Category Archives: Foot

physical therapy for plantar fasciitis pain

Physical Therapy For Plantar Fasciitis Pain

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physical therapy for plantar fasciitis pain

Does your foot or heel hurt with the first step in the morning? Does your foot hurt when you get up from sitting or driving for long periods of time? If the answer is yes, you may have plantar fasciitis. Plantar fasciitis is the most common type of foot pain. Plantar fasciitis is the irritation or inflammation of the plantar fascia. The plantar fascia is a thick dense connective tissue that attaches to the heel and ball of the foot. A related problem is a heel spur which is extra bone that may grow from the heel bone. This is in response to the plantar fascia being tight or inflamed, thus pulling on the heel bone.

Inflammation and microtears occur more commonly in sports that involve running, long distance walking, dancing, tennis, basketball and in non-athletes who spend long periods of time walking on unyielding surfaces. Patients with pes planus and heel pronation have an increased likelihood of developing plantar fasciitis because of the increased tension on the plantar fascia caused by these anatomic features. A tight gastrocnemius can result in heel pronation thereby making plantar fasciitis more likely. Cavus feet with relative rigidity also place more stress on the plantar fascia. The plantar fascia also tends to become more rigid with age making it less effective as a shock absorber and more likely to develop microtears.

Common Causes:

  • Too Rapid of an Increase in Exercise Program.
  • Change in Lifestyle (Active to more Sedentary) Causing Sudden Weight Gain or Sedentary to Active.
  • Muscle Tightness and/or Weakness.
  • Poor Biomechanics (movement) at the Foot and Ankle.
  • Inadequate Cushioning in Shoes or Inadequate Shoes.
  • Occupation with prolonged weight bearing on Hard Surfaces.

Plantar Fasciitis Symptoms:

People with plantar fasciitis complain of searing pain at the point of the fascias insertion into the calcaneus. This pain is at its worst with the first few steps upon arising in the morning or after a sustained period of being off their feet. The plantar fascia origin is often extremely tender to palpation. Pain is also increased after long periods of walking, climbing stairs or doing toe raises.

Finding Relief with Physical Therapy:

Physical therapy evaluation generally reveals an antalgic gait pattern especially when first beginning to walk. Often foot is pronated, gastrocnemius is shortened and there is severe pain with palpation of the inferior, medial heel. Most people can experience relief in just a few sessions. However, the longer the pain remains untreated, the longer it will take to heal. It can even become so chronic in some cases other non-conservative treatments are deemed necessary. If you are experiencing symptoms similar to the ones listed earlier you may have plantar fasciitis. If you are diagnosed with plantar fasciitis physical therapy can help you resolve your pain.

Physical therapists take the time to educate each plantar fasciitis patients on how to prevent a recurrence of pain. They provide preventative stretching programs that can be done at home, instruct on what to look for when purchasing new shoes, and if necessary, help patients adapt their current lifestyle to prevent re-injury.

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For relief at home before your evaluation try these!

plantar fasciitis stretch
Frozen Can Roll
Take a frozen food can and roll your foot forwards and back.

plantar fasciitis exercise

Towel Grab
Grab and pick up a towel or dishcloth using only your toes.

 

 

More Articles about Plantar Fasciitis:

Plantar Fasciitis

Big Toe Problems in Runners

Big Issues with the Big Toe

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Big Toe Problems in Runners

Many runners don’t realize what an important role the big toe plays in stabilizing the foot both during push-off and when the foot hits the ground. There’s a reason the big toe is also called the great toe: if it lacks strength, the foot can collapse. And if it is unable to move fluidly, unwanted motion will occur at the next link up the chain…the foot. And that’s not good. Let’s find out how big toe problems in runners can be addressed with physical therapy.

Quick vocabulary time-out: a joint can be hypermobile (too mobile) or hypomobile (not mobile enough). So how do we manual therapists know if a joint is moving too much or not enough? We look for 60-90 degrees of extension. If you can bend your big toe up so far that your toenail almost hits the top of your foot, that’s too much mobility! But if your big toe doesn’t bend at all or can’t budge up to 60 degrees, then you’ve got too little mobility.

Let’s look at hypermobility first. I see more instances of hypermobility in women than men, especially if the woman sits with her toe in extension, dances ballet now or in adolescence, or frequently wears high heels. Hypermobility can lead to a lengthening and weakening of the tendon or muscle, and can lead to issues like turf toe, plantar fasciitis, posterior tibilais tendinitis, anterior knee pain, and even chronic hip issues.

So what do we do? For a hypermobile joint, we have to stabilize the big toe using strengthening exercises. Research shows that the following exercises help stabilize the foot/arch:

The Isometric Vele Lean (think of the “Michael Jackson lean”)

  • Find a neutral foot position. (A flat foot position will have little to no space between the floor and your middle arch. A high/rigid foot position allows you to fit two fingers between the floor and your middle arch. What you want is a neutral position in which the arch of your foot is just an index finger high off the ground.)
  • Lean about ten inches forward (similar to the position you see skiers use when they jump off a slope to get distance), hold 10 seconds, and then return to the neutral foot position.
  • Perform 10 reps, provided you do not feel pain.

Backwards Walk (sticking with the MJ theme, you could consider this a slow and controlled Moon Walk)

  • Again, find a neutral arch.
  • Walk backwards heel to toe (“retro tandem gait” in manual therapist speak), maintaining that neutral arch.
  • Continue for two minutes, stopping if you feel fatigue or pain.

Let’s not forget that the toe, foot, and leg are like a chain, so we have to address all weak links, not just the hypermobility. For example, if a toe is hypermobile, the next joint up is often stiff. Or the knee might be painful. A manual therapist can help determine the cause (lack of quad strength? hip or foot weakness?) as well as the solution.

OK, now to address hypomobility, in which the great toe does not allow enough movement. Runners with hypomobile toes tend to compensate in one of two ways: they either over pronate, which can result in a bunion or a collapsed foot, or they can keep their feet supinated in order to avoid rolling off their big toes. As with hypermobility, it’s important to find the cause of the cause: what is the reason for the hypomobile big toe, which is the reason for such irritants as turf toe, plantar fasciitis, lateral foot pain, and even lateral ankle pain? And up the chain? Yes, even knee and hip pain can result from a big toe that can’t move freely enough.

While a manual therapist can help address your overly stiff big toe, you can also gain mobility with exercise at home. To determine if your great toe is too stiff, actively lift the toe while in a weight-bearing stance. You should be able to lift the toe high enough to allow you to slide a finger under it. If you can’t lift your big toe that high, try the following to get your hypomobile great toe moving:

  • Kneel down and lift the hypomobile big toe by placing it on a folded towel in front of you.
  • Holding the foot neutral, try a lunge or calf raise. If you feel pain, decrease the height of the big toe.
  • Perform ten reps.
  • Progress to more lifts the following day, provided you are not too sore.

The exercise above will certainly help loosen a big toe with low mobility. But if you aren’t able to get the big toe off the ground at all, then you may need to proceed with caution. Before attempting the lunge/calf raise exercise, simply try to hold a prolonged low-load stretch for seven minutes or longer. Be careful, as overly aggressive stretching can be harmful. I would rather you progress slowly, day by day, to make sure you keep you from pain. (Please seek a manual therapy fellow to prescribe the correct intensity and duration of activity if you DO have pain.)

Now, please don’t read the above and immediately diagnose yourself as having a problem with your great toes; many runners will never experience big toe stability or mobility issues. This is just one tool in a manual therapist’s toolbox. Just because you now have this hammer, it doesn’t mean you have a nail that needs hammering!

Written by: Brad Perry, PT, MS, SMTC, FAAOMPT
Owner @ Kingwood, Lake Houston, Spring-Klein, Cleveland, & Northern Oaks Sports Medicine Physical Therapy
Kinesiologist, USA Triathlon, USATF Certified Coach, & Slowtwitch Certified Running Coach
www.kingwoodotpt.com

Achilles Tendinitis

Treatment Options for Achilles Tendinitis

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The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run and jump.  Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration. Achilles Tendinitis causes pain along the back of the leg near the heel. If you suffer from Achilles Tendinitis – try these pain relief methods.

REST: Cut back your training by decreasing your mileage and intensity. Also avoid hills and speedwork. You may substitute running with swimming, running in water and biking to reduce the irritation.

ICE: Apply ice to the affected area for 10 to 20 minutes with at least one hour between applications. Do not apply ice directly to your skin – a pillowcase or dish towel works well as a protective barrier. Frozen peas or reusable gel packs are flexible and conform well to the injured area.

PROPER FOOTWEAR/ORTHOTICS: This situation can be corrected with arch supports or custom orthotics. Orthotics allow your foot to maintain correct position throughout the gait. Avoid walking barefoot and wearing flat shoes. If your pain is severe, your doctor may recommend a walking boot or to cast you for a short time. This gives the tendon a chance to rest before any therapy is begun.

NON-STEROIDAL ANTI-INFLAMMATORY MEDICATION: Drugs such as ibuprofen and naproxen reduce pain and swelling. They do not, however, reduce thickening.

PHYSICAL THERAPY: Achilles tendinitis can be painful, chronic condition if left untreated. Consult your physician to discuss physical therapy options. Licensed physical therapists coordinate with your physician to provide individualized care and treatment options for your specific needs.

CORTISONE INJECTIONS: Cortisone, a type of steroid, is a powerful anti-inflammatory medication. Cortisone injections into the Achilles tendon are rarely recommended because they can cause the tendon to rupture (tear).

lower limb amputation

Lower Limb Amputations

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The goal for every patient with a lower limb amputation is to walk normally again.
A patient with a lower limb amputation faces many challenges when it comes to walking safely in a variety of walking surfaces and without exerting excessive energy. Generally, the higher the amputation level, the more we can expect to see gait deviations or difficulty walking. This is because with each segment of the anatomy is lost to amputation, more muscle, sensory receptors and leverage are also lost. A Physical Therapy treatment program can be designed to assist a patient return to a “normal” walking pattern in terms of posture, step length, stability, balance, rate of speed, and limb positioning.

GAIT TRAINING
Almost all patients with a lower limb amputation will benefit from physical therapy and gait training at some point in their recovery to help them return to a more normal walking pattern. Pre-amputation exercises will assist the patient in arm and leg strengthening to help them prepare for using a walker during gait training with their prosthesis. After amputation surgery a prosthetist will work with the patient to fabricate and align a prosthesis to assure that it will optimize the patients walking pattern.

WHAT TO EXPECT DURING PHYSICAL THERAPY

  • The physical therapist will typically work with the patient 3 days per week

  • The physical therapist and prosthetest will remain in close communication with gait training is occurring since any changes in the prosthesis will affect the gait pattern

  • Initially physical therapy is focused on standing and walking with enough stability to ensure safety (this initial gait training is performed in parallel bars with the assistance of the physical therapist holding the patient with a gait belt for additional safety)

  • Initial gait training is supplemented with strength and flexibility exercises for the legs and trunk muscles since strong trunk and leg muscles make it easier to progress the patient’s gait training

  • The physical therapist will also work with the patient to improve balance and coordination to help the patient develop a more normal step length and walking speed

Physical therapists use many different techniques during gait training sessions

leg amputee

LEARNING HOW TO WALK AGAIN
Specialized Treatment Techniques

  • SPLINTER SKILLS: Technique where the walking pattern is broken down into a sequence of events that are practiced individually before putting them all together to build the walking pattern
  • WHOLE WALKING: Technique in which the entire gait pattern is performed all at one time without thinking about the individual components of walking therefore relying on the body’s natural tendency to find the most stable and energy efficient way to walk

BUILDING CONFIDENCE
Once the patient feels confident and the physical therapist believes that it is safe, a walker can be used instead of the parallel bars. When using a walker, the focus will change to helping the patient walk on uneven surfaces such as outdoors and walking around obstacles or stepping up and down stairs.

Even patients who have walked with a prosthesis for years can benefit from gait training for a “tune up” of their walking skills or to learn a new skill such as side stepping, tandem walking or even running.

feet cause pain

Can Your Feet Cause Pain in Your Knee, Hip or Back?

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Can your feet cause pain in other areas of the body?  Yes it can.  The foot is an arch and arches decrease compressive forces by distributing them across the span of the arch. Engineers use arches in building and bridges to hold up greater weight across longer spans.  The human foot has 3 arches that all work together to distribute the forces our bodies put on it.  This allows us to walk, run and jump.

We start running into problems when the arch is either too flat or too high – causing the forces put through the foot to be abnormally distributed, resulting in strain.

  • Flat feet limit the range of motion of our ankle, causing our hips to rotate inward and move towards the center of our body.
  • High arches do the opposite to our hip joints.
  • These changes cause strain to our ankle, knee and hip joints, and our back.

knee pain

People can be unaware that their feet cause pain throughout the body because they were born with flat feet or high arches and they do not know what “normal” feels like.   As physical therapists we have treated many children who didn’t realize that their feet are not supposed to be sore.  But instead of seeing them for prescribed foot pain, they come for pain in their joints or back.

Orthotics were developed to correct or adapt to changes in the foot.  Orthotics should be fitted by a healthcare professional trained in assessing the foot and gait.  Standing on a pressure plate in the store is not good enough.  Why?  If your foot hurts are you going to stand on it normally?  Probably not.  This results in an abnormal reading.

An orthotic by itself is not the best treatment.   A physical therapist will assess your function, strength, flexibility and range of motion.  Patients will present with other problems as the result of abnormal arches.  Treatment with orthotics combined with strengthening and stretching exercises, balance training, functional training and manual therapy is necessary to restore full function.

This article was written by Scott Van Bramer, PT, Partner/Clinic Director of Phoenix Physical Therapy.  Phoenix Physical Therapy is an outpatient physical therapy clinic in Canal Winchester, OH. For more information about Phoenix Physical Therapy in Canal Winchester, please call the clinic directly at 614-834-2995 or visit them online at www.phoenixptohio.com

dry needling physical therapist

Trigger Point Dry Needling

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Dry needling uses small, thin needles to stimulate underlying myofascial trigger points, muscular and connective tissues for the management of many orthopedic conditions, both acute and chronic. By inserting a needle into the dysfunctional tissue, it often leads to a contraction of the muscle which then stimulates a relaxation. This leads to a reduction of pain, improvements in flexibility and a restoration of normalized movement when combined with corrective exercises.

WHAT IS A MYOFASCIAL TRIGGER POINT?
A myofascial trigger point is a hyperirritable spot within a taut band of skeletal muscle that produces local or referred pain. The trigger point can lead to increased pain, decreased flexibility and decreased muscle function if not treated. Trigger point dry needling is a safe, effective and efficient treatment technique to release these painful spots.

dry needling

WHAT TYPE OF PROBLEMS CAN BE TREATED?
Muscle dysfunction can be the primary or secondary contributing factor to many neuromusculoskeletal conditions.

WHAT YOU NEED TO KNOW:
• Dry needling must be specifically prescribed by a physician.
• Dry needling is not covered by insurance, it is a cash based modality.

This information was written by The Jackson Clinics, a locally owned physical therapy practice in multiple locations throughout Northern Virginia. They specialize in outpatient orthopedics and sports rehabilitation. Their therapists and assistants possess advanced clinical skills in spinal disorders, sacroiliac joint dysfunction and peripheral joint problems, including rotator cuff injuries, knee injuries and foot and ankle pain. They also also have specialty programs in breast cancer rehab, vestibular rehab, pediatrics, post-cancer rehab, aquatic therapy and women’s health. For more information click here.

Plantar Fasciitis

Hamstring Tightness and Plantar Fasciitis

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Plantar fasciitis is classically characterized by pain in the central to medial plantar heel. It is thought to be caused by chronic inflammation of the plantar fascia due to repetitive strain and trauma to the fascia. There are many other purported causes including, calcaneal spurs and increased intraosseous calcaneal pressure, among others. Many studies have shown inflammatory and histological changes at the origin of plantar fascia and surrounding structures that are consistent with repetitive strain and degenerative changes including a thickening of the fascia.

Biomechanics has long been looked at when investigating possible causes to injuries. Alteration of the load bearing characteristics of the foot has been suggested by several studies to be the underlying problem in plantar fasciitis. Microtears and chronic degenerative changes result from the increased tensile stress places on the fascia due to the changes in biomechanics. Muscles tightness is one factor that can lead to changes in gait mechanics and load bearing of the foot. Hamstring tightness has recently been investigated as a factor in plantar fasciitis and has been shown to induce prolonged forefoot loading due to increased knee flexion during gait. A rapid progression through the contact phase of gait results from increased knee flexion and in turn increases forefoot pressure. The fascia is a fixed length ligament, so an increase in forefoot pressure results in increased tension at it’s insertion on the calcaneous. The increased time spent on the forefoot in gait leads to a chronic traction injury that is localized to the hindfoot insertion of the fascia; which is consistent with the symptoms of heel pain.

plantar

Biomechanical deficits have long been contributed to injuries. Only recently has hamstring tightness been shown to have an effect on plantar fasciitis. Hamstring tightness effects every step, resulting in a biomechanical deficit which may contribute to tensile overload of the plantar fasciitis. The recent studies suggest that all patients with plantar fasciitis should be evaluated for hamstring tightness. Physical therapy treatment for plantar fasciitis should include hamstring stretching.

More information about Plantar Fasciitis can be found in the PTandMe injury center.

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This information was written by Plymouth Physical Therapy Specialists. They are committed to using evidence-based treatments in their practice. This means that their therapists utilize the most current and clinically relevant treatments in their approach to rehabilitation. For more information click here.

Achilles tendon

Achilles Tendon Care – New Therapy Can End Months of Pain

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The Achilles tendon is the large cord-like structure at the back of the ankle. It is responsible for transferring the muscle forces generated by the calf, which in turn allows you to roll onto the ball of your foot during walking and running. Continue reading