More than 80% of us experience low back pain at some point in our lives. In most cases, the pain goes away on it’s own or with a little “help” from the internet, yet recurrence rates of low back pain range between 24% and 80% within the first year.
A literature review by Steffens and colleagues summarizes the benefits of exercise and education for low back pain. The types of interventions included in the studies were patient education, core stabilization exercises emphasizing exercises for the back and abdominal muscles, stretching and spinal range of motion exercises as well as general aerobic conditioning exercises.
The reduction in recurrence rates of low back pain was impressive at 25% to 40% in the short-term.
The effects in the long term were more uncertain. Several studies showed no decline in recurrence rates after one year.
So what does this mean?
More than likely, the participants felt better and they stopped doing their exercises. Sound familiar?
In order to prevent recurrence of pain or injury in the future, it is crucial to continue with an exercise program that includes core stabilization training, flexibility and spinal range of motion exercises and general aerobic conditioning.
Don’t delay. Get a refresher from us ASAP or refer a friend or family member who is in pain.
Do you ever experience a snapping sensation when you bend or rotate your hip?
The most common reason for the snapping is stiffness in the iliotibial band or in the iliopsoas muscle.
As you bend or rotate your hip, the stiffness of the iliotibial band will cause a snapping sensation on the outside of your hip. This is caused by the iliotibial tendon snapping against the greater trochanter of your femur. By the same token, stiffness in the iliopsoas muscle will cause a snapping sensation on the inside of your hip. This is caused by the iliopsoas tendon snapping against the lesser trochanter of the femur.
So what do you do about it? Come on in for a free screening and we will take a look. We need to get you on a stretching, strengthening and self-mobilization program in order to alleviate the imbalances that are causing the snapping.
I have struggled over the years as to the importance of including toe flexor strengthening as part of a program for plantar fasciitis. Many researches agree that the potential causes of plantar fasciitis are just too numerous and multi-factorial. The evidence in the literature has not been conclusive and I have let many of my patient’s comments that “this is silly” when picking up marbles dictate my decision-making. I have slowly but surely, and I believe wrongly, eliminated this important exercise from my treatment approach. I have recently read several articles that have rekindled my enthusiasm for toe flexor strengthening. So why the change in heart??
I am always looking for ways to get our patients better…faster. I have written a book on plantar fasciitis called the Plantar Fasciitis Treatment Manual and it identifies ankle muscle weakness as a result of plantar fasciitis but not include the presence of toe flexor weakness. That is my oversight and I will correct that in the book. Yes, the literature does identify weakness of the ankle muscles and the toes flexor muscles with the plantar fasciits population, yet the research does NOT confirm any causative factor of this weakness on the development of plantar fasciitis.(1,3,4) It is the chicken or the egg conundrum. Unfortunately, there are theoretical assertions that the “flexor digitorum brevis muscle (the muscle directly underneath the plantar fascia) plays an important role in distributing pressure away from the plantar fascia” that are simply not supported by research. (2) Does this mean that we should not perform strengthening exercises? Let me provide some more evidence.
As we get older, we get weaker. We all lose muscle mass, we lose muscle fibers and, as a consequence, we see decreases in strength between the ages of 30 and 80 within a range of 20-40%.(5) Several articles have also shown that “older people” exhibit 24-40% less strength in the muscles of the foot and ankle(5,6,7,8). As a consequence of foot and ankle weakness, older adults are more susceptible to loss of balance, the development of foot and toe deformities and can be susceptible to overuse syndromes such as plantar fasciitis. (5,6,7,8) The biggest question that has not been answered when it comes to strengthening exercises for older adults is WHICH exercises are the most effective?
As a result, we have to rely on some common sense. If the muscles in our ankles and feet get weaker as we get older (proven!), then we should strengthen them to avoid plantar fasciitis. Right? Not necessarily. There is not a direct correlation between weakness and the development of plantar fasciitis but, then again, many people don’t believe that there is a direct correlation between human activity and climate change. My point is why should we wait to change our approach until it is conclusive – whether it be climate change or your plantar fasciitis?
We offer another specialized service at OrthoWell called Cupping Therapy. Cupping has been used in traditional Chinese medicine (TCM) for thousands of years. It is used in TCM to stimulate specific points on the skin which correspond to acupuncture points that lie on energy meridians, or pathways. Through manipulation of the points on the skin, the TCM practitioner can influence or change a specific organ’s blood or energy called Qi (chi).
In our clinic, we use cupping in a different way. We are not TCM practitioners. We are western practitioners with a great respect for eastern treatment philosophy. There are many types of cupping methods. We use Dynamic Cupping in our clinic. I can personally say that I have had incredible results with dynamic cupping. One day I asked myself “if I have such great results, why not use cupping on my patients?”
Our method for using dynamic cupping is to lightly lubricate the skin. We place gel, polymer cups onto a region that we are treating by squeezing the cups and placing them directly onto the skin. When we release the”squeeze”, it creates a negative pressure within the cup which “sucks” the skin up into the cup. The intensity of the negative pressure depends on the tolerance of the patient. Our goal is to pre-stretch the skin and underlying fascia and then to have you slowly move through controlled range of motion exercises in order to increase the effectiveness of the stretch. This is the “dynamic” part of our cupping method. Cupping therapy should NOT be painful! You should experience a warm, pulling sensation during the treatment which lasts around 5-6 minutes. Cupping therapy can improve blood flow and lymphatic drainage. TCM practitioners talk about the release of energy “stagnation” via cupping therapy.
Yes, you will have cupping marks on your skin for several days after a treatment. The color and response to the cupping is dependent on the extent of stiffness or the extent of “stagnation” at the treatment site as well as the amount of time that the cups are in place. TCM practitioners believe that the skin is a mirror of our health. All skinmarks that appear as a result of cupping therapy are usually not painful. The discoloration is a result in a change of blood flow through the area. It is not traumatic “bruising”. There is no external or internal damage inflicted to the skin and the capillaries do not leak as a result of injury due to trauma. The “bruised” areas will turn yellow green before totally fading away.
So, we typically perform cupping therapy after we have completed other manual techniques such as pump massage, Active Release Technique and Graston Technique. It is a good way to mobilize the tissue after the other manual therapy techniques. It is just another treatment technique that we offer at OrthoWell to get you better…faster! Check out the video below for a demonstration.
My subject line is no joke. I really did find a cure for cancer!!
The realization will come as quite a shock to many of you.
I spend a lot of time reading and talking about health and fitness. I thoroughly research each and every blog post before I share it with you. Patient education is a top priority at OrthoWell and it is an integral part of our mission statement. We really DO care about you and your health. For this reason, I feel obligated to share the following information.
I was introduced to a book by one of my patients that may change or even SAVE your life! The title of the book is Outsmart Your Cancer by Tanya Harter Pierce. I have had the unfortunate experience of getting a phone call by my father that he has bladder cancer. The realization, of course, was more unfortunate for him. This came up in the conversation with my patient as we broached the cancer subject. She shared her experiences regarding her own cancer history and then she began to open my eyes, my mind, and my anger to the realization that our medical establishment is intentionally misinforming the public about cancer. Some of you may be saying “yeah, right, why wouldn’t my doctor tell me if there was a cure for cancer?” or, like my father said, “yes, I have heard these things before” but then he dispels the “myth” and decides to go through with his radiation and chemo. Don’t get caught up in the “disbelief factor”. I am telling you, from the bottom of my heart, not to be naïve and not to stay ignorant to this realization. You NEED to read this book as my words alone will not do it justice.
Outsmart Your Cancer is not a promotional vehicle for a new cancer pill or a new cancer prevention diet. As a matter of fact, the author does not promote any one single approach to curing cancer. Her objective is to share with us all that has been hidden from us. Yes, there are MANY alternative treatment options to both prevent and to cure yourself of cancer. Her introduction to cancer was the same as mine. The realization that a loved one may die from cancer! I would like to share some excerpts form the book regarding the misinformation campaign that has been waged on the public.
In the author’s words:
“I have also discovered that for many of these cancer approaches, the way they work has been proven by rigorous scientific research performed by highly respected physicians, brilliant biochemists, and Nobel prize-winning scientists. Effective alternative approaches to cancer ARE obtainable today, and they are not bogus methods developed by quacks and kooks as the public has been led to believe.’
“During my research, I spoke to over 100 people who had recovered from their cancers using the alternative treatments presented in this book.”
“The suppression (of information) has been carried out in many different ways by many different organizations and is simply the result of business economics and common unethical tactics that tend to occur when large money interests are involved in any field.’
‘Surgery, chemotherapy, and radiation involve billions of dollars of profits for the industries that supply them… the cost of developing and bringing a new cancer drug to market is close to $1 billion… A treatment made up of natural ingredients is not patentable… A natural form of treating cancer will never be pursued by a drug company… alternative treatments will always be considered an economic threat to the multibillion-dollar cancer establishment.”
If you want to watch a YouTube video to convince yourself of the misinformation campaign that has been waged by the FDA and American Medical Association, then watch this video on Dr Burzynski’s treatment for cancer. CLICK HERE.
So when should you start an alternative treatment approach if you’ve been diagnosed with cancer?
As soon as possible! Unfortunately, most people start with conventional treatment before they try alternative approaches. It is the fear and shock factor associated with “I have Cancer” that makes people decide prematurely regarding the BEST treatment option. They usually start with the big three…chemotherapy, radiation therapy, and surgery. Don’t become a statistic. Get educated!
So how do you make an educated decision on what treatment path to follow after you’ve been diagnosed with cancer?
Outsmart Your Cancer spells it out in simple terms and in black-and-white. There ARE options…successful options that have cured thousands of patients with cancer. All you need to do is read and/or listen (a DVD of patient testimonials comes with the book).
So when do you start a cancer prevention program?
NOW!!Outsmart Your Cancer will empower you to start a prevention program today. Scrutinize what you put into your body. Yes, you ARE what you eat. Don’t forget to read my post on Vitamins-To Take or Not To Take for more information.
Because I WANT to be your advocate for health and wellness and because I WANT you to stay cancer-free, I am stocking Outsmart Your Cancer in my clinic. I feel that strongly about the information in this book! I have purchased them in bulk so the wholesale cost is only $20 per book. Don’t delay! Get the facts!
Other things that could change your life that are discussed in the book include:
ACIDIC vs ALKALINE
Did you know that it has been scientifically proven that cancer cells cannot survive if the environment is alkaline enough? Did you know that the QUALITY of what you consume determines whether your body becomes acidic or alkaline? Many people, either with cancer or attempting to prevent cancer, strive to maintain their body pH at an optimal alkaline range between 7.0 and 7.5. Your body pH can be evaluated by a simple saliva test using pH strips in the privacy of your own home. So how do you do this? I’ll give you the answer even though you need to read more about it…CALCIUM. One of the most important roles of calcium is to help our bodies maintain proper pH levels. In addition, the absorption of calcium into the body is completely dependent on the levels of vitamin D in the intestinal tract.
WOMEN -THE PILL – HORMONE REPLACEMENT THERAPY
Do you really understand the effect of synthetic hormone replacement therapy? Outsmart Your Cancer discusses what every woman NEEDS to know about the effects of The Pill and hormone replacement therapy. You need to really be aware of the things that your doctor is NOT telling you. Long-term clinical studies have proven the cancer-causing effects of synthetic hormone replacement therapy. Get the facts!
MEN-TESTOSTERONE & PROSTATE CANCER
As for the men, did you realize how controversial conventional treatments are for prostate cancer? There are studies in the medical literature which contradict the current use of testosterone inhibiting drugs to lower your PSA level. It has been shown that testosterone actively INHIBITS cancer growth and that elevated PSA is actually a man’s defensive strategy for fighting prostate cancer. So then, why does the medical establishment advocate the exact opposite approach?
DENTAL FILLINGS & MERCURY
Did you know that the main component of silver fillings is mercury and that mercury is one of the most deadly substances on earth if ingested? Did you know that your dentist is not required to tell you that your filling contains mercury? Did you know that several European countries have band silver-mercury amalgam feelings for decades but they continue to be used in the United States? The toxic nature of amalgam feelings has been down-played by the American Dental Association for a century in spite of warnings to dentists to “never touch the amalgam with your fingers” and “it must be disposed of under strict toxic waste protocols.” Dentists who have been outspoken against amalgam fillings have lost their licenses to practice. Outsmart Your Cancer references a book written by one such dentist who describes the alleviation of multiple sclerosis and Parkinson symptoms as well as cancer via the removal of amalgam feelings. Once again, get the facts.
There is SO MUCH more in Outsmart Your Cancer. The rest is up to you!!
For those of you who haven’t been in to see us recently, we have been using a demo class IV laser device from Litecure since the beginning of June and have been getting some amazing results. We were so impressed with the results that we “bit the bullet” and purchased our own laser. A very worthwhile investment for OrthoWell and for the health of all of our patients.
I have added a page on our website that provides a comprehensive explanation and videos of the benefits and effects that a class IV deep tissue therapy device provides. In a nutshell, the laser uses photon energy to stimulate chemical reactions at the cellular level. Research has demonstrated an increase in metabolism, a decrease in inflammation, a decrease in pain, and an acceleration of healing at the treatment site. In other words, the application of laser in combination with our manual therapy and exercise techniques is getting our patient better even FASTER! It has also been extremely beneficial to conditions that have NOT been responsive to our traditional physical therapy interventions.
If you are interested in trying laser or if you feel that your symptoms have plateaued, then laser may be the answer that you are looking for.
We want you to experience the benefits of deep tissue laser therapy so we are announcing a special offer. Call us now to schedule a FREE laser treatment. We will introduce you to laser therapy and provide a laser treatment FREE of charge. Let us know what works for you!
Patellar Tendonitis, or runners knee, is a common over-use injury that causes pain and stiffness in the front of the knee. Chronic pain can lead to physiologic changes in the structure of the patellar tendon. This new study from JOSPTshows increased micro-circulation of the patellar tendon after prescribed eccentric exercises. Eccentric exercises are lengthening contractions such as slowly lowering during a squat or slowly bending your knee from a fully straightened position. Eccentric exercise can more readily bring nutrition to the tendon and create a healing environment that will reduce pain and stiffness. This approach is very similar to the eccentric protocol that we use to treat achilles tendonitis. The key is in the exercise prescription-so give us a call!
It may sound like a strange question but “do you breathe properly?” Breathing pattern disorders (BPD) are surprisingly common in the general population. They remain commonly under-recognized by health care professionals and can contribute to pain, fatigue, and dysfunctions in the lumbopelvic region i.e. your CORE!
Core activation remains a hot topic in physical therapy. The problem is that there is not a universally accepted strategy to achieve optimal stability. A decade ago, we started using the “abdominal hallowing” technique which I have talked about before. The abdominal hallowing was an attempt to isolate a key core muscle called the transversus abdominis in which you would “pull your navel in and hallow out your abdoman”. The original work done by Hodges and colleagues on the transversus abdominis also demonstrated simultaneous activation of the diaphragm muscle. The diaphragm, however, took a back seat and has often been ignored during core training. So how do we correct your BPD and “wake up” your diaphragm?
Your diaphragm is attached to your lower ribcage, thoracic wall, and lumbar vertebrae. When you breathe, the diaphragm contracts and pushes DOWN into the abdominal cavity. This movement causes a pressure change which draws air into the lungs. As a result of the contraction, intra-abdominal pressure increases and lumbar spine stiffness, hence stability, also increases. The diaphragm acts in coordination with the abdominal muscles, spinal muscles, and pelvic floor to create lumbar stability in all directions. This is what some refer to as “360 degree of stiffness.” The contraction of the diaphragm creates core stability from the inside-out. When you perform an abdominal hallowing or abdominal bracing you create stability from the outside-in. Professor Kolar and colleages performed two MRI studies of the diaphragm and showed that the diaphragm can perform dual functions of inspiration and stabilization simultaneously! The activation of the diaphragm was shown to vary greatly among individuals. This variability may be the reason why one person can resolve low back pain and another cannot.
Lets take a look at HOW you can activate your diaphragm while breathing and HOW you can enhance the benefit of your core stability exercises. Check out the video below.
First of all, I would like to apologize to everyone who is reading this article. I apologize for the fact that you have pain, whether chronic or acute, that may be as a result of unfortunate circumstances or the result of an inadequate health care system. Pain is very misunderstood even in the medical community. Chronic pain sufferers can be stigmatized because of this lack of understanding. Currently, one in four Americans have chronic pain. That’s 75 million people! I want to reassure you that there is an answer. There is a physiological reason WHY you have pain. I want to convince you that the pain you feel may not be coming from where you think and feel it is. You WILL get better. Let me explain your pain!
Anatomically, we are essentially all the same. Each of us has approximately 206 bones, 640 muscles, and 400 nerves in our bodies. Our spine consists of 24 vertebra which are attached via ligaments and muscles to our head at the top and to our sacrum and pelvis at the bottom. Each vertebra is separated from the next via our discs. At each vertebral level, there is a spinal nerve that exits a small hole called a foramen. This nerve is the connection between your spinal cord and the rest of your body. Each spinal nerve sends branches to specific locations in your body. They connect the muscles adjacent to your spine to the small nerves at the ends of your fingers and toes. Think about your spine as the tree and the nerves as all of the branches.
Your nerves respond to any and all types of stimulation such as touch, temperature, pressure, pain and relay a message thru the spinal nerve to your spinal cord and then up to your brain. Impulses and/or commands from your brain are then transmitted back down the spinal cord to the spinal nerve and out to the targeted area. This communication system is active ALL the time. Our brain determines whether we are consciously aware of it or not. For example, if you are running from a lion attack and step on a tack do you think your brain will tell you “Ouch! Stop. You stepped on a tack?” Hopefully not or else “Dinner is Served!” So what happens if something goes wrong with this system? What happens if this system becomes over-sensitive?
As mentioned above, we have 400 nerves in our bodies. That amounts to 45 MILES of nerves! So how does a nerve “talk” to the brain? At rest, a nerve is always “listening”. Every nerve has a certain threshold that, once surpassed, will generate an electrical signal (called an action potential) that will be sent thru the spinal nerve to the spinal cord and up to the brain. If the threshold isn’t reached, then the nerve just continues to “listen”. For example, how long does it take for you to shift your weight while sitting in the movie theater? The threshold of your “buttock nerves” has been surpassed when your brain tells you to shift your weight. This threshold is different for everyone. In the diagram below, you can see that that the resting state of the nerve is at a certain level while it is “listening”. After the action potential occurs, the nerve returns to its previous resting state. However, in certain circumstances, the nerve does NOT return to the previous resting state and the nerve remains in a heightened state. It is essentially MORE sensitive, or hypersensitive, and will fire an impulse much more easily.
After an injury, 1 in 4 people experience this heightened nerve state. Why? The answer has a lot to do with the individual’s response to stress. For example, people that get injured in a stressful environment such as a car accident, playing competitive sports, or a stressful job are 7-8x more likely to develop a chronic pain syndrome. In addition, emotional responses to the injury such as worry, fear, and anxiety perpetuates this stress cycle. To use the lion example above, this fear is like an ongoing emotional lion attack to the nerves of a chronic pain sufferer. The Kendall study found that the biggest predictor of developing chronic pain is FEAR! Fear that your pain will not go away. Fear that your life will never return to normal. All of these responses have one thing in common physiologically, they release both inflammatory chemicals and several stress hormones including one that I am sure you have heard of called ADRENALINE.
Throughout the length of our nerves, there are channels or pores that open or close in response to physical or chemical stimulation. They are called ion channels. The amount and type of ion channels are based on our genetic coding as well as what our brain THINKS we need to survive. Ion channels live for only 48 hours so the amount and type is always changing. When the channel is closed the nerve is “listening”. When it is open the nerve is “reacting”. During cold weather we produce more temperature sensitive channels. During times of stress or fear we produce more adrenaline sensitive channels. The more that we focus on the pain, the more that our brains perceive a threat and continue to send inflammatory chemicals and adrenaline into the area. This response is like a constant “knock on the door” of the ion channels. Regular ion channels stay open for milliseconds. Certain adrenaline channels can stay open for up to 5 minutes! As a result, the nervous system up-regulates and becomes much more sensitive. Can you see the physiological link now between your emotions and your nerves? The initial trauma or injury caused your pain, but it is your BRAIN that perpetuates the pain.
Logically, your next question would be “Is that what’s wrong with me” and “How do we know this?” The explanations are based on what we know about nerve science. We know that you have a pain syndrome based on your physical examination and what you have told us about your pain.
Your next question may be “Why did this happen to ME?” As I mentioned earlier, 1 in 4 people after a traumatic event develop chronic pain. The greatest predictor of chronic pain is uncontrolled acute pain from the injury. Medications, icing, rest, bracing are important strategies in the beginning. Our brain determines our pain tolerance and everyone is different in this regard. Having high levels of stress chemicals in our system not only perpetuates the pain cycle, it also leads to chronic fatigue, depression, mood swings, and sleep disorders to name a few.
So then, “What can we do to treat it?” Our objective is to determine what we can physically as well as mentally do to control your pain. The more that you understand your pain, the more control you have over your brain. Studies have been done that demonstrate a significant reduction in perceived pain just by understanding the physiological process. So re-read this article several times until you REALLY get it. Doing this means you are already moving in the right direction! Choosing the right medications is an important part of the healing process as well. Non-steroidal anti-inflammatories (NSAID’s) such as ibuprofen and Aleve may help. Medications such as Cymbalta, Lyrica, and Neurontin(Gabapentin) function by plugging the openings in your ion channels. Narcotics such as morphine can actually make nerve pain worse! As a side note, your brain can produce pain relieving chemicals that are 50x more powerful than any drug that your doctor can prescribe.
So how do we turn on our brains? As I mentioned earlier, education is the key. The more you know, the more you control. Secondly, choose your foods wisely. Tryptophan is an amino acid that cannot be produced by our bodies. It is a powerful precursor to the “happy” hormone our bodies produce called serotonin. High levels of serotonin can also aid in plugging holes in ion channels. Serotonin is also a precursor to melatonin which plays an important role in mood and sleep disorders. Foods with high levels of tryptophan are turkey, bananas, soy products, tofu, almonds, sesame seeds and walnuts. Lastly, the right type of physical activity is key to controlling your pain and normalizing your nervous system. “Move it or lose it!” certainly applies in this case. There is Gold Level evidence in the literature that aerobic activity performed daily for 10 minutes at 50% max effort can reduce chronic pain. Aerobic exercise cleanses our system of inflammatory chemicals and stress hormones. The most important things that our nerves need to heal are proper movement, adequate space to move, and lots of blood! Our nerves constitute 2-3% of our body weight and use 25% of our blood. The circulation to a nerve will be cut off if the nerve is stretched more than 7-8%. It is very important to determine what kind of movement and/or irritability is occurring in the nervous system. We call this nerve movement “neural dynamics”. Stretching a nerve is NOT something that you want to do. A qualified physical therapist will perform a thorough assessment of your neural dynamics and establish an appropriate plan of care to restore proper and painfree nerve mobility. Manual techniques such as soft tissue and joint mobilizations, Primal Reflex Release Techniques and spinal manual traction can also be beneficial. Hands-on techniques can help to retrain your brain and to desensitize the system. Proper diaphragmatic breathing is also key. If you don’t get enough oxygen, how will you feed your healing nerves?
Once again, I apologize to everyone who has read this article. I know that having pain every day must be very difficult and challenging. I want you to know that there is HOPE. Reading my article is only the beginning. Please let me know if we can help you further.
Yes. We treat a lot of plantar fasciitis. There is a lot of foot pain out there. While performing a literature review of heel pain in 2005 (follow this link to READ MORE), I made reference to several articles about the prevalence of heel pain. One United States study estimated that one million patient visits each year are for the diagnosis and treatment of plantar heel pain. This disorder appears in the sedentary and geriatric population, it makes up one quarter of all foot injuries in runners, and is the reason for 8% of all injuries to people participating in sports. As many of you know, all that we do regarding foot orthotic fabrication and physical therapy is with good, evidence-based reason. I fabricate custom foot orthotics based on sound biomechanical principles and evidence-based research. Patients are always asking me “so how will foot orthotics help my plantar fasciitis?” Here is the answer! I have included both a clinical description as well as a more basic description in the video. This will allow you to refer your doctor and/or PT as well as a relative who may ask WHY or HOW we made your foot orthotics. I have included references for several articles that have had a profound influence on my treatment and fabrication philosophy regarding plantar fasciitis. I would like to share my insights with you.
It has been my experience that positive results can be achieved much more quickly for cases of plantar fasciitis using the combination of softer materials to cushion the foot in combination with stiffer, denser materials to redistribute pressures on the foot. My direct molding techniques produce a total contact orthotic which reduces weight bearing pressure on both the heel and forefoot. These findings for total contact orthoses have been confirmed by both Mueller et al10,11 and Ki et al12. As you can see from my samples on the video, I utilize softer materials as a top layer with the addition of a heel pad on the bottom. I reinforce the arch in order to redistribute pressures up against the talonavicular joint (or midfoot). I utilize a forefoot valgus post (higher on the outside of the forefoot) with a slight reverse Morton extension (ledge under toes 2-5) in order to plantar flex the first ray (big toe lower than the other four toes) and unload both the fascia and 1st MTP joint (big toe joint) As I tell my patients, the foot orthotic is only as good as the shoe you put around it. Our best results with the over-pronating foot are achieved via the combination of motion control shoes and custom orthoses.
In regards to prefabricated orthotics such as ALine, it is one-shape-fits-all and only utilizes rearfoot posting “to help align the leg from foot to hip” per the website. The concept of rearfoot posting for biomechanical control is a much debated topic in the literature. Forefoot modifications are not an option. It is also a very rigid material against a painful heel. It has been my experience that prefabs such as ALine or Powerstep are a good option for the younger, athletic patient.
Don’t forget, our custom foot orthotics range in price from $120 to $165. I direct mold, fabricate, educate and issue in one hour! All adjustments included. Our WalkWell guarantee since 1997!!
Research findings continued……
Research done by Kogler1,2,3 et al has been instrumental in determining the appropriate type of rearfoot and/or forefoot posting for foot orthotics for plantar fasciitis. Kogler showed that rearfoot posting had little effect on plantar fascia strain, forefoot varus posting increased the stress, and forefoot valgus posting actually decreased the strain. Kogler concluded that foot orthotics which raised the talonavicular joint and prevented dorsiflexion of the first ray were most effective in reducing the strain on the central band of the plantar fascia. I recently made orthotics for a patient who said her doctor issued bilateral heel lifts “to take the stress off of the fascia”. Kogler actually showed no change in plantar fascia strain using heel lifts. However, heel lifts have been shown by Trepman et al4 in 2000 to decrease the compressive forces in the tarsal tunnel. Benno Nigg5, a researcher in Canada, has also published over 200 articles on biomechanics. He has stated that based on his results, custom foot orthotics, on average, control only 2-3 degrees of motion. This would be his kinematic results, however, he has done a lot of enlightening research on the kinetic effects of foot orthotics. A little bedtime reading for you!
Paul Scherer6,7,DPM has published several articles on the effects of custom orthotics on the 1st MTP joint. The concept of maintaining the first ray in a plantar flexed position unloads both the 1st MTP joint as well as the plantar fascia. Howard Dananberg8,DPM has also written several articles on this topic. Doug Richie9,DPM has been a great resource for the evidence behind the treatment of plantar fasciitis as well as posterior tibialis dysfunction. You may have heard of the Richie brace. Dr Richie states that the “most effective foot orthotic for plantar fasciitis is one that hugs against the navicular and flares away from (or plantar flexes) the first ray.”
1.Kogler, G. F.; Solomonidis, S. E.; and Paul, J. P.: Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clin. Biomech., 11: 243-252, 1996.
2.Kogler GF, Veer FB, Solomonidis SE, et al. The influence of medial and lateral placement of wedges on loading the plantar aponeurosis, An in vitro study. J Bone and Joint Surg Am. 81:1403-1413, 1999
3.Kogler GF, Veer FB, Verhulst SJ, Solomonidis SE, Paul JP.
The effect of heel elevation on strain within the plantar aponeurosis: in vitro study.
Foot Ankle Int. 2001 May;22(5):433-9.
4.Trepman E, Kadel NJ: Effect of foot and ankle position on tarsal tunnel compartment pressure. Foot Ankle Int 20(11):721, 2000
5.Nigg, B. Biomechanics of Sport Shoes. 2011
6.Scherer PR, Sanders J, Eldredge, DE, et al. Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait. J Am Podiatr Med Assoc 2006;96(6):474-481.
7.Scherer,P. Recent Advances in Orthotic Therapy. 2011
8.Dananberg HJ. Functional hallux limitus and its relationship to gait efficiency. J Am Podiatr Med Assoc. 1986; 76(11):648-52
9.Richie,D. Offloading the plantar fascia: What you should know. Podiatry Today, Vol 18. Issue 11, Nov 2005.
10.Mueller MJ, Hastings M, Commean PK, et al. Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy. J Biomech 2003;36(7):1009-1017.
11.Mueller MJ, Lott DJ, Hastings MK, et al. Efficacy and mechanism of orthotic devices to unload metatarsal heads in people with diabetes and a history of plantar ulcers. Phys Ther 2006;86(6):833-842.
12.Ki SW, Leung AK, Li AN. Comparison of plantar pressure distribution patterns between foot orthoses provided by the CAD-CAM and foam impression methods. Prosthet Orthot Int 2008;32(3):356-362.