One out of 10 people in the United States experience persistent pain along the bottom of the foot, a condition known as plantar fasciitis. In this country alone, outpatient clinics receive more than 1 million visits a year from people seeking help for this type of foot pain. In 2014, the Orthopedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition. In a more recent study published in the February 2017 issue of JOSPT, researchers reviewed the records of people with plantar fasciitis who were sent to physical therapy to determine whether this treatment lessened their pain.
The researchers studied a database of 819 963 patients diagnosed with plantar fasciitis. Only 7.1% of these patients were prescribed physical
therapy. Overall, patients sent to physical therapy received evidence-based treatment. These patients were given manual therapy 87% of the time and supervised rehabilitative exercises 90% of the time. The researchers found that patients who received manual therapy as part of their treatment averaged fewer visits and had a lower cost of care of $340. These results support prior studies that show faster
recovery time for those who receive evidence-based physical therapy for their foot pain. This study shows that despite strong evidence on the
benefits of physical therapy for plantar fasciitis, very few patients were given this treatment. If you have foot pain, evidence suggests that physical therapy will help you recover faster and cost you less than if you do not receive this treatment. This study also indicates that physical therapists are quickly adopting the recommendations in the updated clinical practice guidelines on plantar fasciitis. Therapists’ use of
manual therapy increased from 78% in 2007 to 94% by 2011, while their use of supervised rehabilitative exercises increased from 85% to 91% during this same period. If you have been diagnosed with plantar fasciitis, physical therapy offers evidence-based treatment options to help you recover from your pain.
EXERCISES AND MANUAL THERAPY TO LESSEN FOOT PAIN. Your physical therapist may offer a combination of manual therapy and exercises, which have been shown to reduce your pain. These treatment options include calf stretches (A), foot stretches (B), and hands-on therapy (C). For calf stretches, while standing with your foot straight ahead, lean forward and keep your heel on the floor until you feel a stretch sensation in your calf. Perform this stretch first with the back leg straight and then repeat it with the back knee bent. For foot stretches, while seated, grab the base of your toes and pull them toward your shin. Your physical therapist can add manual therapy to your treatment, such as the ankle mobilization shown here.
Do you have heel pain? Is the heel pain worse first thing in the morning or after sitting for a while? Research has supported the use of certain stretches to the foot and calf muscles, foot taping, night splints, use of foot orthoses, and hands-on manual therapy (by a licensed physical therapists) to decrease heel pain. In addition, application of cold packs and correction of certain hip/knee muscle imbalances and/or joint stiffness may help alleviate heel pain. Consult with your doctor to see if physical therapy would help alleviate heel pain and make walking more tolerable.–Dr. Alex Kranz
Foot pain discourages physical activity, and less activity harms overall health. Bunion, extra bone and tissue at the base of the big toe, is a frequent cause of foot pain. More than 64 million Americans have bunions that can lead to painful walking. Bunions affect some 35% of
women over the age of 65. Bunions can be removed by surgery, which can reduce pain and improve your ability to walk and exercise,
but up to 15% of bunions return. Weak muscles may play a role in bunion-related pain and movement problems. In a review
of prior research and commentary on this topic published in the July 2016 issue of JOSPT, the author identifies muscle-strengthening exercises that may help people with bunions.
The author of the review and commentary identified 3 key muscles in the foot and 2 muscles in the calf that, when strengthened, have the potential to lessen the pain and improve the movement of patients with bunions. These 5 muscles help support body weight and forward motion. They also stiffen the arch of the foot and help keep it from rolling inward, better supporting the big toe. The author found that
people can effectively reinforce these muscles using 3 simple exercises. The exercises—short foot, toe spread out, and heel raise—are easy to do at home and can strengthen these key foot muscles. Stronger feet may help decrease bunion-related pain and its impact on movement.
After your physical therapist evaluates your feet and how you walk, the therapist may prescribe these 3 exercises, additional hip- and leg-strengthening exercises, and possibly arch supports. The exercises to strengthen your feet are easy to perform. If you have
trouble with them, though, your physical therapist may add electrical stimulation to help you learn which muscles to contract. Your physical therapist can also guide you on proper shoe selection to improve your ability to walk and exercise without discomfort. While they may decrease pain and improve movement, these exercises likely won’t change the look of your bunion. More research is needed to determine whether these exercises can help you avoid surgery. For more information on nonsurgical options for treating bunions, contact your physical therapist specializing in orthopedic and sports-related injuries
JOSPT bunion (3)
EXERCISES TO STRENGTHEN FOOT MUSCLES. (A) Short-foot exercise: shorten your foot while keeping your heel and the front of your foot on the ground. Do not curl your toes. (B) Toe-spread-out exercise: lift and spread your toes while keeping your heel and the front of your foot on the ground. While your toes are spread out, push your little toe down and out to the floor. Then, push your big toe down toward the inside of the foot. (C) Heel-raise exercise: stand with your knees bent. Elevate your arch while keeping your heel turned in. Then, raise your heel off the floor while keeping pressure on your big toe. Perform all exercises barefoot. Hold each repetition for 5 seconds. Repeat each exercise until you feel the muscles becoming tired. Exercises are progressed from sitting, to standing on both feet, to performing the exercises
standing on just 1 leg. Perform exercises daily.
Bunions can be a nagging and lingering source of inner foot/toe pain during gait/walking. Certain medical treatments and foot exercises have been shown to decrease these painful symptoms. Should you need surgery to correct the bunion deformity, physical therapy (including manual therapy and therapeutic exercises) can be helpful to improve range of motion, strength, balance, and walking ability following surgery. Consult with your doctor if physical therapy would be appropriate for you.–Dr. Alex Kranz
JOSPT 2015 running
Running is often perceived as a good option for “getting into shape,” with little thought given to the form, or mechanics, of running. Most people assume that running is something natural that we simply know how to do. However, as many as 79% of all runners will sustain a running-related injury during any given year. If you are a runner—casual or serious—you should be aware that poor running mechanics may contribute to these injuries. A study published in the August 2015 issue of JOSPT reviewed the existing research to determine whether running mechanics could be improved, specifically with the help of real-time visual or audio feedback. The ability to improve running form could be important in treating running-related injuries and helping injured runners return to pain-free running. NEW INSIGHTS Researchers reviewed 974 published studies and identified 10 high- and medium-quality studies that examined the effectiveness of visual and audio feedback for improving running mechanics. Overall, the evidence supported the use of real-time feedback. Using feedback tools, physical therapists were able to help runners (1) decrease the force with which their feet hit the ground during running, and (2) improve running form at the hips, knees, and ankles. For visual feedback, runners watched themselves run in a mirror or viewed a video of their running while a physical therapist coached them on how to improve their form. Audio feedback consisted of verbal coaching from the physical therapist, or the use of simple tools such as a metronome, to improve running cadence. Research shows that runners can improve their running mechanics using visual and/or audio feedback training while being coached by a physical therapist. As a result of improved running form, runners may reduce their risk of injury. In addition, evaluation and correction of running form may benefit those who have knee or leg pain when running. If you already have a running-related injury or want to reduce your risk of sustaining one in the future, this kind of supervised feedback can help. For more information on improving your running form, as well as other strategies to reduce your risk of injury during running, contact your physical therapist specializing in orthopedic and sports-related injuries.
BENEFITS OF VISUAL AND AUDIO FEEDBACK. Evidence supports the use of real-time visual and audio feedback to improve running form. (A) The runner on the treadmill exhibits poor running form. (B) Visual feedback on the screen and audio cues from the physical therapist are used to provide the runner with the necessary feedback to improve her running mechanics.
Do you have pain or a lingering muscle or joint issue when you run? Would you like to run more efficiently? There is new evidence showing supervised feedback from physical therapists allow people to run with better mechanics and efficiency. Sometimes the issue can be fixed with correction of a weak muscle group, muscle imbalance, or muscle/joint tightness. With the warmer weather of Summer upon us, if you are having a lingering muscle or joint issue impairing your ability to run efficiently, ask your doctor if physical therapy would be appropriate.–Dr. Alex Kranz