Plantar Fasciitis, Morton's Neuroma, Shin Splints, Ankle & Foot Pain, Knee Pain, Hip Pain
Plantar fasciitis, Morton's neuroma, shin splints, ankle and foot pain, weak ankles, knee pain and hip pain are all treated similarly because they represent, in most cases, different focal representations of the same broad underlying causes.
Most of the time we can fix these with no other intervention required.
Occasionally, it is necessary to use an orthotic device.
On the rare occasions where this is necessary we work with a local podiatrist.
Sometimes, with knees and hips the problems have been neglected for so long that they have resulted in degenerative joint disease or osteoarthritis.
Where this has happened we keep the joints working for as long as possible but when they reach a certain point we refer for surgical intervention.
The longer this can be delayed the better because the technology is improving rapidly such that a person who has a knee or hip replacement in their late sixties may never need a second one.
The plantar fascia is a layer of tough connective tissue that runs almost the full length of the sole of the foot. It functions as a tie-rod, stopping the long arch of the foot from flattening under load. Because it is intimately associated with the biomechanical stability of the foot, it is affected by anything that contributes to increasing the biomechanical challenge to the foot.
Plantar fasciitis is inflammation of the plantar fascia and presents as pain either along the sole of the foot or the anterior aspect of the heel. It is often worse when standing, walking or running (under load). While many professions find this a difficult condition to treat we find it one of the easiest. To track the underlying causes is simply a matter of locking the patient into compromise and muscle testing to locate the various components that have lead to the problem.
Although called a neuroma, this is probably incorrectly named. It presents as pain, tingling, and/or a cold or burning sensation between the toes, which is often worse on standing.
We find it is associated with an inferiorly displaced, or dropped, metatarsal head that compresses the nerve that runs between the toes. The most common metatarsal head to show this problem is the 3rd which is at the peak for the transverse arch of the foot.
A dropped metatarsal head is easy to manipulate into position but, if stability is to be achieved, it is essential to determine why it dropped in the first instance. It is a functional problem of the foot and as such there will normally be underlying causes that have set up this situation.
These are varied and many but include; weakness of the leg and foot muscles, fixation of other joints of the foot that lead to restriction in flexibility of the longitudinal arch, unresolved old ankle sprains, knee or hip problems on the same side or a problem with the other leg that has lead to unreasonable strain on the involved leg.
Shin splints, (medial tibial stress syndrome (MTSS)). Presents as pain between the knee and the ankle in muscles that occupy anterior outer aspect of the leg.
It is usually caused by overloading the muscles or by biomechanical stress due to fixation of joints over which these muscles work.
It responds well to treatment usually resolving within a few visits.
As with other functional musculoskeletal problems it is just a matter of identifying the underlying causes and treating them.
Ankle and Foot Pain
In addition to the specific syndromes that affect the foot there are a number of nondescript problems that can affect the foot.
Excluding pathologies such as inflammatory arthritides and fractures most of these are the result of functional failure and as such will have underlying causes that more often than not are easily located by muscle testing.
Knees are odd structures if you just think about them. They are in effect two posts, one stuck on top of another held together by ligaments muscles and to a lesser extent skin. They would appear to be inherently unstable structures, yet this is not the case.
As with all joints, primary stability comes from the muscles keeping the joint surfaces in contact at exactly the correct orientation and position. This happens because the central nervous system (CNS) is aware of where all the elements that make up the joint and its contiguous structures are, and is able to coordinate the necessary changes in muscle activity to keep the whole structure moving correctly. If there is poor data feeding into the CNS, then this coordination starts to fail and this problem is no more apparent in any part of the body than in the knees.
For this reason, treatment of knee pain - a consequence of underlying causes leading to functional failure, usually involves improving the input into the CNS by keeping all the joints that supply data on body position (proprioceptive information) working to their ideal capacity.
While there might be a history of injury with torn cruciate ligaments or worn joint surfaces, it is almost always possible to improve joint function by addressing the underlying causes to improve function.
Often what people describe as hip pain is in fact a variance on low back pain. If your pain is locate on the outer upper posterior aspect of the hip bones (the innominate) over the lateral buttocks and upper outer leg then it is most likely coming from the sacroiliac joint and is not a hip problem. Having said this we would still like to see you because we can probably solve the problem.
True hip pain is in the groin. Primary hip pain in adults is most commonly a result of degenerative joint disease and as such can only be addressed by removing the factors that are leading to the degenerative change. The hip joints provide most of the body’s ability to flex forward and as the pivotal point carry significant loadings. They are a very constrained joint and as such are not prone to dislocation. The trade off is that they have little capacity to deal with direct translational forces except by taking a huge compressive load onto the joint surfaces. This is normally avoided by flexing the hip and knee together to produce a shock absorbing effect.
Where there is instability in the knee, foot or even the lumbar spine, the capacity of the body to take such impacts is reduced. This strongly suggests that in looking for underlying causes of hip dysfunction we need to ensure the knees, feet, ankles and spine are all functioning to capacity.
In addition the health of the joint surfaces, particularly the hyaline cartilage that coats the articulating surfaces must be in good health. Although there is some dispute of the benefits of glucosamine and chondroitin on joint health our experience is that in the context of our treatment there is considerable benefit.
The main benefits though come from addressing the underlying causes of dysfunction. Of most benefit has been remobilising adjacent structures and the hip joint itself.