The Foot

The foot and it’s parts

The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand upright and perform activities like walking, running, and jumping. The feet are divided into three sections:  
The fore-foot contains the five toes (phalanges) and the five longer bones (metatarsals). The mid-foot is a pyramid-like collection of bones that form the arches of the feet. These include the three cuneiform bones, the cuboid bone, and the navicular bone. The hind-foot forms the heel and ankle. The talus bone supports the leg bones (tibia and fibula), forming the ankle. The calcaneus (heel bone) is the largest bone in the foot.

Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the complex movements needed for motion and balance. The Achilles tendon connects the heel to the calf muscle and is essential for running, jumping, and standing on the toes. 

The foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles.   All of these are used during walking and running – known as the gait phase.  When we put out foot down on the ground the hind-foot bones (joints) need to bend and rotate.  We make use of the tendons and muscles to help.  Then when we move forward on foot to the mid-foot all the bones in that area need to roll, tip and glide in different motions.  Then finally when we come off the front of the foot the fore-foot bones in the toes need to perform specific motions.  

If one of the 26 bones in the foot is out of alignment this will affect a person’s walking/running. Then add in muscle issues and there is a major problem!  

Any type of problems above the foot in the knee, hip, pelvis, tailbone or lower back will affect this motion chain as well.  We also have to think of the transfer of weight to the opposite side – which will affect the other side too!  COMPLEX!

Of Special Interest

The foot contains: 26 bones, 33 joints, 107 ligaments and 19 muscles. 

1/4 of all the bones in the human body are down in your feet. When these bones are out of alignment, so is the rest of the body. 

The average person takes 8,000 to 10,000 steps a day, which adds up to about 115,000 miles over a lifetime. That's enough to go around the circumference of the earth four times.

During an average day of walking, the total forces on your feet can total hundreds of tons, equivalent to an average of a fully loaded cement truck.

Foot and Shin Issues

Flatfeet and rotation of the leg
The feet are the foundation of the lower limb. Poor biomechanics often start with the foot.  If a foot is flat or has high arches there are abnormal changes that can occur to all of the postural joints of the body.

Our feet are highly adaptable.  As they hit the ground and begin to absorb load, the motion they undergo is called pronation.  The flexibility of our joints determines how much energy the lower extremity chain (foot-ankle-knee-hip-pelvis-low back) can absorb. 

For different reasons, both flat and high-arched feet channel a large amount of energy to skeletal structures high in this chain — especially the knee, hip and lower back—making those structures more susceptible to injury.

For example, it is common for the kneecap (patella) to develop pain because a flat foot forces the patello-femoral joint to absorb more energy. The patella can become poorly aligned because of rotation of the foot as shown in the picture to the right. 

Running sports add ‘impact loading’ to the equation. Running and jumping amplify the effects of failed biomechanics. 

Sprains and strains are likely to occur when joints are poorly aligned or when they absorb forces that should be directed to another part of the body.  Make sure your footwear is supportive and appropriate for the activity you’re doing.

Did you know that we have metatarsal pads for sandals and dress shoes?

Heel lifts are used when there are leg length discrepancies – one leg can be shorter due to lower back, hip, knee, leg and/or foot issues.

Lower back pain due to the legs

Figure 2:  When the feet flatten out, this causes shifting of the legs and a change to the lower back curve.

There are a number of causes for low back pain. In many patients excessive foot pronation may contribute to lower back problems. Bilateral excess pronation causes internal rotation of the tibia which in turn leads to anterior tilt of the pelvis and a forward shift of the body's center of gravity.

The result is increased lordotic curvature. Increased lordosis at L1-L5 and compensatory muscular tightness of the lumbo-sacral region causes pain and discomfort especially when standing upright for longer periods of time. The thoracic region commonly develops a secondary kyphotic curvature. 

Unilateral pronation lowers the vertical distance of the foot to the ground, creating a functional short leg and causes a hip mis-alignment. Structural leg length discrepancy means that one leg is actually shorter than the other. In this case the patient will often present with unilateral pronation (i.e. worse on one foot) as a natural compensation for the structural imbalance.

Both functional and structural leg length discrepancy can cause back pain. Patients presenting with a leg length discrepancy often also exhibit Scoliosis. 

Back pain can be treated with stretching and strengthening exercises, chiropractic spinal adjustments, soft tissue massage therapy, and active release. Adding orthotic therapy to your treatment regime can be beneficial. Correcting excessive pronation with FootMaxx orthotics will assist by posteriorly rotating the pelvis, thus reducing pressure on the sacro-iliac and lower back area. 

A heel lift should be added to the orthotic on the shorter leg. By doing so the shorter leg will be raised which aids in rebalancing the lower limb and removing compensatory mechanisms that contributes to lower back pain. 

If you have lower back pain, have your leg lengths checked. Also, check the alignment of your feet, femur, tibia, fibula, and patella bones checked for rotational problems. Also, have a foot scan/gait analysis. 

Please book an exam with Dr. Barbara Rodwin and Keri-Lyn Dudgeon to have these checked. 

Shin splints and Achilles tendonitis

Figure 3: Shin Splints

Shin splints are caused by overusing the lower leg or by using it incorrectly. Improper stretching, warm-up or exercise technique will increase the chances of shin splints. They can also be caused by improper footwear and flatter feet (pronation) which causes rotation of the shin. The soft tissue becomes inflamed due to the stress that has been put onto the shin. This area is enclosed in a compartment and if the tissue swells, there is no place for it to go so the pressure increases. The increased pressure makes it hard for the blood to flow freely and the net result is pain and sometimes tingling, numbness or weakness.

Figure 4: Both the Achilles tendon and the plantar fascia

Achilles tendonitis is a common injury in the running community. It is an inflammatory process that leads to swelling, pain and tissue damage. It results from repetitive strain, which in turn makes it more susceptible to tearing or even rupturing.  

The Achilles tendon attaches onto the heel of the foot as do the posterior muscles of the leg, which help to plantar flex the foot (point the toes down). It is responsible for providing the push that drives the foot down and forward when walking, running, and jumping. All in all, it generates a lot of tension and absorbs a lot of force. It‘s involved in most actions of the lower extremity and becomes more susceptible to tendonitis when engaging in sports where it is under a constant, repetitive load.

Chiropractic treatment of shin splints involves addressing any joint restrictions in the foot, ankle, and knee, muscle tightness and imbalances as well as assessing any biomechanical deficiencies in the feet that may be causing the shin splints. If deemed appropriate orthotics are prescribed to remedy the condition. Also stretching and strengthening exercises will be given.

The goals of massage are to reduce any inflammation, pain, and swelling, muscle spasm, and trigger points. Massage will also maintain range of motion as well as eliminate any scarring or adhesions. Muscular imbalances that may be causing the problem would be addressed during the treatment.  

The Active release technique is very effective in treating these problems!

Plantar Fascia

The plantar fascia (fash-ah) of the foot is a thick band of tissue that connects your heel to the base of your toes. When it is torn, inflamed or over-stretched, this is called plantar fasciitis (fash-e-it-is). This condition can be a result of:  an acute injury (strain) that places an excessive load on the foot, prolonged or excessive pronation (flat foot) of the foot, a high-arch or a change in footwear. You will often feel the pain at the base of your heel when you step out of bed in the morning or through the arch of your foot. This injury can be very pesky and quite painful limiting your daily activities significantly

Self Care Tips:  Before you get out of bed, wrap a towel around your toes and gently pull them towards you. Do this with your knees straight as well as bent.  Massage your arch often by sitting on a chair and rolling a marble, golf ball or another massage device under your foot.  Stretch your calf and Achilles tendon - we have specific stretches that we can suggest for you to take home….Just ask us!! Keep your shoes by your bed and wear around them house.  Rolling a frozen water bottle under the foot helps too!

Chiropractic adjustments, active release, and massage are effective treatments for plantar fasciitis. Custom orthotics are also very effective because they can correct the excessive pronation of the foot causing the problem.

Are all orthotics created equal?

 No they are not!  Keri-Lyn Dudgeon, our orthotic specialist will, based on the patient’s symptoms and the dynamic gait analysis, determine what types of accommodations or postings need to be built into the patient’s orthotic.
Keri-Lyn has had over 17 years’ experience in working with some of the most difficult foot cases.

These accommodations and postings are specific to the patient’s needs for their feet.  Some names for them are: lesion accommodation, heel-maxx (for heel spurs/heel pain), met bar (calluses, toe pain/numbing), horseshoe pad (plantar fasciitis, heel pain), morton’s extension (bunions, limited movement of first toe/arthritis).

 The Cobra – what is it? A snake in your shoe? Read on….

Back to Health would like to introduce a new product line for women’s dress shoes! It has been difficult for women to be able to wear their normal orthotics in their dress shoes. These orthotics do not fit well and due to this often the orthotic is not worn during the day. We at Back to Health have realized this causes numerous issues.

This model is called the COBRA.  Improved fit and flexible module ensures better support in a greater variety of footwear.  

The hook design at the heel allows the foot to sit lower in the shoe. The sulcus length allows for greater padding underneath the ball of the foot. This length also allows for metatarsal pads to be located further forward if necessary. This was an issue with previous models. The top coat material is in a natural beige suede or black leather.  

Patient Story

A patient came in to see Dr.Rodwin and Keri-Lyn.  She had symptoms of toe pain/discomfort.  It was affecting her walking and causing issues into the knees, hips and lower back due to compensation.  

A biomechanical exam with a gait analysis was performed and this indicated toe joint restrictions.  

It turned out from requesting her medical reports that she had a stress fracture in the toe.  We recommended orthotics with meta-tarsal pads, acupuncture, active release, and adjustments for the toes, foot, knees, hips and lower back. She is now virtually pain free and walking normally again!

Golf

hfs-clinics.co.uk

The foot explained!

The foot is made up of 26 bones, ligaments, muscles and tendons. The foot functions as one link in a biomechanical kinetic chain, where movement at one joint influences movement at other joints in the chain. Each bone in the foot performs bending, and rotational motions during the gait phase. 

When the foot hits the ground, a series of events extending throughout the body is set into motion. This complex interaction of bone and soft tissue can cause or contribute to a number of conditions.

Flexible, custom-made orthotics support and encourage normal foot function, which in turn helps protect the body from the harmful effects of faulty biomechanics. When the feet provide a balanced foundation for the body, its components can work together most effectively. A house with a flawed foundation may stand for years, but problems (leaks, cracked walls or sagging windows) will eventually develop. The effects of foot imbalance on the body can be just as insidious.

Common Swing Faults

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Common swing faults occur due to tight shoulder, tightness in the hip joint, spinal injuries, and repetitive strain injuries. When shoulder rotation is restricted the body compensates with excessive spinal rotation. This can result in back injury because most people already lack flexibility in the spine.

In addition, golfers will notice that they have difficulties in:

• Keeping their eyes on the ball.
• Maintaining an optimal swing plane.

This results in fat or thin shots. When the golfer attempts to compensate at the shoulder joint, the chances of a hook or slice increases. Tightness in the hip joint rotational muscles places additional strain on the rotational requirements of the shoulder or spine. Often a golfer will compensate by lifting up during the back swing and then chop down on the ball resulting in a flat shot.

Wrist and elbow injuries often occur when the body does not have the capacity to effectively compensate at either the shoulder or spine. The wrists are then over-used to drive as well as decelerate the golf club.

Stretching Will Not Break The Adhesions

Even individuals such as professional athletes who are constantly stretching find it difficult to release these soft tissue adhesions. This is why so many professional and amateur athletes are turning to Active Release Technique (ART) to release and remove these restrictions.

Scar tissue (or soft tissue adhesions) is several times stronger than normal tissue. Often muscle groups will literally adhere to each other, preventing the sliding necessary for full mobility. During normal stretching, the first tissue that elongates is not the scar tissue, but the normal healthy tissue. Stretching is essential at the right time, but it never releases the restrictions that often occur between two soft tissue surfaces.

Do you think within your body you have stiffness that is limiting your golf swing?

The most common injuries in golf are back injuries.  Most of these injuries are muscle, ligament or joint strains that can be treated effectively if caught early.  Changing technique and equipment can help golfers with chronic (long-term) back pain play around with the injury – it will not help correct the problem though.  Constant bending over and rotational motions cause extreme stress on the muscles and joints of the lower back. The use of newer and longer clubs can allow your body to remain closer to the upright position and help relieve stress on your back. 

Shoulder problems are often due to improper mechanics between the shoulder, lower neck area, mid-back and the shoulder blades. This is known as SCAPULO-THORACIC Motion. If a limitation of motion in this area, then the GLENO-HUMERAL (Shoulder) Joint will have to compensate. If compensation occurs at the shoulder joint, the chances of hooking or slicing the ball increase exponentially. Rrestricted shoulder range of motion is compensated with excessive spinal rotation, leading to back injury because most golfers lack rotational flexibility in the spine to begin with.

Golfer’s elbow is an inflammation of the tendons which allow the elbow to flex (bend).  Treatment consists of ice, rest, adjustments, soft tissue therapy (Active release technique/massage therapy), wearing a brace and stretching. 

Your golf swing is all about proper body mechanics. A good golf swing requires full rotational capacity of nearly every joint involved and must be done - efficiently - easily - explosively - repeatedly. Many swing faults are directly attributable to poor joint mobility with soft-tissue restrictions.

In order to effectively balance your muscles and remove joint restrictions we must first identify your unique pattern of muscle imbalances. By utilizing a series of muscle balance and swing analysis tests, we can identify the exact type, extent, and location of muscle restriction.

Is it time to have it checked?

______________________________

Most Common Injuries for the PGA Tour:

1. Low back pain (25%)  

2. Left wrist (16.1%) 

3. Left shoulder (10.9%)

4. Left knee (7%)

5. Left hand (6.8%)

Many people stop playing golf because of injury. Interestingly, golfers will spend hundreds of dollars each year on new or improved equipment but will not invest any time or money in the most essential piece of equipment—  their body.

Biomechanics of the Knee, Shin and Foot

The feet are the foundation of the lower limbs. Poor biomechanics often start with the foot. If a foot has high arches or is flat, there are changes that can happen to all of the postural joints of the body.

Our feet are highly adaptable. As they hit the ground and begin to absorb load, the motion they undergo is called pronation. The flexibility of our joints determines how much energy the lower extremity chain (foot-ankle-knee-hip-pelvis-low back) can absorb.

For different reasons, both flat and high-arched feet channel a large amount of energy to skeletal structures high in this chain, especially the knee and the hip, making those structures more susceptible to injury.
For example, it is common for the kneecap (patella) to develop pain because a flat foot forces the petellofemoral joint to absorb more energy. The patella can become poorly aligned because of rotation of the foot as shown in the picture to the right.

Running sports add ‘impact loading’ to the equation. Running and jumping amplify the effects of failed biomechanics. Sprains and strains are likely to occur when joints are poorly aligned, or when they absorb forces that should be directed to another part of the body. Make sure your footwear is supportive and appropriate for the activity you’re doing.

What is Metatarsalgia?

Metatarsalgia is a type of inflammation that causes pain in the ball of your foot (metatarsal) and is also known as “stone bruise”.

footsolutions.co.uk

While this condition usually affects physically active people, it can also be caused by footwear that doesn’t fit properly or is of low quality. 

Metatarsalgia develops primarily from high impact on your feet through activities such as jumping or running. 

You should contact us about having a foot scan/dynamic gait analysis to see if you require custom orthotics. Especially, if you run or are physically active and experiencing symptoms of Metatarsalgia.

Although it is most common that middle aged females experience Metatarsalgia, it can affect both men and women of all ages. It is important to seek treatment as soon as possible to prevent further damage and eliminate the pain you are feeling. 

Contact us to setup an appointment to discuss treatments for Metatarsalgia and to discuss different options such as: metatarsal pads or custom orthotics that can help reduce the pain you are feeling while allowing you to maintain your active lifestyle.