat this injury:
1. Ice massage every day.
2. Night Splint every night
3. Small steps in the morning
4. Low Dye tape protection
5. Ultrasound in physical therapy
6 Discontinue activity temporarily
7. After the injury calms down (about three weeks) then start stretching and strengthening
8. Custom orthotic therapy
9. Gradual return to loaded activities.

This is an example of a Plantar Fascia night splint. Some are more elaborate than others, but this one is a good one.

Lets say you try the above and it STILL does not seem better, then I have my ace in the hole….Crutches. Yep, you have to go non-weight bearing for 6 weeks, and also do all the items above as well. Honestly, I have helped hundreds of people recover from persistent Plantar Fascia inflammation using this strategy.