Hello Dr. Blake.
I attempted to post this as a comment in your blog, but I was unsuccessful. I hope that this email finds you well. I have been dealing with achilles pain since March. I believe it started because I was putting all of my weight on my heels when doing the elliptical, to avoid stressing an injury I have on my forefoot. I have tried PT and it did not work, the therapist kept telling me that all the exercises that make patients better were working the opposite on me-making me worse. The exercises included the type on your blog, the eccentric calf exercises. No negative heel drops. I am wondering if I have no relief because I have an over stretched tendon. The calf stretches and exercises replicate my pain, I have no relief from them. The pain that I get is exactly the pain created when I bring my entire foot upward toward my body (picture a negative heel stretch but without weight bearing). I had an MRI which showed a normal tendon, with some non specific swelling at the heel. The pain started bilaterally, but now, the right side is much worse and the left has improved. I have completely rested from all activity for months. Still nothing. Heel lifts work a little. I can't even sleep on my back because my own body weight is enough to cause pain on my heel. Could you please share some thoughts on treatment of an over stretched tendon? Thank you so much! You are an amazing resource.
Dr Blake's comment:
You could have an overstretched tendon that the PTs should be able to measure, but it sounds like radiculopathy which is localized nerve pain below the low back. Stretching of the hamstrings and calf make radiculopathy worse. Sometimes, MRI of the back can help. I would see a chiro or physiatrist to help the PT develop a plan. When you held your heels back, you probably also could have hyperextended your knee causing the problem. Any postures, movements that effect the sciatic nerve can effect this problem. Try ice packs 2 times daily to the low back and neural flossing 3 times a day (seen on my blog), but avoid calf and hamstring stretches for the next 6 weeks. Keep me in the loop. Rich
Showing posts with label Achilles. Show all posts
Showing posts with label Achilles. Show all posts
Sunday, September 7, 2014
Sunday, October 27, 2013
Achilles Tendon Flexibility Measurement and Strength Daily Routine
I hope you enjoy my new video on the Achilles Tendon
Sunday, August 8, 2010
Injury Rehabilitation: Am I looking at The Tip Of The Iceberg?
Each week I have patients that present with their first foot or ankle injury and I wonder whether I am looking at the Tip of the Iceberg of this and other future injuries. No matter how minor the injury appears, I wonder if it will be followed by another and another and another. What can I do as a health car provider to eliminate or at least minimize the onslaught of future injuries? How serious should I take these initial injuries which will heal relatively quickly? Should I always follow the KISS Principle (see separate post) and Keep It Simple Stupid when I think some of these injuries are definitely the Tip of the Iceberg? More pain is on the way.
What goes into the thought process of deciding who should get more treatment when relatively simple injuries present into my office? The treatment of any overuse injury (without an acute single episode) should always be directed at the one or two common causes, or the several possible causes for this individual patient. Take Achilles Tendonitis for example. The common causes of Achilles Tendonitis are:
1. Straight overuse situation in which the Achilles Tendon is put in major stress (i.e. stair running for the first time, or working out too many days in a row, etc.)
2. Very tight Achilles Tendons.
3. Worn out shoe gear with lack of stability or cushion at impact.
4. Unstable shoes, or excessive wearing of shoe gear with inadequate support (i.e. too much time in the flip flops, etc.)
5. Short leg with compensation of early heel lift.
6. Excessive pronation of the foot/ankle with excessive torque on the Achilles.
7. Excessive supination of the foot/ankle with lateral instability and over firing of the Achilles Tendon to stabilize the ankle joint complex.
8. Very loose Achilles Tendons from over stretching or patients with loose ligaments in general. This produces a weakness in the tendon (see future post on the force/length curve).
9. Weak Achilles Tendons from many reasons (just returning to regular exercise program, following prolonged casting, aging process, genetics, dietary, etc.)
10. Achilles Tendonitis secondary to another problem (heel spurs, ankle injuries, sciatica, tibial stress fractures, etc.)
After performing an initial history and physical examination, and making the diagnosis if possible, the clinician will try to assess the reasons this individual patient developed their injury. It is the experience of the clinician that separates them from other health care providers in getting to the cause(s) of some injuries. Some “reversal of cause” treatment must be initiated in all cases. But for some patients, looking below the surface level of water, below the Tip of the Iceberg, is really what is crucial. What factors could lead, if not addressed, to either prolonged injury/treatment, or frequent recurrences of the symptoms. This is so crucial, but in a busy medical practice, often times not proactively explored. The patient and clinician only stumbles into the discoveries.
When a ship’s captain looks at the iceberg approaching, the captain scrutinizes the situation, assesses the severity, and then makes an appropriate plan. Health care providers, and proactive patients, can be slower than the sea captain at final making these decisions, but must look at possible severity of the injury, and severity of the cause of injury, to come up with an appropriate plan. Since we can grade the severity of anything 3 typical ways—mild, moderate, and complex—let us look at these 2 factors in injury treatment from this angle. Perhaps then you can understand when under the Tip of the Iceberg danger may be lurking in the forms of prolonged treatment, possible incomplete healing, and frequent recurrences of the symptoms. After the initial assessment (history and physical), and perhaps after several follow up visits, the clinician will place the patient in one of 9 categories. These are:
1. Mild Injury/Mild Severity of Cause
2. Mild Injury/Moderate Severity of Cause
3. Mild Injury/Complex Severity of Cause
4. Moderate Injury/Mild Severity of Cause
5. Moderate Injury/Moderate Severity of Cause
6. Moderate Injury/Complex Severity of Cause
7. Severe Injury/Mild Severity of Cause
8. Severe Injury/Moderate Severity of Cause
9. Severe Injury/Complex Severity of Cause
With the Severe Injuries, the treatment is usually prolonged enough that the patient and doctor/therapist gradually work at recognizing and correcting all possible causes of the injury along the way. It is the Mild and Moderate Injuries, that the KISS principle and Tip of the Iceberg principles must be reconciled. It is when the injury is classified as mild or moderate that the health care provider must decide when to look under the Tip of the Iceberg and explore the depths of moderate to complex causes. It is in the 4 categories below that I find most problems in dealing with these injuries. These are:
1. Mild Injury/Moderate Severity of Cause
2. Mild Injury/Complex Severity of Cause
3. Moderate Injury/Moderate Severity of Cause
4. Moderate Injury/Complex Severity of Cause
In these cases, I see the most patients for 2nd opinions. Why is the injury not healing? Why does the injury keep coming back? The mild and moderate nature of the initial injury makes the health care system relax and not look to deep into cause of injury.
I will end this discussion with one example of this dilemma. Since I already used Achilles Tendonitis above, I will finish using an example of Achilles Tendonitis. The patient had pain in the Achilles for 3 months prior to seeing the initial doctor. The patient was a runner who pronated too much, rarely stretched the Achilles, when stretching only did Negative Stretching off a curb (see separate post), was a vegetarian (not to pick on you guys too much!) but ate well, ran a lot of hills after moving from Dallas to San Francisco, and was told he had one leg shorter but never did anything about it. The initial treatment addressing the possible causes of the injury were Orthotic devices for the pronation, new motion control running shoes, power lacing see separate post), Achilles stretching 3 to 5 times a day, and running on flat ground, not hills until the symptoms got better. The doctor had categorized the patient mild injury/moderate cause of injury and had addressed the causes on the surface well. Was he/she just looking at the Tip of the Iceberg? What was below the surface that needed to be addressed? The patient after six months of treatment still was not much better in function. Running was still very limited. The initial treating doctor told him to stretch more and give it more time at their last visit (of 6 visits overall). This patient then sought a 2nd opinion.
On review of the injury itself, the right diagnosis had been made. The plan of treatment initiated was good, but never improved upon when the patient was struggling. Each of the treatments initiated were subpar in retrospect. The pronation was only partially corrected with the new Orthotic devices (but they were easy to modify to greatly improve), the running shoe store had convinced him to not get a motion control shoe since he had Orthotic devices (and the doctor never evaluated his running after the first visit), the power lacing was been done incorrectly (and was also modified), diet counseling came up with non optimal protein intake (something that will help the patient forever), measurement of his flexibility showed him off the charts in over flexibility (too flexible means too weak and this was improved with 6 weeks of no stretching at all—he thought I was crazy when I proposed that one), and exact measurement of his legs showed over ½” short leg on the injured side (treatment with heel lifts helped him immensely). Within several weeks, he was feeling much better, and by 8 weeks was back running regularly with a better diet, heel lift for the short leg, sensible stretching routine before and after exercise, no negative achilles stretching, stable Orthotic devices, stable shoes, proper power lacing, and a gradual re-strengthening home program under a physical therapist with 6 one/month visits to up the ante. Yes, under the Tip of the Iceberg for this athlete was a considerable short leg, a considerable dietary problem, slightly harder to treat pronation, and an Achilles that could become over flexible too easily. His mild injury did not initially respond since the cause of injury was misread as moderate, when it really was complex.
The Golden Rule of Foot: When treating athletic injuries, if the symptoms and function plateau, look under the Tip of the Iceberg to a deeper level of possible answers.
What goes into the thought process of deciding who should get more treatment when relatively simple injuries present into my office? The treatment of any overuse injury (without an acute single episode) should always be directed at the one or two common causes, or the several possible causes for this individual patient. Take Achilles Tendonitis for example. The common causes of Achilles Tendonitis are:
1. Straight overuse situation in which the Achilles Tendon is put in major stress (i.e. stair running for the first time, or working out too many days in a row, etc.)
2. Very tight Achilles Tendons.
3. Worn out shoe gear with lack of stability or cushion at impact.
4. Unstable shoes, or excessive wearing of shoe gear with inadequate support (i.e. too much time in the flip flops, etc.)
5. Short leg with compensation of early heel lift.
6. Excessive pronation of the foot/ankle with excessive torque on the Achilles.
7. Excessive supination of the foot/ankle with lateral instability and over firing of the Achilles Tendon to stabilize the ankle joint complex.
8. Very loose Achilles Tendons from over stretching or patients with loose ligaments in general. This produces a weakness in the tendon (see future post on the force/length curve).
9. Weak Achilles Tendons from many reasons (just returning to regular exercise program, following prolonged casting, aging process, genetics, dietary, etc.)
10. Achilles Tendonitis secondary to another problem (heel spurs, ankle injuries, sciatica, tibial stress fractures, etc.)
After performing an initial history and physical examination, and making the diagnosis if possible, the clinician will try to assess the reasons this individual patient developed their injury. It is the experience of the clinician that separates them from other health care providers in getting to the cause(s) of some injuries. Some “reversal of cause” treatment must be initiated in all cases. But for some patients, looking below the surface level of water, below the Tip of the Iceberg, is really what is crucial. What factors could lead, if not addressed, to either prolonged injury/treatment, or frequent recurrences of the symptoms. This is so crucial, but in a busy medical practice, often times not proactively explored. The patient and clinician only stumbles into the discoveries.
When a ship’s captain looks at the iceberg approaching, the captain scrutinizes the situation, assesses the severity, and then makes an appropriate plan. Health care providers, and proactive patients, can be slower than the sea captain at final making these decisions, but must look at possible severity of the injury, and severity of the cause of injury, to come up with an appropriate plan. Since we can grade the severity of anything 3 typical ways—mild, moderate, and complex—let us look at these 2 factors in injury treatment from this angle. Perhaps then you can understand when under the Tip of the Iceberg danger may be lurking in the forms of prolonged treatment, possible incomplete healing, and frequent recurrences of the symptoms. After the initial assessment (history and physical), and perhaps after several follow up visits, the clinician will place the patient in one of 9 categories. These are:
1. Mild Injury/Mild Severity of Cause
2. Mild Injury/Moderate Severity of Cause
3. Mild Injury/Complex Severity of Cause
4. Moderate Injury/Mild Severity of Cause
5. Moderate Injury/Moderate Severity of Cause
6. Moderate Injury/Complex Severity of Cause
7. Severe Injury/Mild Severity of Cause
8. Severe Injury/Moderate Severity of Cause
9. Severe Injury/Complex Severity of Cause
With the Severe Injuries, the treatment is usually prolonged enough that the patient and doctor/therapist gradually work at recognizing and correcting all possible causes of the injury along the way. It is the Mild and Moderate Injuries, that the KISS principle and Tip of the Iceberg principles must be reconciled. It is when the injury is classified as mild or moderate that the health care provider must decide when to look under the Tip of the Iceberg and explore the depths of moderate to complex causes. It is in the 4 categories below that I find most problems in dealing with these injuries. These are:
1. Mild Injury/Moderate Severity of Cause
2. Mild Injury/Complex Severity of Cause
3. Moderate Injury/Moderate Severity of Cause
4. Moderate Injury/Complex Severity of Cause
In these cases, I see the most patients for 2nd opinions. Why is the injury not healing? Why does the injury keep coming back? The mild and moderate nature of the initial injury makes the health care system relax and not look to deep into cause of injury.
I will end this discussion with one example of this dilemma. Since I already used Achilles Tendonitis above, I will finish using an example of Achilles Tendonitis. The patient had pain in the Achilles for 3 months prior to seeing the initial doctor. The patient was a runner who pronated too much, rarely stretched the Achilles, when stretching only did Negative Stretching off a curb (see separate post), was a vegetarian (not to pick on you guys too much!) but ate well, ran a lot of hills after moving from Dallas to San Francisco, and was told he had one leg shorter but never did anything about it. The initial treatment addressing the possible causes of the injury were Orthotic devices for the pronation, new motion control running shoes, power lacing see separate post), Achilles stretching 3 to 5 times a day, and running on flat ground, not hills until the symptoms got better. The doctor had categorized the patient mild injury/moderate cause of injury and had addressed the causes on the surface well. Was he/she just looking at the Tip of the Iceberg? What was below the surface that needed to be addressed? The patient after six months of treatment still was not much better in function. Running was still very limited. The initial treating doctor told him to stretch more and give it more time at their last visit (of 6 visits overall). This patient then sought a 2nd opinion.
On review of the injury itself, the right diagnosis had been made. The plan of treatment initiated was good, but never improved upon when the patient was struggling. Each of the treatments initiated were subpar in retrospect. The pronation was only partially corrected with the new Orthotic devices (but they were easy to modify to greatly improve), the running shoe store had convinced him to not get a motion control shoe since he had Orthotic devices (and the doctor never evaluated his running after the first visit), the power lacing was been done incorrectly (and was also modified), diet counseling came up with non optimal protein intake (something that will help the patient forever), measurement of his flexibility showed him off the charts in over flexibility (too flexible means too weak and this was improved with 6 weeks of no stretching at all—he thought I was crazy when I proposed that one), and exact measurement of his legs showed over ½” short leg on the injured side (treatment with heel lifts helped him immensely). Within several weeks, he was feeling much better, and by 8 weeks was back running regularly with a better diet, heel lift for the short leg, sensible stretching routine before and after exercise, no negative achilles stretching, stable Orthotic devices, stable shoes, proper power lacing, and a gradual re-strengthening home program under a physical therapist with 6 one/month visits to up the ante. Yes, under the Tip of the Iceberg for this athlete was a considerable short leg, a considerable dietary problem, slightly harder to treat pronation, and an Achilles that could become over flexible too easily. His mild injury did not initially respond since the cause of injury was misread as moderate, when it really was complex.
The Golden Rule of Foot: When treating athletic injuries, if the symptoms and function plateau, look under the Tip of the Iceberg to a deeper level of possible answers.
Monday, June 21, 2010
Shin Splints Part II: An Anatomy Lesson
As I discussed in Part I of Shin Splints, the pain is from below the knee to above the ankle. It is a large area with many possible structures involved. In most cases the pain is self-limiting, but with some use of the 10 basic treatments (see Part I) you are guaranteed that the rehab will be quicker than with just REST.
Let us review the anatomy of Shin Splints. The 4 basic types of shin splints are Medial (most common), Anterior (2nd), Lateral (3rd), and Posterior (4th). The medial group of muscles (function) are the posterior tibial (controls over pronation), flexor hallucis longus (stabilizes the big toe), and the flexor digitorum longus (stabilizes toes 2 to 5). Photo below shows where medial shin splints occur. Since over pronation, bunions (unstable big toes), and hammertoes (unstable lesser toes) are all common problems, this type of shin splint is the most common. More specific treatments of these problems include various methods in controlling pronation (there will be a series of posts on this topic), stablizing the big toe area or stablizing the lesser toes.These include toe separators/spreaders, shoe inserts with Morton’s extensions, and big toe spica taping to stabilize the big toe area, and toe crests, toe taping, reverse Morton’s extensions all to stabilize the lesser 4 toes.
Many patients purchase shoes too wide in the toe box leading to marked instability, especially when they have bunions. Too much room with resultant sliding around is just as bad on bunions and hammertoes as having too little room with resultant crowding.
The 2nd most common form of shin splints is anterior shin splints (see photo above). The muscles (functions) involved all help to control foot slap after heel strike, and then to help lift the foot off of the ground at toe off. Overuse situations can easily occur with hill running and increases in the speed of workouts. The muscle/tendons involved are the anterior tibial (controls over pronation and stabilizes the first metatarsal), extensor hallucis longus (stabilizes big toe and lifts toe up at toe off), extensor digitorum longus (stabilizes lesser toes and lifts these toes up at toe off), and the peroneus tertius (stabilizes the outside of the foot including the cuboid , 4th metatarsal and 5th metatarsal).
This muscle group is normally the weakest of the 4 groups and has to constantly pull against the more powerful Achilles tendon. As the calf/Achilles gets too tight/too strong with vigorous exercise, it is hard for the anterior group to keep up. These muscles will strain under the added stress of working against the tight Achilles. Hopefully, you can see, when someone has anterior tibial shin splints, treatment should be directed towards:
• Stretching of the calf
• Decreasing hills/speed for awhile
• Stabilizing pronation (medial support) or stabilizing supination (lateral/cuboid area support)
• Stabilizing any digit appearing unstable (with toe separators, taping, toe crests, etc.)
The 3rd most common form of shin splints is lateral shin splints (see photo). The muscle/tendons (functions) involved are the peroneus longus (stabilizes the lateral ankle against excessive supination and stabilizes the cuboid and the first metatarsal), and the peroneus brevis (stabilizes the lateral ankle against supination and stabilizes the cuboid and fifth metatarsal). So they stabilize the lateral ankle, and both sides of the midfoot area. Ankle braces, ankle proprioceptive exercises (see post on flat footed balancing), power lacing, and stable shoes if you pronate or supinate too much can all be part of the treatment.
The 4th common form of shin splints is posterior shin splints (see photo). The upper 2/3 of the calf is considered a shin splint if the pain is deep. This is normally a stress fracture on the posterior aspect of the tibia (very common in runners) and often misdiagnosed as calf muscle strain. It may also be a strain of the soleus muscle (deep part of the calf) where it originates on the tibia. The gastrocnemius (or gastroc) is the bigger, more superficial, muscle of the calf. The soleus muscle starts deep to the gastroc and becomes the other ½ of the Achilles tendon below. Therefore, the soleus functions to lift the heel. It also attempts to slow down pronation at heel contact, so over pronators may strain the muscle. It is harder to strengthen the soleus then the gastroc, so weaknesses may develop and muscle strains can occur with relatively minor overuse situations.
A further post will discuss various ways to strengthen the gastroc versus the soleus. In general, soleus strengthening is done with the knee bent 45 to 90 degrees and the ankle is then plantarflexed with resistance (pointed downward like a ballerina on her pointe shoes). Treatment of this type of shin splints must initially rule out tibial stress fracture which requires more modifications. Once tibial stress fractures are ruled out, functional changes include decreasing ankle plantarflexion (extension) and stabilizing pronation. Also, avoiding activities that produce a negative heel effect (see separate post), like getting off your seat in cycling. A slight biomechanical change in activities to minimize heel lift (ie. walking more flatfooted even when going up hills, or lowering the seat on your bike) can greatly speed up treatment.
Let us review the anatomy of Shin Splints. The 4 basic types of shin splints are Medial (most common), Anterior (2nd), Lateral (3rd), and Posterior (4th). The medial group of muscles (function) are the posterior tibial (controls over pronation), flexor hallucis longus (stabilizes the big toe), and the flexor digitorum longus (stabilizes toes 2 to 5). Photo below shows where medial shin splints occur. Since over pronation, bunions (unstable big toes), and hammertoes (unstable lesser toes) are all common problems, this type of shin splint is the most common. More specific treatments of these problems include various methods in controlling pronation (there will be a series of posts on this topic), stablizing the big toe area or stablizing the lesser toes.These include toe separators/spreaders, shoe inserts with Morton’s extensions, and big toe spica taping to stabilize the big toe area, and toe crests, toe taping, reverse Morton’s extensions all to stabilize the lesser 4 toes.
Many patients purchase shoes too wide in the toe box leading to marked instability, especially when they have bunions. Too much room with resultant sliding around is just as bad on bunions and hammertoes as having too little room with resultant crowding.
The 2nd most common form of shin splints is anterior shin splints (see photo above). The muscles (functions) involved all help to control foot slap after heel strike, and then to help lift the foot off of the ground at toe off. Overuse situations can easily occur with hill running and increases in the speed of workouts. The muscle/tendons involved are the anterior tibial (controls over pronation and stabilizes the first metatarsal), extensor hallucis longus (stabilizes big toe and lifts toe up at toe off), extensor digitorum longus (stabilizes lesser toes and lifts these toes up at toe off), and the peroneus tertius (stabilizes the outside of the foot including the cuboid , 4th metatarsal and 5th metatarsal).
This muscle group is normally the weakest of the 4 groups and has to constantly pull against the more powerful Achilles tendon. As the calf/Achilles gets too tight/too strong with vigorous exercise, it is hard for the anterior group to keep up. These muscles will strain under the added stress of working against the tight Achilles. Hopefully, you can see, when someone has anterior tibial shin splints, treatment should be directed towards:
• Stretching of the calf
• Decreasing hills/speed for awhile
• Stabilizing pronation (medial support) or stabilizing supination (lateral/cuboid area support)
• Stabilizing any digit appearing unstable (with toe separators, taping, toe crests, etc.)
The 3rd most common form of shin splints is lateral shin splints (see photo). The muscle/tendons (functions) involved are the peroneus longus (stabilizes the lateral ankle against excessive supination and stabilizes the cuboid and the first metatarsal), and the peroneus brevis (stabilizes the lateral ankle against supination and stabilizes the cuboid and fifth metatarsal). So they stabilize the lateral ankle, and both sides of the midfoot area. Ankle braces, ankle proprioceptive exercises (see post on flat footed balancing), power lacing, and stable shoes if you pronate or supinate too much can all be part of the treatment.
The 4th common form of shin splints is posterior shin splints (see photo). The upper 2/3 of the calf is considered a shin splint if the pain is deep. This is normally a stress fracture on the posterior aspect of the tibia (very common in runners) and often misdiagnosed as calf muscle strain. It may also be a strain of the soleus muscle (deep part of the calf) where it originates on the tibia. The gastrocnemius (or gastroc) is the bigger, more superficial, muscle of the calf. The soleus muscle starts deep to the gastroc and becomes the other ½ of the Achilles tendon below. Therefore, the soleus functions to lift the heel. It also attempts to slow down pronation at heel contact, so over pronators may strain the muscle. It is harder to strengthen the soleus then the gastroc, so weaknesses may develop and muscle strains can occur with relatively minor overuse situations.
A further post will discuss various ways to strengthen the gastroc versus the soleus. In general, soleus strengthening is done with the knee bent 45 to 90 degrees and the ankle is then plantarflexed with resistance (pointed downward like a ballerina on her pointe shoes). Treatment of this type of shin splints must initially rule out tibial stress fracture which requires more modifications. Once tibial stress fractures are ruled out, functional changes include decreasing ankle plantarflexion (extension) and stabilizing pronation. Also, avoiding activities that produce a negative heel effect (see separate post), like getting off your seat in cycling. A slight biomechanical change in activities to minimize heel lift (ie. walking more flatfooted even when going up hills, or lowering the seat on your bike) can greatly speed up treatment.
Thursday, June 3, 2010
Athletic Injury Rehabilitation: The Law of Parsimony
Deception Point
The Law of Parsimony: When multiple explanations exist, the simplest one is usually correct.
This is my first post being inspired by the Mediterranean Sea along the coast of the Italian Riviera (this time from Diano Marina, Italy).
As I watched the Mediterranean Sea and read Dan Brown's Deception Point thriller, on page 238 he mentions the Law of Parsimony. This is a common law utilized in medicine; a good starting point in the treatment of injuries. I will use the Law of Parsimony in this post to describe the common starting point of treatment based on the commonest cause for several injuries listed below. If you have one of the injuries mentioned below, make sure that your treatment is addressing this issue.
Achilles tendinitis--tight achilles tendons
Plantar Fasciitis--inadequate arch support
Recurrent Ankle Sprains--weak peroneal tendons
Chondromalacia Patellae or Patello-Femoral Dysfunction--weak vastus medialis
Ilio-Tibial Band Tendinitis--tight Ilio-Tibial Bands
Morton's Neuromas--tight front area of your shoe or boot
Posterior Tibial Tendinitis--excessive pronation
Bunion Pain--tight front area of shoes
Metatarsal Area Pain--development/increasing of hammertoes (see post on Budin Splint)
Peroneal Tendinitis--lateral instability in shoes
Generalized Arch Pain--weak intrinsic foot muscles
These are great starting points to treat these injuries. In many cases, it will take awhile to get weak areas strong, tight areas flexible, and correct biomechanical and shoe issues. Other treatments will be used to address anti-inflammatory concerns, and less common causes of the same injuries at the same time to hopefully sped healing along. See the post on Tips for Bunion Care as a good example. Thank you Dan Brown and the Mediterranean Sea for this inspiration. Now off to a great pasta or seafood dinner.
Wednesday, June 2, 2010
Heel Pain or Heel Blisters: Achilles Gel Pad to the Rescue
Silipos Achilles Gel Heel Pad, Large - Extra Large - Each #10395
If you develop pain in the back of your heel that possibly is caused or made worse by shoe pressure, Silipos Company has come up with a great help called Silopad or Achilles Gel Pad. A thin, but effective, gel pad is placed into a thin Nylon/Lycra sock which is normally worn under your regular socks. Backpackers, known to blister terribly the back of their heels, normally love this sock to prevent this problem from re-occurring. Many patients wear the sock even while wearing dress or other types of shoes. Even when the problem starts out as achilles tendinitis, irritation from the back of the heel counter of the shoe can greatly slow down the rehabilitation. More information can be attained at http://www.silipos.com/ .
If you develop pain in the back of your heel that possibly is caused or made worse by shoe pressure, Silipos Company has come up with a great help called Silopad or Achilles Gel Pad. A thin, but effective, gel pad is placed into a thin Nylon/Lycra sock which is normally worn under your regular socks. Backpackers, known to blister terribly the back of their heels, normally love this sock to prevent this problem from re-occurring. Many patients wear the sock even while wearing dress or other types of shoes. Even when the problem starts out as achilles tendinitis, irritation from the back of the heel counter of the shoe can greatly slow down the rehabilitation. More information can be attained at http://www.silipos.com/ .
The outline of the gel has been highlighted in this photo above, and the side view seen below.
I hope some of the backpackers reading this post will consider this, especially if you have had previous blistering problems. I would like to refer you also to the separate post on Guidelines for Blister Care.
Tuesday, May 25, 2010
Achilles Stretching Technique
Proper Stretches for the Achilles Tendon are a vital part of every pre and post activity, and especially with injuries to the achilles, calf, plantar fascia, and hamstrings. Please refer to the post entitled "Generalizations in Stretching". There are two muscles, gastrocnemius and soleus, that make up the achilles tendon. These two muscles can be stretched separately by first having the knee straight (gastroc stretch on the left photo above), and then having the knee bent (soleus stretch on the right photo above). With both stretches, it is important to keep the heel on the ground. Hold each stretch for 30 to 60 seconds, or 8 deep breathes. Deep breathing gets oxygen into the stretch, a good yoga principle. Do not bounce, ballistic stretching. It is never good to jerk the muscle or stretch through pain. You want that good ache feeling. Try to stretch several times a day to actually gain in flexibility, even on days you do not do your normal activities. When non-athletes complain of cramping in their calves, often low potassium or dehydration is blamed. Have them try stretching 2 or 3 times a day and many will experience complete elimination of the cramps.
Saturday, May 1, 2010
Achilles StretchIng: One Stretch to Avoid (when you have achilles tendinitits or plantar fasciitis)
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