Foot pain can occur due to many different reasons. There is toe pain, heel pain, arch pain, ankle pain and much more. Before we can understand the how and why of foot pain, we need to understand the foot.
The foot is divided into three main sections, the hindfoot, the midfoot and the forefoot. There are numerous bones, joints and muscles throughout the foot. The larger bones and muscles are located towards the ankle and heel (hindfoot) to assist with shock absorbtion and the smaller bones and muscles are located towards the toes and arch (forefoot and midfoot) to assist with push off. Each joint is connected by ligaments or capsules (connective tissue).
The foot is well adapted function for weight bearing and locomotion. It provides support and shock absorption as well as balancing the body. The foot requires mobility and stability for the rest of the body. Dysfunction at the foot/ankle may have consequences throughout the entire body. The ankle is a hinge joint and injuries to this region can greatly limit mobility. Impact forces sustained during gait, increase with body weight and with gait speed. The structures of the foot are anatomically linked such that load is evenly distributed over the foot during weight bearing. Approximately 50% of body weight is distributed through hindfoot (heel/ankle) joint and remaining 50% transmitted across forefoot (toes).
The foot and ankle bends down (plantarflexion) and up (dorsiflexion). The foot can move in and out and rotate (pronate or supinate). The strike pattern consists of a swing phase (predominant in running) and a stance phase (predominant in walking). Shoe wear is directly associated with gait patterns as well as surfaces (e.g. treadmill, roads, dirt, etc.).
Common types of pain include:
Common locations of pain include:
Types of Injuries
Most of the injuries that we treat in our clinic are associated with repetitive strain injuries. Our initial goal is to assess the region and type of pain, the biomechanics and gait, and the history of the injury. In most cases, the injury is actually a tear in either the muscle or the tendon of the foot and/or ankle. Sometimes there is a lot of tearing and sometimes there is just a little tearing (microtears) that adds up over time. This tearing leads to inflammation (tendonitis), weakness, soreness, swelling, bleeding and eventually scarring (adhesion / fibrosis). The key to fixing foot pain, though, is to reduce or eliminate all of the above symptoms plus the adhesions and fibrosis that comes from the tearing process.
The formation of adhesions and fibrosis (or scar tissue) is the body’s response to healing a tear. What actually occurs is that the spread of sticky fibrin, which is the sticky substance you feel when you bleed, seeps throughout the layers of the muscle and leads to scar tissue formation. The scar tissue and adhesions that forms are made up of collagen. This creates a strong bond and binds the injured tissue back together.
The scar tissue that binds injured tissue back together also binds the healthy tissue together. This causes decreased circulation and tightening of the muscle resulting in inflammation and lack of oxygen to tissues, creating biochemical changes, increasing fibroblasts and resulting in fibrosis and adhesions. More and more fibrosis and adhesions develop within the muscles causing the muscle to become less elastic (like a rubber band) and more leathery (like a belt). The more leathery the muscle becomes the more stress is placed at the tendon (where muscles inserts into bone). Too much load or force can create tearing of the tendon!
There are different grades of tears that occur in the muscle and tendon. The most common is a Type I muscle strain or ‘Repetitive Strain’. This basically consists of micro-tears. The other grades of tearing are Type II and Type III, which can result in complete rupture of the muscles and ultimately require surgery.
There are many things involved in determining the grade or type of tear that has occurred. In general, the degree of tearing can be based on the extent of bleeding that will create swelling and bruising on the surface. It is important to note that the degree of tearing is NOT based on the level of pain!!
There are many forms of treatments for tennis elbow. They can include:
What is Active Release Technique (ART) and Graston Technique?
ART and Graston Technique address the scar tissue (adhesions and fibrosis) and works to make the leathery muscle fibers more elastic again. It is the most effective way to breakdown scar tissue.
How does ART and Graston Technique work?
The doctor locates the scar tissue and traps the scar tissue with hand/thumb or Graston tool while the patient actively lengthens the involved muscle. The trapped scar tissue is held back as the muscle moves through. ART and Graston technique is so effective because it makes the muscle elastic again and gets to the root of the problem by increasing circulation to the injured muscle and tendon.
Overview of Ideal Treatment Plan
While ART and Graston Technique is not a cure-all, removal of scar tissue is a key to a majority of cases. It addresses all hindrances to healing such as faulty mechanics of gait, footwear, poor biomechanics, hobbies (running, cycling, etc.), and allows proper rest and recovery. Most importantly, ART and Graston technique addresses the scar tissue.
Other types of treatment
SPINAL AND SPORTS CARE FOR THE ACTIVE INDIVIDUAL: (916) 933-9870