The Foot - series of articles for athletes + others

I'm going to read those articles when I have some more time. I have problems with my feet.

I've been reading these articles gradually. A world of information there...

thought I'd post this one, but you may still be able to read the full batch of articles from my link above.

This one is about toe exercise - and could be really useful to some.


Work that toe! Work it!

Yes, feet need exercise to stay strong and flexible. Stretching classes and tools help.
By Janet Cromley, Times Staff Writer
January 1, 2007


Warm-up


They may never pull a locomotive with their toes, but a few intrepid fitness pioneers are diligently exercising their feet with the dedication of true believers.

And they may be on to something. Many podiatrists believe that putting feet through a simple exercise regimen designed to build up foot strength and flexibility can save some folks a world of hurt.

"A lot of injuries we see can be prevented if you have stronger feet," says Dr. Noreen Oswell, chief of podiatric surgery at Cedars-Sinai Medical Center in Los Angeles. And though podiatrists have many recommendations for preventing injuries (such as wearing proper shoes), only one thing, they say, will directly strengthen the feet ?- and that's exercise.

Regularly exercising your southernmost appendages can strengthen muscles of the foot and ankle, warding off tendonitis, plantar fasciitis and good old-fashioned foot pain, says Dr. Douglas Richie, a podiatrist in Seal Beach and past president of the American Academy of Podiatric Sports Medicine.

A toned, strengthened foot, furthermore, can reduce the occurrence of "sore, aching feet," which are often the result of muscle fatigue.

Regular exercise can also improve flexibility, thus boosting mobility.

Most people who seek out foot exercises ?- generally athletes and folks who are on their feet a lot ?- do so with physical therapists or trainers. But an elite few go a different route: foot fitness classes, in which students assemble for regular muscle-strengthening workouts.

Finding these classes takes a little legwork. "It's not like you can open up a catalog to a college and say, 'Oh, foot aerobics!' " says Carolyn Sery, a sales rep and dedicated foot exerciser.

Sery has been taking foot fitness classes off and on for almost three years, ever since painful bunions made standing on the job increasingly difficult. She was introduced to the concept by exercise instructor Shuriu Lo, who was training her in Pilates at the time.

On a recent Friday morning, we paid a visit to Lo's new studio at 2020 Fitness in Long Beach, to learn what goes on at a foot fitness class.

Lo and three students sat in a circle on stools at the homey mom-and-pop Pilates and Gyrotonics studio and commenced their weekly 30-minute foot exercise routine without any ceremony or small talk.

They knew the exercises by heart, and moved into and out of them with the precision of a well-trained drill team.

They scrunched their toes like little inchworms, scooting the foot forward and back.

They raised their toes, then lowered them one at a time, starting with the littlest.

They interlaced their fingers in their toes, rotated each foot and walked over small rubber domes known as wakers.

Then, toward the end, the students repeated some of the exercises while standing on a "hypergravity platform" ?- a vibrating exercise device that provided a little shake-n-bake foot buzz.

Thirty minutes a week may not sound like much, but Sery credits it with helping her stay longer on her feet ?- and with less pain ?- during her job servicing accounts at greeting card stores. She also believes it has helped her avoid surgery.

"Standing for long periods is tiring and painful unless I do my foot class exercises," she says.

To supplement the benefits of the class, she has her own personal pair of toe stretchers that she wears when she can: soft, pliable devices worn on the feet that fan the toes outward, forcing a little extra space between them.

Although there isn't empirical evidence proving their efficacy, some physical therapists and their clients believe the stretchers improve flexibility and reduce pain.

Foot fitness isn't exactly a booming business, but a number of physical therapists and trainers do incorporate the principles into their practice.

For example, Marie-José Blom-Lawrence, director of Long Beach Dance Conditioning and Angel City Body Kinetics, and an instructor of anatomy and physiology at Loyola Marymount University's department of dance, is a big proponent of foot exercises ?- instructing trainers in foot fitness and lecturing on the topic at workshops.

She believes that certain orthopedic problems, such as back pain, can often be traced to the feet. "The feet are carrying and organizing your body," she says.

She thinks it's a shame that when most of us formulate a fitness plan, feet are the last thing we consider.

"When we think of the feet, it's related to fashion and not health," she says.

"People work out, and go and have pedicures, and it's all for the outside. They're not paying attention to the structure of the foot."

Kim Finklestein, a physical therapist at Postureworks in Santa Monica, also includes foot therapy and foot fitness instruction as part of her practice. She even has a "toe mobilization" program, designed to restore flexibility of the toes.

The system includes "tractioning" each toe, which involves pulling the toe, twisting it gently clockwise and counterclockwise, then "scissoring" the toes ?- pushing one toe up, while pushing the toe next to it down.

Ruth Phillips of Century City says the toe mobilization system worked well for her problem: a crooked second toe. Finklestein, she says, was able to straighten that toe over the course of a month of triweekly toe-stretching treatments.

Finklestein encourages clients contemplating surgery for bunions or hammer toes to consider exercising first. She also endorses weekly wearing of toe stretchers to stave off injury.

"Toe stretching improves jumping, flexibility, mobility, strength and balance, which translates into more efficient movement," she says.

She even goes so far as to say that exercise can alter the form of the foot ?- which is not as far-fetched as it sounds, according to Richie.

It's not an everyday occurrence, but he says he's seen people "literally raise the arch with persistent exercise."

The beauty of foot fitness, Lo says, is that the exercises are simple and can be done at home. The tools are even simpler ?- primarily tennis balls and rubber domes to roll the feet over.

Sery has found that embarking on a foot fitness regimen has some unexpected perks: It's great fodder for cocktail party conversation or an ice breaker when talking to clients.

"I tell them about my foot class, and I have them all in stitches," she says. "When I tell people I've got Japanese toe stretchers, they tend to picture me hanging upside down."

And there are other, less tangible benefits, says Erin Holloway, who also attends Lo's class.

"Feet are truly a metaphor for how you move through life," says Holloway, a licensed acupuncturist and health education specialist. "If your feet are hurting, you're not going to want to walk on them ?- and move forward with your goals, with your life."

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I guarantee there are no foot aerobics classes around here, but I have been doing some of the exercises from the article when I think of it. Granted, it's probably not often enough to do me any good. I do one where you try to scrunch a towel with your toes. I hope it's doing some good. I have two conditions, plantar faciitis and Morton's neuroma. I think they are both associated with weakening connective tissue.

I think I've had capsulitis for decades and not known it except for the odd occasion of not being able to walk, say after walking around in, for example, san francisco, on vacation for days. Slap slap slap on concrete with my high arched foot. So I've worn cushioned shoes with good arch support all this time, and that has mostly worked - though it's affected my wardrobe toward the less fetching.

Interesting articles.

I suffer from Morton's neuroma too, Swimpy. After years at home with my kids and always wearing sneakers I went back to work, stuffing my feet into narrow, modest, heels. Next thing I know I can hardly walk. Now I have indoor, outdoor, and dress-up Birkenstocks and wear custom orthotics in everything else (wide width New Balance mostly). It has improved though -- I have those Dr Scholl insoles for diabetes/arthritis in some runners and can wear them without orthotics if not walking for hours. We do a range of toe and foot exercises when warming up for t'ai chi -- I guess it's helped!

I just developed the neuroma in the past year or so. I have two pairs of shoes that have wide enough toe boxes that I can where them without pain all day. I don't know if the exercises are helping, but I'll try to remember to do them more often.

What's capsulitis, osso?

Capsulitis is described in this article (part of the series of articles about feet) -

coddle tendons and bones

Whether you run marathons or walk, injuries are just a step away. Knowing what ?- and what not ?- to do can help avoid them.
By Jeannine Stein , Times Staff Writer
January 1, 2007


Action plan


From the pickup basketball player to the motivated marathoner, all who exercise can suffer the agony of the feet.

During the simple act of walking, the foot absorbs one-and-a-half times the body's weight. In running, it bears two to three times the body's weight. One giant leap to dunk a basketball can ratchet that force up even higher. Because one stress fracture can seriously derail an entire sports career, researchers are continually studying athletes to determine the optimum methods of training and treatment, to both prevent and care for these injuries.

The most common athletics-related injuries, say sports medicine orthopedists and podiatrists, are plantar fasciitis, Achilles tendinitis, neuromas, capsulitis and stress fractures.

Plantar fasciitis

Any activity that involves jumping, plus sudden stops and starts, can lead to plantar fasciitis. And apparently plenty of activities do. This overstretching of the ligament that runs from the heel to the ball of the foot, straight through the arch, affects about 14% of men and women ages 18 to 60, according to the American Podiatric Medical Assn.

"It comes on slowly," says Dr. Doug Richie, a Seal Beach-based podiatrist and past president of the American Academy of Podiatric Sports Medicine. "It's not a sudden event. But it's always worst first thing in the morning, and it can be worse while playing the sport."

Cause: The repeated stress of propelling the foot upward strains the ligament, sometimes creating small tears and possibly also causing pain at the arch. Being overweight can exacerbate the condition for the additional load it puts on the foot. The injury is especially common this time of year, when resolution-makers start exercising with a little too much gusto.

Although the pain can be felt in the arch, it's usually felt in the heel in part because that's where the ligament is weakest, says Dr. John Pagliano, a Long Beach-based podiatrist and fellow of the American College of Sports Medicine. "The fascia is nice and broad in the arch, but narrows as it comes into the heel." The heel is also where the foot bears the brunt of impacts.

"It's supposed to be a nice, soft, pliable material," Pagliano says, but after taking a pounding, it can form adhesions and scar tissue, becoming "gristly and hard."

Prevention: Warm up before an exercise routine, and gradually increase your workout intensity over time. Wear shoes with adequate arch support.

Treatment: First, try rest, plus orthotics that lift the arch and take the pressure off the ligament. If that doesn't do it, try a leg splint worn at night to keep the foot at a 90-degree angle, so the plantar fascia is prevented from tightening up. For those prone to plantar fasciitis, physical therapists often recommend exercises to stretch the ligament. For instance, while seated, roll the foot on a tennis ball for about five minutes twice a day. But do the move only when warmed up ?- never first thing in the morning when the foot is stiff ?- and only on the fleshy bottom of the foot under the arch. A study published last year also showed good results, finding that curling the toes backward while flexing the ankle resulted in less pain and more improvement than those who did an Achilles stretch.

Another therapy could be on the horizon: In a pilot study presented at a meeting last year of the American College of Sports Medicine, 29 men and women recently diagnosed with the injury were given eight weeks of standard care ?- ibuprofen, rest and stretching exercises. Half were given glucosamine supplements, and half a placebo. Although all started off with the same severity of pain, six of the 15 who took glucosamine were pain-free after about a month, compared with only one of 14 in the placebo group.

Achilles tendinitis

The tendon that brought down the mythic hero Achilles also fells numerous runners, dancers and gymnasts. Some 6.5% of people suffer from general tendinitis, according to the American Podiatric Medical Assn. In 2002, Washington, D.C.-based sports medicine podiatrist Dr. Stephen Pribut surveyed nearly 10,000 runners via the Internet and found that 7% reported that Achilles tendinitis pain prevented them from running for more than a week.

The Achilles tendon connects the calf muscle to the back of the heel bone. But it's the action of the foot that can cause injury, says Richie ?- specifically too much bounding, jumping or fast-paced running.

"The more you get up on the toes, the more that uses the Achilles," he says, "since it's the propulsive tendon of the foot, lifting the heel and driving the body forward over the foot." The less flexible the Achilles, the more strain it endures.

Cause: All that stress can eventually lead to inflammation, strains and micro-tears in the tendon, forming scar tissue that results in even more inflexibility, says Pagliano. That can cause severe pain that shoots like a thunderbolt from the back of the ankle with every step. In extreme cases, the Achilles can completely rupture.

Saying goodbye to weekend basketball games or five-mile daily runs is usually the first call to action for Achilles tendinitis sufferers, although sometimes people can substitute an activity with less impact such as an elliptical trainer or bike workout, Richie says. They should also make sure their shoes have proper cushioning for greater shock absorption.

Prevention: Do stretching exercises, three times a day when warmed up, to increase the tendon's flexibility.

Begin with a classic calf stretch, leaning against a wall, one foot in front of the other, gradually pushing the back heel down, then slightly bending that leg.

The tendon can also be stretched using a large, rubbery band. While sitting on the floor, extend one leg and wrap the band under the arch of the foot. Hold the ends of the bands in both hands while pointing and stretching the foot.

Treatment: Shoes that offer a slight heel raise (about 1 1/2 inches) can take stress off the tendon while it heals. Ultrasound can help break up scar tissue, as can massage therapy.

In a promising new development, low-level laser therapy is being tested to treat Achilles tendinitis. The treatment has been used to reduce inflammation in other areas of the body, because the laser light can activate changes in the cells, such as stimulating wound healing.

In a study published last year in the British Journal of Sports Medicine, seven people who had Achilles tendinitis in both legs were given laser treatment and a placebo treatment on each. The laser treatment proved to significantly reduce inflammation and pain compared with the placebo treatment.

Neuromas

The front of the foot has its own set of sports-related problems. Neuromas are nerves that are squeezed between tissue and metatarsal bones, those long bones behind the toes. They're especially common among cyclists, whose forefeet are under constant pressure while pedaling and who frequently squeeze into tight cycling shoes. Almost 15% of people complain of pain in the ball of the feet, says the American Podiatric Medical Assn.

Pain is usually felt on the ball of the foot, between the third and fourth metatarsal bones, behind the toes. It's often sharp, but can sometimes feel like a burning or tingling sensation, causing sufferers to doff their shoes and massage their feet the first chance they get, possibly discovering a little bump ?- a sign of an inflamed nerve. But trying to rub away the pain isn't the best thing to do since putting additional pressure on the area can exacerbate the injury, says Judy Seto, a physical therapist with HealthSouth in Los Angeles.

Cause: The area is thought to be a prime target for problems, says Richie, since "the nerve has an extra branch, making it more likely to be pinched." Also, some feet may have metatarsal bones that are naturally closer together, leaving even less space for the nerve.

Prevention: The first line of defense is simple: change shoes. If they're on the worn side, opt for ones with more cushioning, Richie says. If you're feeling a squeeze in the forefoot, try another brand that has a wider toe box. Orthotics may help too, especially ones that distribute pressure more evenly throughout the bottom of the foot.

Treatment: Cortisone shots can shrink the nerve and reduce pain. Some doctors inject an alcohol solution into the foot to kill the nerve. Surgery, used in a few cases, removes the nerve, usually causing no serious side effects.

Capsulitis

Basketball and tennis players ?- and those with unusually high arches ?- know the feeling well: a bruised sensation in the ball of the foot that can bring pain with every step.

Known as capsulitis and caused by inflammation around the joint capsule, the condition usually occurs under the second or third metatarsal bone. Distinguishing between a neuroma and capsulitis is important in terms of treatment, but MRIs might help.

In a study presented earlier last year at the annual meeting of the American College of Foot and Ankle Surgeons, the scans altered the treatment for several, leading some to skip surgery and others to have more precisely targeted surgery. MRIs are helpful in detecting these injuries that usually can't be seen on X-rays.

Cause: Pounding on the ground on a hard surface can bring it on. Wearing hard-soled shoes can intensify the condition.

Prevention: Choose well-padded athletic shoes. "You must have adequate cushioning and your shoes shouldn't be abnormally worn. That focused, unrelenting pressure compacts the foam [in the shoe]," Richie says. Another option is to wear two pairs of socks for more padding, a trick Seto says many pro basketball players use.

Treatment: Cortisone shots can reduce inflammation and orthotics can help redistribute the body's weight more evenly.

Stress fractures

For these micro-cracks within the bone, a casual walker could be as much at risk as an ultra-marathoner ?- if both are overdoing the activity and overtaxing the feet.

Excessive running, stair-climbing or other cardio activity can leave the bone unable to adapt and repair quickly enough by building up more calcium and becoming stronger. "In a stress fracture, the body doesn't have time to adapt to the stress, and it fails by breaking down internally," Richie says. Pain intensifies over several days, he says, but without the dreaded "pop" that's usually associated with a break.

Cause: The metatarsal bones, those skinny, long bones that connect the toes to the mid-foot, are the most common spots for stress fractures because they bear much of the body's weight. Other conditions also contribute, such as high arches, which can put even greater pressure on that area.

Stress fractures can also occur in the shins. If the feet don't do a good enough job absorbing the shock from workouts, sometimes due to over-pronation, supination or plantar fasciitis, "the shockwave goes up the leg and it's now straining the bone," says Dr. Phillip Kwong, an orthopedic surgeon at the Kerlan-Jobe Orthopaedic clinics in Los Angeles and Anaheim. The heel bone is another hot spot for stress fractures. The clue is pain that radiates all through the heel that doesn't get better with time.

Prevention: Gradually increase activities, even in pursuit of a shape-up for the new year. Says Richie: "The body needs more time to adapt and recover." Those training for a marathon, for instance, should take one or two days off after long runs.

Treatment: Rest alone usually doesn't fix the problem since even a minimal amount of walking can put stress on the foot, Richie says. More drastic measures are required to give the bone time to heal, so often the foot is immobilized in a cast for several weeks.

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It sounds very similar to Morton's neuroma. Have you had a diagnosis. I haven't and assumed that's what I have.

No, but it sounds exactly right. I did go to an orthopedist decades ago, just after that time I walked many days in san francisco and could hardly walk after - and he did xrays, etc. Told me about the high arch and the way the some high arched feet can hit concrete expecially hard re the ball of the foot, and then solved my problem by suggesting a certain running shoe (they didn't make women's running shoes back then, or were just beginning to.)
Anyway, those running shoes with arch support, the smallest men's adidas I could find, fixed the problem immediately. So, I've always since followed Runner's World suggestions for my type of feet, and generally avoided the problem. I end up wearing Dansko's a lot in every day life, and Air Max sneakers when walking miles on concrete.