Biomechanical Assessments and Mobilisation

Complete Musculoskeletal Foot  Related Lower Limb Treatment Clinic

At Compleet Feet we are experts in identifying the etiological causes/ reasons why a patient has a lower limb related anatomical pain or problem, in a specialised appointment called a Biomechanical Assessment. We will instigate a treatment plan to achieve a satisfactory resolution or improvement of the presenting issues. Contrary to popular belief what a podiatrist can do to settle a musculoskeletal problem goes far beyond the feet to go right up the kinetic chain of movement to the neck.

Example: A stiff neck could be as a direct result of having stiff big toes, thus leaning forward to get forward momentum during gait or from a limb length shortening, and a head tilt.

Your feet are your foundations, and if you don’t have good footings you will get subsidence upstairs”

The positioning of feet has a direct effect on function of joints, muscles, ligaments and tendons. The body can accommodate and compensate for small structural anomalies, but over time unwanted pathologies can occur e.g. abnormal wear and tear, being prone to injuries. Simply by altering the position of the foot can make a significant difference. Even if you do not have any painful symptom the wearing of a specialised insole can be a preventive measure for the future to stop potential problems occurring.

Example: A flat foot, collapsing arch can lead to joint degenerative problems and lower back pain. Abnormal wear and tear resulting in a joint replacement procedure.

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A detailed assessment to include history, examination and diagnosis. Foot and lower limb posture and alignment are assessed.
Functional abnormalities are identified, treatment plan made and implemented.

Advice on footwear, exercises. Low level laser therapy with Erchonia XLR8 or PL Touch. Mobilisation techniques to free up foot movement. Issue of specialist orthotic insoles; off-shelf or prescription orthoses. Simple footwear adjustments. Making simple deflective/ pressure relieving insoles. Appropriately referring on e.g. Kipp Clark ( Advanced Bodyworks). We have an extensive range of orthotic insoles to select the right one for a particular issue

Improving the alignment of the foot/ feet. Support and control movement in the foot. Facilitate the correct functioning of the foot. Re-distribute weight-bearing pressures through the foot. Deflect pressure/ off-load painful areas. Control/ stop unwanted positional and functional stresses up the kinetic chain into leg.

All forefoot conditions:

  • Degenerative joint conditions e.g. hammer toes, bunions, bursitis, capsulities
  • Nerve involvements e.g. Morton’s neuroma
  • Stress fractures
  • Muscle weaknesses
  • Painful corns, callosities resulting from poor function or alignment

Mid- foot conditions:

  • Plantar fasciitis/ arch pain, ‘dropped arches’, tendon ganglions
  • Degenerative joint conditions
  • Subluxed cuboids
  • Styloid process pain/ stress (base of 5th metatarsal)

Ankle and Rearfoot Conditions:

  • Weak/ unstable ankles
  • Post-ankle sprain/ injury pain
  • Degenerative arthritis
  • Posterior Tibial Tendon dysfunction issues
  • Positional/ alignment issues
  • Tendo-achilles problems
  • Severs Disease
  • Heel pain
  • Posterior heel ‘bumps’/ Haglands Deformity
  • Shin splints
  • Calf strains
  • Knee pain/ injuries
  • Hip pain
  • Hamstring issues
  • Hip pain
  • Lower back pain

Yes, we treat all sporting activity and dance related presenting problems.

Yes, we treat children.

Prices vary at each clinic:

Alton

Biomechanical Assessment  Adults                                                   £55.00

Biomechanical Assessment Children                                                 £50.00

Southsea

Biomechanical Assessment  Adults                                                   £50.00

Biomechanical Assessment Children                                                 £45.00

Additional costs for any orthotic insoles or materials issued.

Simple shoe and orthotic adjustments                                        From: £8.00

Orthotic insoles ‘Off-shelf’                                             From: £25.00 – 55.00

Prescription Orthotics, inc.casting, fitting, review  appointments          £260.00

 

 

 

Southsea

Foot Mobilisation and Manipulation

We combine foot mobilisation and manipulation techniques taken from physiotherapy and osteopathy to help restore movement and function in the foot and ankle. We have a thorough understanding of foot anatomy and function to resolve niggling aches and pains which don’t respond to other treatments. Maybe a joint articulation is stuck or out of alignment which will have a knock- on effect to gait. After a treatment, your foot (feet) will feel more relaxed, with increased movement around the joints and reduced pain.

  • Aching feet
  • Stiff joints
  • Flat feet
  • High arched feet
  • Bunions
  • Knee pain
  • Problems adjusting to orthotics
  • Unlocks stuck joints
  • Reduces pain in both joints and structures that cross the joints
  • Improves movement patterns immediately
  • Changes neurological input and output from a joint
  • Can be used as part of your podiatry biomechanical treatment programme
  • Applied as a course of 3-6 treatment sessions

Heel pain, policeman’s heel, plantar fasciitis…whatever you choose to call it, it is a common condition that can really impact on your day.  In my clinic, I see at least one person every day who is complaining of heel pain which limits or severely impacts on their daily activity.

So….what is it?

Our foot is a complex structure made up of 26 bones and many tendons and ligaments.  The structure encased on the plantar aspect (bottom of the foot) by a tight band called the ‘plantar fascia.’ The band spans the length of the foot from its main insertion at the heel, to the many insertions it makes at the toes.  Injury to this band causing pain is called ‘plantar fasciitis’ (PF).

PF is caused due to overload of stress. The feet support the weight of our whole body and allow us to move.  The injury can be caused by different factors in different people and can either be chronic (long term) or acute (sudden onset).  Understanding why it happens can ensure you get the best treatment for your condition.  The current thinking is that osseous bone spur formation is a direct result of the body trying to increase the weight bearing load area of the heel bone (calcaneum).

Chronic

Imagine the plantar fascial band is like an elastic band. With every step that you take that elastic band stretches and contracts. This pressure over man steps can cause a small inflammation at the insertion, then the repeated following steps cause more and more micro trauma to the area.  This results in pain and inflammation over a long period of time.

Acute

A change of activity or footwear that puts a vast amount of pressure through the band of fascia causing overload and injury.

Heel spur

In chronic PF, the pull of the plantar fascial band on the heel bone (calcaneus) can cause the bone to ‘over heal’ itself and causing a calcification around the insertion point of the band.

So…what causes it?

Many different factors can cause PF, and causes vary from person to person.  Essentially the cause always has a biomechanical root, ie the foot is not functioning optimally for the task that it is trying to carry out.  Common causes are:

*overpronation/ “flat feet”

*Incorrect footwear

*muscle tightness in the calf/hamstring muscles groups

*muscle weakness in the foot

*change of activity e.g. taking up a new sport

*weight gain

*climbing ladders/carrying heavy objects

Treatments

Treatments can vary from person to person.  Every person with PF can benefit from a biomechanical assessment with a podiatrist.  This will look at how your feet function on their own, and in relation to the rest of the body. Following on from this the practitioner will often:

 

  • Prescribe orthotics

 

These are specialist insoles which are worn inside your shoes and help to ensure the foot functions correctly.  They also help to hold your foot in an ‘at rest position’ meaning pressure is relieved from the area.

 

  • Stretch and strengthening programme

 

Calf stretches are important in every person suffering with plantar fasciitis.  If the calf muscles are elongated, this releases the upward pull of the calf muscles onto the heel so can ease the restriction.  Strengthening of the muscles that support the arch is also important.

 

  • Ice and rest

 

It is important to rest the area from your sporting activities as much as possible, and to not continue through the pain as this can do further damage and mean treatment takes longer.  Aim to Ice the area 1-2 x daily.

  • Taping and strapping

Kinesio tape can be very effective in helping to alleviate the pain caused by PF.  Zinc oxide tape may be used to strap the heel in certain cases.

 

  • Low level laser therapy

 

Low level laser therapy (3LT) can accelerate and  enhance healing. 3LT has an FDA market  learance to be effective in the treatment of plantar fasciitis. The application of healing  red 635 nm wavelength can increase cellular energy; adenosine triphosphate (ATP) to initiate   release of growth hormones, fibroblasts, collagen and elastin renewal.

  • Soft tissue and joint mobilisation

When we have pain, our body ‘tenses up’ and therefore movement is restricted.  With restricted movement you can then have ‘new pain’ as the foot function is impaired.  By mobilising the joints and soft tissues, the foot is able to function optimally. The blood flow can improve which also means healing is accelerated.

 

  • Footwear advice

 

Ensure all sports shoes are always fitted correctly in a reputable sports shop.  Bring a selection of footwear to a biomechanics appointment so that the podiatrist can give you advice on what footwear is best while you recover. Important to wear a small heel to alleviate traction stresses on fascia.

 

  • Rolling

 

You should aim to roll your foot on a golf ball or frozen water bottle daily to try and release muscle pressure in the area.

 

  • PRP Injections

 

Platelet rich plasma therapy is very effective in the treatment of plantar fasciitis. Injections of concentrated plasma made by a patient’s own blood being centrifuged can be injected safely into the area around the plantar heel fascia insertion to stimulate repair. PRP is a concentrated source of growth factors and bioactive proteins required for healing.

  • Cortisone Injections

Steroid injections can be performed under ultrasound to treat plantar fasciitis, but these are a last result until all conservative methods have been tried. It is important to treat the cause of plantar fasciitis e.g. address poor biomechanics and not just the symptoms.

  • Shock Wave Therapy

Shock wave therapy is literally what it says on the tin. Applying targeted shock wave energy  directly over the painful heel area to cause an analgesic effect and encourage healing responses.

But Remember! Each patient is different and each person will take different lengths of time to recover, some recovering quickly, some taking a bit more work.  This is the same with any injury, but patience and perseverance are the key to success.

Kristina Kanyuka

I recently read two brief articles in the paper questioning whether barefoot running is a good thing over wearing trainers and whether running is a precursor to osteoarthritis? In my experience as a podiatrist both these are greatly dependant on whether the individual has great biomechanics to start with. (more…)