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foot pain

foot pain, Health, running

Heel pain running? Check your shoes and hips…

February 25, 2014 • By

Plantar fasciitis treatment and exercisesHeel pain running is one of the most common running injuries and can really put the brakes on living an active life. Today we will sort out some hidden causes behind heel pain!

Heel pain running is most often caused by Plantar Fasciitis and this is what I will be writing about today. The pain will be on the base on your heel – if it is on the back of your heel where your Achilles tendon attaches to the bone, that is another matter and I see to this in a future post.

Plantar Fasciitis is the 3rd most common running injury behind “shin splints” and Achilles tendinopathy(Lopes et al, 2012), yet is something than can be improved quickly if the right things are done to help it. Earlier in the week I wrote a post explaining Plantar Fasciitis and how re rehabilitate it at home. Have a quick read of that as it gives you a good base knowledge for what we will talk about next and also shows you the exercises you should be doing if you have heel pain.

 

Why check your running (or walking) shoes?

Windlass mechanism, heel pain - self treatment and exercisesThis is very important, especially with the new craze at the moment being lightweight, flexible footwear. Giving the foot move movement is fantastic if you have great foot mobility, flexible, strong calves and fascia. But if you don’t have that then these can really increase your chances of getting heel pain OR worsen it. This is because when you are running, as the heel comes up off the ground, your big toe is pushed up, putting the fascia on the bottom of your foot on stretch. This is a natural spring-like mechanism called the windlass mechanism, which when you have heel pain, can really tug, pull and stretch at your heel – Causing you more pain and inflammation.

So what is the best footwear to wear if you have heel pain?

It doesn’t matter if you have Plantar fasciitis, achilles pain or shin splints, this applies to them all. You should wear running shoes with a supportive arch (some padding under the arch), heel support (not zero-drop shoes) and with reaonably inflexible sole. Over all it is very important to get your shoe matched for you as every persons foot is different and moves in a different way, there is no perfect or “normal” way for a foot to move.

If you are trying to venture into minimalist running shoes or even barefoot running, it is very important to do this progressively as your muscles work very differently in different foot wear or lack there of.

A recent study by Shih, Y et al 2013 showed what affects load and stress on the muscles and tendons most is your running technique and not shoes. So it is important to get you technique right (form before footwear) before heading into minimalist shoes or making any big change. The study also showed that forefoot running (which a lot of people start doing when they go into minimal or no shoes) increased the work of your calf muscles – leading to increased risk of shin pain, achilles pain and heel pain.

Hips:

Often with lower limb injuries there is glute weakness that is contributing to this. Having string hips that can control your foot and knee, absorb force and power you forward is so important and if you are not already regularly strengthening your hips, you should add this to your routine.

First of all it is good to test you hips to see if you do have a problem: Have a go at this quick balance and stability test to see how you stack up.

And HERE is the glut strengthening for you that I prepared earlier – This can really decrease your injury risk and improve not just your running but everyday function.

End note: Minimalist and flexible shoes are not a bad thing if you go about it the right way but for heel, calf or shin pain they should not be your first choice.

 

Please like, share and let me know how you get on 🙂


foot pain

Plantar Fasciitis: Heal Fast and strong

February 22, 2014 • By

Plantar fasciitis is the most common cause of heel pain in adults and accounts for 10% of running injuries. I will show you the WHAT, WHY and HOW to treat it yourself!

How common in it really?

  • Accounts for 15% of all podiatry visits
  • Is bilateral (in both feet) in up to a 1/3 of cases!
  • 10% of running injuries

That’s enough stats to show you just how common this is and how important it is that you can treat and rehabilitate this yourself.  Unfortunately it is often looked at as a trivial injury and if not treated right can last for months to years, really stopping you doing what you love.

So what is it?

The plantar fascia is a strong band of connective tissue that starts at the bottom of your heel  and runs along bottom of the foot, attaching into the toes. It is important for:

  • Maintaining your arch when walking and running – tracking from your heel to the toes it stops them spreading apart as your land on and push off your foot.
  • Stabilises your foot: as you push iff your toe the fascia is put on more stretch, raising up the arch into a more stable position so you can propel yourself forward!
  • Provides proprioception – feedback to your brain about how your foot is moving
  • Facilitates good foot motion/bio-mechanics – Check out this post for the plantar fascia’s role in running and walking.

Plantar fasciitis is degeneration and a small amount of localised inflammation of the proximal fascia (the part closest to the heel). The most common area of pain is near the origin of the fascia at the base of the heel. Fasciitis happens when the fascia is overloaded, whether this be from:

  • Tight calves or Achilles.
  • Sudden increase in activity or training.
  • Poor footwear e.g. worn or over-flexible running shoes.
  • Hard training surface.
  • Arch being too high or too low
  • Or increased weight.

Plantar fasciitis treatment and exercisesThis overload produces excessive stress on the fascia leading to a lot of tiny little tears in the fascia. This causes your body to go into protective mode, starting an inflammatory (healing) reaction, which makes the fascia thicker, less flexible, more sensitive AND painful. If this is not treated properly, it gets stuck in a chronic inflammatory phase and can be very frustrating.

 

 

Symptoms – to see if you do have it:

  • Pain upon waking and taking your first few steps –This “start up pain” is because your plantar fascia and calves have been in a contracted, shortened position all night.
  • Sharp stab or dull ache in your arch or at the heel.
  • Pain after long period sitting.
  • Pain that eases gradually in a walk or run as it warms up.

The big question, so how do you get rid of it?

It is important to address all aspects contributing to  plantar fasciitis in order for it to heel strong, these include:

  • Foot wear
  • Calf tightness
  • Training volume
  • Inflammation and dysfunction of the fascia
  • Lower limb and hip muscle weakness

And this is how we you will do it:

Rehab exercises for Plantar fasciitis:

plantar fasciitis treatment1. PF rolling: In order to re-align the fibers in the plantar fascia and lengthen it out, it really needs a good deep massage. This works best with a hard ball (I use a lacrosse ball). The other option is to freeze a small water bottle full of water and roll this under your arch (the ice gives great pain relief at the end of a day!)

Roll the bottom of each arch between the heel and toes (not under the heel) for 2 minutes.

This should be done at least 2 times daily.

 

 

calf stretch , soleus, gastroc - self treatment for shin splints2. Calf stretch: Drop your heel off the edge of a step and hold it for 1-2 minutes.

This needs to be done 3 times daily (the more the better).

 

 

 

 

3. Hip strengthening: Often the foot gets more force put through it due to poor hip strength and control.  Do this Quick test to see if you have hip weakness, and if you do, then you should also seriously rehab you hips also.

4. Ice: For ten minutes at a time after a long day, exercise of when hurting.

Taping: Taping to support the arch is great for unloading the plantar fascia. Using rigid strapping tape strap from the outside of the foot to the inside, pulling it tight up the arch. See this video for an example.

Footwear: This video shows how the plantar fascia works during walking and running. You can see from this that if your toe was pushed up less when Walking (In case you didn’t watch it: As your heel comes off the ground the toe is pushed up – putting your fascia on more stretch) there would be less repetitive stress on the fascia. So wearing supportive running shoes with arch and heel support and ditching minimalist of over flexible shoes will really help this. Wearing flats all day also aggravates the fasciitis as this puts the calf on stretch which wraps under the heel and pulls on your fascia – so having some heel support is great (but not high heels!)

Orthotics: Orthotics do help this condition a hue amount if your problem is with poor foot bio-mechanics – Head along and see your local Physio or Podiatrist for a foot and gait assessment.

Training volume: it is important to decrease the load for a short time to decrease the overload on the fascia while you sort out the contributing factors (above). This may involve:

  • Walking or running halve your normal distance and then increasing this by 10% per week.
  • Decreasing training on hard surfaces and hills/steps.
  • Adding in time to stretch and warm up.
  • Remember the training rule that you should not increase your distance by more than 10% per week – this is often a big cause.

This needs to be followed to 6-12 weeks for best results and when, better you should keep looking after it so that it doesn’t happen again. Keep stretching your calf, keep your hips strong and don’t have sudden increases in activity – build up to it.

You will also benefit from:

The importance of core stability on lower limb injuries

Shin splints: What why and how to sort it

 

Please like, comment, share and let me know how you get on.

More reading: A good scientific paper if are detail orientated.


foot pain

The Windlass Mechanism

February 19, 2014 • By

The windlass mechanism is an integral function of the foot that is critical to efficient walking and running. I am going to tell you all about how the windlass mechanism works to help you do what you love and how to test it yourself!

The windlass mechanism is simply put, the tightening of the fascia (rope may be the better term) on the bottom of your foot as you push-off. As it tightens it acts to stop your foot collapsing by supporting your arch and helps propel your forward, conserving precious momentum and energy!

It is so incredibly important that this works. If you want to keep walking or running pain-free – you need this mechanism functioning. If it doesn’t you could end up with one of a number of injuries, including:

Not to mention the undue pressure that gets put through your knees, hips and low back.

So how does the windlass mechanism work?

Your Plantar Fascia (or aponeurosis) is a very strong band of connective tissue that begins at the base of your heel and extends along the bottom of your feet to the toes. As you walk and run a huge amount of force is put through your feet and so the plantar fascia has a very high tensile strength to hold the foot together and prevent it collapsing. Because the fascia runs from the heel to the toes, as the foot is put down, the fascia is stretched which stops the toes spreading away from the heel – and so keeping the arch from collapsing.

Without this we would walk with no efficiency and our feet would be continually collapsing in (over-pronating) – Not ideal.

The really fantastic part of the mechanism is at the end of the gait cycle when our heel comes off the ground. As the heel comes up and the big toe stays on the ground getting pushed up, the plantar fascia is put on further stretch. This winds the fascia around the balls of your feel like a pulley system which shortens the distance between the heel and the balls of your feet to raise and stabilise the arch of your foot. This means there is no weak point in the foot – it is nice and stable to that you can really push-off and not lose any force.

Now if that didn’t make it clear, then check out this clear and concise video that shows the mechanism well.

Interestingly the Achilles tendon also helps tension the plantar fascia. This is because collagen fibers from the Achilles tendon go around the heel to blend in with the outer layer of the plantar fascia. This is a great example of how the body is connected and really works in synergy and not in isolation. This connection can also have a negative effect on the plantar fascia if the calves are too tight but we will address this in a future post.

 

If you want to see how the windlass mechanism works at home, you can test it yourself:

Have a buddy standing up, fully weight-bearing and then you lift their big toe (they need to be putting their weight through the foot). You will see the inside arch lift up as you lift the toe up. This is exactly what happens (or close to anyway) when you step through and push-off your big toe!

This is a really simple test but it can tell you so much. The windlass mechanism could be:

  • Delayed
  • Not happening at all
  • Or needing a lot of force to initiate

And it is also a great test to see if your orthotics do in fact help: Do the test standing on the ground and then standing on your orthotic and see if:

  • It is easier to lift the big toe
  • The arch rises up easier or smoother
  • The arch lifts up quicker or earlier.

Summary

This is another pretty cool example of how our body is an amazing machine! A simple little mechanism and yet it makes us be able to run far, fast and smoothly while absorbing shock and preventing injury. And it’s an important aspect for any health professional to check for any lower limb or back injury.

 

A good example of an injury where the Windlass mechanism is often not working is Plantar Fasciitis, so if you have arch or heel pain when walking, running and getting up in the morning – check this page out for exercises to rehab it and for your own sake – Don’t wear flip-flops.

keep tuned in!


Ankle, foot pain, Health, Lower limb

Sprained Ankle – Heal Fast and Strong with Self Treatment

September 30, 2013 • By

Treating a sprained ankle the RIGHT way early on means a stronger ankle, faster recovery and less chance of re-injury. In this series I will tell you what a sprained ankle involves, the most effective self treatment and the best rehab exercises to get you back out there!

This post is Level 1 but when you need to step it up after the first 48-72 hours, switch over to the Level 2 and Level 3 rehab exercsies.

First of all, a little information about what a sprained ankle involves, but if you are in the know about Sprains already, skip the info and scroll down to Self – Treatment

Sprained ankles are known by a few different names:

  • Twisted ankle
  • Rolled ankle
  • Lateral ankle sprain
  • Inversion ankle sprain
  • And of course “Oh no!”

The most common type of sprained ankle is the lateral ankle sprain (85%), and that is what we are going to discuss and sort out today.

Mechanism of injury: The plain and simple is that a sprained ankle is typically when your foot is forced inward (inversion) and down at the same time (often when changing direction, turning and/or on uneven surfaces). This puts the ligaments under too much stress too fast which causes a tear of one or more of your ankle ligaments.

sprained ankle - lateral ligaments

 

Quick anatomy: The lateral (outer) ankle has 3 ligaments supporting, with the weakest of these (and so most often injured) being the ATFL. The ATFL is the Ligament at the front of the ankle shown here and in most simple sprains, this is the one torn with or without the ligament below it.

 

Sprained ankle recovery time: The general recovery time is 2-6 weeks (if looked after properly) and keep in mind, even if it feels bad now, if you do all the right things you will be one of the 95% who return to sport and activity within 6 weeks.

 

Not taking ankle rehab seriously often leads to far too many chronic ankles, long-term disability and other injuries so YOU NEED TO TAKE THIS SERIOUSLY!

Note: it is important to rule out fractures early on. An accurate way of doing this is using the Ottawa ankle rules, or going to see your local Physio for a quick assessment – These rules are great for minimizing unnecessary X-rays.

 

Self – treatment

Initial management: In the first 72 hours it is very important to follow the RICE and HARM principles – This will take weeks off your recovery.

DoRICE injury treatment, heal strong and fast: RICE

    • Rest – From running etc.
    • Ice – 10 minutes at a time, no more, every hour you are awake.
    • Compression – Eg. Tubigrip compression
    • Elevation – Get your foot above your heart when possible.

Note: Don’t wear compression at night time

Don’t: HARM

  • Heat
  • Alcohol
  • Running
  • Massage

HARM increases blood flow to the area, worsening inflammation and so causing more secondary damage and a longer healing time.

Keep moving (within reason of course) – It is important not to baby sprained ankles and start weight-bearing through them as soon as possible to normalize movement and decrease loss of muscle activity. If necessary you may need to be on crutches for the first 24 hours (if very painful and you really have tried to walk on it) then move to partial weight-bearing and then full weight-bearing.

Foot paddling is a great exercise to do in these early days – In sitting or lying, simply point your toes up then down repeatedly in a pain-free range. You can try doing small circles with your foot also, remembering not to push into pain. Do this every 1-2 hours (little and often)

Footwear: Wearing good supportive footwear with heel and arch support(such as your runners) is great as this takes the pressure off the injured ligaments and lets them heal well. DO NOT WEAR HIGH HEELS (Please!).

 

AND THEN: After the first 48-72 hours of doing this, click over to rehab exercises and get started rehabilitating your sprained ankle! And remember you still use ice after the first few days whenever it is sore or swollen.

 


Back pain, foot pain, groin pain, Knee pain, Lower limb, running, training

Quick Stability and Balance test

July 29, 2013 • By

Here we discuss an easy test you can do in front of a mirror at home to see why you are having hip, knee or back painGood lower limb stability and control comes straight from your gluteal muscles, and if these aren’t functioning right – your back, hip, knees and feet better watch out!

Stability of the Lower limb ultimately derives from you hip. The muscles surrounding your hip work to keep your entire body upright on top of your leg and vice versa work to maintain correct alignment of your leg. I see far too many injuries caused by poor hip stability, such as:

– Patello-femoral pain (knee pain)

– Femoral acetabular impingement (hip pain)

– Iliopsoas tendinopathy (groin pain)

– Patella tendinopathy

– and much more hip, knee and foot repetitive strain injuries!

The simple Single Leg Squat is a fantastic test to look at Lower limb biomechanics and control and can easily show you why you are getting pain or tightness down the chain,

The test:

This is best done in front of a mirror or video camera.

Position: Standing on one leg with your arms straight out in front of you (Your other leg can be out in front or bent beside your other leg but never touching the ground or other leg).Single leg Squat, hip stability and strength

Action: squat down like you are going to sit on an imaginary chair behind you. Stop and come back up when you reach your challenge point (before you fall over).

Repeat 10 times (If you can!), then start again on the other leg.

What to look for:

  • Your knee should track straight above your foot, towards your big toe. Typically with poor hip stability you will see the knee going inwards or shaking – If it does this your gluts are not firing or strong enough.
  • No hip drop – your pelvis should stay level (horizontal), if it drops – we have a problem!
  • Your knee bends right forward past your toes – you are relying far too much on your quads and not using your Glutes and so leaving your leg vulnerable.
  • Can’t do 10 reps or you start doing any of the above three towards the end – your Glutes have poor endurance.

 

So, how do we improve your results? See my post on Exercises to Improve Glut activation and strength and re-test every two weeks to check your progress.

 

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