Suffering from Foot and Ankle Pain? By Ayelet Connell, PhD, PT, IMT,C
re you an athlete with foot and ankle pain? Or an elderly person with balance issues? Or suffering from bunions or fallen arches? Surprisingly, there are some common denom- inators found in the body that connect all of you. Though the feet are the part of our body that connect with the ground, they can strongly be affected by our low back. The alignment of our low back affects the posture of our feet and ankles. By addressing the low back with treatment as well as the feet and ankles directly, we can make great strides in reducing pain, improving foot posture, and improving overall function, strength and balance.
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There are a variety of approaches that can support improved foot and ankle health. One of these approaches is a combined ap- proach of Integrative Manual Therapy and shoe orthotic interven- tion (shoe inserts). Though the feet and low back are not directly neighboring, it is helpful to understand that they are strongly related. Whereas the forces from the ground enter through our feet as we walk or run, these forces are then transcribed and dispersed up the legs and low back. This process is essential to being able to function through life with any kind of movement. Having mobil- ity in the feet as well as the low back allows us to move through life without pain. When the alignment or biomechanics of the low back is affected, this affects the alignment of our feet and ankles and causes us to ‘break down’. Correcting the biomechanics at these sites in the body typically will help to reduce pain, improve function and strength, and improve overall movement in the whole body.
Manual Therapy Integrative Manual Therapy (IMT) is a gentle type of treatment that can identify underlying reasons for pain. An IMT practitio- ner looks at the ability of the joints to move, for example, the low back and pelvis. They also assess the alignment of the joints. Gentle techniques are used to improve mobility and alignment. IMT Therapists assess the tension of the fascia in the low back and pelvis to determine areas of compression. Assessment goes beyond the joints and includes soft tissue to fi nd possible underlying contributors to pain. IMT is benefi cial in creating a more neutral alignment in the low back and pelvis, to support reduction and elimination of pain.
Upward movement of the foot and ankle is critical for proper alignment of the foot, leg and low back. This upward movement is
22 Natural Nutmeg - April 2017
called ‘dorsifl exion’. Stretching of the calf muscle will correct mild problems, but often, this does not correct more severe limitations. Biomechanical correction of the ankles by a skilled therapist that practices manual therapy will lead to an outcome that can then be maintained by stretching. IMT is a very effective way to improve alignment and soft tissue dysfunction of the ankles, knees, hips, and low back joints. Combining IMT with custom orthotics can help to create and maintain these positive changes.
Shoe Orthotics There are many different brands of shoe orthotics or shoe inserts. Some are soft to attempt to relieve foot pain or pressure on the bottom of the foot. These are often used with people that have medical conditions such as arthritis or diabetes. More rigid foot orthotics are also available. These were developed to control the posture of the foot during walking, specifi cally when the foot hits the ground. Many people are aware that their foot position is im- portant when running. They ‘pronate’ which means that their foot arch collapses and the foot rolls inward, contributing to conditions like foot pain, shin splints, and reduced performance.
Biomechanics of the low back, or healthy alignment of the
low back joints, serves as the foundation to the house that is our body. This is like the alignment of a car. If the car alignment is ‘off’, the tires will wear down incorrectly. If your low back, hip, knee, ankle or foot alignment is ‘off’, you may develop ‘wear patterns’ in other joints. Commonly, when the mechanics of the pelvis and legs are faulty, the leg usually rolls inwards during impact with the ground. That rolling inwards of the leg causes our foot to fl atten and over-pronate.
The position of the foot in such sports as skating or skiing
is also very important. When people have foot or ankle pain or other symptoms such as swelling, and they seek therapy for these symptoms, the therapist must evaluate the whole person. Forces from the ground must be normalized through good joint alignment therapy techniques or the stresses of this joint dysfunction can cause pain.
Custom orthotics are precisely measured to each person’s
foot. A rigid orthotic helps to change the forces traveling from the ground as they contact the foot. Sole Supports, a brand of custom rigid orthotics, offers a unique quality to orthotic intervention.
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