Feet

The clinic that I work in both Torben (the chiropractor) and I have been seeing a lot of foot injuries lately. A reason for this sudden foot epidemic is due to increased activity with better weather.

As the weather gets warmer we tend to spend more time outside playing. We put more demand on our body and expect it to recover fast, so that we can get out and play again tomorrow. In general a lot (not all) of the foot problems we see can be avoided by simply stretching.

Yep that’s right, stretching.  Tight calves are usually the culprit however, tight calves can be a result of tight hips, over pronation of the foot and other biomechanical imbalances in the body.

Injuries that we are seeing are:

• plantar fascitis
• heel spurs
• stress fractures

Plantar Fascitis is inflammation of the plantar fascia

The plantar fascia is a thick band of fibrous connective tissue that starts at the heel of the foot (calcaneus) and expands out towards the toes. This fascia plays a key role in both providing stability to the arch during foot movement and dissipates impact forces on the foot.

Causes of plantar fascitis

• repetitive movements such as running and walking                                                
•  jobs with excessive weight-bearing
• tight calve muscles and achilles tendon
• wearing shoes with poor support
• mechanical imbalances of the foot
• high arch or low arch feet (pes cavus / planus)

We are seeing a lot of runners coming into the clinic with  plantar fascitis. With overpronation (foot rolling in) there is added stretching of the plantar fascia. Also calf muscle and achilles tendon tightness is common among runners. In the foot the calcaneus (heel bone) is the attachment for both the achilles tendon and the plantar fascia.

The achilles tendon is the attachment for the plantaris, gastrocnemius and soleus muscles to the calcaneus bone. So as you can see the foot is a highly mechanical machine and by keeping the clave muscles loose you are decreasing excessive tension on the clacaneus and on the fascia. Understanding the anataomy of the foot will help you see why your fascia is acting up on you. A really good website with a better description of how our foot works can be found at this website http://www.coachr.org/planfasc.htm

Heel Spurs are associated with plantar fascitis, heel spurs form on the fascia attachment of the calcaneus.A heel spur is a pointed bony outgrowth off the bone of the heel (the calcaneus bone).  A heel spur is developed the same way plantar fascitis happens (tight calve muscles, poor foot biomechanics). With irritation of the fascia on its calcaneus attachment, calcification occurs with excessive inflammation. A heel spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.

This video shows a great eccentric (lengthening of muscles while under tension) exercise. Slowly lower on one leg and raise back up on two.

Stress Fractures

A stress fracture of the foot is usually due to overuse. With muscle fatigue the muscle can no longer  bear the load and then the bone absorbs all of the impact resulting in a small crack in the bone. This usually happens with repetitive pounding and impact on hard surfaces AKA Running! This can also happen with some jobs and other sports such as gymnastics, volleyball and basketball.

Ways to avoid stress fractures with running:

• limit runs on pavement, try trail running
• make sure that your shoes are not worn out
• proper strength training
• rest between long runs on pavement
• eat calcium rich foods
• do not ignore swelling and sharp pain
• ensure proper running biomechanics

If you have ever suffered from any one of these foot conditions you know how debilitating it can be. Pain in a foot can quickly stop some if not all activity. Treatment of these foot conditions include:

• rest
• ice ice and more ice
• stretching
• strengthening
• change of shoes
• arch supports
• orthotics
• night splints

Do not ignore foot pain!