Excel PT: Foot & Ankle Pain

THE NEWSLETTER ABOUT YOUR HEALTH AND CARING FOR YOUR BODY Health Tips Newsletter

FOOT FOCUSED: THE IMPORTANCE OF A STRONG FOOT CORE SYSTEM

Whether you are a school-aged child with chronic ankle injuries, a competitive athlete wanting to improve your skills, a “stand all day” hard worker with lingering back pain, or a retired grandparent concerned about changes in your balance, there is potentially a shared quality among you: a weak foot core system. (continued inside)

By Jess Hoerr, PT, DPT, ATC, Assistant Clinic Director

INSIDE : • Foot Focused: The Importance Of A Strong Foot Core System • Getting To The Bottom Of Your Sprain Or Strain

• Patient Success Spotlight • Coupon Corner!

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THE NEWSLETTER ABOUT YOUR HEALTH AND CARING FOR YOUR BODY Health Tips Newsletter

FOOT FOCUSED: THE IMPORTANCE OF A STRONG FOOT CORE SYSTEM

INSIDE : • Getting To The Bottom Of Your Sprain Or Strain • Coupon Corner!

• Exercise Of The Month • Patient Success Spotlight

low back pain.4 Foot core training has resulted in increased performance in 1-legged jump distance, greater vertical jump height, and shorter 50-meter dash time.5 Furthermore, foot strengthening can alter running performance by increases in quadriceps activation6, muscle volume, and vertical impulse.² Another essential role of the foot core is the system of sensory receptors located in the plantar fascia, ligaments, joint capsules, muscles, and tendons. The sensory system of the foot is critical to gait and balance. The alignments of the intrinsic muscles along the plantar surface provide immediate sensory information via a stretch response about changes in the foot’s posture.¹ Specific training of these muscles via a short foot training program over the course of 4 weeks has resulted in reduced arch collapse or flattened arch and improved dynamic balance.7 Research suggests that foot and ankle strength exercise training may improve balance and functional ability and reduce the risk of falls in older adults.8 In younger populations, 4-week training of intrinsic strength during balance exercise demonstrated improved function in those with chronic ankle instability.9 Continued research introduces promising interventions for foot core training, offering substantial benefits to several populations with various conditions and goals. Excel Physical Therapy can help you begin to stand strong on your feet by providing an individualized program based on your specific needs using research-proven evidence.

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Too often, the strength of the foot is completely neglected in exercise training programs. Recent research has pushed to bring attention and understanding to the importance of foot strength in treating musculoskeletal injuries and balance impairments.

By Jess Hoerr, PT, DPT, ATC, Assistant Clinic Director

The foot is a complex structure that serves many diverse functions. It is rigid, dynamic, and flexible in adapting to the frequently changing demands. 1-3 Researchers equate the foot core to the well-known lumbopelvic core, proposing that the concept of core stability can be extended to the arch of the foot.¹ Of the foot’s 29 muscles, 20 are categorized as intrinsic muscles that control movements in the foot.² These intrinsic muscles are the local stabilizers that run along the foot’s bottom or plantar surface, making up four core layers. Without proper functioning of these muscles to provide stability, the foundation becomes unstable and misaligned, resulting in abnormal movement of the foot, ultimately leading to foot-related¹ and lower extremity-related problems.² Foot core training has been found to have positive benefits for reducing the risk of injury and improving performance. Variations in foot posture correlate with pelvic alignment, lumbopelvic muscle activation during walking, and transmission of force during running, all of which can lead to

1. McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015; 49:290. Doi: 10.1136/bjsports-2013-092690. 2. Taddei UT, Matias AB, Ribeiro FIA, Bus SA. Effects of a foot strengthening program on foot muscle morphology and running mechanics: a proof-of-concept, single-blind randomized controlled trial. Phys Ther Sport. 2020;42:107-115. 3. Tas S, Unluer NO, Korkusuz F. Morphological and mechanical properties of plantar fascia and intrinsic foot muscles in individuals with and without flat feet. J Ortho Surg. 2018;26(1):1-6. Doi: 10.1177/2309499018802482. 4. Mentz HB, Dufour AB, Riskowski JL, et al. Foot posture, foot function and low back pain: the Farmingham foot study. Rheumatology. 2013;52:2275-2282. 5. Hashimoto T, Sakuraba K. Strength training for the intrinsic flexor muscles of the foot: effects on muscle strength, the foot arch, and dynamic parameters before and after the training. J Physc Ther Sci. 2014;26:373-376. 6. Kean CO, Behm DG, Young WB. Fixed foot balance training increases rectus femoris activation during landing and jump height in recreationally active women. J Sports Sci Med. 2006;5:138-148. 7. Lynn SK, Padilla RA, Tsang KK. Differences in static- and dynamic-balance task performance after 4 weeks of intrinisic-foot-muscle training: the short-foot exercise versus the towel- curl exercise. J Sport Rehabil. 2012; 21:327-33. 8. Spink, MJ, Fotoohabadi MR, Wee E, Hill, KD, et al. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Arch Phys Med Rehabil. 2011;92:68-75. 9. Sauer LD, Saliba SA, Ingersoll CD, et al. Effects of rehabilitation incorporating short foot exercises on self-reported function, static and dynamic balance in chronic ankle instability patients. J Athl Train. 2010;45:S67.

HAVE YOU FOUND YOURSELF STRUGGLING WITH ACHES & PAINS WHILE WORKING FROM HOME? NO REFERRAL NEEDED - CALL EXCEL PT TODAY! WE CAN HELP EASE YOUR PAIN!

Jason Drott, PT, DPT, Clinic Director Jason is a therapist & director at our University City cl inic location. Read his ful l profi le here: FEATURED PT

Foot and ankle pain treatment depends on where the injury happens and how long ago it occurred. If it is not possible to walk more than two or three steps without pain or if the joint looks out of place, it is important to visit a doctor as soon as possible, because a fracture may be suspected. However, within a few hours of compression wrapping and elevation, most people notice that the swelling begins to subside, and they can carry on with most of their daily tasks with minimal discomfort. However, this initial treatment of a foot or ankle sprain does not help strengthen the area and prevent injury in the future. For optimal results, it is best to consult with a physical therapist to see what the best methods would be for healing and avoiding re-injury of the affected area. Once the acute phase of the injury has passed (the point where there is pain), it is possible to prevent future injury through exercises targeted at strengthening the muscles that surround the ankle. Your physical therapist will prescribe certain strengthening exercises to regain your normal levels of function. This may include drawing the alphabet with your toes to improve range of motion, performing calf raises every time you stand at the sink, or raising your toes slowly off of the ground when you are standing in line at the grocery store. How will physical therapy help my sprain or strain? Physical therapy is designed to relieve the pain of a foot or ankle problem, improve range of motion, and strengthen your muscles so they are able to take on the shock of normal activities. While pain within your foot or ankle may subside on its own, there are dysfunctions up the chain that can last for years and lead to other injuries. For example, changes in gait pattern can result in ankle injury, making it difficult for you to move around freely. Physical therapy is the best way to make sure that these injuries do not occur. Our physical therapists will show you therapeutic exercises that target the muscles that keep the foot or ankle supported. They may even recommend a customized physical fitness program that can help you reduce stress on your feet and ankles. Whether you sustained a sprain or strain, physical therapy is the answer to achieving long-term relief. Contact Excel Physical Therapy today to schedule a consultation or to find out more about how physical therapy can help relieve your foot and ankle pains. Getting To The Bottom Of Your Sprain Or Strain

1. How did you decide to become a physical therapist and what motivates you to work with patients? My first exposure to physical therapy was following my father’s rehabilitation after a severe stroke. He spent a prolonged period in both inpatient and outpatient settings. I was immediately impressed by the compassion, skill, and knowledge that all of his therapists possessed. This was a large factor in

my decision to change careers from that of a research scientist to a physical therapist. It was during PT school that I fell in love with the orthopedic aspect of physical therapy. The outpatient orthopedic environment has been a really great fit for me. It provides me the opportunity to connect with a variety of different people and help them reach their goals, while continuously being presented with problem-solving opportunities. 2. In your words, what makes Excel Physical Therapy different from other physical therapy clinics? I believe it’s the one-to-one care that genuinely sets Excel apart from other clinics. Excel provides both the patient and the therapist an environment where time can be spent to tailor a specific program, including a lot of manual therapy, to directly address a patient’s specific needs and also be able to adjust it as necessary along the way. In other therapeutic settings, where the PT has to see several patients at a time, neither the patient nor the therapist is in the ideal environment for success. 3. What was your most memorable patient experience? My most memorable patient experiences come from helping patients reach goals they no longer thought were possible to attain. One such example was helping a woman with years of chronic back pain go upstairs again. She hadn’t been on the second floor of her house in 2 years, but also be able to lie flat and sleep in her own bed again. She said, being able to sleep in the arms of her husband again meant the world to her. 4. If you could be any animal, what would it be and why? I would be a dog, preferably a good dog, they get more treats. I really think there is a very unique and special companionship between people and dogs, and I’d be happy to be on either end of that bond. 5. If you could describe yourself in one word what would it be and why? Humorous. If you can get someone to laugh, then you can get them to like you. If they like you, they will trust you. If they trust you, they will listen to you and will ultimately rehab better. :) 6. What do you like to do in your off time, outside the clinic? My wife and I really enjoy spending a lot of time traveling, hiking, and camping with our two dogs, especially more of the latter, given the recent turn of worldwide events. Even when our one older dog was blind and not walking well, he still enjoyed all the smells of being outdoors, so we got him a doggy backpack and brought him along. I continue to enjoy running and strength training, having had been fortunate to participate in several Broad street runs and Philly marathons over the years. I also enjoy practicing and teaching martial arts, next year marking the 20th anniversary since I first started.

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“I was hesitant and doubtful when my doctor recommended physical therapy. My mindset was that a severe ankle sprain would just heal. I am so thankful I took his advice and went to Kelly Nelson, PT, DPT at Excel’s Royersford location. At times it wasn’t easy and I had a few setbacks. Kelly kept me on a regime that helped me to not only heal, but to avoid re-injury. Excel is the ONLY team I will work with in the future but hopefully I won’t have to! Thank you to Kelly and Excel Physical Therapy.” - R.F. (Royersford Clinic Patient) Don’t delay we can help you! Contact us: Downtown Philadelphia & South Jersey, Northeast Philadelphia and Lower Bucks County, Montgomery County, The Main Line, Delaware County, Chester County, Allentown, Lancaster: www.excelphysicaltherapy.com/contact-us Using a nearby wall for support, execute by standing with one foot in front touching the wall. Slowly lean forward. You should feel a stretch in your back calf. Keep your back knee locked and hold for 5-10 seconds. Repeat 3 times per leg. STANDING CALF STRETCH EXERCISE OF THE MONTH “Excel is the ONLY team I will work with in the future but hopefully I won’t have to!”

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