Here is some of the information I recently shared in the October newsletter. Each newsletter has a specific focus.  This newsletter is focused on foot pain and plantar fasciitis. If you would be interested in receiving my newsletters, which include links to the studies as well as special offers and sales coupons, please head over to my contact page and sign up.

TABLE OF CONTENTS

  1. Comparing toe separators and insoles in hallux valgus treatment
  2. Effect of Local Percutaneous radiofrequency for chronic plantar fasciitis
  3. Comparing stretching exercise and high-load strengtheing exercise
  4. Acute Kinetic and Kinematic differences between minimalist sandal, shod and barefoot running
  5. Comparing intralesional platelet rich plasma injection and extracorporeal shockwave therapy
  6. Functional evaluation and pain symptomatology or foot and ankle in severely obese
  7. Comparing splinting, exercise, and electrotherapy in hallux valgus
  8. Comparing phonophoresis and myofascial release in plantar fasciitis
  9. Comparing plantar fascia stretch and moist heat heel pad

The impact of anti-cancer treatment on feet

The Foot Tripod

STUDIES and ARTICLES

1. A study titled Comparison between the plantar pressure effects of toe separators and insoles in patients with hallux valgus at a one-month follow-up, published in Foot and Ankle Surgery Feb 2021, looked at the difference between prefabricated toe separators or customized insole. The study concluded: After one month of use, the customized insole was more effective in plantar pressure reduction than the toe separator for a hallux deformity.

2.  An article, titled Local Percutaneous Radiofrequency for Chronic Plantar Fasciitis, published in Arthroscopy Techniques in May 2021, compared the use of bipolar radio frequency treatment with open surgery and concludes: Bipolar radiofrequency appears to be a safe procedure for refractory plantar fasciitis that can provide outcomes equivalent to open plantar fascia release with less morbidity.

3. A study titled Physiotherapy Approach to Patients with Chronic Plantar Fasciitis: Comparison of the Effects of Specific Stretching Exercise and High-Load Strengthening Exercise, published in Journal of the Korean Society of Integrative Medicine in Sept 2021 compared Extracorporeal shock wave therapy combined with daily plantar-specific stretching with extracorporeal shock wave therapy and high-load progressive strength exercise every other day. The study concludes: the high-load strengthening exercise consisting of the progressive exercise protocol resulted in superior results after 12 weeks compared with plantar-specific stretching.

4. A small study, performed as a part of a Master’s Thesis at Stellenbosch University, titled Acute Kinetic and Kinematic Differences between Minimalist Sandal, Shod, and Barefoot Running in Habitually Shod Male Recreational Trail Runners, concludes: minimalist running simulates barefoot running. Vertical load rates may be higher in a barefoot and minimalist sandal condition during the initial transition period because of a lack of kinematic changes at the knee.

5. A study titled A comparative study between intralesional platelet rich plasma injection and extracorporeal shockwave therapy for the treatment of plantar fasciitis, published in Journal of Arthroscopy and Joint Surgery in Sept 2021, concludes:Both autologous Platelet Rich  Plasma and extracorporeal shock wave therapy can become extremely useful modalities for management of recalcitrant cases of plantar fasciitis with no known adverse effects.

6. A study, titled Functional evaluation and pain symptomatology of the foot and ankle in individuals with severe obesity—controlled transversal study, published in Rev Bras Ortop (Sao Paulo) in Apr 2021, concludes: the incidence of foot pain was higher in the group of severely obese patients (BMI >40) compared with the control group. According to the American Orthopedic Foot and Ankle Society scale, functional forefoot, mid foot, and hind foot performance was worse in severely obese individuals.

7. A study titled A comparison of the effectiveness of splinting, exercise, and electrotherapy in women patients with hallux valgus: A randomized clinical trial, published in The Foot in Sept 2021, concludes:
    Conservative treatment methods improve foot function in patients with mild to moderate Hallux Valgus
    Splinting was more effective than exercise and electrotherapy in the management of Hallux Valgus.
    A combination of splinting, exercise and electrotherapy may be more beneficial to improve Hallux Valgus symptoms.

8. A study titled Effect of phonophoresis and myofascial release in plantar fasciitis, published in Journal of Clinical Orthopaedics in 2021 concludes: phonophoresis was found to be more helpful than myofacial release in lowering pain and improving functional status.

9.  A study titled A comparative study to analyze the effect of plantar fascia stretch and heel pad with moist heat in the patients of plantar fasciitis, published in Global Journal of Medical and Clinical Short Communications in Aug 2021, concludes: plantar fascia stretch has more significant effect on plantar fasciitis than heel pad with moist heat.

TIDBITS, UPDATES, and RESOURCES

REFERENCE

  1. An article, found at iocp.org.uk, titled The Impact of Anti-cancer treatment on feet by Afni Shah-Hamilton in spring 2021, is a great reference on the effects of chemotherapy on the feet and how those challenges may be treated.                                                     
  2. A great facebook post, by Michael Mcaleese, titled The Foot Tripod shows the importance of standing on the whole foot, not just the heel or toes.

Here is some of the information I recently shared in the April newsletter. Each newsletter has a specific focus.  This newsletter is focused on foot and ankle pain and plantar fasciitis. If you would be interested in receiving my newsletters, which include links to the studies as well as special offers and sales coupons, please head over to my contact page and sign up.

TABLE OF CONTENTS

  1. Increasing ankle dorsiflexion range of motion
  2. Comparing Active release and Positional release for Gastrosoleus trigger point release
  3. Correlation between Gastrocnemius tightness and heel pain
  4. Effect of upward toe springs on walking biomechanics
  5. Comparing Botulinum Toxin A, Corticosteroid, and anesthetic injection for plantar fasciitis
  6. Effect of foam roller on pain and ankle range of motion
  7. Comparing adjuvant low-dye kinesio taping, sham taping, or extracorporeal shockwave therapy
  8. Comparing muscle energy technique versus ischemic compression on pain and disability
  9. Effect of myofascial release with lower limb strengthening on plantar fasciitis
  10. Dry needling effectiveness for plantar heel pain
  11.  Exploration of Valgus, Varus, Vargus

STUDIES and ARTICLES

1. An article titled Strategies to increase ankle dorsiflexion range of motion by Drs. Howe, Waldron, North, and Bampouras reviews exercise-based strategies to restore ankle dorsiflexion range of motion.

2.  A study titled Comparison of Active Release Technique and Positional Release Therapy for Gastrosoleus Trigger Point Release in Recreational Runners, published in International Journal of Health Sciences and Research in July 2020, concludes: Positional Release Therapy is a better intervention for the release of trigger points as it shows a greater increase in ankle dorsiflexion range of motion and a significant reduction in pain.

3. A study titled Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis, published in Foot & Ankle International in Sept 2020 concludes: a strong, statistically significant correlation between gastrocnemius tightness and the severity of heel pain in plantar fasciitis.

4. An intriguing study titled Effect of the upward curvature of toe springs on walking biomechanics in humans, published in Scientific Reports in Sept 2020 found: although most features of modern footwear have been intensively studied, there has been almost no research on the effects of toe springs. This nearly ubiquitous upward curvature of the sole at the front of the shoe elevates the toe box dorsally above the ground and thereby holds the toes in a constantly dorsiflexed  position. While it is generally recognized that toe springs facilitate the forefoot’s ability to roll forward at the end of stance, toe springs may also have some effect on natural foot function. Our results help explain why toe springs have been a pervading feature in shoes for centuries but also suggest that toe springs may contribute to weakening of the foot muscles and possibly to increased susceptibility to common pathological conditions such as plantar fasciitis. 

5. A study titled Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis, published in Foot & Ankle International, concluded: no significant differences between treatment groups were observed. The pain relief and functional improvement obtained with the different treatments was maintained during the 6-month follow-up.

6. A study. titled Immediate effect of foam roller on pain and ankle range of motion in patients with plantar fasciitis: A randomized controlled trial, published in Hong Kong Physiotherapy Journal in Oct 2020, concluded: both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in pressure pain thresholds at gastrocnemius and soleus.

7. A study titled Effects of Adjuvant Low-dye kinesio taping, adjuvant sham taping, or extracorporeal shockwave therapy alone in plantar fasciitis: a randomized double-blind controlled trial, published in Europe PMC in Nov 2020, concludes: Low-dye KT, in addition to ESWT is more effective than sham-taping and ESWT in pain relief and foot function improvement at a 4-week follow-up.

8.  A study titled Effect of muscle energy technique versus ischemic compression on pain and disability in patients with plantar fasciitis, published in International Journal of Physiology, Nutrition and Physical Education in 2020 concluded:  both the muscle energy technique and ischemic compression were individually effective in improving the flexibility and strength. While comparing both techniques there is no significant difference present between the groups.

9. A study titled Effect of myofascial release with lower limb strengthening on plantar fasciitis, published in International Journal of Physical Education, Sports and Health in 2021 concludes: myofascial release is significantly effective when given with lower limb strengthening programs for reducing pain and improving the functional status in subjects with plantar fasciitis.

10. A study titled Is Dry Needling effective for the management of plantar heel pain or plantar fasciitis? An updated systematic review and meta-analysis published in Pain Medicine in Mar 2021 concluded: moderate to low evidence suggests a positive effect of TrP dry needling for improving pain intensity and pain-related disability in patients with plantar heel pain of musculoskeletal origin at short- and long-term, respectively.

TIDBITS and RESOURCES

REFERENCE

A great article, by Whitney Lowe, titled Valgus, Varus, Vargus…What is it? in Nov 2015, covers a very understandable definition of these joint dysfunctions and what they can cause.

Here is some of the information I recently shared in my September newsletter. Each newsletter has a specific focus.  This month is focused on foot and ankle problems. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.

TABLE OF CONTENTS

  1. Manual therapy interventions in the treatment of plantar fasciitis--three approaches
  2. Medical Massage vs Secondarily developed plantar fasciitis
  3. The effect of high-intensity laser therapy in the management of painful calcaneal spur
  4. Extracorporeal shockwaves treatment for plantar fasciitis
  5. Effectiveness of customized insoles in patients with Morton's neuroma
  6. Manual therapy interventions in the treatment of plantar fasciitis: 3 approaches
  7. Effects of plantar intrinsic foot muscle strengthening exercise on static and dynamic foot kinematics in pes planus
  8. Outcomes of ultrasound-guided gastrocnemius injection with Botulinum toxin for chronic plantar fasciitis
  9. Can an insole for obese individuals maintain the arch of the foot against repeated hyper loading?
  10. Graston Technique® as a treatment for patients with chronic plantar heel pain

TIDBITS

  1. Athletic Taping for Pes Planus and Plantar fasciitis
  2. Flexor Hallucis Longus anatomy and pathology review
  3. Ballet Foot "En Pointe"
  4. When you stop moving 66 joints in your body
  5. Grandmaster Yang Jun lecture on "bubbling well"

STUDIES and ARTICLES

I receive a weekly update on anything published on the internet that includes information about foot and ankle problems and treatments.  I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to: info@holistichealingarts.net


1. A study titled Manual therapy interventions in the treatment of plantar fasciitis: A comparison of three approaches, published in Health SA in Sept 2019 focused on comparing: 1) manipulation of the foot and ankle plus cross friction massage of the plantar fascia, 2) cross friction massage of the plantar fascia and gastroc-soleus complex stretching, and 3) a combination of both protocols. Conclusion: all three protocols had a positive effect on the ROM and pain perception for patients with plantar fasciitis.

2.  A case study titled Medical Massage vs Secondarily Developed Plantar Fasciitis, published in Journal of Massage Science in their blog by Dr. Ross Turchaninov gives a wonderful example of how plantar fasciitis pain could be attributed to other causes and linger after treatment.

3. A study titled The effect of high-intensity laser therapy in the management of painful calcaneal spur: a double-blind, placebo-controlled study, published in Lasers in Medical Science at SpringerLink in Sept 2019 focused on hight intensity laser therapy plus exercise versus placebo high-intensity laser therapy plus exercise. Conclusion: No superiority of High-intensity Laser Therapy over placebo.

4. A case study analysis titled Extracorporeal shockwaves treatment for plantar fasciitis, published in Eur J Transl Myol in 2019 concludes: The application of ESWT in the insertional site of the plantar fascia alone can heal the local impairment but may not be sufficient to solve the primary cause of plantar fasciitis and may expose the patient to risk of recurrence…the application of shockwaves in the impaired myofascial points of the leg and pelvis aimed at restoring the sliding properties and the equilibrium in the myofascial system of the entire lower limb in order to return the correct function of the plantar fascia without treating the plantar fascia itself which is often found to be inflamed and painful.

5. A study article, titled Effectiveness of customized insoles in patients with Morton’s Neuroma: a randomized, controlled, double-blind clinical trial, published in Clinical Rehabilitation in Sept 2019, concludes: The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton’s neuroma.

6. A study titled Manual therapy interventions in the treatment of plantar fasciitis: a comparison of three approaches, published in Health SA Gesondheid in 2019 compared 1) mobilization and manipulation of the ankle and foot with cross friction of plantar fascia, 2) stretching of gastroc-soleus complex and cross friction of plantar fascia, and 3) combination of both protocols. Conclusion: all three of the approaches utilized have a beneficial effect in patients with plantar fasciitis. The use of manipulation seems to increase plantar flexion, while passive stretching increases ROM and decreases pain.

7. A study titled Effects of plantar intrinsic foot muscle strengthening exercise on static and dynamic foot kinematics: a pilot randomized controlled single-blind trial in individuals with pes planus, published in Gait and Posture In Jan 2020, concluded: For individuals with pes planus, the short-foot exercise effectively corrected static foot alignment and temporal parameters of foot kinematics during gait. Short-foot exercise might effectively prevent or treat injuries related to the pes planus alignment.

8. A study titled Outcomes of Ultrasound-guided gastrocnemius injection with Botulinum toxin for chronic plantar fasciitis, published in Foot and Ankle International in Oct 2019 concludes: the use of Botulinum Toxin A had a positive effect on improvement in pain and foot function 1 year after treatment.

9. A study titled Can an insole for obese individuals maintain the arch of the foot against repeated hyper loading? published in BMC Musculoskeletal Disorders in Oct 2019 concludes: Use of insoles for obese individuals may help to slow time-dependent foot structural changes. However, the effect was not enough to maintain the foot structure against repeated hyper loadings.

10. A study titled Graston Technique® as a treatment for patients with chronic plantar heel pain, published in Clinical Practice in Athletic Training in 2019, concludes: Participants improved in variables measured over a six-week treatment of GT. This was both shown to be not only statistically significant but clinically significant utilizing minimal important difference.

TIDBIT

  1. Short video from ConEd Institute Athletic Taping application for a Plantar Fasciitis or a Pes Planus
  2. A good anatomy and pathology review of the Flexor Hallucis Longus by Whitney Lowe can be found on his Academy of Clinical Massage website.
  3. Ballet Foot "En Pointe" 
  4. Per Michael McAleese: When you stop 66 joints in your body from moving, for example by wearing tight or rigid shoes, you are found to create problems. Joints are made to move—the foot has 33 joints, so get your shoes off and let them move.
  5. Grandmaster Yang Jun shared at his lecture: It is important to understand your whole foot takes weight. If you cannot pick up your toes without shifting your weight and if you cannot pick up your heels without shifting your weight, you are placing your weight into the correct area of your feet. Also notice: when your weight is placed into the bubbling well, you will have a natural and comfortable feeling in your abdomen. Physical balance and ease of breathing go together.” 

 

During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.

Condition: Left ankle sprain                                                                                    ankle-sprain

Why I chose this client/condition?  Ankle sprains are a common injury for any person and this was the only condition that I came across that required some further research.

Summary of client condition:  The client was playing soccer when his left foot planted awkwardly causing his ankle to roll out, injuring the lateral ligaments, specifically the anterior talo-fibular ligament. The injury occurred three weeks prior to his massage. He did have quite a bit of swelling and bruising following the injury, but that had almost completely resolved except for some minimal swelling. The ankle was not painful at the time of the massage. He had been elevating the foot and ankle as well as taking over-the-counter anti-inflammatory medications, was wearing an ankle sleeve and modified his activities since the injury. He mentioned that he has sprained his left ankle a couple of times over the past ten years and it is a bit lax.

My understanding of the condition:  An ankle sprain occurs when at least one ligament surrounding the ankle joint tears or stretches beyond its capacity. This can happen in many different ways, such as walking on uneven surfaces, rolling and twisting the foot while playing sports or landing awkwardly after jumping. Symptoms of ankle sprains include swelling, discomfort/pain, possible bruising and instability. There are different grades of ankle sprains, Grade I (mild), Grade II (moderate) and Grade III (severe). A doctor can determine what Grade sprain it is with a physical exam. The client most likely had a Grade II sprain of his left ankle since he did have some mild laxity. His pain, swelling and brusing had pretty much resolved by the time of the massage. The best treatment for a sprained ankle is to, initially, elevate and ice the ankle and take anti-inflammatory medications. Immobilizing the ankle joint is an option, too, if there is any instability. If the pain, swelling and brusing do not seem to improve after a couple of days, it would be best to see a doctor. The client said that he had done all of this treatment so far, although he did not see a doctor because he was improving.

My treatment plan:  Since my client's left ankle sprain had improved and he was having minimal swelling and tenderness, I decided to do a normal, Swedish massage on the client including the ankle. In regards to his left ankle, I did effleurage over the area to promote blood flow and then did some friction over the anterior talo-fibular ligament, which stimulates healing of the ligament while preventing scar tissue from forming. I also did some very gentle range of motion of the ankle, but avoiding any stretching. Following the massage, I taught the client how to do some friction massage to the area on his own and advised him to try to do this at least a couple of times per day. I suggested that he continue to elevate the ankle if he notices swelling and to wear his ankle sleeve if it feels unstable. I thought it was too soon for him to get back into playing soccer, but told him to wear support over the ankle if he felt ready to get back into exercising. He was also advised to schedule another massage with me in a week or two.

Research article:                                                                                                                                       I found an article titled Ankle Sprains: Principles of Orthopedic Massage and their Application on massagetherapy.com, which was written by Ben Benjamin and was initially published in Massage & Bodywork magazine in the February/March 2004 edition. The article discusses, in detail, how ankle sprains occur and what all happens to the ligaments in these types of injuries. It also goes into detail how bones and ligaments all work together to provide stability as well as movement and how important it is that ligaments not be too lax. The importance of a therapist developing the ability to assess which ligaments are involved with the injury is also an important topic in this article. The author even includes a couple of possible tests that can be helpful with this. He goes on to discuss how scar tissue can occur following ankle sprains and the best way to avoid this from happening is to work on gentle range of motion exercises as soon as it is tolerable. The article ends with a discussion of how deep massage and friction therapy can be very effective in treating ankle sprains. I learned that friction can promote healing of the ligament while it is also helping to keep scar tissue from forming.

www.massagetherapy.com/articles/index.php/article_id/643/Ankle-sprains

Ankle Sprains: Principles of Orthopedic Massage and their Application by Ben Benjamin, originally published in "Massage & Bodywork" magazine, February/March 2004

Expected Outcome:  I expected the client to continue to improve as long as he continued with the treatment he was already doing. His swelling and tenderness should completely resolve and he should be able to get back to doing his regular activities with no restrictions, even playing soccer again.

Actual outcome:  The client did not ever come back for another massage, but I was able to touch base with him to follow up on his condition about two weeks following his massage. He said that his ankle was doing much better and that the friction massage that I showed him really did help. He noted that he continued to have swelling, but that his ankle was pain-free. He was getting back into soccer and, so far, the ankle was doing well. He does wear an ankle sleeve while exercising or playing sports for support.

During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.

Condition: Foot pain after running (not during)                                                      footpain

Why did you choose this client/condition?    I work with this client for strength training and fitness. He has chosen running to help him with fitness and weight loss. I chose this client because I believe it is muscle related and I want to help him achieve his goals.

Briefly summarize the condition for this client--what led to the condition, how long has it existed, has it changed, etc.                                        The condition started after one of the longer runs the client did. The client started experiencing foot pain after being seated for a while and upon standing. The pain generally lasts anywhere from minutes to hours depending on activity level. More activity causes less pain. Pain usually goes away a few minutes after starting cardio exercising.

Discuss your understanding of the condition (causes, symptoms, pathology, treatments, etc.)                                                                                              I believe the condition is related to clients running gait (right foot strikes with the foot extended & pronated) causing more pressure on medial longitudinal arch which is supported by Tibialis anterior, Peroneus longus and Peroneus brevis, that form the anatomic stirrup. It is possible that this is caused from lateral rotators of the right hip including piriformis.

Identify your treatment plan and explain why you chose that treatment plant.                                                                                                                                        My treatment plant for the client involved working on Tibialis anterior and Peroneus longus as well as the Medial longitudinal arch to release the tight muscles. Also the lateral rotators of the right hip.

Find a research article that includes massage for that condition and summarize the information in the article and cite the referenced article.                                                                                                                                        In "Massage Therapy for Tired feet (and Plantar Fasciitis) by Paul Ingerham, Vancouver, Canada (Painscience.com), the author discusses the importance of the arches in the feet and how they function and how running in improper shoes and not stretching enough can cause problems resulting in pain in the feet. He then discusses how to use trigger point in the arch to release the tension.

What was your expected outcome from your treatment plan?                         Two outcomes were expected from the treatment plan:

Actual outcome and new plan                                                                                          There was lessening of pain, but it has not gone away completely since right foot inversion continues, due to continuing presence of cause. The new plan involves attacking the cause of continuing strain that causes right foot eversion and more frequent stretching of muscles after running and foam roller after.

© 2020 Advanced Holistic Healing Arts 
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