Book 3 Practical Biomechanics for the Podiatrist

https://store.bookbaby.com/book/practical-biomechanics-for-the-podiatrist-book-3

     I am so excited about published my third book on Practical Biomechanics. These books, with one more to be completed next year, are an accumulation of my 44 years as a Podiatrist. This book covers injuries from the ankle to low back as treated by a conservative Podiatrist. It also covers the injuries produced by pronation and supination. There are chapters limb length difference, shock absorption problems, weak and tight muscles, and current concepts being used to treat these issues. 

Make Sure Shoe Lacing is Tight!

https://scholar.google.com/scholar?hl=en&as_sdt=0,14&q=foot+sliding+in+shoes&btnG=#d=gs_qabs&t=1682140474682&u=%23p%3DQuHvU32VEDEJ

Use this Website to learn Foot Anatomy

https://radiopaedia.org/cases/foot-x-ray-labelling-questions

This is very cool, especially if you are trying to read a radiology report to understand your injury. Rich

Tibial Nerve Test Video

https://youtu.be/qwbDfG71dgU

     So many patients with foot and leg pain may have the tibial nerve as a component. They may think they just have plantar fasciitis, achilles tendonitis, or metatarsalgia. This test can point to nerve involvement, which of course, has certain specific treatments different than standard. 

Big Toe Joint Pain: Could there be Nerve Pain?

https://onlinelibrary.wiley.com/doi/10.1002/acr.25125

Excellent Article on Conservative Care of Achilles Ruptures vs Surgical

https://www.tandfonline.com/doi/full/10.2147/TCRM.S116385

Great Video with 3 easy Internal Hip Rotator Strengthening Exercises

https://youtube.com/watch?v=JlxndP60w8E&feature=shares

The Importance of Extrinsic Rear Foot Posts in Pronated Patients

Very Everted Heels with initial Orthoses and no Rear Foot Posts

Subtalar Neutral Almost Obtained with Extrinsic Rear Foot Posts Applied

     These photos were sent by my friend, Dr Jinwook Song, from Seoul Korea. He was treating a patient with the Inverted Orthotic Technique and captured the heel correction without and then with the Extrinsic Rear Foot Posts. 

Metatarsal Doming (aka Short Arch exercises) shown to reduce pain of Pronation

https://pubmed.ncbi.nlm.nih.gov/30860412/

https://youtu.be/GY-mJjXmeIc

Balance and Flexibility for Movement

Human movement is often taken for granted, but it is crucial tour existence. Movement for various activities is complex and learned. What Michael Jordan can do to a basketball or Tiger Woods to a golf ball, is complicated, but learned (with the help of genetics). "Muscle memory" is a term coined for the adaptation of muscle to perform a task. Want to learn to do something? Break the task down to each of its component motions. Practice each motion 10,000 times (100 times a day for 100 days). Muscle memory will take over. 

But what are the attributes that are key to completing complex tasks - attributes that you and I need to be graceful, and less injury-prone, when learning or performing a task? These attributes include strength, balance, coordination, flexibility, agility, etc. This article will focus on balance and flexibility. As a practicing sports medicine podiatrist, I spend most of each day attempting to make my patients/athletes more balanced and more flexible. I will attempt to keep this discussion as practical as possible. 

Flexibility is a good place to start since most athletes are familiar with this topic. Flexibility of muscles and tendons allows for overall less strain on the muscles as they move us around. The tighter we are (I like to use the term "muscle bound"), the greater our chance for injury. A muscle pull or strain is created taking weeks or months to heal. Doing simple stretching exercises on a daily basis can help prevent these injuries

But, what if you know the stretch and do not know how to stretch? There are some generalizations I use successfully when teaching patients to stretch: 

1. The best time to stretch is after your activity. This is when your muscles are warm and easily stretched. You will make the most progress when you stretch after activity (i.e. after running, after basketball, after aerobics). 

2. Before activity, warm up your muscles. This is a time for a walk before you run, or a slow run before a more intense run. If there is time to stretch gently after you have warmed up the muscles, even better. However, this is usually not crucial. Many patients have actually hurt themselves by aggressively before an activity. 

3. Stretch 3 times a day to gain flexibility, and 1-2 times a day to maintain flexibility. This seems to be a tried and true rule, especially as we age. This means even on your days off from running, the flexibility exercises should continue. Remember NO REST FROM STRETCH. 

4. Forget counting, and BREATHE. Breathing gets oxygen into the muscles to help with flexibility. When you count, you normally stop breathing (hold your breath). Most stretches require 5-10 deep breathes to get adequate elongation. Slowly breathe in and as you exhale, gently lean into the stretch, getting deeper into the position. Hold that position while you inhale again, then relax into the stretch deeper as you exhale again, 

5. Know your tight muscles and stretch these more (50% more than other muscles). As you begin to stretch consistently, you will begin to know your body better. Some muscle groups will be harder to stretch than others. For me, it is my hamstrings, always much tighter than other muscle groups. Even more complicated, my left hamstring is always tighter than my right hamstring. I do more hamstring (back of thigh) stretches than any other group, and I hold the left stretch 5 more deep breaths than the right stretch. Just try each day to even them out, and slowly you should be able to. 

6. NO BOUNCING while stretching (Don't be a jerk!). Stretch slowly, gradually, evenly. 

7. Stretch muscle groups in various positions to optimize the stretch. For example, a great way of stretching the hamstring is to put your foot out in front of you, and onto an elevated platform (i.e. car bumper, a chair, a table), as long as you can comfortably stretch the muscle and not lose your balance. Now, your foot position dictates the line of pull of the stretch. First, while doing this stretch, hold your foot straight with your big toe on the right foot pointing towards the ceiling. After 5-10 deep breaths, now point your right big toe to the left. This will stretch your inside hamstrings more. When you point your big toe to the right, you will stretch your outside hamstrings more. Most muscle groups have 3 or more fairly easy variations like this to get better stretching of any particular group.

8. During some times of injury, it is important to heat up a muscle/tendon before stretching, and especially before activity. Reusable hot packs, deep heat liniments, massage, and hot soaks are all commonly utilized. And this practice can be especially beneficial in cold environments and after long waits. One athlete I was treating who went to the 1988 Olympics in Seoul, South Korea, said the long waiting from the warm-up area, through 5 or more security checkpoints, until you were into the event area, was so bad that her muscles all tightened up. A gentle massage can excellently heat up a muscle, and relax it, and mobilize swelling when needed. When athlete has tendonitis, I recommend heat before and ice after activity, 

Therefore, tight muscles/tendons can limit range of motion of joints, interfere with optimal performance and lead to injury as the muscle strains, pulls, or tears. The tears can be microscopic, but require lengthy rehabilitation. A sidelined athlete is an unhappy athlete, so preventative exercises can play a major role in your quality of life. 

Balance and coordination define the athlete. Watching the moves of John Stockton, Scottie Pippen, Michael Jordan, or the recent British Golf Open, reminds me of the complexity and beauty of fluid, graceful motion. In any activity, success occurs when the athlete conquers the components that throw off the balance of the movement. In a golf swing, it can be hand placement on the club, too fast a back swing, and on and on. In running, there are many factors which I look at daily that make up that balance or fluidity of movement. Some of the factors are: show selection, terrain, joint stability, limb-length difference, foot motion, muscle coordination/strength, and running style. When I watch an athlete walk and/or run in the office, I can observe all of the above factors, except terrain. I ask myself "How balanced or coordinated is their running?", and "Are there easy ways to help smooth out their gait?" Gait refers to style of ambulation (still a funny word). Our office has several shoe recommendation handouts that can be requested. One of the handouts is the current list of stable athletic shoes, and another handout is "Tips on Buying the Proper Running Shoe" (i.e. time of day, etc.). There are many ways that shoes alone can severely affect gait. It is important for runners to find good shoe stores in their area that are aware of running and proper shoe selection.

 Limb length difference can greatly affect the balance of a runner, even a difference as small as 1/8′′, or 3 mm. With a short leg, the body must try to even itself with every step. The energy expenditure is great, with loss of stability, proficiency, and an overload to various muscles/tendons and joints. With a runner, there are few exceptions to treatment of all or most of those with a shore-leg difference. Simple inserts to elevate the short leg can have miraculous results. A sports-minded physician, podiatrist, therapist, or chiropractor can help you evaluate your limb-length inequality. Some experts have the opposite opinion than I, that is, that most leg-length differences should be left alone. I have seen too many injuries get remarkably better with lift therapy to agree with that approach. 

It is relatively easy to improve your balance. On a daily basis, do 3 to 4 of the 8 positional balancing exercises. Do each position for 1-2 minutes. See if you can follow these instructions for better balance. Stand in a doorway. Stand up one leg time, with the other leg bent at the knee, off the ground. Put both hands at your side. Do each exercise first with the knee straight, then with the knee bent. 

After 30 seconds of balancing with your eyes open, close your eyes. Feel your foot roll side to side. Hold on to the side of the doorway as much or as little as you need. Try to stay on that one foot for 1 minute without opening your eyes, First, knee straight, then bent 20-30 degrees, transferring your weight to another area of your foot, making balance more difficult. Then slide a 1⁄2" thick book under your heel. Repeat the balance exercises, 30 seconds eyes open, 1 minute eyes closed, knee straight; 1 minute eyes closed, knee bent 20-30 degrees. Then turn the book so that the whole side of your foot facing your other foot is elevated off the ground (i.e. under the inside of the heel and big toe). Again, 30 seconds eyes open, 1 minute eyes closed, knee straight, 1 minute eyes closed, knee bent. Lastly, place the book under the outside rim of your foot (from heel to little/baby toe). Then repeat the exercise pattern. Every day do 4 of these positions for each foot. Do with shoes on or off. Do with orthotics in or out. In all perceivable patterns, let muscle memory begin the 10,000 times needed. Athletes who perform these simple exercises which affect the foot, ankle, knee, and hip in a functional weightbearing way, have testified to its effectiveness in strengthening and coordinating their legs. 

In summary, some simple but, I believe, powerful advice for improving flexibility and balance or coordination has been given. These two often neglected areas of daily athletic endeavor can help lengthen your time of athletic pursuit and also improve the quality of your performance greatly. 

Thank you.