Why do people get Bunions?

Have you seen anyone in sandals with their toes hanging over the side?  This is a Bunion.  Bunions are a malformed bony bump on the outside portion of the big toe.  It becomes enlarged and angles toward the second toe putting pressure on the foot.  This can be very painful.

So how does this happen?  Wearing shoes that are not supportive or move properly which leads to a person “toeing off” on the outside of the toe.

In the past, we were barefoot walking on dirt, sand and soft surfaces.  Now we walk on hard surfaces and put a lot more force on the foot leading to dropping of the arch , Plantar Fasciitis and Bunions.

Here are the symptoms of a bunion:

  • Bump or angulation on the outside of the first toe
  • Swelling, redness and tenderness of the big toe
  • Thickening of the skin on the bottom of your foot under the big toe
  • Corns or calluses
  • Pain of the first toe
  • Restricted movement

Women are more likely to get bunions because of wearing high heels or shoes that don’t fit properly. Improper shoes can cause foot problems because the big toe begins to push on other toes and tissues.

Doctors that do not specialize in the management and function of extremities may not know that bunion formation can be caused by several dysfunctions of the foot.  Bad body mechanics may go unnoticed until symptoms become more prominent.  Improper walking or standing puts added stress on the foot and prevents toes from moving and gliding the way they should.

Wearing shoes that are too tight or loose can get bones stuck together and prevent the toes from functioning normally.  Now the foot, ankle, knees and hips begin to pay the price.   Many people have been told there is nothing that can be done to change or manage this problem except tape the toe, put a divider between the big toe and second toe or have surgery where part of the toe is shaved off.  This is just a short term solution and will result in further destruction of the foot.

At Precise Moves Chiropractic we specialize in extremities and can help you relieve foot problems and help you walk and stand better resulting in less pain and stress on your foot.  We can also teach you the right things to do for your feet so you don’t continue to have problems.

Give our Redwood City Chiropractic office a call today to start your journey to long term health!

Medical Doctors Debate Over Plantar Fasciitis Causes. WHY?

Plantar Fasciitis is pretty darn painful.  Common symptoms are stabbing pain in the heel or arch, tight achilles tendon.  10% of all runners get plantar fasciitis at some point.  Any sport with running has had athletes sidelined by this problem. Kobe Bryant from the Lakers, quarterback Eli Manning, olympic marathon runner Ryan Hall have all been victims to this ailment.

But while plantar fasciitis is not well understood, medically as pointed out in NY Times issue in 2013*.   Medical experts agree that plantar fasciitis is the the plantar fascia is irritated.  This fascia attaches at the heel and goes all the way up to the top portion of the toes.   Pain is most common in the morning after the fascia has tightened during the night.

But scientific agreement about the condition and its causes ends about there.

For many years, “most of us who treat plantar fasciitis believed that it involved chronic inflammation” of the fascia, said Dr. Terrence M. Philbin, a board-certified orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, who specializes in plantar fasciitis.

Many doctors believe repetitive movements like running, jumping, standing will cause inflammation in the fascia.  This can become chronic and it is really painful and can prevent people from working if they have to be on their feet for any period of time.

But when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, “they did not find much if any inflammation,” Dr. Philbin said. There were virtually none of the cellular markers that characterize that condition.  According to Dr. Karim Khan “Plantar fasciitis does not involve inflammatory cells,” said Dr. Karim Khan, a professor of family practice medicine at the University of British Columbia and editor of The British Journal of Sports Medicine, who has written extensively about overuse sports injuries.

He believes it is caused most likely by degeneration or weakening of the tissue.  Small tears occur and the tissue.  The small tears don’t heal correctly and begin to accumulate leading to shredding and more tearing which leads to pain.

Dr. Philbin states that people can be pain free within a few months with injections or other invasive treatments.  they must do less running, jumping, walking and stretch the foot involved along with the achilles tendon and hamstrings.

Well, I have been working with people with Plantar Fasciitis for years and in my opinion, it is not the activity, it is the foot.  How a person lands on their foot while walking or running needs to be addressed along with what kind of shoes they wear.  They need a good support of the arch and the heel needs to be supported properly.

HERE IS THE METHOD I HAVE FOUND THAT WORKS BEST:
Yes, rehab is necessary and what I do is adjust the foot, teach patients about proper shoes and proper walking, stretching and soft tissue work.  I also get them to buy orthotics that help them land on their feet properly.  Shots are not going to solve the problem, just cover numb the pain.  With a little bit of time, the pain goes away and the patient now knows how to take care of their feet.  This seems much better than shots or surgery which can slow down healing and sometimes lead to more pain or no change at all.

*References:  http://well.blogs.nytimes.com/2013/02/20/no-consensus-on-a-common-cause-of-foot-pain/?_r=0

Runners May Be In Great Shape, But They Are Prone To Injuries

By most estimates, nearly 70 percent of runners will become injured. While many of their injuries will appear minor, they can become more serious over time if not properly treated.

Running injuries may impact other areas of the body as well. Because I am an extremity expert as well as a chiropractor, I am trained to look at the body.   I want to identify the true source of the problem treat any malfunction in the body and develop a training or rehabilitation program to solve it.

Among the most common running-elated injuries are:

  • Runner’s Knee – This is the most common running-related injury. Known as patello-femoral pain, and sometimes diagnosed as chondromalacia of the patella, runner’s knee is essentially irritation of the cartilage of the kneecap. The condition results in pitting or fissuring of the cartilage to varying degrees. While running, various mechanical conditions may predispose runners to a poorly tracking kneecap. This can result in irritation and/or damage to the kneecap. Runners will notice pain near the kneecap, especially after sitting for extended periods of time with knees bent or while walking down stairs or downhill. Appropriate treatment involves eliminating or modifying activities that cause the pain; correcting improper biomechanics that allow the injury to arise; and avoiding positions that further irritate the condition, such as sitting for prolonged periods of time.
  • Iliotibial Band Syndrome – Symptoms of this syndrome include pain or aching on the outside of the knee, usually occurring in the middle or at the end of a run. When you flex and extend your knee, the iliotibial band, which runs along the outside of the thigh, can become irritated from repetitive rubbing over the outside of the knee. There are several causes of this syndrome, including weak gluteal muscles, bowed legs, over-pronation of the foot, leg length discrepancy, and running on uneven surfaces. Running on a circular track may also contribute to the problem. As with other running injuries, athletes should decrease their training regimen. In addition, they should also add stretches for the ouside of their thigh to their warm-up program, avoid running on uneven or circular track surfaces, and some should wear motion control running shoes.
  • Shin Splints – Also called medial tibial stress syndrome, “shin splints” refers to pain occurring in either the front or inside portions of the lower leg. Tenderness extends along the length of the lower leg at either of the surfaces. Those most at risk for shin splints are beginning runners who are not yet used to the stresses of running or who have not stretched or strengthened properly. To care for shin splints, runners should decrease their training, and begin with ice and rest, later adding strengthening of their lower leg muscles. They may use swimming and biking as alternative forms of exercise. If symptoms persist, runners should consult their physicians.
  • Achilles Tendinitis – The Achilles tendon is the connection between the heel and the muscles of the lower leg. Several factors contribute to the development of Achilles tendinitis, including excessive hill running, sudden increases in training, and improper shoes. One of the major factors is excessive tightness of the posterior muscles of the leg, including the calf muscles and the hamstrings. Runners with this condition should reduce their running. They can use ice and gentle stretching to reduce pain and tightness. If not treated properly, Achilles tendinitis can develop into a chronic problem.
  • Heel Pain (Heel Spurs and Plantar Fasciitis) – The most common heel problems are caused by strain of the plantar fascia, which extends from the heel to the toes. Strain in this tissue can become very painful, especially with the first steps of the day. The condition can cause swelling at the origin of the plantar fascia at the heel. The pain is most noticeable when the foot flattens during weightbearing or when pushing off with the toes during walking or running, and it is usually located near the heel. The problems tend to occur in flat, flexible feet and in high arched, stiff feet. Left untreated, the pain can spread around the heel. Treatment should include a decrease in the intensity and duration of running workouts. Runners should also evaluate their running shoes for excessive wear and for proper fit. The wrong shoe for a foot type can worsen biomechanical flaws and cause plantar fasciitis.

Runners can take several precautions to prevent being sidelined because of an injury. While some of these steps might seem time-consuming or expensive, they are a good way to keep you on the right track.

  • Prepare for exercise/activities – Understand what muscle groups will be used and slowly start conditioning them by strengthening them. Talk with a PM&R physician to determine the appropriate type of exercises.
  • Properly stretch muscles before running – Muscles and joints need to warm up before beginning a run. Also be sure to allow for a “cooling down” period afterward.
  • Use an appropriate running shoe – There are several brands and models of running shoes. Make sure you are using the type best suited for your feet and your running style. Running shoes should also be replaced regularly. Consult a specialty running store to choose an appropriate shoe.
  • Incorporate hard days and easy days into your training program – Mileage should only be increased approximately 10 percent each week. Runners should make sure to decrease their mileage slightly every third week as a way to allow for recovery prior to additional mileage increases. Runners should also be patient with their development, being careful not to push themselves too far or too fast.
Some information provided by the 2012 American Academy of Physical Medicine and Rehabilitation: http://www.aapmr.org/patients/conditions/msk/Pages/runfact.aspx

What turraine is best for running?

Soft or hard surfaces while running?  That is what people ask me all of the time.  I normally like to tell them to run on the beach barefoot since this is the best for shock absorption of the foot.  But….if someone is getting over a sprain, it is not good to have them run on uneven soft surfaces because the ankle or leg can’t handle the bumps and it may irritate old chronic injuries.

Running on hard surfaces is hard on the body and does add shock to the foot and kinetic chain.  I guess the answer to the question of running on soft surfaces versus hard ones depends on the individual and what is going on with them.  Here is a great article discussing the differences between each option.

Article:

Hirofumi Tanaka, an exercise physiologist at the University of Texas at Austin, bristles when he sees dirt paths carved out of the grass along paved bicycling or running routes. The paths are created by runners who think softer ground protects them from injuries.

Dr. Tanaka, a runner, once tried it himself. He was recovering from a knee injury and an orthopedist told him to stay away from hard surfaces, like asphalt roads, and run instead on softer surfaces, like grass or dirt. So he ran on a dirt path runners had beaten into the grass along an asphalt bike path.

The result? “I twisted my ankle and aggravated my injury while running on the softer and irregular surface,” he said.

In the aftermath of his accident, Dr. Tanaka said he could not find any scientific evidence that a softer surface is beneficial to runners, nor could other experts he asked. In fact, it makes just as much sense to reason that runners are more likely to get injured on soft surfaces, which often are irregular, than on smooth, hard ones, he said.

His experience makes me wonder. Is there a good reason why many runners think a soft surface is gentler on their feet and limbs? Or is this another example of a frequent error we all make, trusting what seems like common sense and never asking if the conventional wisdom is correct?

Perhaps a runner who, like me, strikes the ground with her forefoot instead of her heel, might risk more injuries on softer ground. After all, every time I push off on a soft surface, I twist my foot.

Exercise researchers say there are no rigorous gold-standard studies in which large numbers of people were assigned to run on soft or hard surfaces, then followed to compare injury rates.

There’s a good reason for that, said Stuart J. Warden, director of the Indiana Center for Translational Musculoskeletal Research at Indiana University. It’s too hard to recruit large numbers of people willing to be randomly assigned to one surface or another for their runs.

“I think the reason people haven’t answered that question is that it is not an easy question to answer,” Dr. Warden said.

When Dr. Willem van Mechelen, head of public and occupational health at VU University Medical Center in Amsterdam, searched for published studies on running injuries and how to prevent them, he, too, concluded that there were no good studies that directly support running on softer ground. “Significantly not associated with running injuries seem age, gender, body mass index, running hills, running on hard surfaces, participation in other sports, time of the year and time of the day,” Dr. van Mechelen concluded.

So what is going on? It seems obvious that the forces on your legs and feet are different depending on whether you run on soft packed dirt or on hard concrete. Why aren’t injury rates affected?

An answer that many accept comes from studies that addressed the question indirectly. In several of them, study subjects ran on plates that measured the force with which they struck the ground. Instead of varying the hardness of the ground, the researchers varied the cushioning of the shoes. More cushioning approximated running on softer ground.

Over and over again, studies like these found that the body automatically adjusts to different surfaces — at least, as mimicked by cushioning in shoes — to keep forces constant when foot strikes plate.

That finding makes sense, Dr. Warden said. If you jump from a table to the floor, you automatically bend your knees when you land. If you jump on a trampoline, you can keep your knees stiff when you land. Something similar happens when you run on different surfaces.

“If you run on a hard surface, your body decreases its stiffness,” Dr. Warden said. “Your knees and hips flex more. On a soft surface, your legs stiffen.” Running on a soft surface “is basically a different activity,” he said.

But those studies did not actually measure forces inside the body, Dr. van Mechelen noted. Instead, they used biomechanical modeling to estimate those forces.

“It is models, so God knows whether it is true,” Dr. van Mechelen said. “But to me it doesn’t seem far-fetched.”

Dr. Warden said some people adapt quicker than others to running surfaces, and he advised that anyone wanting to change from a soft to a hard surface, or vice versa, play it safe and make the change gradually.

Changing your running surface, Dr. Warden said, “is much like increasing your mileage, changing your shoes or some other aspect of your training program.” Abrupt changes can be risky.

But with no evidence that softer surfaces prevent injuries, there is no reason to run on softer ground unless you like to, Dr. Warden and other experts said. Dr. van Mechelen tells runners to get a pair of comfortable shoes and run on whatever surface they prefer.

Dr. van Mechelen, a runner himself, says his favorite surface is asphalt. Mine is too.

My coach, Tom Fleming, never suggested soft surfaces and never thought they prevented injuries. And, he said, there’s a good reason to run on asphalt, at least if you want to compete.

“Most road races are on hard roadways,” he told me. “So let’s get used to them.”

References: Gina Kolata NY Times

What to do about your High Foot Arch

How does this happen?

High arches can be genetic or in most cases can be caused by wearing improper shoes and/or imbalances of leg muscles.  Muscle imbalance can arch the foot.  This puts additional pressure under the big toe and toes begin to curl and become “claw toes”.  If the toes are curled, it changes the way we walk and stand. We begin putting added pressure on the heel of the foot and because of this, some muscles weaken and others become stronger.  We also tend to land on the outside of the foot, which can lead to twisted ankles and sprains.

A high arch foot may develop because the posterior tibialis muscle next to your shin becomes strong, but the muscle on the outside of the leg (peroneus brevis) remains weak.   This moves the foot in a position that adds strain to the arch and forefoot.  It is important to stretch the strong muscle and strengthen the weak one.    Making sure the foot moves properly is imperative.   There are 26 bones in the feet and they all have joints.  These joints can be moved with gentle guidance allowing your foot to be in a better position and relieve the stress on the big toe.

So how can we help?

We can teach you how to strengthen the proper muscles of your leg and relax strong muscles to keep a balance in your feet.  We also keep your foot moving properly with gentle adjusting and soft tissue work. We can also make custom orthotics, which may be necessary to keep your foot in proper position and prevent twisting and pulling on your leg muscles.

Plantar Fasciitis An Epidemic?

Plantar Fasciitis is becoming a problem in our community.  Why is this so?

Over the years our shoes have changed, we walk on hard surfaces all day long and we sit for long hours everyday without exercising our feet the way we should.  The plantar Fascia underneath our feet helps us to move our feet when we walk.  It is made of ligamentous tissue and when stretched too far, it will inflame and become tender and sore.

Our bones in our feet are meant to move and glide on dirt and adhere to surfaces.  Now that we walk on hard surfaces all day long, owe slam our bones on the ground and our slam on our fascia.  Cold laser can help alleviate the pain, but is not necessarily a long term solution.
Keeping these bones in the proper place is essential to stop the incidence of Plantar Fasciitis.  Adjustments and soft tissue work to the feet along with proper orthotics is key to keep your feet healthy and functioning properly.

Come into our office and we can address this issue and keep you running, walking, dancing or just keep you pain free!

Spinal And Extremity Care

Chiropractors are masters of the spine and nervous system.  We track and follow symptomatic patterns in the body and relieve stressors in these areas which allow the body to function at its highest level.  Did you know that we can affect any joint in the body?  Yes! Its true!  Some chiropractors believe that the whole body including your hands, feet, shoulders etc. are all involved in symptomatic problems in the body and here is why….

Everyone has heard about the kinetic chain we have on our bodies.  Remember the song…hand bones connected to the wrist bone, the wrist bones connected to the elbow bone?  Well, chiropractors certified in chiropractic extremities by the Council of Extremity Adjusting believes this to be true.

Everything is connected so after we adjust the spine, we make sure the other areas of the body are addressed to make sure they don’t affect the movement and function of your body.

I am the only chiropractor in the San Mateo County area that is certified by the CEA to adjust ribs, arms, legs, shoulders, feet and address TMJ problems.  If you have any problem in your body, we can help!

Reasons For “Turf Toe”

Turf Toe is pain occurring at the base of the big toe.  Most commonly it happens where your big toe bends when you are walking or running.  Turf Toe happens after a after constant slamming of your toe down when running, jumping or walking.  This can be a repetitive injury that can keep re-occuring throughout life if a person does not learn how to prevent it.  This injury is frequently seen with athletes who play football, rugby, soccer, wrestling or any sport that promotes “pushing off” quickly with resistance.

Keeping the foot healthy and moving properly with the use of stiff sole Orthotics when necessary can prevent the symptom of Turf Toe.   It is common to have bracing during athletic performances to prevent excessive hyperextension of the toe.  This is fine but what about when we are not working out?

Chiropractic adjustments along with proper Orthotics can prevent Turf Toe.  Jamming your foot into the ground constantly will jam up the foot joints making it impossible for your foot to function the way it is supposed to.  We will Make sure that all 26 bones in the foot are moving properly.  This will make sure that there is not any added pressure to the big toe and prevent chronic flare ups from occurring.

If you have this problem, please call our office today for a consultation!

How Can I Prevent Spraining My Ankle?

Ankle sprains are becoming more common.  Sprains occur when the ligaments of the ankle are stretched and pulled beyond their capacity.  Rolling your ankle happens when stepping into a hole in the ground, stepping wrong off a curb or wearing high heels.  This sometimes leads to partial tears or complete tears in the foot.  In 85% of ankle sprains, the Anterior Talofibular ligament is damaged by someone planting their foot, then rolling over the outside of their foot and pulling the ligaments and tendons.  This inside of the foot is only sprained about 15% of the time.

In a total tear, stabilization of the foot is necessary along with R.I.C.E (rest, Ice, compression, elevation) for regrowth and restoration of the tissues.  The foot can still be checked for proper movement and can be manipulated safely but with caution.  Partial tears require R.I.C.E and stabilization is not normally necessary.  Exercises after the inflammation is gone along with getting the foot and ankle in their proper position helps and gets patients back walking normally quickly.

People with chronic sprains sometimes think it is normal to keep spraining their ankle.  This in NOT true!  The reason why someone sprains their ankle many times can be because of balance issues, pathological gait patterns and improper foot position.  Also, once you have sprained your ankle it will be weak unless it is rehabilitated correctly.  Learning balance exercises, proper gait and getting the foot in the proper position can prevent future sprains and keep patients healthy and active for a lifetime.

We are extremity experts and can help with any sports injury or extremity problem.  Please call us today to make an appointment for an exam and consultation!

Precise Moves Chiropractic has been serving the Redwood City, CA area since 2007!

Facts About Bunions

Bunions are a malformed bony bump on the outside portion of the big toe.  It becomes enlarged and angles toward the second toe putting pressure on the foot.  This can be very painful.

Symptoms of a bunion:

  • Bump or angulation on the outside of the first toe
  • Swelling, redness and tenderness of the big toe
  • Thickening of the skin on the bottom of your foot under the big toe
  • Corns or calluses
  • Pain of the first toe
  • Restricted movement

Women are more likely to get bunions because of wearing high heels or shoes that don’t fit properly. Improper shoes can cause foot problems because the big toe begins to push on other toes and tissues.  Improper shoes cause improper movement which may not be a problem now but will increase in the future if not managed.

Practioners that do not specialize in the management and function of extremities may not know that bunion formation can be caused by several dysfunctions of the foot.  Bad body mechanics may go unnoticed.  Improper walking or standing puts added stress on the foot and prevents toes from moving and gliding the way they should.  Bones that are stuck prevent the toes from functioning normally and the foot, ankle, knees and hips begin to pay the price.   Many people have been told there is nothing that can be done to change or manage this problem except tape the toe, put a divider between the big toe and second toe or have surgery where part of the toe is shaved off.  This is just a short term solution and will result in further destruction of the foot.

At Precise Moves Chiropractic we specialize in extremities and can help you relieve foot problems and help you walk and stand better resulting in less pain and stress on your foot.

Give our Redwood City Chiropractic office a call today to start your journey to long term health!