Diagnosis questions

curraheeeasyc

Barefooters
Jul 6, 2011
72
11
8
37
Panama City, FL
So I saw a physical therapist on base (read: questionable care...) about the soreness I was having on the outer edge of my right foot on the bottom. It started in October after a longer race than I should have run, and has nagged me since. The PT said I had low arches and because of this the rays of my foot were crashing outward and pinching the peroneal brevis, or something similar in that area. He recommended I run in stability shoes which I rejected, and he ultimately said he'd treat it with ice and ultrasound hydrocortisone. He also said that basically this would keep happening if I persisted in running bf or in minimal shoes like the NB Minimus Zeroes I wore to see him. While ultimately I agree that the treatment is correct, so I don't really care why he thinks it's happening, I wanted to see what you guys thought about his diagnosis. It seems counter intuitive that my arch being low (which would lead to more pressure on the inner foot if anything) would cause the "crashing" of my rays outward. What are your thoughts? Thanks!
 
I can say I had lots of issues with the peroneal tendons before I started barefoot and had a lot of trouble with the first year adapting to barefoot/minimalist running. I had very bad pain in the same area as you...its where the tendon ends and connects to the toe bones sorta. I way way over did on mileage and racing the first 6 months into barefoot and like you had some pains after a race...I had to basically take several months off plus I discovered the root cause was really in the upper ankle area where the peroneal tendons run down the side of the leg, this indirectly was causing the problem down lower in the foot. So check out the peroneal tendons up higher, see if they are tight, swelled up, sore etc. Hopefully the Doc's will be along with some better advice.
 
This is a interesting post which is easy to respond to. your physical therapist said that the rays of your foot were crashing out word and pinching the peroneus brevis or something in that area.

What you said you did to cause this was that you ran further than you should. so what you're saying is that you had fatigue set in at the end of the race that caused your supportive musculature to falter leading to this disarray of your rays.

the key to running safely without injuries is obviously having good conditioning, no restrictions on the moving parts, and excellent form and technique in your running. Everyone starts off in a race looking like an Olympic champion. At the end of the race they look like cripples at times limping in or face planting on the finish line. The not so obvious break in the form and technique is what causes abnormal movement patterns that allow bones to slip out of position, block or become hyper mobile leading to pain.

What your physical therapist said was that your rays were out of position crushing something. So what he is describing is a mechanical problem. Mechanical problems with prior mechanical solutions. What he offered you was a chemical solution. Ice, ultrasound hydrocortisone is a chemical solution. Ice, ultrasound and hydrocortisone in combination will not unlock joints that cause other bones to move excessively or mechanically improve the biomechanics to allow you to run without pain. So what we can say is this treatment approach is obviously not going to work because it defies the laws of physics gravity engineering nature few other laws.

So instead what you might want to try is some self-help soft tissue techniques of your foot on your own. I have some that I have found to be extremely effective and I'm going to share them with you. Just park yourself on the carpet flip on your favorite television show and give your foot by hand with these simple deep tissue treatments to soften up spasms legal bones loose and overall get more acquainted with your foot. After you've tried them e-mail us back and see how it goes. In the meantime find another visible therapist because he's not tuned to your barefoot running dream. He's offering you a brace which is a shoe instead of restoring your normal biomechanics.

Release your feet and legs when you get home with the spring release techniques I gave you in tutorial 77 – 89 when you get home
Video Tutorial #77 Dr James Stoxen DC Demonstrates How to Self Adjust Your Toes
Video Tutorial #78 Dr James Stoxen DC Demonstrates Self-Help, Deep Tissue Treatment Of The Knee Popliteus Muscle
Video Tutorial #79 Dr James Stoxen DC Demonstrates Self-Help, Deep Tissue Treatment Of The Gluteus Medius Muscle of the Hip
Video Tutorial #80 Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Subtalar Joint Of The Ankle On The Inside
Video Tutorial #81 Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside)
Video Tutorial #82 Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Treatment Under The Big Toe And Second Toe
Video Tutorial #83 Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Treatment Above The Big Toe And Second Toe
Video Tutorial #84 Dr James Stoxen DC Demonstrates Scissor Stretching Of The Feet
Video Tutorial #85 Dr James Stoxen DC Demonstrates Stretching Great For Mortons Neuromas And Narrow Heels
Video Tutorial #86 Dr James Stoxen DC Recommends The Best Shoes To Prevent The Foot From Deforming
Video Tutorial #87 Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Of The Ankle Mortise
Video Tutorial #88 Dr James Stoxen DC Demonstrates Stretching Of The Foot While Sitting At Your Chair
Video Tutorial #89 Dr James Stoxen DC Demonstrates A Stretch To Increase The Flexibility Of The Arch Of Your Foot
 
I hope you have good results with these self-help tips. They are highly effective and because you can do them yourself you're not limited to a 20 minute treatment three days a week. When I treat patients am doing deep tissue work for at lease an hour the first visit if not more and sometimes two, four, six, 10 hours a day on VIP clients that pay by the hour. So, you can give yourself the same VIP treatment by doing the deep tissue and stretching of your feet yourself while sitting at your desk or in a focused session in the grass or on the carpet in your living room. Just work in these points for hours at a time until you've resolved your condition. You don't have to do 20 minutes and stop and you don't have to rest your body every other day like you do with training.

My patients are treated daily. When they say, EVERY DAY? I say, DO YOU WANT TO GET BETTER FAST OR SLOW? We all know how they respond.... :)

As far as your diagnosis peroneal insertion tendinitis, these diagnoses are just explanations of where things hurt or were the inflammation is. What causes the inflammation and pain is always much more complex than just describing where the information is. In fact just describing where the inflammation is in applying some anti-inflammatory in my opinion is the old treat where it hurts method as outdated in fact quite prehistoric. The reason why I offer the more complex view is because I am trying to get you to think differently about your body as a human spring mechanism that works with a symphony of suspension system muscles that control the movement of 33 individual joints of the human foot. If you go to a health care professional and they treat where it hurts and do not restore your human spring mechanism can you take up impact forces of 3-4 x your bodyweight into a barefoot? Doubtful.

We think about the a 3 dimensional structure that has 33 movable joints and a suspension system that can set these joints in millions of different positions you can understand how the human body is able to balance the mass over the top of these tiny little feet in various terrains at many different speeds with external objects effecting the balance, i.e. a football player running getting hit by another player but regaining his balance to run into the end zone.

When any one or many of these joints in the human foot get locked the ability for the foot to create these millions of positions to balance the mass over the top of it is diminished. Balance is not as accurate. As we age footwear and injuries caused our tissue to become stiffer and even lock in some places the foot reducing our ability to attain these positions because of a lack of flexibility in the foot. The leading cause of accidental death in the elderly is falls. When joints in the foot lock then when the tendons pull against these locked joints the bones don't move the way they were designed to move so the tendon strains So now instead of you saying you have strained inflamed tendon, you can say I have a strained peroneal tendon which is inflamed because the bone and joint complex it is pulling against won't give and therefore it gets strained Treating this strained inflamed tendon without releasing the stiff or locked mechanism that is straining it will only provide temporary relief if that. If all I had was anti-inflammatory aids to treat these conditions I would lose my mind. Honestly I don't know how people who treat this way get anyone better It is beyond my comprehension.

By setting your sights on barefoot running for the rest of your life your challenge is much greater on a daily basis to maintain the movement of these joints, however because you are challenged to keep these 33 joints moving and the strength within the spring suspension system's to take up impact forces or three times your body weight on a barefoot your have a better chance of getting into your later years with the ability to still run. As you age the challenge to keep your 3dimensional flexible springy foot healthy enough to take these impacts will be harder and harder. You cannot wear shoes 8 hours a day and think that you can just barefoot run ONLY as a way of maintaining the ability to run barefoot for life. You have to do the fine tuning every run by hand. Why wait for your peroneal tendon to get inflamed again or worse before you do the hands on? When athletes are in competitive sports, they all have pre practice warm ups which involve a 30-60 minute stretch, massages etc. If you are running 3 days a week barefoot you might as well consider yourself functioning as a professional athlete level and treat your body as a pro athlete would.

Those who feel it's a good idea to wear a brace on the foot and protect the foot from impacts are saying that they don't trust the ability of the foot to be able to do what it's designed to do, so the Reliant external braces to assist the foot. The next step is when they can't rely on the flip to be able to walk so they need a cane and then a four prong Walker, and then a wheelchair, and then they're bedridden. This is the normal standard of care that medicine opts for, to raise the body constantly instead of re-storing the natural spring mechanism that you're born with as a child. The inability to run barefoot is the first sign of aging.

Unfortunately, doctors may not have the same degree of excitement to strive to maintain your youth as you do. So therefore, you have to take matters in your own hands. So take the time to look through these videos and give your foot hand, and work on these points yourself.

I recommendation is that you spend 30 minutes before every wrong for the next 6 to 8 weeks fine-tuning the movement patterns of these joints in the spring mechanism of the foot. What you'll find my doing these techniques before you run is that the foot will become more flexible and you are running will become more natural.

After that during this process the brain will start to readjust the movement patterns that are stored so that your form and technique will become a burned into the brains nervous system. After that you won't have to do with these fine tuning techniques as often.

That's what I determined when I did the self-help tips myself prior to barefoot running and I run on the solid concrete surfaces of the lakefront in Chicago at 50 years of age. So go for it and let me know how things work out. Let me know where it points you are finding to be tender on these self-help tips
 
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Opening our eyes, Dr. J. Thank you.
 
Thanks for all of the advice. I certainly was disappointed with the PTs diagnosis and treatment. He was definitely down on barefoot running and only offered orthotics with a warning that I'd always have problems if I persisted in running BF. I believe my tendonitis began when I ran a 9 mile trail race when I hadn't run further than 5 miles. I haven't rested or given it an adequate opportunity to heal before now. I will take your exercises and do them regularly to make sure I stay healthy. I truly appreciate everything you've written here and the videos, along with the time.