Pathomechanical Foot Types –Part 2 of 2

By Chad Yoakam
chad@excelptmt.com

In my last post I introduced the term “pathomechanical foot type”.  I’d like to give an overview of what this means and identify the most common problematic feet.  A pathomechanic foot type is a foot that is put together in such a way that it can cause problems under the right (or wrong) circumstances.  There are five pathomechanical foot types that I most often see in our clinics.   They are as follows (I have included the problematic motion that the particular foot type causes in parenthesis):

  1. Rearfoot varus foot type (over-pronation)
  2. Forefoot varus foot type (over-pronation)
  3. Forefoot valgus foot type (under-pronation)
  4. Plantarflexed and rigid 1st ray (under-pronation)
  5. Forefoot equinus foot type (excessive ankle and mid-tarsal dorsiflexion)

These foot types are all naturally occurring meaning they are not the result of a trauma or anything that one has done wrong.  These terms describe the way a foot is built.    I believe many people go through life without significant problems but, others develop pain and dysfunction when their feet encounter circumstances that cause extra stress.  These circumstances can be internal or external.

Internal circumstances can include level of maturity (age), changes in the level of fitness (strength, endurance, flexibility, body weight, muscular endurance, etc.) and injuries.  External circumstances include chosen work and play activities as well as footwear.

The pathomechanical foot types listed above typically cause too much or too little pronation of the feet and lower extremities.  Pronation is a fancy word for the “rolling-in” motion that our feet need to undergo initially with each step that we take.  Feet that over-pronate roll-in too much and stay rolled-in too long during the stance phases of walking.  Feet that under-pronate (often mistakenly called supination) pronate too little or for too short of a time during each step.   

Over-pronation can lead to the following types of problems: heel pain, arch pain, bunions, hammer toes, shin splints (muscle/tendon pain in the lower legs), stress fractures, abnormal callousing patterns on the feet, anterior knee pain, lateral hip pain and sacro-iliac joint pain (in the low back area). 

Foot types that cause under-pronation can cause chronic ankle sprains, stress fractures, joint pain in the feet/ankles/knees/hips/spine, lateral knee pain, abnormal callousing along the pinky toe and lateral aspect of the feet.

Once correctly diagnosed, these pathomechanical foot types and the associated problems they cause can be effectively treated with exercise, correct foot wear, correctly designed foot orthotics or some combination of the above.  If you are having problems in the areas listed above, you may have a pathomechanical foot type.

Click Here to read Chad’s Blog article: Foot Problems & Orthotics, Part 1

If you are struggling with foot or lower extremity pain, we would be privileged to assist you.  Please contact us at our Bozeman (406-556-0562) or Manhattan (406-284-4262) office to schedule an appointment.  You will be thoroughly evaluated and a comprehensive, individualized treatment plan will be developed to address your problem and help you get your fun back!

Foot Problems & Foot Orthotics -Part 1 of 2

By Chad Yoakam
chad@excelptmt.com

The term “foot orthotics” can be quite confusing considering the wide variety of shoe inserts available today; from your local Wal-Mart “Dr. Scholl’s” aisle to those offered at shoe and sporting goods stores and a number of healthcare providers including physical therapists, podiatrists, orthotists and even chiropractors.  The term “foot orthotic” is used to describe a wide variety of products designed to alleviate foot, ankle, knee, hip, sacro-iliac joint and back problems.   The purpose of this blog is to clear up some of the confusion and help you address pain or problems with these body parts.

A foot orthotic is simply a shoe insert designed to make a change in how your foot functions.   A biomechanical foot orthotic is designed specifically to promote or control motion of the foot to bring motion within normal or more normal ranges with a goal of alleviating tissue stress and pain throughout the lower extremities, hips, pelvis and spine.   Unfortunately, one type of orthotic does not address all of the potential problems that result in pain of the foot and lower extremity.  In practice, I have seen a huge decrease in some types of foot patients over the last 20 years.  I attribute this to the ever increasing number of quality off-the-shelf foot orthotics available at very affordable prices in today’s market.  These include such products as “SuperFeet” and “Sole Supports”.  Many of the simple foot problems that people experience are now easily solvable with patients being able to self-diagnose and self-treat using these types of products in conjunction with the wealth of information available on the internet.

Things get complicated when individuals cannot solve their problem on their own and then seek help from a medical professional.  Many of my patients have tried a variety of different orthotics and/or arch support which have yielded little to no benefit; often at considerable expense.  Frequently I find that the patient has what is called a pathomechanical foot type.  This is a bony foot structure that is prone to causing problems.  Often times this includes structural problems of the forefeet that have not been diagnosed or addressed with the appropriately designed foot orthotic.   In part 2 of this series I will further introduce the idea of pathomechanical foot types and the problems they can cause.  For this post, I will conclude with saying that if you have unresolved foot or lower extremity pain, your feet may need further examination and, perhaps, may need a different type of foot orthotic. 

If you seek help for your foot or lower extremity problems and an orthotic is suggested, I do recommend the following: 

  1. Make sure that your healthcare provider does a thorough exam of your feet with their eyes and hands. 
  2. Make sure the orthotics are adjustable.  Feet are very complex and adjustments may need to be made.
  3. Make sure that your strength, flexibility, muscular endurance, balance and footwear are addressed as well.  If these factors are not addressed, foot orthotics often do not help as much as they could.      

Click Here to read Chad’s Blog article: Pathomechanical Foot Types – Part 2 of 2

 

If you are struggling with foot or lower extremity pain, we would be privileged to assist you.  Please contact us at our Bozeman (406-556-0562) or Manhattan (406-284-4262) office to schedule an appointment.  You will be thoroughly evaluated and a comprehensive, individualized treatment plan will be developed to address your problem and help you get your fun back!

 

Free Excel PT Running Camp - 6/4/2016 - Register Online Now

By Tiffany Coletta
tiffany@excelptmt.com

Sometimes the best way to start running is not to put on your running shoes. Your first best step is to attend the Excel Physical Therapy Running Camp – a free three-hour boot camp on Saturday, June 4, 2016 to help you start running correctly and avoid pain & injury. Excel Physical Therapy is hosting this running boot camp at our Bozeman location at 1125 West Kagy Blvd., Ste. 101A (corner of South 11th Ave. and Kagy Blvd.).

Our Running Specialist PT Team will guide 30 participants through:

  • Appropriate stretching and strength exercises to prevent injury

  • How to choose the correct running shoes

  • Introduce proper training guidelines to reduce the risk of running injuries

  • Attendee’s will receive a performance t-shirt and a running training program handout from our Running Specialist PT Team 

page.seminars.sidebar2Presented by: 

Megan Peach, DPT, OCS, CSCS

Jason Lunden, DPT, SCS

Chad Yoakam, MS, PT

with special guests from the Gallatin Valley running community

Megan Peach, DPT, OCS, CSCS will be leading a free follow-up training day on Saturday, June 18, 2016 for camp participants. One-on-one with Megan leading your warm-up, a local run and answering your questions. Awesome!

Register for the Excel Physical Therapy Running Camp Here – https://excelptrunningcamp.eventbrite.com

 

 

Running Injury Seminar - 5/18/2016 @ Bozeman Library

By Tiffany Coletta
tiffany@excelptmt.com

running injury seminar infoJoin us Wednesday, May 18, 2016 at 6:30-7:30pm in the Community Room of the Bozeman Library for a discussion of running-related injuries, risk factors, foot mechanics and injury prevention how-to’s. Our team of running specialists, Megan Peach, DPT, OCS, CSCS, Jason Lunden, DPT, SCS and Chad Yoakam, MS, PT will review tips and tricks to help you run strong and pain-free.

 

Our physical therapists will discuss:

  • Risk factors for Running-related injuries
    • running mechanics, flexibility, strength and training errors
  • Foot Mechanics and their relation to Running-Related Injuries
    • pathomechanical foot types, shoe selection
  • Prevention of Running-related injuries                                                                                                                                     
    • strength and conditioning, stretches
  • Q&A: Bring your questions for the Excel PT team to answer.

We’ll have door prizes too! Free and open to the public.

Our team’s mission at Excel Physical Therapy is to support our community through service, education, and promoting the value of physical well-being; this seminar is our commitment to you to provide you with the most up to date strategies for a successful running program so you can Live Better and Play Smarter.

 

Excel PT Team to talk at Schnee's Foot Health Seminar, 4/14/2016, 7-8pm

By Megan Peach, DPT, OCS, CSCS
megan@excelptmt.com

Not sure why your feet are hurting? Or which kind of shoe will help? Join us at Schnee’s Boots Shoes & Outdoors, Thursday April 14th from 7-8pm for a Foot Health Seminar. Megan Peach, Chad Yoakam and Jason Lunden of Excel Physical Therapy will be discussing “Foot and Arch Myths and How They Impact Your Movement”. Special Guest, Scott McCoubrey of Scott Footwear. Bring your questions for Q&A after the talk. See you at Schnee’s Montana!

Prevention! See Us Before Your Injury

By Megan Peach, DPT, OCS, CSCS
megan@excelptmt.com

Why wait until after you are injured to see a physical therapist? Did you know that a great time to see a physical therapist is before you are injured? I recently evaluated a patient who wanted to see a physical therapist to learn a home exercise program to prevent future episodes of low back pain. Orthopedic physical therapists are trained in injury prevention and recognizing range of motion or strength deficits that may lead to a future injury. A comprehensive home exercise program can address deficits, ensure proper mechanics, and build strength to reduce the risk of future injury especially for those involved in athletics or repetitive movements. Runners, soccer players, skiers, and people who frequently lift heavy items are all great candidates for a physical therapy evaluation before an injury occurs!

Megan Peach, DPT, OCS, CSCS specializes in manual treatment of spinal dysfunction, as well as knee and shoulder pain. After receiving a Bachelor of Science in exercise science from Montana State University, Megan earned a doctorate in physical therapy from Duke University. Post-graduation, Megan became a Certified Strength and Conditioning Specialist and is a member of the National Strength & Conditioning Association. Shortly thereafter, Megan completed the Kaiser Permanente Residency program in advanced orthopedic manual physical therapy in San Francisco, California. Megan received the advanced Orthopedic Certification Specialization (OCS) after passing a rigorous exam from the American Physical Therapy Association’s American Board of Physical Therapy Specialties. If you have specific questions about how to strengthen, restore, or get back to what you love to do, contact us at Excel Physical Therapy, 406.556.0562 in Bozeman, Montana or 406.284.4262 in Manhattan, Montana. #excelptmt

Injury Prevention in Nordic Skiing: Elbow & Shoulder Pain

By Jason Lunden, DPT, SCS
jason@excelptmt.com

Due to the repetitive stress from poling, Nordic skiers can develop overuse injuries of both the elbow and/or the shoulder. The most common of these are medial epicondylitis and shoulder impingement syndrome.   The underlying cause of the development of these injuries is multi-factorial: poling technique, pole length, and poor strength and conditioning.  

Shoulder impingement syndrome is caused by underlying weakness of the rotator cuff and muscles around the shoulder blade.  This underlying weakness causes impingement or pinching of the rotator cuff between the humerus and glenoid (ball and socket of the shoulder joint), which can be further exacerbated by poor poling technique.  Therefore to prevent developing shoulder pain during your Nordic ski season, make sure you incorporate strength and conditioning of your rotator cuff and periscapular musculature.

Medial epicondylitis is an irritation of the tendon of the wrist flexors and presents as pain on the inside of the elbow.  This irritation is caused by repetitive stress to the tendon mainly from poor poling technique, but also from underlying weakness of the wrist flexor muscles.   Thus prevention of medial epicondylitis can be achieved through working on your poling technique and ensuring you have proper forearm strength.

See More Injury Prevention in Nordic Skiing: Knee Pain

See More Injury Prevention in Nordic Skiing: Lower Back Pain

See More Injury Prevention in Nordic Skiing: Technique

 

Jason Lunden, DPT, SCS specializes in the rehabilitation and prevention of sports-related injuries, with a particular interest in the biomechanics of sporting activities – running, cycling, skiing, snowboarding and overhead athletics. He has published on the topic of shoulder biomechanics and the rehabilitation of knee injuries and has a strong commitment to educating others. Jason serves as a physical therapist for the US Snowboarding and US Freeskiing teams and is a frequent, well-received local and national presenter on the topics of sports rehabilitation and injury prevention. If you have specific questions about how to strengthen, restore, and get back on the slopes and trails, contact us at Excel Physical Therapy, 406.556.0562 in Bozeman, Montana or 406.284.4262 in Manhattan, Montana. #excelptmt

Injury Prevention in Nordic Skiing: Lower Back Pain

By Jason Lunden, DPT, SCS
jason@excelptmt.com

Low back pain has been found to be more common in cross-country skiers, than non-athletic controls1.   Compared to skate skiing, low back pain is more prevalent in classic skiing because of the repetitive flexion-extension loading pattern of double poling.  In addition to making sure your technique is sound, it is important to make sure you have adequate core abdominal, hip, and spinal extensor strength.  So make sure you incorporate proper core and hip strengthening in to your training.  Furthermore, improving hip flexibility has been shown to decrease the rate of low back pain in Nordic skiers2.  Hip flexor flexibility is especially important, so make sure to incorporate hip flexor stretching as part of your normal routine.

1Bahr R, Andersen SO, Løken S, Fossan B, Hansen T, Holme I. Low back pain among endurance athletes with and without specific back loading–a cross-sectionalsurvey of cross-country skiers, rowers, orienteerers, and nonathletic controls. Spine (Phila Pa 1976). 2004; 29(4):449-54.

2Alricsson M, Werner S. The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study. Br J Sports Med. 2004;38(2):148-53

See More Injury Prevention in Nordic Skiing: Technique

See More Injury Prevention in Nordic Skiing: Elbow & Shoulder Pain

See More Injury Prevention in Nordic Skiing: Knee Pain

 

Jason Lunden, DPT, SCS specializes in the rehabilitation and prevention of sports-related injuries, with a particular interest in the biomechanics of sporting activities – running, cycling, skiing, snowboarding and overhead athletics. He has published on the topic of shoulder biomechanics and the rehabilitation of knee injuries and has a strong commitment to educating others. Jason serves as a physical therapist for the US Snowboarding and US Freeskiing teams and is a frequent, well-received local and national presenter on the topics of sports rehabilitation and injury prevention. If you have specific questions about how to strengthen, restore, and get back on the slopes and trails, contact us at Excel Physical Therapy, 406.556.0562 in Bozeman, Montana or 406.284.4262 in Manhattan, Montana. #excelptmt

"Got to Keep on Moving" by Matt Heyliger, DPT

By Matt Heyliger, DPT
matt@excelptmt.com

I have recently been thinking quite a bit about the importance of joint mobility, not strictly for function, but for joint health. In manual therapy, assessment of a given joint in the body always consists of consideration of joint mobility. Is there enough mobility? If not, why not? Does the joint itself have a motion restriction? Or is there perhaps some tissue outside the joint, like a tight muscle, that is limiting mobility? While it makes sense that a certain degree of motion is important for functional tasks, like bending your knee a certain amount to ascend stairs, mobility is also critical for joint health.

Joint pain is often accompanied by some loss of joint mobility. While it may be possible to get by with a small loss of motion this may be taking its toll on your joint. Taking a joint though it full available motion is critical to providing nutrition to a joint. Nutrients and metabolic waste products are housed in a joint’s synovial fluid and are moved in and out of a joint through motion. Each joint has a position, either fully bent or fully straight, that provides the most narrowing of the joint space. This position in physical therapy is called the close-packed position which allows the joint to excrete waste products. This in turn provides room to draw nutrients into the joint through the joint capsule. When one loses the ability to close-pack a joint it can lead to a slow degenerative process resulting in conditions like osteoarthritis and pain.

This principal applies to the smallest joints at the tips of the fingers, to the joints in the spine, as well as to larger joints like the shoulder and knee. If you have a joint that seems to be getting stiff consider having this assessed by an orthopedic professional. Preserve the motion of your joints and you will be taking an important step to promoting good joint nutrition and health.

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About Matt Heyliger, DPT: Matt completed his Doctorate in Physical Therapy at Eastern Washington University in Cheney, Washington. During his clinical experience with the Sports Medicine and Extremities team at The Orthopedic Specialty Hospital in Salt Lake City, Matt was exposed to a wide variety of surgical and non-surgical conditions and developed a solid foundation for the assessment and treatment of orthopedic conditions related to the extremities. Prior to completing his Doctorate of Physical Therapy degree, Matt obtained his Bachelor’s Degree in in philosophy at the University of California, Santa Barbara.

 
Matt has developed a specific interest focus in biomechanics and how impairments at one level or joint affect other body structures. More specifically, he has a particular interest in the relationship of cervical/thoracic spine mechanics and upper extremity conditions. Matt is an avid rock climber, telemark/backcountry skier and mountain biker. Matt regularly practices yoga and enjoys frequent adventures in the mountains with his wife and their Alaskan Malamute.
 
Matt treats patients out of the Excel Physical Therapy offices in Bozeman and Manhattan, Montana offices. You may schedule an appointment with him at 406.556.0562 (Bozeman) or 406.284.4262 (Manhattan).

Thank you David, Megan, and Adam! I am finally feeling good this week and couldn't have done it without y'all!             ---Bozeman Patient

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