Tag Archives: Foot Pain

Posted on

7 Tips to Self-Treat Morton’s Neuroma

Do you have pain between your toes?  Does it feel like you are always standing on a pebble or have a lump in your socks between your toes?  This may be a Morton’s neuroma.  A neuroma is a painful condition that affects the ball of your foot.  It involves a thickening of the tissue that surrounds the digital nerve bundle.  A Morton’s neuroma is one of the most common types of neuromas, typically occurring between the 3rd and 4th toe, but can form between any of them.

Morton’s neuromas occur due to repeated stresses, irritation, and pressure at the ball of the foot, affecting one of the nerves that lead to the toes.  It’s effectively a repetitive trauma or overuse injury.  There is typically no swelling bumps or bruises with a Morton’s neuroma.

Symptoms:

  • Numbness or tingling affecting the ball of the foot, between the toes, and/or the toes themselves.
  • Sharp, stabbing or burning pains that are intermittent and only affect either the ball of the foot or toes (usually 3rd and 4th toe).
  • The sensation of standing on a pebble or marble or having a lump in your shoe or sock.
  • When running, the pain is often felt during the push off from the toes, prior to the swing through phase.

7 Tips to Self-Treat a Morton’s Neuroma:

1. Avoid wearing tight fitting, ill-fitting, and high heeled shoes.  Be sure that your shoes have an appropriately sized toe box.  In the case of athletic shoes (particularly, for distance running), extra room in the toe box can be beneficial as the foot will often swell during the course of the run.  If you wear high heeled shoes, consider wearing them less frequently and/or switching to a shorter heel.  Even wearing socks that are too small can potentially cause too much compression and lead to increased symptoms.

2. Orthotics.  Many people respond well to a rigid orthotic with an extension underneath the first metatarsal bone.  You may not necessary need custom orthotics.  Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles.  The blue tends to fit most feet, but a variety of options are available for customization.  In my experience, these insoles can last 1,000 to 1,500 miles easily.

If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.  Seek assistance from a professional who is a runner and has experience with treating other runners.  A full length orthotic is indicated.  Try to find one that has a little cushion over the hard rigid plastic portion.  This will significantly help with comfort.  Be sure to see a sample of any custom orthotics before you buy.  I recommend not buying any orthotics without a small layer of foam or cushioning.  The top layer can wear out, but hard rigid plastic without a cushion is too uncomfortable for most people to wear regularly.

3. Improve your foot mobility and strength.  Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) is often found in cases of a Morton’s neuroma as part of the biomechanical issues that lead to its development.  Complete with instructions and photos, this guide, Morton’s Neuroma Rehabilitation Exercises, outlines how to safely perform exercises in order to improve your mobility and strength.

4. Improve your balance.  Poor balance and proprioceptive awareness is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature.  Poor balance and weakness throughout the kinetic chain will cause the foot and ankle complex to have to work harder to compensate (potentially, overworking the tissues).  Also, weakness and balance deficits can lead to poor foot biomechanics.  Please refer to the Balancing on One Foot exercise in the Morton’s Neuroma Rehabilitation Exercises. 

5. Stretch.  It’s critical to maintain proper calf and foot mobility.  Be gentle in stretching any muscles or tissue near the painful site as to not aggravate the neuroma further.  Although the initial focus is on stretching the calf muscles, also consider a full lower body stretching protocol.  Tightness in the calf muscles and loss of dorsiflexion is a risk factor for many foot related disorders.  Work on improving general calf and ankle mobility with an emphasis on dorsiflexion.  Stretching shouldn’t cause more than a mild increase in pain or discomfort.  (If you are lacking mobility in any other part of your body, this is the perfect time to work on it.)

6. Mobilize the Foot.  Be sure to avoid the painful areas (particularly, near the neuroma site).  It’s critical to insure proper foot mobility in the ankle as well as the first metatarsal joint.  Poor mobility in the foot, specifically the first toe, will affect the biomechanics of the foot.  Proceed with great caution if you attempt to mobilize the tissue in or near the neuroma. 

7. Seek Help.  Research concludes that nearly 80% of all cases of Morton’s neuroma can be treated through conservative measures (as outlined above).  However, if you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing the condition.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.  You may need assistance in identifying the biomechanical cause of the condition in order to eliminate the pain and may need additional hands on techniques or modalities to help address the injury.  A custom orthotic may be necessary.  Other modalities, such as iontophoresis (a process of transdermal drug delivery by use of a voltage gradient on the skin either via a hand held machine or self-contained patch) or low-level laser therapy (LLLT), may be indicated.

More specific strategies to help you determine the cause of your Morton’s neuroma along with more thorough treatment and prevention strategies for those suffering from a Morton’s neuroma are covered in the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.

What’s Inside the Resilient Runner Program:

  • Guidance on preventing and self-treating common running related injuries, including Hip Flexor Pain, Runner’s Knee, IT Band Syndrome, Piriformis Syndrome, and more!
  • Specific guidelines on when and how to return to running after experiencing an injury.
  • Rehabilitation guides with step-by-step photos demonstrating recommended exercises.
  • Step-by-step instructions on how to apply Kinesiological tape.
  • Downloadable podcasts, videos, and more!

If you’re tired of ongoing aches, pains, and injuries, learn how to become a resilient runner so that you can continue to train and compete in order to meet your goals!

I WANT TO BE RESILIENT!

Posted on

Plantar Fasciitis? Do this First Thing in the Morning

Plantar fasciitis is a very painful and potentially very debilitating condition. It’s one of the most common causes for heel and/or bottom of the foot pain. In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk. It’s typically at its worst in the morning with your first several steps after sleeping.

In this video, I demonstrate a simple, yet effective warm up to perform whenever you get up from sitting or lying down to prevent foot pain from plantar fasciitis.

Since the tissue on the bottom of the foot tightens as you sit or lay down for any length of time, be very intentional about preparing this area BEFORE you walk. This will lessen the pain and speed recovery. This is why I recommend doing this warm up throughout the day and especially, first thing in the morning.

CLICK HERE TO WATCH NOW

Be sure to check out my post, How to Self-Treat Plantar Fasciitis, for more tips! If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by following The Physical Therapy Advisor!

Posted on

How to Perform a Key Lower Leg Stability Exercise

Weakness in the deep external rotation muscles and poor lower extremity single leg balance are commonly associated with many lower extremity overuse injuries. A simple and effective exercise to improve strength, balance, and general stability of the deep hip external rotator muscles is the clock exercise (also called the star drill).

The important points to remember in this exercise are to keep the stance knee unlocked (the leg you are standing on) with the patella (knee cap) slightly externally rotated (usually pointing towards the 3rd or 4th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators needs to be the primary focus.

Slowly touch the ground very gently with the opposite leg. The amount of pressure touching the ground should be so slight that if there were a package of crackers taped to the bottom of the foot the crackers would not break. Performing the drill on a balance pad will significantly increase the difficulty level of the exercise.

In the following video, I demonstrate how to use a balance pad to perform the clock exercise, a key lower leg stability exercise for treating knee pain, hip pain, and foot and ankle related issues as well as balance.

CLICK HERE TO WATCH NOW

For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:

For prevention strategies and to learn more about on how to self-treat the most common lower extremity overuse injuries, be sure to check out the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.

Have you performed the clock exercise before? If so, what was your experience like? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

Posted on

How to Perform a Key Hip Stability Exercise

Hip pain, knee pain, and even foot pain (such as plantar fasciitis or posterior tibialis syndrome) can have an associated hip external rotation weakness. An important yet often overlooked component to proper lower extremity stability is how the deep hip external rotator muscles need to work along with other hip external rotators and hip abductors, such as the gluteus medius, to insure proper lower extremity positioning when the leg is in full weight bearing. Particularly, in a single leg stance position during walking, running, skipping or landing from a jump as the leg accepts full weight bearing while the opposite leg is in swing phase.

The deep hip rotators, also known as the short external hip rotators, are a group of muscles consisting of the superior and inferior gemelli, obturator internus, quadratus femoris, and the piriformis. This group of muscles is extremely important for stability of the body, pelvis, and leg as the leg/foot initiates full ground contact.

Weakness in these muscles is often associated with many of the more common lower extremity overuse injuries:

  • Foot injuries: Plantar Fasciitis, Achilles Tendinitis, Posterior Tibialis Syndrome
  • Knee injuries: Patella Femoral Pain Syndrome (PFPS), Iliotibial Band Syndrome (ITBS)
  • Hip related issues: Piriformis Syndrome, Hip Bursitis,  Hip Impingement

A simple and effective exercise to improve strength of these muscles is the standing hip 3-way exercise. The important points to remember in this exercise are to keep the stance knee unlocked and in a “soft” stance with the patella (knee cap) slightly externally (laterally) rotated (usually pointing toward the 3rd or 4th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators should be the primary focus.

In the following video, I demonstrate how to use an exercise band to perform the standing hip 3-way exercise, a key hip stability exercise for treating hip pain, knee pain, and foot and ankle related injuries.

CLICK HERE TO WATCH NOW

For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:

For prevention strategies and to learn more about on how to self-treat the most common lower extremity overuse injuries, be sure to check out the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.

Do you suffer from hip, knee or foot pain? If so, hip external rotation weakness may be part of the reason for the ongoing pain as you overload and overuse other structures trying to gain extra lower leg support. Additional discussion can help others to manage this condition more effectively. Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

Posted on

The Clamshell: A “go to” Exercise for Treating Foot, Hip, and Knee Pain

Do you suffer from foot, hip or knee pain? If so, hip external rotation weakness and poor single leg balance may be part of the reason for the ongoing pain as you overload and overuse other muscle groups in order to gain extra lower leg support. Weakness in the deep external rotation muscles is commonly associated with many lower extremity overuse injuries.

Injuries commonly associated with hip weakness include:

  • Foot/ankle injuries such as plantar fasciitis, Achilles tendinitis or posterior tibialis syndrome.
  • Hip related issues including piriformis syndrome, hip bursitis, and hip impingement.
  • Knee injuries such as Patellar Femoral Pain Syndrome (PFPS) and Iliotibial Band Syndrome (ITBS).

The deep hip external rotator muscles need to work along with the hip abductors (such as the gluteus medius) to insure proper lower extremity positioning when the leg is in full weight bearing. (Particularly, in a single leg stance.) One leg bears the full weight while the opposite leg is in the swing phase while walking, running or skipping.

The deep hip rotators (also known as the short external hip rotators) are a group of muscles including:  the superior and inferior gemelli muscles; obturator internus; quadratus femoris; and the piriformis. This group of muscles is extremely important for stability of the body, pelvis, and leg as the leg/foot initiates full ground contact.

The clamshell exercise is a commonly prescribed exercise designed to target the hip abductors and hip external rotators. However, this exercise is often performed incorrectly or ineffectively. 

In the following video, I demonstrate my preferred method of performing the clamshell exercise in order to insure optimal effectiveness.

In order to engage the deep hip rotators, you should feel the muscles working deep into the buttocks and directly behind the greater trochanter (the hard bone that pokes up at the top of the hip).

This exercise should be performed very slowly. I advise a count of 5 seconds up, a 5 second hold, and then a 5 second slow return to the starting position for at least 10 repetitions.

If you aren’t feeling the deep hip rotators activate, then you may need to reposition your legs. Usually, repositioning the knees and moving them up toward your head into a more fetal position will do the trick.

CLICK HERE TO WATCH NOW

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

Posted on

Do I have Morton’s Neuroma in my Foot?

Do you have pain between your toes?  Does it feel like you are always standing on a pebble or have a lump in your socks between your toes?  This may be Morton’s neuroma.  A neuroma is a thickening of the tissue that surrounds the digital nerve bundle.  Morton’s neuroma is one of the most common types of neuromas and typically occurs between the third and fourth toes.

Morton’s neuromas occur due to repeated stresses, irritation, and/or pressure at the ball of the foot which affects one of the nerves that leads to the toes.  There typically isn’t any swelling, bumps or bruises with Morton’s neuroma.  Learn how to determine if you have Morton’s neuroma in your foot and how to self-treat it.

Morton’s Neuroma Symptoms include:

  • Numbness or tingling which is affecting the ball of the foot, between the toes, and/or the toes themselves.
  • Sharp, stabbing and/or burning pains that are intermittent and only affect either the ball of the foot and/or toes (usually the third and fourth toes).
  • The sensation of standing on a pebble or marble or having a lump in your shoe or sock.
  • When running, the pain is often felt during the push off from the toes prior to the swing through phase.

Common Risk Factors for developing Morton’s Neuroma:

  • Sports and activities that involve repeated impact affecting the feet (such as jogging and running sports).
  • Poorly fitting footwear.  This is particularly true for high heel shoes, but it’s also very common in athletic and running shoes.  Most commonly, the toe box is too small.  A sole that is overly flexible in the wrong location can cause excessive give in a location which isn’t in proper alignment with the metatarsals of the foot.
  • People with common foot deformities, such as bunions, hammertoes, flat feet or overly high arches, are at risk for developing Morton’s neuroma.
  • Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
  • Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
  • Women are eight to ten times more likely to develop Morton’s neuroma.  High heels are a likely culprit.

Do I have Morton’s Neuroma in my Foot?

Morton’s neuroma is often diagnosed through a physical examination and imaging.  However, a very thorough history and physical examination can be quite conclusive.  The imaging is typically only to rule out other possible causes of the pain such a stress fracture.

The physical examination includes palpating between the toes.  The painful area will feel “thicker” on the affected foot in comparison to the other.  There is often an associated clicking of the bones when the area is squeezed or moved back and forth.  When the forefoot is squeezed and held for several seconds for a Morton’s Neuroma test, it will often reproduce or worsen the symptoms of burning and or tingling.

How to Self-Treat Morton’s Neuroma:

Avoid wearing tight fitting, ill-fitting, and high heeled shoes.  Be sure that your shoes have an appropriately sized toe box.  In the case of athletic shoes (particularly, for distance running), extra room in the toe box can be beneficial as the foot will often swell during the course of the run.  If you wear high heeled shoes, consider wearing them less frequently and/or switching to a shorter heel.  Even wearing socks that are too small can potentially cause too much compression and lead to increased symptoms.

Orthotics.  Many people respond well to a rigid orthotic with an extension underneath the first metatarsal bone.  You may not necessary need custom orthotics.  Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles.  The blue tends to fit most feet, but a variety of options are available for customization.  In my experience, these insoles can last 1,000 to 1,500 miles easily.  If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.  Seek assistance from a professional who is a runner and has experience with treating other runners.

Metatarsal buttons and pads.  Adding a metatarsal button or pad may be enough to spread out the metatarsal heads and alleviate the pain for those who don’t want a full orthotic.  Although often a metatarsal pad may be incorporated into a custom orthotic.  I recommend these Pro-Tec Athletics Metatarsal Pads.

Anti-inflammatories.  Initially an anti-inflammatory may be necessary.  Speak to your physician about the best type of anti-inflammatory for you.  In severe cases, a cortisone injection may also be warranted.  However, you must address the biomechanical causes for the pain in order to prevent it from recurring.

I am a supporter of natural supplements and remedies.  Many supplements include herbs which are designed to help reduce inflammation and support the healing response. 

My most recommended supplement to help recover from injury is Mt. Capra CapraFlex.  Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation and support healing.  CapraFlex can be taken long term or intermittently.

Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation.

Another supplement I frequently recommend to help recover from injury is Tissue Rejuvenator by Hammer Nutrition.  It contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation.  It’s a fantastic supplement.

I recommend taking either CapraFlex OR Tissue Rejuvenator, not both concurrently.

I initially recommend trying a 30 day protocol.  If the supplements are aiding your recovery, you may choose to continue taking them for an additional 30 days.  I sometimes implement this protocol as part of a prevention strategy during times of heavy volume or high intensity training.  (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol.  Herbs could interact with some medications particularly if you are taking blood thinners.)

Improve your foot mobility and strength.  Complete with instructions and photos, this guide, Morton’s Neuroma Rehabilitation Exercises, outlines how to safely perform exercises in order to improve your mobility and strength.

Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) is often found in the case of Morton’s neuroma as part of the biomechanical issues that led to its development.  I recommend initiating a complete ankle/foot strengthening protocol.  Please refer to Ankle Resistance Exercises Using the Elastic Exercise Band.

Improve your balance.  Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature.  Weakness and balance deficits can lead to poor foot biomechanics.  Standing on one foot can be an excellent way to improve your balance.  This technique is demonstrated in the Morton’s Neuroma Rehabilitation Exercises.  For additional ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle.

Research concludes that nearly 80% of all cases of Morton’s neuroma can be treated through conservative measures (as outlined above).  In the rare cases where conservative measures fail, then one may need to consider surgical options.

One surgical option offered is decompression surgery.  During this surgical intervention, the surgeon can relieve the pressure on the nerve by cutting nearby structures (such as the ligament that binds together some of the bones in the front of the foot).  Unfortunately, this alters the shape of the foot and may affect foot dynamics into the future.  Another option is to resect or remove the nerve.  Surgical removal of the nerve is usually successful, but the procedure can result in permanent numbness in the affected toes.

If you’re not experiencing significant relief from Morton’s neuroma upon changing your footwear and addressing other risk factors while progressing into your exercise program, please consult a medical professional.  I recommend a physical therapist that specializes in feet.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for Morton’s neuroma helped you?  Which treatments haven’t worked for you?  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Q & A: How did I get a Stress Fracture in my Foot?

Q.  I have been diagnosed with a stress fracture in my foot.  What causes a stress fracture?  Now what should I do?  The doctor wants me to avoid any weight bearing for the next four weeks.  How do I heal?  –Denise

A.  Thanks for your question, Denise.  I’m sorry to hear that this has happened to you.  Stress fractures are a unique type of bone fractures as they rarely occur due to a specific trauma.  Stress fractures typically occur due to a silique of events that leads to the bone not being able to handle the stress of your activity which results in a crack in the bone.  Stress fractures are common in the foot, but they can occur almost anywhere.

Initially, you might barely even notice the pain associated with a stress fracture, but the pain tends to worsen with time.  The tenderness usually originates from a specific spot and decreases during rest.  As the injury worsens, the pain tends to spread out and become more diffused with a focal area of tenderness.  You might have swelling around the painful area.  In some cases, the entire foot may begin to swell.

footpain

Stress fractures typically occur as the bone is subjected to a new unaccustomed force without enough time for recovery.  Bone adapts gradually to increased loads through remodeling, a normal process that speeds up when the load on the bone increases.  During remodeling, bone tissue is destroyed, and then rebuilt.  This is a similar process in muscle tissue.  When the load and/or volume of activity are too much for the bone, a fracture will occur.

Risk Factors for a Stress Fracture:

  • Certain sports.  Stress fractures are more common in people who participate in sports such as track and field, basketball, tennis, dance or gymnastics.  High repetitive impact sports tend to have the most stress fractures.
  • Increased activity.  Stress fractures often result from increasing the amount or intensity of an activity too quickly.  For example, people who suddenly shift from a sedentary lifestyle to being more active (increasing training volume significantly) or those who rapidly increase the intensity, duration or frequency of training sessions.
  • Gender.  Women are more likely to develop a stress fracture, especially those who have abnormal or absent menstrual periods (known as amenorrhea).
  • Foot problems.  People who have flat feet or high, rigid arches are more likely to develop stress fractures.  Worn or poorly fitting footwear or high heels can also contribute to this issue.  For runners, transitioning too quickly from a more built up running shoe into a minimalistic style can be a factor.
  • Osteoporosis.  Osteoporosis or osteopenia causes weakening in the bones that makes it easier for stress fractures to occur.
  • Prior stress fractures.  If you have experienced one or more stress fractures, you’re at a higher risk.
  • Poor nutrition.  Lack of Vitamin D, calcium, Vitamin K, and magnesium can make bones more likely to develop stress fractures.  Generally poor eating habits are also a factor.
  • Hard surfaces.  Spending long periods of time or training on hard surfaces, such as concrete, can increase your risk.
  • Smoking.  Smoking leads to poor blood flow and affects the body’s ability to heal and recover.
  • Obesity.  The heavier you are, the more forces that ultimately go through your foot.  Depending on how you are exercising, your particular footwear and the surface which you walk on can contribute to increasing your risk factors.
  • Gait abnormalities.  Alterations to your normal mobility (from either another injury or a change in your body) that affect how you typically move.  The change in mobility, along with your activity level, can be enough to overload the bone.  Particularly, when other risk factors are present.

In most cases, it’s not one specific risk factor that leads to the stress fracture, but a combination of risks and events that lead to the injury.  Diagnosis is usually through X-ray.  However, an acute injury may not initially show, so a second X-ray may be needed after a week or so to confirm the diagnosis.  A bone scan can also be useful to determine if there is an injury to the bone.

In the case of a poorly healing bone, the use of a bone stimulating electrical device may be recommended by your physician.

Initial Treatment

Non-weight bearing or limited weight bearing for four to six weeks is a very common course of treatment.  It provides enough time to initiate the healing response while reducing the stress on the injury site.  If you continue to stress the site of injury, the fracture can worsen and require more invasive treatments (possibly even surgery).  Crutches, a walker or a Roll-A-Bout knee walker can be used while you have weight bearing restrictions.  A walking protective boot is also typically used to protect the injury site.

As with many injuries, the initial treatment for a stress fracture in the foot is PRICE (Protection, Rest, Ice, Compression, and Elevation).

  • Protection.  Wear a walking boot, and limit weight bearing on the foot.
  • Rest.  Limit any activities that cause pain.  Depending on the severity and your personal health status, this can last from two to eight weeks.  Those with diabetes usually take a significantly longer period of time to heal.
  • Ice.  Use ice as needed for pain and edema control.  The rule for icing is to apply ice no more than twenty minutes per hour.  Do not place the ice directly against the skin, especially if you are using a gel pack style.  A bag of frozen peas can be ideal.  Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression.  If swelling is present, utilize a simple ACE wrap around the foot and ankle to help with the swelling and pain.  Start at the toes, and work up the leg.  Take care to not apply the ACE wrap too tightly as over squeezing the foot can be irritating.
  • Elevation.  Use pillows to position the foot above the level of your heart to help reduce swelling.  This would be an excellent time to apply ice, too.

In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness.

Addressing Your Risk Factors

After you have initiated PRICE and the pain and swelling has decreased, address any risk factors (if and when possible).

Stop Smoking

If you smoke, please stop.  It not only affects your bone density, but it has negative effects on every other body system.  It also increases your risk of cancer and heart disease.

Nutritional Management

Address any nutritional deficits.  This includes having adequate levels of Vitamin D3, Vitamin K1 and K2, magnesium, and healthy fats.

Vitamin D3 is critical to the absorption of calcium, through the intestinal wall, which is important for bone health.  Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).  Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function with in the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected (including heart function).  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.

Vitamin K, found in green leafy vegetables, has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.

I also use magnesium as a sleep and recovery aid.  I consume it at night to help me sleep.  Magnesium can also reduce muscle soreness, cramps, and/or spasms.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.

Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not quite as absorbable, Thorne Research Magnesium Citrate is also a fantastic product.

If you’re female (and especially if you suffer from amenorrhea, abnormal or absent menstrual periods), then consuming adequate levels of fats is pertinent.  Adequate levels of Omega-3 fatty acids and other healthy fats (primarily from plant sources such as avocados and coconut or olive oil) are critical in order to insure that your body has what it needs for proper hormonal support.  Amenorrhea can be a sign that your diet is lacking in adequate high quality fats as well as a sign of overtraining.

Avoid Soda and Distilled Water

Excessive soda intake (particularly diet soda) has been linked to poor bone density.  The exact cause isn’t entirely clear.  Many theorize that the acidic nature of the soda along with the chemicals and additives cause increased osteoclast activity in the bones.  This releases more calcium into the blood stream in order to help fight the negative effects of soda consumption.  It’s clear that too much soda is bad for your health and bones.  Similarly, distilled water is water that has been leached of all other nutrients and minerals.  Drinking too much distilled water can leach needed nutrients out of the bones. 

Weight Management

It’s important to manage your weight effectively.  Excessive body weight can cause additional stress on the body.  Whenever possible, work toward optimizing your health.  This includes maintaining a healthy body weight.  The heavier you are the more stress forces present throughout the lower extremity.

Rehabilitation

Once you’re cleared by your physician to initiate exercise and activity, it’s time to progress your rehabilitation.  For detailed descriptions and photos of potential helpful exercises, please refer to Foot Stress Fracture Rehabilitation Exercises.  (If you’re already working with a rehabilitation professional, such as a physical therapist, consult with him or her prior to starting my recommended rehabilitation exercises.)

  • Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the tissues on the bottom of the foot including the plantar fascia.  I recommend initiating a complete ankle/foot strengthening protocol.  Please refer to Ankle Resistance Exercises Using the Elastic Exercise Band.
  • Improve your balance.  Poor balance is often associated with muscle weakness in the foot and ankle as well as weakness in the knee and hip musculature.  Weakness and balance deficits can lead to poor foot mechanics, which ultimately can lead to a stress fracture or even metatarsalgia.  Improving your balance can help to reduce the risk of metatarsalgia and is an important part of the rehabilitation process.  For more ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle.  As your pain level improves, I recommend that you perform these balance exercises without shoes on.
  • Add an orthotic.  Often times, the stress fracture occurred due to alterations in foot mechanics or an old or poorly fitting shoe or orthotic.  If you are recovering from a stress fracture, consult with a podiatrist or a physical therapist that specializes in orthotics to determine the proper orthotic or shoe for you.
  • Did you progress too quickly into a minimalistic shoe?  The standard built up shoe offers more foot support and padding than most minimalistic style shoes.  If you attempted a quick progression, this may have contributed to the injury.  Unless you are a child or teenager, expect a safe transition to take at least three months.  A slow transition will allow your body to adequately adapt to the new stresses.
  • Weight training.  Once you’re cleared by your physician, initiating or returning to a weight training program is critical to the development and maintenance of strong bones.  Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density.  It also positively affects the hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength.  Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation.  The key to maintaining and improving bone density is always progressive axial skeletal loading and the associated pull of muscles against the bone during activity (particularly, strenuous activity).  Examples of such exercises include squats, lunges, and dead lifts.

It’s critical that you to slowly progress back into high impact activities.  It’s equally important that you address any of these risk factors in order to help reduce the risk of re-occurrence.  If you have experienced one or more stress fractures, you’re already at a higher risk.  As you taper up activity, monitor for signs of swelling and pain.  If symptoms occur, taper down the intensity.  Continue to work in a pain free range in order to strengthen around the injury site.

If you don’t experience a significant relief as you progress into your rehabilitation, please consult your medical professional.  I recommend a physical therapist that specializes in feet or who works with athletes for the treatment of stress fractures.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  You may also consider consulting with a podiatrist.

Thanks, Denise, for the question.  I hope you find this information to be helpful as you manage your condition.

Have you experienced a stress fracture in your foot before?  Which treatments worked the best for you?  Which treatments didn’t seem to help as much?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Posted on

How to Self-Treat Metatarsalgia

MTA_Metatarsalgia

http://marathontrainingacademy.com/how-to-self-treat-metatarsalgia

Marathon Training Academy

February 22, 2016

In this guest post for Marathon Training Academy, you will learn how to identify the potential causative factors for metatarsalgia and how to self-treat this condition so you don’t lose too much time with your training.

Pain in the female footMetatarsalgia is a general term that refers to pain in the foot (typically around the ball of the foot). It’s common in runners, track and field athletes, and for those who participate in high impact related sports (such as basketball and soccer).  It’s also commonly associated with overuse syndrome.

Metatarsalgia is pain and irritation at the end of the metatarsal joints near the toes. Potential causes for the pain include:  a stress fracture; gout; osteoarthritis; hammertoes; calluses; and pain in the joint from swelling and irritation.  It can also be from neuromas, in which nerves tend to bundle and become irritated between the metatarsal heads.

Metatarsalgia typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run. The key to treatment and management of this condition is to intervene quickly and to identify the actual cause or causes that led to the pain and irritation.  Learn the potential causative factors for metatarsalgia and how to self-treat this condition so you don’t lose too much time with your training.  Continue Reading

Posted on

How to Self-Treat Plantar Fasciitis

Plantar fasciitis is a very painful and potentially very debilitating condition.  It’s one of the most common causes for heel and bottom of the foot pain.  The plantar fascia is essentially a band of connective tissue (a ligament) which runs the length of your foot from your heel to your toes.  It helps to support the arch of your foot by using “windlass mechanism” to make the foot more rigid and aid in the foot’s ability to transfer force and push off when walking or running.   In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk.  It’s typically at its worst in the morning with your first several steps after sleeping.  Plantar fasciitis is also more common the older a person becomes.

Image courtesy of www.runnersgoal.com

Risk factors for developing plantar fasciitis include:

  • Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
  • Either excessively high arches or overly flat feet.
  • Spending long periods of time standing or walking.
  • Spending long periods of time on hard surfaces, such as concrete.
  • Obesity
  • Your shoes don’t fit well or the shoe is worn out.
  • You have transitioned too quickly from a more built up running shoe into a minimalistic style.
  • Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
  • Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.

Plantar fasciitis typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run.  Plantar fasciitis may occur after a specific event.  The plantar fascia could be over stretched due to a slip.  It could occur after an overzealous training day in unfamiliar circumstances, such as running barefoot in the sand.

Fortunately, plantar fasciitis doesn’t always require formal medical treatment.  The key is to intervene quickly to identify the actual cause or causes that led to the inflammation and irritation.  The recommended treatment is the same whether or not the plantar fasciitis developed over time or due to a specific event.

How to Self-Treat Plantar Fasciitis:

  • Begin your rehabilitation. Start with these Plantar Fasciitis Rehabilitation Exercises. Complete with instructions and photos, this guide outlines how to safely self-treat your plantar fasciitis. Stretch your calves as tight Achilles tendons and calf muscles can cause excessive strain on the plantar fascia, which increases your risk of pain. Stretch your plantar fascia by performing stretches prior to standing or walking upon morning waking and after any prolonged sitting.
  • Mobilize the tissue. Depending on how aggressive you want to be, a tennis ball, lacrosse ball, or golf ball can be used to mobilize the tissue. I recommend mobilizing once or twice per day for 2-3 minutes. Then perform additional stretching of the plantar fascia and calves.
  • Use ice. My favorite technique for icing this area is to use a frozen water bottle. Roll your foot over the bottle for 3-4 minutes until your foot starts to feel numb and the pain subsides. It’s possible to frost bite your foot, so be mindful of the length of time you’re icing.
  • Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the plantar fasciitis. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.
  • Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help reduce the risk of plantar fasciitis and is an important part of the rehabilitation. Please refer to Improving Balance by Using a Water Noodle.
  • Start a supplement. I am a supporter of natural supplements and remedies. Many supplements include herbs which are designed to help reduce inflammation. Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. If you are taking blood thinner medication, please consult with your physician prior to taking Phenocane Natural Pain Management.
  • Use a plantar fasciitis night splint. Although a little cumbersome and annoying, night splints can be helpful. While lying, the natural tendency is to flex the foot to point your toes (plantarflex). This position causes the plantar fascia to shorten and tighten, which explains the pain you might experience during the first few steps after sleeping or resting. The night splint helps you to heal by maintaining a neutral position which doesn’t allow the fibers to shorten.

While you’re self-treating your plantar fasciitis, you’ll likely need to modify your exercise or running program.  It’s an excellent time to focus on cross training activities.  I recommend following this protocol for two to three weeks.

If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional.  I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for plantar fasciitis helped you? Which treatments haven’t worked for you?   Additional discussion can help others to manage this condition more effectively.  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the new Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!