02 Aug Fixing Foot Pain
NON-INVASIVE TREATMENT OPTIONS FOR FOOT AND HEEL PAIN
By Dr. Matt Fontaine
A Common Injury for Runners and Other Active Individuals
Christine’s foot and heel pain began back in college while playing soccer. For years she suffered with recurring shin splints and intermittent sharp debilitating foot pain. Sometimes she could play through the pain, other times it was too excruciating to even walk, let alone run. Like many athletes, she continued to run after college. She ran several half marathons, 4 full marathons, including Boston Marathon and the Chicago Marathon. She participated as a member of a Ragnar Relay Race team and completed several triathlons. For nearly a decade she endured recurring foot, hip and lower back injuries that would often return if her running mileage got too high. After years of seeing various doctors and trying physical therapy, which provided some temporary relief, she continued to he plagued by on again off again pain. Finally, frustrated she had all but given up running because it was just too painful. That is when a friend of hers recommended she get a treatment called Active Release Techniques.
A Common Thread
Christine is just like hundreds of patients I have seen over the years. If you have suffered from heel pain on and off for months or years, you are in very good company. Many people have had this for a long, long time. Maybe you had to give up wearing high heels or dress shoes. You may wake up in the morning in such severe pain, that walking is almost unbearable. Are you no longer able to run or jog? Does standing on your feet all day at work cause your foot and or low back pain? Maybe you have a drawer full of arch supports, heel pads, inner sole supports etc. Many have spent a lot of time and money, only to have temporary relief from pain, if at all.
If you are like most people, you have likely seen a variety of doctors and therapists. Many people have been diagnosed with a heel spur, plantar fasciitis, shin splints, medial tibial stress syndrome, flat arches, bunions, neuromas etc. Some have even gotten repeated cortisone injections to relieve the pain. Many have been told by surgeons that surgery was not the answer. Many often then find themselves trapped in a cycle of daily pain, limited activity, periodic injections that help for a while, only to have the pain return. “It has been said that when your feet hurt, you hurt all over”. This is true for many people with foot pain.
Understanding Your Foot and Heel Pain
First, let us look at biomechanics and structure & function of the foot and ankle. There are some 28 joints and 56 bones in the foot and ankle, depending on which anatomy source you reference. Either way, it is a bag of bones, literally. A good place to start is to have your foot type evaluated. There are three basic categories:
Normal arch> NEUTRAL.
Flat arch (pes planus)> STABILITY or MOTION CONTROL
High arch (pes cavus)> NEUTRAL
Know Your Foot Type
Figure above taken from roadrunnersports.com
Many people who have a high arched foot also have a rigid foot, which is one of the most difficult foot types to treat. People with rigid feet are predisposed to chronic hip and lower back pain, in addition to foot pain. Their foot lacks the mobility to be a good shock absorber. It is repetitive motion injury to these soft tissues that results in tissues becoming “glued down” and less elastic. As these tissues become more and more stiff, the stress of weight bearing activity can further strain these muscles, resulting in a chronic cycle of tearing of tissue, gluing down of the tissues during recovery and chronic pain and inflammation.
Making matters worse, many people have decreased joint motion of the midtarsal (middle part of the foot). The arch of the foot is like the truss of a roof, and it must have some flex for the foot to function normally. Stiffness in the foot causes the bottom of the foot to become overstretched, resulting in tissue injury and pain and inflammation.
While proper shoe selection can help, these people benefit greatly from manipulation of the foot and ankle as well as manual therapy to release scar tissue in the muscles and fascia of the lower back, hips, lower leg, shin and foot.
Fixing Your Foot Without Surgery
The plantar fascia is a ligament comprised of thickened fascia on the bottom of the foot. Although this can become overstretched and inflamed, this is seldom the sole cause of heel and foot pain. There are three layers of muscle on the plantar surface (bottom) of the foot, and nerve entrapments can occur here.
Note in the picture above, the plantar fascia is the most superficial layer. There are three layers of muscle which lie deep to the plantar fascia.
Fascia, when healthy forms a free gliding interface between and within muscles, allowing free movement to occur. When fascia, muscles, tendons, and ligaments get mechanically overloaded, injury can occur resulting in fibrosis and adhesions that disrupt the “sliding and gliding” of tissues.
In a healthy state, these soft tissues are free to slide relative to each other allowing for normal sliding of muscles, tendon, ligaments and nerve. When fascia and muscle become injured through repetitive strain, these tissues become sticky, and the fascia becomes glued down. This glued down tissue is inelastic and susceptible for more strain injury. Manual treatments must be properly deployed to these tissues to resolve this problem.
Often times the cause of heel and foot pain and even heel spur is due to a problem with the muscles of the lower leg. These muscles help to stabilize the foot and ankle and control the arch of the foot. If your toes curl under tightly, this may indeed be your problem.
The Fix:
Manual therapy must be applied to the soft tissues of the calf, deep posterior tibial compartment (muscles deep to the calf) and plantar foot. There are hands on treatments and instrument assisted treatments. A movement based soft tissue treatment called Active Release Techniques® has helped many people like you resolve their heel and foot pain, and even treat the common running injury known as shin splints. Active Release works quickly and addresses the cause of the problem, thereby providing a solution with long lasting results.
Remember that fascia, when healthy allows for normal sliding of muscles, tendon, ligaments and nerve. When injured, fascia and muscle become sticky, and the fascia becomes glued down during the body’s healing process. This glued down tissue is inelastic and susceptible for more strain injury. Active Release Techniques ® is a patented, state of the ART soft tissue movement based treatment that is used to locate and break down scar tissue that results from soft tissue injuries to muscles, tendons, ligaments, fascia, and nerves.
Manual therapy must be applied to the soft tissues of the calf, deep posterior tibial compartment (muscles deep to the calf) and plantar foot.
Active Release Techniques
There are hands on treatments and instrument assisted treatments. A movement based soft tissue treatment called Active Release Techniques® has helped many people like you resolve their heel and foot pain, and even treat the common running injury known as shin splints. Active Release works quickly and addresses the cause of the problem, thereby providing a solution with long lasting results.
Remember that fascia, when healthy allows for normal sliding of muscles, tendon, ligaments and nerve. When injured, fascia and muscle become sticky, and the fascia becomes glued down during the body’s healing process. This glued down tissue is inelastic and susceptible for more strain injury. Active Release Techniques ® is a patented, state of the ART soft tissue movement based treatment that is used to locate and break down scar tissue that results from soft tissue injuries to muscles, tendons, ligaments, fascia, and nerves.
How does Active Release Treatment Work?
During a treatment, the doctor will move your foot up and down while holding tension in the muscles of the leg and foot. Moving the muscles through this tension is what breaks up scar tissue and tightness that restricts normal joint movement. When your foot and ankle cannot work properly, your body cannot absorb the shock that occurs when walking or running. As this continues, plantar fasciitis and heel pain ensue. After an ART treatment, the joints of your foot, ankle, and hip may need to be manipulated to restore normal joint motion and allow them to move freely. For many people, even in chronic cases, long lasting results can be expected in as few as 6 to 10 treatments. Some difficult chronic cases may take up to 20 visits to completely resolve the issue, it all depends on how long the scar tissue has been there. Scar tissue can calcify overtime, making the adhesions very stubborn to treatment, but these are typically rare, extreme cases.
Instrument Assisted Soft Tissue Release
Instrument Assisted Soft Tissue Release or Instrument Adhesion Release is a technique employed by skilled physicians. During treatment these highly skilled manual therapists use stainless steel instruments, or instruments made up of other materials to generate a releasing of the tissue. One of the most notable techniques is the Graston Technique. Practitioners trained in Graston Technique have specialized training in using these specially designed, surgical stainless-steel tools to release adhesions in the body. Stainless steel tools are preferred because they can be decontaminated and sterilized easier between treatment.
“The latest evidence based research shows that the best outcomes come from integrating manipulation with soft tissue treatment and corrective exercise. That’s our approach at Potomac Physical Medicine” -Dr. Matt Fontaine
Potomac Physical Medicine is now offering Light Force Deep Tissue Laser. This high-tech class IV laser delivers healing energy deep into the tissue at the cellular level to increase mitochondrial production of ATP(energy) which your body uses to repair and regenerate tissue. The laser increases circulation and oxygenation of tissue and reduces pain associated with acute and chronic setting sports and repetitive motion injuries, arthritis, and other muscle and joint pain syndromes.