165 Lilly Rd NE, Suite B, Olympia • 360.455-8014

Plantarfasciitis

Morton’s Neuroma–why does it happen, what muscles out of sync?

On our website, Comstockpt.com and MusclesInSync.com, you’ll notice a tab which is called Muscles InSync (TM). It describes muscles getting out of sync with injury, and how we look to get the timing and coordination of the muscles working well again to get you better. How does this idea relate to Morton’s Neuroma? And….how can it help you if you have Morton’s neuroma?

First, what is Morton’s Neuroma? mortons-neuroma2 It is tangle of nerves which bunch up between the bones on the bottom of the ball of the foot. It causes a lot of pain when you walk and put pressure on the ball of the foot when you walk. It is a lot worse when you wear high heel shoes or heeled boots.

What Muscles get Out of Sync causing Morton’s Neuroma? The foot, when you put weight on it spreads the weight in the “foot tripod” position. Here is the foot tripod:
tripod-foot

If your foot puts pressure down on the ball of the second toe, instead of the first toe, you end of lifting the outer toes too early, and the weight of your body can spin on the ball of the second toe. Below is a video from The Gait Guys which demonstrates the foot tripod

Which muscles are out of sync if you have a poor foot tripod? In the foot, the adductor halluces muscle, transverse portion (runs under the ball of the foot) supports the piece of the tripod which runs from the big toe to the little toe. adductor_hallucis

The Gait Guys are of the opinion that the extensor halluces brevis also plays a role in tripod support:

Try these two exercises slowly for 2 weeks and see if you can achieve a good tripod!

Physical Therapy in Olympia, Tumwater and Lacey, Where should I go?

There are many fine physical therapy clinics in the Olympia, Tumwater and Lacey area. How do you chose where to go?

You can choose based on location. A friend of mine told me today she chose to go to physical therapy at a clinic close to her house. What would prompt a close choice versus reputation? Maybe she needed to go 2 or 3 times per week. If someone needs to go to PT 2 or 3 times a week for a month or so, then going close to your house would be very convenient, HOWEVER, ask yourself the question: does your condition warrant 2 or 3 times per week?

Recently a former patient returned for a new session of physical therapy. She is a fairly frail 80 something year old, and was sent for BOTH headaches AND shoulder pain by her physician. Her prescription from the physician was directed to be 2 to 3 times per week for 4 to 6 weeks. She may have thought she needed to come that often, but…….when I evaluated her headache AND shoulder pain, I determined that both problems were mainly caused by the same anatomical structure.

I gave her an exercise program based on this one problem, and added customized and specific exercises for the shoulders and neck. As of Friday (January 30) 100% better in the headache and 75% better in the shoulders. She came for 6 visits at 1 x per week.

So the bottom line is, unless you actually NEED to have therapy 2 or 3 times per week consider going somewhere that uses less visits more effectively and you may save yourself some time and money.

The therapists at Comstock Physical Therapy, Joyce Mills, Lori Waterman and Linnea Comstock have extensively studied the body to make our exercise programs very effective and efficient. Give us a call if you would rather go to PT once per week instead of three times a week!

Why does my pain keep coming back? :(

WHY, WHY, WHY does my pain keep coming back? 

I go to my doctor and get pain medications yet the pain returns.  I go to a health care practitioner and feel somewhat better, get a standard protocol for certain exercises, or some other treatment, then my pain returns. 

I go to a MELT class (a self massage class using foam rollers and ball) and the pain returns.  (See this link)  http://www.nytimes.com/2015/01/02/arts/a-class-in-the-melt-method-of-body-work.html?src=me&module=Ribbon&version=origin&region=Header&action=click&contentCollection=Most%20Emailed&pgtype=article

headache

occipital headache
tension headache


Headache

I garden on my hands and knees, weeding for a few hours and get a headache that night AGAIN! 

Heel Pain

I have pain in my heel that comes on for no known reason, and get a cortisone shot, and still have pain. 

plantarrfasacia

plantarfascia

I have wrist pain and can't fully bend my wrist forward and I have weak grip.   

wrist pain

wrist pain

What is the problem?

Probably an old injury or a bad habit of movement.  What to do? 

To help the headache, strengthen the muscles which lift and support the shoulder blades;  that will take strain off the other shoulder blade muscles which connect to the head and cause the headache. 

scapular elevation and upward rotation

scapular elevation and upward rotation

To help the foot pain, have your physical therapist stretch the heel bone away from the ankle bones to take pressure off the plantar fascia.

plantarfascia relief

plantarfascia relief

wrist strengthening

wrist strengthening


Wrist Pain

To help the wrist pain have your physical therapist give you a specific exercise to strengthen bending and twisting your wrist up and in.

In short, Comstock Physical Therapy is here to help you help yourself by diagnosing the exact problem and giving you the exact exercise program you need to fix your problem!

Do you want radiation treatment for plantarfasciitis versus other treatments?

A flyer came in the mail last week from Capitol Medical Center that included an article about radiation treatment for plantarfasciitis.

(Plantarfasciitis is a very painful condition in the bottom of the arch of the foot when the plantarfascia, pictured below, becomes inflamed , causing a lot of pain with walking and standing and significant pain on the bottom of the feet after sleeping or sitting followed by getting up)

plantarfascia

plantarfscia

You can see the link to an advertisement for this on Comstock Physical Therapy’s link page.http://comstockpt.com/links-resources-directory/

I was SHOCKED and SURPRISED that radiation treatment is used for a diagnosis/condition that can be treated safely and effectively with no side effects. Many other treatments are available which treat plantarfasciitis without side effects.  I  researched information  about the level of radiation used for treatment of plantarfasciitis, and found that typically .5 Gy to 1 Gy dosage of radiation is given one time to someone with the heel pain.  (at the bottom of this article, please see the links that you can use to look up this information,   1 Gy = 1 Sv in Xray measurements) .  I also found out that this is higher than the maximum level of radiation considered safe for diagnostic x-rays and CT Scans.

What treatments does science tell us work? The summary linked below mentions shock wave treatment and physical therapy treatments being very good at  treating this condition.

http://www.ncbi.nlm.nih.gov/pubmed/24728397

Here is another very complete rundown of the science about what works to treat plantarfasciitis:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951039

Many treatments that help relieve plantarfasciitis are mentioned including stretching, rolling your arch over a can and massaging the bottom of the foot.  Physical therapy specifically helps by using the therapist’s hand to move the stiff joints on each other as well as massage the plantarfascia, and giving strengthening exercises to the feet, legs and hips the take stress of the plantarfascia using the muscles to support the legs instead.

Self treatments to help relieve plantarfascia also include these:

calf stretch

Calf and arch stretch using a towel. Consider keeping the towel near the bedside and performing before going to sleep and before taking first steps in the morning. Pull back on foot for 30 seconds 3 times with 30 seconds of rest in between.

 

soup can foot

Roll plantar fascia with can or ball. Consider keeping at the bedside and performing before going to sleep and before taking first steps in the morning. Roll plantar fascia for 1 minute 3 times with 30 seconds of reset in between.

 

 

manual therapy plantarfascia

Manual plantar fascia stretch with cross-friction massage. Stretch and massage before taking first steps for 1 minute 3 times with 30 seconds of rest in between.

 

If you do consider radiation treatment for plantarfasciitis, please ask about side effects, for your own benefit.

 

This link documents the dosage used in one treatment protocol for plantarfasciitis:   http://www.ncbi.nlm.nih.gov/pubmed/23443608

This link documents the level of radiation considered safe:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996147/

 

Muscle of the Week: Peroneus Longus pain masking as plantarfasciitis

The peroneus muscles are on the outside of the lower leg and ankle and usually get strained when the ankle gets sprained.  This makes sense to most people because the tendons run so close to the outside of the ankle. 

 

But…..the peroneus longus tendon crosses UNDER the foot after running along side the ankle bone to help support the arch.  It attaches in the middle of the arch on the bottom side. 

Here is  a picture of the bottom of the foot:

When the peroneus longus tendon insertion starts to pull and get irritated, it can feel like plantarfasciitis and be confusing.  However, the fix is usually the same, stretch your Achilles and plantarfascia and strengthen the side to side  muscles as well as get manual therapy. Sometimes orthotics help too.  Your physical therapist is particularly well trained to fix this condition.