Hey Team!

People in my office who I have treated over the years know I like to play basketball. Morning basketball at the Jr. High was a twice-a-week behavior before social distancing became a standard. I miss the competition and the guys who consistently woke up before 6 am to watch me make baskets over them. Ha! But in all seriousness, for over ten years, I played with multiple people who love to exercise, play basketball, and are just great. I thank them.

But this is about foot pain! Ok… I'm getting there. I was playing basketball one morning and turned quickly and pushed off the right foot. I felt a quick pop and warmth to the arch under my foot. The pain was present immediately, and to put weight on the leg was a mistake. The sharp pain was present with each step, and I immediately grabbed my gear, waved to the guys, and went home. I found swelling, discoloration, and pain directly in the arch when I got home.

What happened? In short, I tore part of my plantar fascia; it was traumatic and took a while to heal properly. What did I do to heal it? (that will be a different tip for another day). I didn't expect consistent pain in the foot, ankle, and sometimes my back!

FOOT TO BACK PAIN?

Often I find pain linked to a patient's biomechanical issue with the feet. What is the source? How can the foot create ankle, knee, hip, or back pain? Let's dive a little deeper. The foot is a fantastic structure. The foot mechanics allow a transfer from a rigid lever to push to a flexible system to absorb forces… but how? I have explained in previous material the windlass mechanics and the power of this structure. In short, the Achilles tendon and the plantar fascia work collectively to assist with creating propulsion forward. As a person steps forward, the trailing foot will bend, and the big toe movement creates tension to the plantar fascia. As the plantar fascia comes under stress, the midfoot bones are pushed into a locked position, thus creating a rigid lever. (Blah, Blah) In summary… the foot is incredible because it is dynamic!

But the opposite is true as well. As the heel strikes the ground, this unlocks the midfoot bones and allows the midfoot and forefoot to become supple (or loose). As a person places more weight on the midfoot, the ankle's muscles (posterior tibialis) will slowly lower the arch to the ground. This subtle progression is called pronation.

Why the pain above the foot? Excessive pronation (over rotating) occurring from trauma can create compensation to the structures above the joint. For example, the foot will overly turn into pronation, thus flattening the foot to the floor; this makes excessive rotation to the lower leg and drives the knee inward. This movement alone can create ankle or knee pain, but what about the hip or back?

Imagine the knee being driven inward due to the excessive movement of the foot. What is happening at the hip? Picture the hip muscles along the buttocks, attempting to control the hip as the knee progresses inward. Pain occurs to the muscles of the buttocks and increases with weight-bearing activities. It sounds like a real pain in the butt-ock!

But what about the back? The back has to compensate too. With one foot flattening, this creates a pseudo-leg length difference. A leg length difference, regardless of cause, will make compensation for the surrounding structures. The low back is required to fire muscles on the shortened side, thus increasing pain towards the end of the day. This pain is a dull, nagging ache.

ONE HACK TO STOP FOOT-TO-BACK PAIN!

It sounds like we have addressed the foot mechanics well, but what can we do to address all of these pains? What is the cause of all of these issues? The arch of the foot falling! A simple solution is to prevent this motion by supporting the arch. How do we do this? Here are the keys:

• Prevent the arch from falling slowly but not too slow. The natural flattening of the arch (pronation) is needed to absorb forces, but we get in trouble when it is excessive or too fast. If we prevent all the arch motion, new pain develops at the arch.

•  A solution is to help absorb forces to the foot, ankle, and knee with some cushion.

•  Prevent falling to the arch with a shoe insert or a custom orthotic.

WHAT TO USE 

1.  Shoe Insert: Most people can use an over-the-counter foot insert such as a Sole Foot Insert to control this foot motion. These are rigid (but not too rigid) and are great for holding some mild to moderate pronation. These also have a soft pad over the insert allowing a more comfortable fit.

2.  Custom Orthotic: A custom orthotic is for people who are not getting the needed support to the foot with an insert due to excessive pronation, body weight, or repeated use (runners). A custom orthotic is a mold created of the foot, and a laboratory uses the mold to create the perfect fit for the foot. This custom orthotic can also place specific modifiers to the mold to accommodate variations of your foot.

WHAT NOT TO USE 

If an orthotic/insert is what you need… what should you not use? Do not use a heel cup or a gel insert. Both of these are gel pads only and do not prevent the foot from controlling excessive foot motion. In all… these will not work.

Overall, to return to my example earlier with my foot. I used a Sole insert to assist with my plantar fascia tear. After rehabbing the initial pain and preventing continued irritation with taping, I slowly added some arch strengthening activities and a foot insert. I used the insert when playing basketball, and I was able to return to full function. Also, people are reaching out to me regarding this newspaper column. Knowing I am helping people in our community means the absolute world to me. If you have questions about acquiring a Sole insert or a custom orthotic, feel free to call the office or email me. Thank you for your support, questions, and praise. I hope everyone is stepping in the right direction this week…pun intended. Keep Moving!

•  The author, Rob Sumner, is a Doctor of Physical Therapy and owner of Sumner Specialized Physical Therapy. He's happy to answer any questions about this article, wellness, fitness, or physical therapy overall by phone at (509) 684-5621 or by email at Rob@SumnerPT.com