Dear Jim,Here is an
Dear Jim,
Here is an encyclopedia of advice... I hope it helps you and others.
Thank you for your posts. What I like about your post is that you are very descriptive with your signs and symptoms and I was really impressed with your description of the exact range of motion that you felt your pain. it's not easy to learn the movements of the human foot and even at times I can get confused so bravo to you for trying to learn.
Now let's get to the point of analyzing your situation.
First, we have to evaluate how the human foot takes up force. That's extremely important when we're running with between 500 - 1,000 pounds of impacts per landing on a barefoot in surfaces such as concrete asphalt and other hard surfaces. Then we have to look at how your activities of daily living may be affecting the function of your human foot and other joints of the seven floors of the human spring mechanism to determine what you are doing that could be undermining the integrity of the human spring mechanism to absorb these impacts. oftentimes Broadway dancers I have worked with are fitted with a specially designed dance shoe which costs $500 or more for their dancing and can't figure out why they have aches and pains. When in fact they spend two or three hours walking up and down Michigan Avenue and flip-flops carrying heavy bags of shopping prizes which creates an abnormal distribution of the mass across the spring mechanism for sometimes 5000 to 10,000 impacts. The safest way to impact human spring mechanism is with the mass perpendicular to the spring or on the forefoot.
The human foot and ankle has 33 movable joints. The purpose of these joints is to allow for maximum flexibility of the foundation so that force of the
impact of landing can be spread across these joints making the impact more smoothly attenuated through the foot and human body as a
spring and roll rather than a
bang in a twist.
It is my opinion that an orthotic is another object that occupies a space within the shoe to jam these 33 joints not allowing the force to spread its energy of impact smoothly into these 33 joints. That is because they've lost joint play flexibility from being compressed within the shoe. So the fact that you wore shoes with orthotics for so long might have caused the foot to be in a state of what I call
FOOT LOCK (this is not to be confused with Footlocker)
Some chiropractors and other practitioners have learned how to motion palpate (examine) the motion of these 33 joints of the foot to determine the joint play within the articulations. After many years of examining joint play in the human foot and other body parts one can determine whether or not these joint play is
locked or whether it's
stiff or whether it's
freely moving. It takes a lot of experience and a good sense of touch to be able to determine this joint play however it's vital to understanding whether or not there's a locking of this mechanism. If ANY of the 33 joits are locked or stiff it will contribute to a greater force of impact or what I call the
bang rather than the
spring of the force of the landing into the foot.
The second way that the human body absorbs impacts is through the loading of the forces within what I call the human spring suspension system muscles. Many people (including physicians) don't realize this but the arch of the foot is actually suspended from above by muscles that attach at the back of the calf underneath the gastroc and soleus muscles. Some physicians and other doctors call this muscle group the arch sling, some call it the ankle sling and I call it the human spring suspension system muscles. There is even a syndrome named for dysfunction of one of these muscles, the tibialis posterior called the TIBIALIS POSTERIOR TENDON DYSFUNCTION SYNROME http://orthoinfo.aaos.org/topic.cfm?topic=a00166
When your foot impacts the ground the force of the landing is absorbed into the foot by loading this force into the flexible arch mechanism of that impact and also into these muscles called the tibialis posterior, tibialis anterior, peroneus longus and peroneus brevis primarily with help from others to a minor degree.
What we really have to do is find out what the cause of all these joint problems are because if we can determine the source of your joint problems we can eliminate that and we've limited the cause and you won't have to keep treating it. Now, there was something you mentioned that was very important in your history. It was that you said that after standing on your feet for approximate four hours that you start to have heel pain. You also mentioned that you describe the heel pain primarily in Dorsiflexion and slight inversion. The action of Dorsey flexion and slight inversion is produced primarily by the sub talar joint. The sub tailor joint can become painful primarily if you have over pronation or over supination.
The primary cause of most joint problems that affect the human spring mechanism is
- fatigue of the spring suspension system muscles
- weakness in the spring suspension system muscles to maintain the safe loading and keep the foot in the safe range between super nation and pronation during foot plant.
- lack of mobility or movement of specifically all 33 joints in the joints up the seven floors of the kinematic chain causing the force to bang into the kinematic chain rather than load force safely into the human spring mechanism thus protecting the body from the impacts and stimulating that recycling of the energy through the spring mechanism. the result is breakdown of the joints causing chronic pain, increase risk of injury and decreased ability to load the energy into the spring mechanism leading to chronic fatigue because the force of the landing and push off is being generated by muscles rather than the connective tissue tendons and natural spring mechanism of the arch of the foot and the suspension system muscles.
There are 20 or 30 different ways to fatigue the human body but the most important to methods of fatiguing the human body deal with movement patterns and those are:
- Static fatigue–this is the kind of fatigue where you're standing in one place stressing muscles which maintain the body in that position for this extended period of time beyond their capacity to sustain this position.
- Dynamic fatigue–this is what we mostly recognized as fatigue which is related to walking or running or movement of any kind for a long stretch of time such as running a 10K, half marathon or marathon. At the end our body is fatigued from movement.
What you have described as the cause of your problem is static fatigue. Standing on your feet for four hours at a time causes static fatigue of the suspension system muscles that maintain the arch loading mechanism as well as provide joint play or spring space in the subtalar joint space. This is the domino effect that is typical of a static fatigue situation which affects the integrity of the human spring mechanism to be able to maintain itself.
- Static fatigue causes weakness in the spring suspension system muscles
- Weakness in the spring suspension system muscles leads to a drop in the lock of the spring mechanism (The joints that lock are typically
[*]the metatarsal cunieform border of the first metatarsal cunieform joint[*]the second metatarsal cunieform joint and sometimes the third metatarsal can you form joint. [*]this leads to a locking of the medial and lateral subtalor joint initially (the area of the pain you described under the lateral maleolus when you dorsiflexed the foot and internally rotated it.[*]You also typically find a locking of the talus in the ankle mortice medially.
When these joints lock your foot and akle are no longer a 33 joint flexible spring suspension system capable of absorbing i
mpacts and recycling energy. Instead it typically becomes more of a locked "frozen foot".
Since the mechanism is no longer a spring suspension system it can no longer traverse through its normal path with the second toe pointing towards a target or the axis of the foot pointing towards the direction you're moving. Your foot and ankle are engineered differently. Its obvious that any two moving structures are engineered differently move differently. this newly engineered foot changes its movement pattern from a spring roll to a bang in a twist using more muscles instead of spraying from the connective tissue tendons ligaments etc to a movement outside of the normal movement pattern or a movement that is along the path of least resistance. This is the movement of either oversupination or overpronation.
Walk towards the mirror and see if your second toe is pointing towards the target or if your feet are pointing outside of this range. Please get back to us on what you find during this simple gait analysis.
Here's the rest of the story...
- The abnormal movement pattern causes stress and strain and muscles tendons and ligaments.
- Stress and strain leads to wear and tear of the joints.
- these combined will cause the natural release of inflammatory chemicals. Initially these areas of highly inflamed tissues will not cause pain which is registered in your brain. That is because the inflammation is silent at first until the concentration level increases to a level which can stimulate the nerve fibers that register the pain in the brain.
- My theory is that because you take 5000 steps on one leg and 5000 steps on the other everyday what we know for a fact is that the body engineering forces the stress and strain through the lower back with the combination of 10,000 steps per day. This is why I feel that the lower back and hips are the first area to be affected by this abnormal movement pattern because they receive twice as much stress and strain during walking and running as the lower limbs due. It just seems to make sense from the laws of physics, engineering and the laws of nature. Typically patients don't make the connection between the abnormal movement patterns resulting from the lack spring mechanism in the foot and lower back pain until it starts to work down the kinematic chain into pain around the kneecap shin splints plantar fasciitis and these strange pains that you're feeling around your ankle or your subtalar joint.
how to fix it:
[*]If it hurts put pressure on it until the pain goes away. This is a simple way to break up spasms around any joint that can lead to stiffness or locking of the joint. You can do this when watching TV or before you do your run as part of the preparation. I have found the more that you do the preparation the less preparation you have to do over time. The other thing I can recommend on how to find these stiff muscles is if it hurts then its a good place to work. What you can do to find the muscles tendons and ligaments for more precision self help is to buy a Greys or comperable anatomy book, open it up and study it on the floor while giving your foot a hand
[*]If you want to be a barefoot runner you cannot stand on your feet for long periods of time because it will lead to static fatigue which will critique this set spring suspension system muscles rendering your spring mechanism locked. The cat run barefoot or shot for that matter with the likely mechanism because the impacts will be taken up into the joints of the body with a bang in a twist rather than a spring and roll. If you know you are going to be on your feet for a long time then get a shoe with
a strong counter support to keep the heel as close to perpendicular as possible through the day. When the fatigue sets in you KNOW that the foot will either collapse in one of two directions, over pronation or over supination so if you have a strong piece of leather on both sides when your muscles and tendons give out you have the leather to hold your foot with the mass loading into the spring as close to perpenducular as possible until you can get off your feet. The bottom line is you should not be standing in one place for a long time in the first place so this is the next best thing. [*]Second of all if you know that you've had your foot locked in the shoe and further compressed by a physical device such as an orthotic an issue for long periods of time it's more likely that you have a locking of some of the joints of these 33 joint complex that is functions as the mechanism that displaces the force of the landings to these 33 joints thus reducing the impact on the human body during running. So the best thing I could recommend to get that anatomy book that has the joints in the foot listed visually so that you can see them and with your hands
Wiggle these joints free prior to your running. You can also do a ton of stretching while you're at your desk when with your shoes off at the computer reading this blog post. What I do is what I'm writing I take my foot and angle it so I can get the ball of the foot pusining into the bottom of the opposite foot.. Then I work the other foot by using the opposite foot to contort my foot in all different directions to try to stretch the joints in the different directions. What people don't realize is that the human foot takes up the majority of the impact forces when flexible.
- The human foot is a three-dimensional structure therefore it must be stretched in all directions in order for it to allow the impact to absorb into the foot with equal force throughout the various joints instead of more force in joints that are not stretched and less force in joints that are stretched. Look at the configuration of these joints in the anatomy book again.
Stretch the foot and ankle in all of the ranges of motion that the foot moves:
- Pull your toes apart
- scissors stretch them one way and the other
- dorsiflex stretch
- plantar flex stretch
- inversion stretch
- eversion stretch
- abduction stretch
- abduction stretch
- supination stretch
- pronation stretch
With all those stretches you've covered all the ranges of motion required to release this three dimensional spring mechanism to get those 33 joints released to be able to absorb the impact forces of the landings from impacts from all angles of force. (I spend 30 minutes preparing my human spring mechanism with deep tissue and stretching before setting out for my barefoot run on the hard streets of Chicago) Preparation is how you avoid injuries and have a long career as a runner.
Last thing I recommend is that since the spring suspension system muscles move the foot in directions other than the forward and backward direction if you want these muscles to be strong you have to run in directions other than the forward and backward direction.... Hello? Why do you think you just cannot go in the gym and do bench press and go home? Why do you think its ok just to run straight down the path without a more balanced running training program in other directions other than forward? Think logically about this body part and it will start to click and I dont mean your knee cap
Good luck with your recovery and may you have a long career as a barefoot runner! :-D
Dr James Stoxen DC
President, Team Doctors Treatment and Training Center
www.barefootrunningdoctor.com
