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Thursday, May 10, 2018

Foot Pain from Hamstring Stretch: Probably Nerve Irritation

Rich,

     Your treatment plan for the fractured sesamoid in my left foot is going well, especially since I got Dr. Jill's 1/4" felt met pads, which work better with your orthotics than the 1/8" felt I was using for months. I've been able to increase my weekly walking distance gradually to about half what it was before the injury, but last week I suddenly developed a new problem in the right heel which has immobilized me again.
Dr. Blake's comment: Thank you for that feedback. I will try to tell all my sesamoid patients to experiment with the Dr. Jills product, even with their orthotics. So happy you are off the long plateau you were on. 

     Before starting a hike, I was doing a standing hamstring stretch with leg elevated onto the tailgate of my truck (I had already done my other stretches, including the "wall" stretch for calves). Toward the end of the stretch, I flexed my toes back toward my knee, and when I set my foot back on the ground (wearing heavy hiking boots and orthotics as always), I felt a sudden sharp pain in my heel.
Dr. Blake's comment: This is nerve irritation at the end of the sciatic nerve branch that feeds the bottom of the heel. The sciatic nerve is most stretched, and potentially irritated, with the hip flexed, the knee straight, and the ankle bent. Maximum stretch. It only takes slightly bending the knees or not pulling up the foot towards your chest, or both, to relax the nerve. So, you irritated the nerve deeply. 
Here similar situation with hip flexed, knee straight, and toes pulling up towards knee

     I had no idea what was happening and went on with my hike, being super-mindful about walking slowly, taking short steps and trying to focus weight away from that heel and onto the arch and toe, meanwhile just feeling discomfort in the right heel rather than outright pain. But the next morning when I woke up, I couldn't put any weight on that heel without bad pain.
Dr. Blake's comment: Have you a history of sciatic on that side or any low back or spine in general issues? These can be the first low grade irritation, that makes the sciatic nerve grouchy, but the stretch does you in. Nerves love motion, not prolonged stretches. 

     I ALWAYS wear your orthotics with the heavy boots, except when in the shower, and I've been really good about stretching, so this new problem really stumps me. The pain is under the center of the heel, and gets worse as the foot flexes and the back of the leg stretches (e.g. when doing a "wall stretch"). You say on your blog that PF develops slowly, so I initially thought it might be bursitis. But I don't do anything that results in impact on the heel - all I do is walking. And the pain seems to have been triggered simply by a routine stretching movement.
Dr. Blake's comment: Yes, see my video on neural flossing, get some Neuro-Eze to massage 3 times a day, avoid  low back, hamstring, or achilles stretching until it is better. Lift everything with your knees bent. Soak in warm water to see if it helps. Give me feedback within the next 2 weeks. 

I've been doing the ice bottle roll combined with mild stretching for a week with no improvement. I understand these things are sometimes tough to diagnose, but in any event I haven't had good results with our local podiatrist and thought I'd run it by you first. Feel free to post to blog if desired.

Thanks,



https://youtu.be/E0E60NpOSHg

1 comment:

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.