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arch support

Calf Pain, Foot pain, Health, Shin Pain

Flip-flops and moon boots

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jandals profWhenever I see a patient with a lower limb injury come into the practice wearing flip-flops I cringe inside. Really, these simple bits of plastic are causing a lot of pain and injury and are not something you should wear all day.

Flip-flops absolute lack of arch or heel support puts you at risk of unnecessary pain and injury. We are (I am generalizing here) so careful to wear the best footwear when exercising, keeping up to date with the latest running shoes, orthotics, braces etc but when it comes to relaxing and what we wear outside of work and sport – we aren’t so smart. A study found that in a large shopping center, 43% of all women were wearing flip-flops(1) – That is a huge amount of foot, calf, shin, knee and back pain! Yes this may keep Physio’s and podiatrists in business but it keeps a lot of the population out-of-pocket – And often there is a very simple thing you can do to ease your pain and injuries….

Throw your thongs away!!

Really flip-flops aren’t that bad if you just wear them to the beach, around the changing room or shower etc – It’s when you start wearing them out shopping, to lunch, all day, everyday that they can cause real problems. What problems can flip-flops cause you may ask? and why? Flip-flops can lead to:

  • Plantar fasciitis
  • Stress fractures – Hence the moon boots
  • Shin splints
  • Calf pain and strains
  • Foot pain e.g. Mortons neuroma, metatarsalgia
  • Low back pain
  • and more

And Why?

Flip-flops change the way we walk

They wouldn’t be so bad if our feet weren’t so weak and de-conditioned. Yes we evolved to roam the open plains and jungles barefoot but now that we live in this concrete world – we need a little more protection for our feet. Also because we so often wear cushioned supportive shoes the rest of the time, our feet are not able to handle the complete lack of control and support when wearing flip-flops – Like sleeping on a nice comfy bed one night and then on concrete the next – You will get sore right?

And because they change the way we walk, we use our muscles in a different way, while increasing the shock going through and feet and legs due to lack of shock absorption. Wear them for a long time and the repetitive strain leads to overuse injuries. For example:

  • Every time you step, you need to squeeze and scrunch your toes to hold the flip-flops in place! Meaning your feet and calf have to work very, very hard = tight, tight calves.
  • Due to the total lack of arch support the arch can repeatedly over-pronate, increasing the stretch on your plantar fascia. Repeat this over hundreds of steps and you get micro-tears, inflammation and pain. You can read more about this here.

Good things in moderation

So, you don’t need to go and throw your flip-flops out but PLEASE limit the amount you wear them as they can be a huge cause of pain and injuries. This is also such an easy thing to change that can drastically improve your function and decrease injury risk, so why not do it huh?

jandalsAddendum: As a proud Kiwi I feel I should give a quick history on the proud origin of flip-flops.. or should I say Jandals! The flip-flops was originally invented in Auckland, New Zealand in 1950. The idea came from the original Japanese sandals which allied soldiers saw while doing occupation duty in Japan during WWII. The original name Jandal (Japanese sandal) was trademarked so that lead to other countries having t come up with other names such as:

  • jandals 1Flip-flops
  • Sandals
  • Slippers
  • Thongs, etc

So wear this great invention in moderation and save yourself a lot of trouble. Please Share, like and comment away!


foot pain, Health, running

Heel pain running? Check your shoes and hips…

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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

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Note: We have an updated version of this post HERE AND our new Comprehensive Plantar Fasciitis Rehab Guide

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 is 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.


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