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Category: Active Feet
Plantar Fasciitis REVIEWED
Feet play an important role in posture and gait. Foot pathologies are common amongst the adult population, in particular plantar heel pain. Foot pathologies contribute to a negative impact on quality of life. Plantar heel pain (or Plantar Fasciitis) is a common musculoskeletal foot injury and the most common condition presenting to our Townsville Podiatry clinic. Below is a summary of a recent review of the research on plantar heel pain. Learn more about Plantar Fasciitis or Heel Pain here. Review of research on Plantar Fasciitis or Heel Pain Plantar heel pain is most common between 40 and 60 years and may affect both athletic and non-athletic populations, but the incidence is higher among runners (affecting 17.4% of running population). The pathology is characterized by pain in the medial (inside) heel that is exacerbated by weight-bearing activity, as well as after periods of rest. Plantar Heel Pain is often chronic with typical symptoms lasting more than a year. Despite the name “Plantar Fasciitis” – the condition is considered a degenerative pathology rather than a primary inflammatory condition. Therefore, the more correct terms which should be used from now on are fasciosis or fasiopathy or plantar heel pain. Authors found that while Body Mass Index (BMI) was not associated with plantar fasciitis in the athletic population, there was evidence to support such an association in the non-athletic population. Muscle function and muscle size differences between those with and without plantar fasciitis was reviewed in seven studies - and the strength of muscle groups including hallux plantar flexion, lesser toe plantar flexion, ankle dorsiflexion, ankle inversion, and ankle eversion was lower in patients with plantar fasciitis. Studies found that patients with plantar fasciitis were more likely to have increased plantar fascia thickness, hypoechogenicity, and plantar calcaneal spurs. Patients with plantar fasciitis had 2.16 mm thicker plantar fascia than controls and tended to have absolute plantar fascia thickness values exceeding 4.0 mm. Review of Treatments for Plantar Heel Pain Corticosteroid Injections: Corticosteroid injections have been used for the treatment of plantar fasciitis as it can reduce inflammation, fibroblast proliferation and ground substance proteins, which have been thought to play roles in pathogenesis of plantar fasciitis. The review of the literature concluded that compared to placebo, corticosteroid injection was more effective in relieving pain at one month but not over longer intervals. Among 21 trials that reported adverse events, two ruptures of plantar fascia, three injection site infections, and 27 minor adverse events such as post-injection pain were reported. ESWT Extra-Corpeal Shockwave Therapy: The proposed mechanisms for the effect of ESWT include increasing nerve supply, blood supply and collagen synthesis in degenerative tissues. Shockwave reportedly have benefits in pain reduction at 12 weeks, unlike corticosteroid injections. ESWT showed greater reduction in VAS pain scores and success rate of improving heel pain by 60% over placebo when taking first steps and during daily activities. The most recent of studies compared ESWT with other therapies and found greater success rate, greater reduction in VAS pain scores, decreased return to work time, greater overall reduction in plantar fascia thickness up to 6 months post-treatment and less complications in those treated with ESWT compared to other interventions. The 39 studies concluded that while there may be common side effects such as pain during treatment and transient erythema (redness), complications during the first year of follow-up are highly unlikely and concluded that Shockwave Therapy is safe for treating plantar fasciitis. Low-Level Laser Therapy (LLLT): LLLT is a form of photobiomodulation therapy that involves the use of wavelengths ranging from 620 nm to the infrared (820–904 nm) over the surface of patient’s skin. The proposed mechanisms include anti-inflammatory effect as well as stimulation of cell proliferation, microcirculation, vascular neoformation, and collagen production . Fewer studies have been conducted on the efficacy of LLLT in the treatment of Plantar Fasciitis, however the systematic reviews that have been done found that LLLT significantly improved pain and function and decreased plantar fascia thickness compared to other therapies, such as exercise. In Summary Regarding treatment efficacy for management of plantar fasciitis, outcomes using corticosteroid, PRP, and ESWT may have the largest number of studies and most reviews concluded longer-term outcomes favoured non-corticosteroid interventions. Similar to tendinopathy, plantar fasciitis has been characterized by degeneration of collagen even though inflammation may play an important role in the early disease process. However, this does not mean that inflammation and degeneration represent a continuum of disease but reflect two distinct or often coexisting processes. Therefore, corticosteroids may offer benefits in short term particularly within 1 month following treatment. By Hayley Paterson | Biomechanical Podiatrist A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar FasciitisHye Chang Rhim 1,† , Jangwon Kwon 2,†, Jewel Park 3, Joanne Borg-Stein 4,5 and Adam S. Tenforde 4,5,*Read More
All About Running Footwear
Chris Weber - Biomechanical Podiatrist & Runner - shares her insights into Running Footwear Correct Fitting A comfortable and correct fit is the most important consideration for all shoes. Incorrect fit can be the sole cause of pain or injury. Consider the length, width and depth of the shoe.Read More
Townsville Heel Pain Clinic
Welcome to Townsville’s Heel Pain clinic where we pride ourselves on the non-surgical, effective treatment of your heel pain. Heel Pain is the # 1 condition we treat on a daily basis at Foundation Podiatry - in fact over the last 15 years here in Townsville we have helped 8000+ happy campers resolve their heel pain and get back to enjoying their active lifestyle! [feature-block] Do you wake up in the morning limping from a painful heel? Feeling frustrated as you can’t exercise or chase the grandkids around? Have you tried other treatments and nothing seems to be working? Want to avoid a big needle… or even worse… surgery? [/feature-block]Read More
Running Related Injuries
Image A is an injured runner displaying contralateral pelvic drop – that is, the hip/pelvis on the non-weight bearing limb drops lower than the weight bearing limb during the stance phase which results in an inward position of the knee and subsequent increase in foot pronation (rolling inwards). This position has been linked to developing pain at the front (patellofemoral pain) and at the side (ITB friction syndrome) of the knee, shin splints and achilles tendon pain. Image B is a healthy runner who is not displaying contralateral pelvic drop.Read More
I have heel pain - I must have a heel spur!
A very common question I get asked in my Townsville Podiatry clinic: "I have heel pain, so I must have a heel spur!" Having heel pain does not necessarily mean you have a heel spur. Conversely, having a heel spur does not necessarily mean you will have heel pain. One study showed that 45% of the heels analysed were either painful with no plantar heel spur or had a plantar heel spur but were not painful. Another study showed plantar heel spurs in 10-63% of asymptomatic controls. The most common cause of heel pain in adults is Plantar Fasciitis (now more correctly termed plantar heel pain) however there are many other causes of heel pain.Read More
Runners with good running economy use less energy and therefore less oxygen. Townsville Podiatrist and Running Coach Chris Weber shares some tips below on how to improve your running economy - however it is important to note that when attempting to modify your running technique there will be an initial increase in the amount of energy consumed (reduced running economy). Therefore, the more you practice the technique modification, the more efficient you will become. Reduce your ground contact time. This is the amount of time your foot is in contact with the ground. Some strategies to reduce ground contact time include: Taking quieter steps – a quiet foot strike typically spends less time in contact with the ground than a loud foot strike (and there’s much less stress through the lower limb too) Take quicker steps – the more steps you take per minute (cadence) the less time your foot spends in contact with the ground. As cadence increases, ground contact time usually decreasesRead More
Barefoot. Is it good or is it bad? Townsville Podiatrist Hayley explains...
Barefoot gets both a good and a bad rap. Here is Hayley's take on the topic.Read More
'Start low & go slow’ – How to begin an exercise regime from scratch
The New Year is a great time to focus on becoming fit and healthy. Nobody will dispute that exercise (movement) is good for us. Due to our more sedentary occupations and lifestyles – even the act of getting up off the ground, climbing a ladder or cleaning out a bottom drawer may be a monstrous task. So think of the benefit of exercise (movement) as improving our ability to do daily tasks and sprucing overall health and well-being – not just minimising those tuck-shop arms and muffin tops! "As a Biomechanical Podiatrist I treat many patients who - due to yucky foot and lower limb pain - have become very inactive for a very long time. Once we have worked together to manage or resolve their pain, they have more energy, a positive head-space and are now ready to embark on some regular exercise". So here’s some advice I will often give to my patients: Have a goal in mind Do you want to enter the Townsville 5km, walk around the block without getting winded, or finish a 100-rep circuit without vomiting??? Have a goal that is clear, realistic and concise. Start Low & Go Slow If you have not exercised for quite some time, do not expect to race up Castle Hill on your very first go, even if you used to do it in a breeze. When people commit to starting an exercise program they are often so pumped and excited that they do ‘too much too soon’. If walking is your exercise, start with a short walk (20 mins) and increase the time by 10-15% each week. Rest days are good! To begin with I would recommend having a rest day every 2nd day. This is particularly so if coming back from injury. Rest days allow your body to recover and repair. After 2 weeks of exercise you may reduce your rest day to 2 on, 1 off. After 2 more weeks of exercise you may only need 1 rest day per week. Alternate your training Mix it up - keep your body guessing! Where possible you may consider aqua aerobics, yoga or tai chi, weight training etc. Alternating your training styles means you are using different muscle groups, different energy systems, different loading patterns. This greatly reduces your risk of over-use injury, achieves greater results and keeps things interesting! When commencing an exercise program (whether that be following an injury, or starting from scratch for the first time) being SENSIBLE is the key. In Townsville we are very fortunate to have an abundance of gyms, amazing yoga teachers, water aerobics classes galore, great environment for outdoor sessions, zumba classes and the list goes on. Find something you enjoy and give it a go this New Year! Remember….. Active FEET > Active BODY > Active LIFE By Hayley Paterson | Biomechanical Podiatrist TownsvilleRead More
FOOT PAIN hindering your New Year's Fitness Resolution?
Most people try to kick off the New Year with a healthy, positive goal in mind. Whether that be regularly walking Castle Hill or training for a half marathon, it’s important to have a plan in place. Unfortunately for many people embarking on a new exercise regime… PAIN often follows! Foot pain, shin pain and knee pain are common culprits that can quickly put a stop to your training. 3 things to consider when embarking on a new exercise regime: FOOTWEAR is a biggy! What type of training are you doing? Running, CrossFit, netball, hiking?? A particular shoe may be required for a particular activity. In many instances, footwear can be the cause of an injury, or may help to resolve an injury. Have a read of our ‘How to choose the correct training footwear‘ article. Be careful of TOO MUCH TOO SOON! Most people are super excited when starting a new exercise regime. Take it easy and slowly build up the intensity, duration and frequency. Rest days are allowed! Any niggly injuries should be addressed before you start! Are you having heel pain or forefoot pain after training? Knee pain doing squats or shin pain when sprinting? The sooner you address these issues the sooner they will resolve, and the more likely you will be to reach your fitness summit. At Foundation Podiatry Townsville our Podiatrists Hayley, Chris & Emma are leaders in their field of Biomechanical Podiatry. Visit us for a detailed Posture, Movement and Gait Assessment to identify the cause of your problem, instead of just treating the symptoms. Remember….. Active FEET > Active BODY > Active LIFE By Hayley Paterson | Biomechanical Podiatrist TownsvilleRead More
The pitfalls of focusing on Foot Strike
So running boils down to a lot more than just chucking your runners on and putting one foot in front of the other. In this blog I’m going to discuss foot strike – particularly the pitfalls of ONLY focusing on foot strike. The way your foot strikes the ground when you run will fall into 3 categories. But it is important to note that 1 foot strike isn’t necessarily always better or worse than another. The most suitable foot strike required may change throughout a run – depending on terrain, ascending/descending hills, when you need to put the pedal to the metal etc. HEEL STRIKE (Heel hits the ground before the rest of your foot) For adult runners, heel strike is the most common foot strike – here’s why: If you spend most of your day seated, you’ve probably developed chronically tight hips and sleepy glutes. As a result your stride reaches out much further in front of you than it needs to. This is because you’re not using your glutes, hips and hamstrings to drive your running. You may have heard the statement HEEL STRIKE is EVIL?More correctly, OVER-STRIDING is EVIL! But heel striking will often result in over-striding. "Over-striding (when your foot hits the ground in front of your body instead of underneath your body) – is like running with your brakes on". Or another way to think of it is to drive your car with one foot on the accelerator and the other foot on the brake. You are trying to go in a forward direction - running - but every time the heel hits the ground out in front it is actually slowing you down. So most heel strikers will over-stride, but you can still land with a forefoot or mid-foot strike and over-stride. A good time to heel strike (throw the brakes on) is when you need to decelerate coming down hills or make a sharp turn. FOREFOOT STRIKE (Forefoot hits the ground first) Body weight is heavily focused onto the ball of the foot and the toes. Heels are likely not hitting the ground between steps. Your upper body may be a little bent forward from the hips. Forefoot strike is helpful to up your speed towards a finish line or up a small hill. Spending the majority of a long run in this position may lead to tightness and cramping in your calf and achilles complex. MID-FOOT STRIKE (The middle ground) It is the most neutral foot strike of the three. Most of your foot hits the ground at once, underneath your body (not out in front or too far behind). Your torso is balanced even on top of your hips, knees and ankles. Though you will need to call on your ‘brake’ and ‘gas’ pedals (heel and forefoot strike) at times during a run – you will need to find your version of the mid-foot strike for the majority of your longer runs. The Pitfalls of only focusing on Foot Strike.... So I’ve just talked A LOT about the different foot strikes and how mid-foot strike is most efficient. BUT – foot strike is not the be all and end all of efficient running. To think of it another way - specific foot strike is not the CAUSE of efficient running, it is the RESULT of efficient running. The problem with concentrating just on foot strike when running is that it usually results in a runner having a stiff, tight dorsi-flexed ankle at ground contact. This stiff, rigid ankle inhibits the 33 joints and 20 muscles in each foot from doing their job – acting like a dynamic spring. Focusing on the following tips will harvest far greater benefit to your running that just focusing on a specific foot strike: Mobility/proprioception/strength exercises to get your feet working like dynamic springs Good posture – think tall, tummy, tail and toes Quicker rhythm / cadence Appropriate drills and movement patterns – eg. low pulls / hammy snaps Strength & conditioning training – esp hips/glutes Improving the points from above will ultimately improve your foot strike and stop you from over-striding – without you even having to think about your foot strike!Read More
Let's be BAREFOOT!!
Take a moment to watch a pre-school aged child run, jump and play without fear. Notice how nimble and light they are on their feet? Rocks or rough terrain does not slow them down, that is of course, until they go to school and we put shoes on their feet. Our feet are AMAZING! They are designed to feel, cushion and spring our way through life. Wearing big clumpy shoes on our feet all day long denies our feet the opportunity to work to their true potential. In the video below, Hayley shares some insight into the many benefits of spending time barefoot – especially on natural surfaces: We humans are supposed to be barefoot! Most modern shoes are EVIL – they make our feet stiff, weak and lazy. Unique plantar proprioceptors are found on the bottom of our feet – they constantly talk to us – tell us what surface we are walking on etc. But they also sense VIBRATION – which prepares our foot to work like a DYNAMIC SPRING. Remember - our feet are the only contact we have with the ground. Each layer we add between our foot and the ground (shoes & socks) is interfering with this feedback. Have you heard of Earthing or Grounding – which is spending time barefoot on natural surfaces?? We operate in a heavily shod society. Most of our time is spent on man-made surfaces such as concrete and tiles.Let’s change this! Are you prepared to take on Hayley’s challenge??Read More
How you STAND - is how you WALK - is how you RUN!
I often get asked the following questions in my Townsville Podiatry clinic: How do I run faster? Should I be running on my forefoot or my heels? What is the best running shoe for me? How do I get rid of my stupid shin splints?? (insert frustrated emoji here) These are all good questions. Certainly - improving your running technique, wearing the most suitable running shoes, training appropriately and getting the right recovery time is integral to improving your performance. But what is also extremely important to consider is what we do for the other 23 hours a day when we are not running. This has a massive impact on our running gait and efficiency (for example our work footwear, occupation and our sitting, standing and walking posture). How about we consider these questions as well: 1. What shoes am I shoving my feet in all day at work? Are they switching off my instrinsic foot muscles and making my feet lazy? Are my work shoes pushing my big toe towards my 2nd toe and rendering it a useless arch support? Hang on, are my fancy high heels which shorten my calf muscles all day – are they helping my running gait?!? (I’m talking to the blokes here too – check out the heel height on your business shoes!) 2. How much do I sit down during the day & evening? We humans are supposed to be out in the bush hunting, tall & upright. Instead we sit at computers all day and slump forwards scrolling through Facebook. Even with the best sitting posture, too much sitting equals tight hip flexors and tight glutes. How can we then expect to run tall? 3. Hmmm… do I stand with my feet straight… or do I resemble Donald Duck? Lots of people stand and walk with their feet pointing outwards – instead of forwards. This again switches our glutes off, loads the lower back more and uses our stability muscles for going forwards instead of our prime movers. Check out my video below which explains this a bit better!Read More
What causes Heel Pain (Plantar Fasciitis)???
Plantar fasciitis is the most common cause of heel pain. Heel pain is most common in the 40 – 60 year age group. It is so prevalent that ~80% of adults will suffer a bout of heel pain over the course of their adult life-time. The plantar fascia is a strong structure in the arch of the foot, kind of like a bow-string. When the plantar fascia becomes injured, pain is felt in the front of the heel and sometimes in the arch of the foot. It is much worse first thing in the morning and after rest periods, causing you to hobble like old Mother Hubbard. Unfortunately this hobbling can then cause pain and tightness in other parts of your body! So what actually CAUSES heel pain?? To put it simply, plantar fasciitis occurs when the continual daily mechanical load on the plantar fascia (main supporting structure of the arch) is greater then what the body can continue to repair. Every time you rest or sleep, your body goes into repair mode to heal any little niggly stuff that has happened throughout the day. In an optimally functioning body, tissue load would equal tissue repair. When plantar fasciitis occurs it is because tissue load is much greater than tissue repair. This excessive load causes a weakening and degeneration of the plantar fascia, and in some cases tears may be present. The condition is now more correctly termed plantar fasciosis (degeneration) instead of plantar fasciitis (inflammation). The following factors may contribute to increase mechanical load of the plantar fascia: Occupations which require lots of walking or standing on hard surfaces. Foot Posture – having collapsed arches or high arch, rigid feet cause increase load on the plantar fascia. Over-training or sudden increase in training. Being over-weight – even with good foot posture those extra kg’s dramatically increase the load on the plantar fascia. Certain types of training that place a lot of stress on the feet – long distance running, sprinting, ballet, basketball etc - may contribute to an earlier onset of plantar heel pain. Certain medical conditions may predispose people to developing heel pain such as diabetes and rheumatoid arthritis. Quite often however, the finger pointing can’t just go towards the over-training, the long hours or the hard surfaces at work. More often than not, our feet are just not capable of doing their job! They’ve become stiff, rigid and weak and therefore no longer act as efficient springs for our bodies. This is largely due to our modern footwear. Shoving your feet into pointy toe shoes all day switches off your intrinsic foot muscles which makes your feet lazy. As your big toe gets pushed towards your second toe – it can no longer support your arch. Having a heel raise in your shoe tightens up your calf muscles which in turn strains your arch more. Our toes are supposed to be able to spread, our heels should be on the ground. Over time our feet have become stiff, weakened, crappy structures – allowing heel pain to occur. To address the real cause of heel pain we need to wake these feet up again – unlock their true potential! At Foundation Podiatry we have designed the ACTIVE FOOT FORMULA to do just this. For more detailed information on heel pain click here. Don't walk like old Mother Hubbard any longer! Talk to us today!Read More
Our feet are connected to our core – Townsville Podiatrist Hayley explains…
So yogis have been awake to the powerful interconnection between FOOT to CORE for a very long time – referring to the foot as ‘Pada Bundha’ and the pelvic floor as ‘Mula Bundha’. Focusing on the communication between these two Bundha’s allows for a very strong practice. The pathway between the deep foot stabilisers (intrinsic foot muscles) and the deep core stabilisers (pelvic floor, deep lateral hip rotators) is referred to as our local stabilisation pathway. During movement, the local stabilising muscles of the foot and core need to fire first before the big global stabilising muscles. The local stabilisers job is to stabilise the joints, provide proprioceptive feedback and increase muscle stiffness and tension thereby providing cushioning. The global stabilisers generate the force to control acceleration and deceleration. If the local stabilisers do not fire first or if the ‘foot to core’ sequencing is delayed, then injury risk is greater - think plantar fasciitis (heel pain), labral tear of hip, sciatica… Our foot to core integration is via our deep frontal line – a fascial pathway starting with the intrinsic muscles of the foot working up to the pelvic floor, to the Psoas and into the diaphragm. So our feet are part of our core stability! During walking and running the only contact point between the body and the ground is our foot – therefore foot stability is crucial for the correct transfer of impact forces. The faster our feet and core can “talk” to each other, the more efficient our gait will be and therefore our injury risk decreases.Read More
5 tips for healthy, strong feet
Your feet are an engineering masterpiece, let’s keep them that way! The 66 joints that make up your feet affect every joint right up to your neck. Neglecting our feet over time can lead to foot pain and discomfort. Below are 5 tips for maintaining healthy, strong feet: Stretch your feet daily. Your feet are the shock-absorbers for the body, allowing you to run, climb, jump and tackle uneven ground. Massage your feet daily. Roll your feet over a can or firm ball, focusing on the arch and any tender points. Releasing the strong fascia in your feet can also relax calf & hamstrings! Strengthen your feet daily. Toe scrunches, calf raises, arch roll-ups and more. Your feet have to carry your body everywhere it wants to go – so keep them strong! If the shoe fits, wear it. Footwear should promote the natural alignment of your feet. Say NO to ridiculously high heels, pointy toes, stiff sole shoes etc (sorry). Get back to nature! Add barefoot time outside on grass or sand to your daily habit. ‘Earthing’ has many benefits that are not just foot related! Remember: Active FEET > Active BODY > Active LIFERead More
No more Falls! Balance boosting tips for the Elderly
Falls are the leading cause of injury-related hospitalisations in people aged 65 years and over. A common and very debilitating injury sustained from a fall is a fracture to the neck of the femur (broken hip). There are many common causes of falls in the elderly population: Chronic health conditions such as heart disease, low blood pressure, obesity and dementia Impairments such as poor vision and inflamed ear drums Environmental causes such as upturned rugs, objects on ground, poor lighting, wet and slippery surfaces etc Another common cause of falls is poor mobility, balance, proprioception, and strength in our legs and feet – and this is where our Podiatrists can help you out. As we get older it is natural that our bodies are not as nimble, agile and strong as they once were. Unfortunately nobody can escape the aging process, however the more we keep moving and doing things the more able-bodied we remain. Like I have mentioned many times before – use it or lose it! With age our feet become less mobile than they used to be. This stiffness makes walking on different, uneven surfaces more difficult and unsteady.ANSWER – do exercises to keep your feet flexible! With age our proprioception (message pathway from feet to brain) slows down. For example, the message to your brain telling you that you’ve stood on your grandkids lego may not fire as quickly – making you stumble.ANSWER – do exercises to improve your proprioception and balance! With age our muscle strength may dwindle – making climbing stairs, lifting heavy objects, side-stepping out of the way of a trolley etc more difficult.ANSWER – do exercises to improve muscle strength! Now you’re probably thinking that I’m suggesting you head to the local gym and pump some serious iron? Not necessary. Incorporating certain exercises (with correct technique of course) into your daily activities is most helpful and also most sustainable. Doing a few extra chair squats each time you sit down, or parking a bit further away from the shopping centre and making yourself walk a bit further each day. At Foundation Podiatry Townsville we appreciate how amazing our feet are and what they are designed to do - and hence have developed our ACTIVE FOOT FORMULA. We can give you specific exercises to improve the mobility, proprioception, balance and strength of your feet and legs. This will reduce pain and give you more confidence and endurance with walking, managing your daily tasks and allow you to return to the hobbies you love most! To best address your needs, we also work alongside other local health professionals such as Exercise Physiologists and Physiotherapists. Our senior Podiatrist Hayley also has a great appreciation of the benefits of yoga, tai chi and pilates when it comes to foot health and balance.Read More