Hi, this is Dr. Steve Gangemi. And in this second part of the foot and ankle injuries, I want to discuss now the foot, one of the most common areas of complaints for people. Even if you just have sore feet at the end of the day, that’s actually not normal. But many people injure their feet through landing wrong, jumping wrong, running too much too often, running in the wrong type of footwear. And basically, what it comes down to is people end up with sore feet and injured feet a lot of times. So let’s look at some things that can go wrong with the feet and how to properly assess and treat those to get you back running and walking and moving about properly.
One of the most common injured areas or one of the most common injuries, I should say, is what’s known is plantar fasciitis. So plantar fasciitis is one of the most common injuries that runners and people who are moving about all day tend to exhibit and, actually, even people who don’t even move a lot. One of the most common symptoms of plantar fasciitis is when you get out of bed in the morning, you feel like your heels have basically a sharp object or a knife sticking through them. In other words, it’s a sharp type of heel pain. And it actually tends to get better as you walk about during the day.
Now, like in any injury, you don’t have to fit the textbook definition just perfectly. You tend to maybe have heel pain only when you’re working out, when you’re out running, or when you’re out playing or when you’re out moving. Or you might have heel pain only at certain times of the day. But basically, it’s a type of heel pain because of the tension of the fascia which is the connective tissue on the bottom of your foot.
So like most injuries, and this one is definitely no exception, typically, you want to stay off the area that is actually injured. So plantar fasciitis, you’re typically going to feel pain right here in the bottom of your heel, your calcaneus bone. Sometimes, you’ll feel it more towards the arch, and you can’t even feel it anywhere in the bottom of your foot. But typically, as you go more towards the toes, then it’s given a different name, but it tends to come from the same area.
The muscle to think about here is one called your tibialis posterior that actually starts way up here behind your lower leg bones, behind your tibia and actually your fibula too, the two bones of your lower leg. So I want you to look for points especially on the inside of this tibia, your shin bone that people know as, and coming with your thumbs like this and work your way down the inside of your tibia right on the inside there. So you can’t get it from the back, because as I showed in the ankle video, you’re going to be really going through the calves here. Even if you’re a skinny person, the muscles are too thick there to try and get to this muscle, because it integrates with the connective tissue that connects your tibia and your fibula together. So I want you to work your thumbs all the way down and look for a tender spot in here in the inside of the tibia where you’ll have pain on the heel.
The other spot to check out is right here where that tibialis posterior catches and helps to support your medial arch. That’s the main arch of your foot that gives you the proper arch of your own foot. So that is right there just below…Let me say it this way, just where the midpoint of your arch is. If your foot is flat, come right down from your inside ankle bone here, a little bit diagonal, and it’s right there. It should be really tender there or typically is if you have an issue with plantar fasciitis in the heel.
And the last spot to check for this is behind your fibula bone, which is the bone on the outside your leg. You can see it sticking out right there a little bit. Come right in here behind that, just at the top here. That’s where some of the tibialis posterior starts and then comes down to more the inside, wraps around here, and attaches to that arch. This muscle not functioning properly is the number one reason and by far the most common reason for plantar fasciitis issues.
So there are many other types of foot injuries that can occur. And people are given diagnoses from their doctors such as tarsal tunnel syndrome, functional hallux limitus. Morton’s neuroma and Morton’s toe issues are big problems with people. And what I want you to understand is that it’s more important to diagnose why these problems have happened rather than to actually tell you what the actual symptom is. It’s more important to figure out why and where they have come from, so you can figure out why you have been given a certain diagnosis or have ended up with a certain symptom.
So just like the plantar fasciitis, you may not feel pain, but that’s just a name given to that injury or that type of symptom where we’re going to look and see why that happened, has happened. And it has to do with that posterior tibialis muscle. And most of the problems with the foot have to do with an imbalance of that muscle with other muscles of your foot. Basically, what I’m saying is if you treat that tibialis posterior muscle, it will help a lot with any type of injury to the bottom of your foot, especially more in neuroma type injuries where you have nerve type pain especially between the third and the fourth toe as well as what’s called tarsal tunnel syndrome and especially with big toe issues, functional hallux limitus or functional hallux rigidus type problems, because basically what it comes down to is that people end up with foot problems due to pronation and supination imbalances of their foot.
And these are how we naturally move. Our foot is supposed to naturally pronate and supinate when we walk and when we run. And if the balance of the foot is off, if you pronate more than you supinate, maybe you’re given a name an overpronator or an undersupinator, then you’ll end up with an imbalance of the foot and a foot type injury. And it really has to do with the structure and the function of the tibialis posterior muscle.
Again, a lot of other things could go wrong in the foot. It’s too much to address here. Right now, I want you just to focus on that muscle and assess and see how far it can get you.
So the last thing I’d like to discuss are the conventional versus natural, more holistic therapies, which I employ in my own office. And the number one therapy or device you’re going to get if you go to a doctor, especially a podiatrist, with a foot issue is an orthotic device. And orthotics really support dysfunction of your foot and even your ankle and lower leg and, actually, even your knee. Orthotics don’t really correct any problem. If they did, a person would be put [sp], they’d be cast in this orthotic brace type device. They would resolve their injury, and they would be able to take the orthotic out and never need it again. But this rarely happens.
Some doctors do use them for acute injuries. Most have you put them in your shoes, all your shoes, and tell you to wear them all the time to prevent other injuries from occurring and to help heal up the injury that you’re dealing with at the time. But since they don’t actually correct injuries because it doesn’t allow your foot to naturally move the way it is intended to move, you might end up with some dampening of the pain, because it’s supporting the area that’s injured. But what happens is then you end up with a new injury later on.
So now, next thing you know, maybe a month later or maybe many months later, now your knees bothering or your hip or your lower back, and you’re not making the connection between the orthotics and the gait change, in other words, how you move about with that device that you’ve been wearing for so long at the same time, while your foot muscles are actually becoming more and more fatigued, because they’re being supported. It’s actually impossible to support your arch with arch supports, which many orthotics contain, because you can’t support an arch by pushing up on the arch itself, but you support an arch by supporting the ends of an arch, much like you are making a bridge over a span of water or a span of land. You don’t just push up on that area. You support the ends.
And finally, one of the best ways just like the ankle to go about and strengthen your foot muscles is basically just to stand and walk around barefoot as much as you comfortably can. And if you can already do that, then do a little bit of barefoot running, because that’s how you can just naturally strengthen your feet without having to do any band exercises or actually therapies during the day where you got to take time apart and count certain repetitions with bands or any sort of silly device that’s out there to try and help you heal up your foot.
And definitely, don’t be stretching your plantar fascia or any of the foot muscles when they become injured. That’s a common therapy for plantar fasciitis is to really stretch the fascia and wear a splint at night to stretch it. And again, you’re pulling the connective tissue away and not helping it heal up. You’ve got to get in there and get those fibers to join back together. So don’t stretch, but compress it, and you’ll heal up a lot faster especially if you’re dealing with a chronic problem that nobody is able to figure out.