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Heel Spurs – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors

Heel Pain ICD-9 719.47  Heel Spur ICD-9 726.73 Heel Spurs – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors Tips For Better Health Ask the doctor, Dr. James Stoxen DC In this article is everything you ever wanted to know about Heel Spurs and more! Do you think you […]

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Heel Pain ICD-9 719.47  Heel Spur ICD-9 726.73

Heel Spurs – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors

Tips For Better Health

Ask the doctor, Dr. James Stoxen DC

In this article is everything you ever wanted to know about Heel Spurs and more!

Do you think you have a Heel Spur because you have Heel Pain?

Does a heel spur even cause heel pain? Maybe the pain your having is plantar fasciitis?

What is a Heel Spur, Foot Spur or Calcaneal Spur?

A Heel Spur ICD-9 726.73 is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). They are attributed to chronic local inflammation at the insertion of soft tissue tendons or fascia in the area. Heel spurs can be located at the back of the heel or under the heel, beneath the sole of the foot.

Heel spurs can occur alone or be related to underlying diseases that cause arthritis (inflammation of the joints), such as reactive arthritis (formerly called Reiter’s disease), ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis.

It is important to note that heel spurs may cause no symptoms at all.  You might not recall any heel injury or trauma, which would have caused a bruised heel. and may be incidentally discovered during X-ray exams taken for other purposes.

Heel spurs are also called, foot spurs, bone spurs or a calcaneal spur, which in medical terms is a calcaneal exostosis, bone spurring of the heel or an osteophyte.

What are osteophytes?

Osteophytes take many months to years to form.  You may feel no pain at all in the beginning and all of a sudden you wake up and say “my heel hurts”!

What are the symptoms of a heel spur?

Heel spurs start as a pain on the inside of the foot at the sole of the foot in the media aspect of the base of the heel.

It usually starts in the morning as sharp pains in the heel with the first few steps, which feel like someone is stabbing your heel.

As the day goes on usually the pain eases up to be just a sore heel pain.

They are associated with plantar fasciitis (plantar fascia is the connective tissue from the ball of the foot to the heel but can occur alone.

They are found mostly in middle-aged women and men but are common in younger people as well.

Few people get plantar fasciitis under 25 but more lately have been getting this condition.

I feel the reason for this is because footwear design is towards softer materials, which lack support. People are carrying more weight on their feet (overweight or obese) and most do not get enough of the right exercises.

How do you diagnose heel spurs? 

When you present to the doctor pain in the bottom of the heel, there are a number of conditions this could be, such as:

  • Plantar fasciitis-  This is usually pain which is worse in the morning and commonly felt after prolonged sitting or standing
  • Plantar fascia rupture – When the plantar fascia ruptures you will notice a fairly noticeable drop in your arch on that side with the over rolling of the foot in pronation
  • Heel pad atrophy –The heel fat pad has some role in shock-absorbing on the landings with each step.  How much of a roll has not been determined however some feel that the loss of thickness of the heel pad have can be a source of heel pain.” I really have never seen this to be the cause in any one of my patients with heel pain.
  • Tarsal tunnel syndrome – this is different from heel spurs or heel pain as it is accompanied by pain, numbness or tingling in the heel radiating ONLY into the foot.  If numbness is above the ankle it is coming from somewhere else above.
  • Neuroma – This growth should be diagnosed with MRI.
  • Bone cyst – This cyst of the heel should be diagnosed with x ray and or MRI.
  • Osteomyelitis – This infection of the bone should be diagnosed with x ray and or MRI.
  • Heel Fracture – This should be diagnosed with x ray and or MRI.
  • Stress fracture(s) This should be diagnosed with x ray, bone scan or MRI.
  • Tumor - This should be diagnosed with x ray and or MRI.

The diagnosis is made with an x ray of the heel spur from the side or a lateral film.  

However, just because your doctor sees the obvious spur, it does not mean the spur is the cause of your pain.  Remember, spurs take years to develop so if your heel pain is recent (even months old) then the spur is only evidence that inflammation has been in the area for a long time but not necessarily the reason for your heel pain.

Just because the doctor sees no spur on the x ray around a painful and inflamed heel does not stop doctors from calling it  heel spur syndrome.  I don’t call it  heel spur syndrome unless there is a heel spur on the x ray but every doctor is different.

Doctors feel that this osteophyte formation is a calcium deposit, build up on the heel bone from tissue around the heel stretching.

The heel spur or osteophyte does not cause the pain.  In fact, over 50% of heel spurs are painless.

When the area around the heel spur is under abnormal stress it becomes inflamed causing heel pain or calcaneus pain.

Heel pain leads to them walking on the balls of the foot.   When you walk on the balls of the feet to compensate it causes more pain because it pulls the fascia aggravating the plantar fasciitis more leading to more inflammation and calcium deposits on the spur.

How do you know how old a spur is?

The size of the spur can determine how old it is.

Then we can determine better when the spur started to form and that sometimes leads us to what caused the spur.  This is easier in an area of the neck or lower back.

When I started reviewing x rays of the neck, lower back, shoulders etc, I would see calcium spurs in the spine of various sizes.

Then I would ask the patient “Did you have an auto accident, whiplash, sports injury or fall in your past where you ended up with neck pain?

Over the years I noticed that the older the injury the larger the spur.  Soon I was able to predict within a few years when the patient had their injury based on the size of the spur.

A heel spur is different from arthritis spurs in that the spur does not form around a joint.

Heel spurs are NOT the cause of the heel pain!

I have never seen a case where the spur was the cause of the pain.  We know this because after a few weeks the patient is pain free for 6-10 weeks of active rehabilitation but the spur is still there.

Spurs do not cause pain.  They just tell you how long the area has been inflamed.

Evidence of this is with thousands of patients we note with back spurring, osteophytes or back spurs found on x-rays in areas that have not had pain in twenty years.  You ask them if they had an injury 20 years ago and they can reflect on the exact injury.

Commonly they got relief and it had not hurt for 19 years then the area got aggravated recently prompting the visit to our center and the medical necessity for the x rays.

When you consult the American Podiatric Medical Association, they say that heel spurs are caused by strain on the muscles and ligaments of the foot and by stretching of the plantar fascia, which is a fibrous band of tissue that connects the heel and the ball of the foot.

It is normal for the body to lay down scar tissue, which calcifies.  In a protective response, on the heel bone where it attaches to the plantar fascia.

We have to understand why spurs develop and that will lead us to the cause.

Spurs develop when the body tries to protect or repair itself.  From pressure, pulling, rubbing or stress over years of abnormal motion.

What causes the spur to form?  

This is still up for debate.

Without the obvious heel injuries it is hard for many to understand why the heel hurts.  Without trauma, it is sometimes difficult for the doctor to understand why your heel hurts too.

So, x-rays are taken to determine why a patient has pain symptoms in the heel at the sole of the foot or a swollen foot and that is when the doctor detects the heel spur.

People think the pain comes from the sharp spur digging into the fascia but this is a misunderstanding.

It is estimated that 70% of patients with plantar fasciitis who do have discomfort will also be found to have a heel spur when observed via x-rays.

The spurs look sharp on the side x ray but the pain does not come from the spur stabbing the tissue.  It comes from the stress on the heel.

  1. Where the plantar fascia, tendons of the foot, or ligaments of the foot are too tight
  2. Some doctors feel it is from tiny stress fractures in the base of the heel.

What are the risk factors for heel spurs?

  • Shoe selection – You have a history or wearing high heels which maintain the Achilles in the shortened position stressing the arch.
  • Shoe selection – You have a history of wearing flip-flops or sandals that force you to dorsiflex the foot to prevent the flop or sandal from falling off your foot.
  • Plantar spurs may be a more modern phenomena resulting from long periods of standing and excess weight. (1)
  • Having weak feet and ankles – There are many causes of weakness that cause the foot to roll into over pronation.
  • Being pregnant, overweight or obese – Too much weight for the feet and ankles to support.

Where is the plantar fascia and what does the plantar fascia do?

This fascia attaches to the three main points of the foot (the heel or calcaneus, first, second, third, fourth and fifth meta-tarsal heads) to form the arch.  This fascia is key to allow you to step down, move the weight of your body across the foot and to push off when you step.

According to research, scientists feel it only holds up 14% of the weight of the arch.  Obviously some other structures hold up the other 86% of the load of standing, walking and running.  In my opinion since it is not a contracting structure I don’t think it holds any of the load. Since there are no contractile elements like the muscles it must work via elastic recoil like a trampoline.

I feel the fascia is like a safety net that catches the load when the spring suspension system muscles are not doing their job.  That also explains what happens when you have severe plantar fasciitis and the doctor cuts the fascia, the arch falls.

The conditions doctors say increase tension on the plantar fascia are acquired flat feet (pes planus), high arch (pes cavus), stiff or locked ankle joints and a tight Achilles tendon.

So I guess only those with arches that aren’t too high or aren’t too low are less susceptible to these heel spurs. That seems like everyone, doesn’t it?

You know why I disagree with this theory.  Telling a patient that because they have a high arch that is the reason for their heel spurs is a cop out for a thorough exam to determine the true cause.

Also if you have had high arches all your life why do you suddenly feel pain one day and it’s a heel spur?

This is what doctors who believe in the lever model feel is the cause of plantar fasciitis and heel spurs:

  • Walking patterns that put abnormal stress on that area of the heel bone (I agree)
  • Excess weight, obesity pregnancy (I agree)
  • Standing on feet for long periods (I agree)
  • Sudden increase in mileage (I agree)
  • Sudden increase in speed of walking or running (I agree)
  • Increasing age which decreases the plantar flexibility and fat pad  (I disagree)
  • Running on hard surfaces (I disagree)
  • Inadequate flexibility of the Achilles muscle group (I disagree ) This is not the only muscle group to focus on)
  • Shoes lacking arch support (I totally disagree)

What it could mean is that the abrupt bang of the foot on the ground may be the cause of degeneration of the attachment of the fascia to the bone.

These are the standard treatments recommended by doctors who agree with the lever model and my opinion of them.

Pain symptom treatment involves relieving what causes the inflammation that leads to the pain.  Here are the standard treatments that you may be offered by your doctor.

  • Rest the feet – Rest is necessary at times to reduce the stress to allow the area to heal.  However if the reason why you have too much stress in your heel area is from a weakness in muscles and tendons that take the load off this area then too much rest makes them weaker.
  • You could ice the area with an ice massage.  I would recommend this to decrease inflammation and pain.
  • Some doctors recommend over the counter anti-inflammatories.  I don’t recommend these as they can have side effects with prolonged use.  I would recommend fish oil, turmeric and other natural anti-inflammatories instead.
  • Some doctors prescribe you anti-inflammatories.  The reason why you need a prescription for these drugs is because they come with risks or side effects with prolonged use.  We have good results without them so why take the risk.

Inflammation is the healing process for the stress that is damaging the tissue. Instead of slowing the healing process why aren’t you focusing on what is causing the damage to the tissue and correcting that?

  • Some doctors just give patients an injection of cortisone for the pain around the heel spur.  As you know cortisone has major side effects.  Did you ever wonder why you are not recommended more than three shots in your lifetime?  In the case of plantar fasciitis the negative reaction can be serious and make it worse.  You could more easily rupture of plantar fascia causing the entire arch to collapse requiring pretty radical surgery.
  • Some chiropractors, massage therapists, physical therapists and athletic trainers recommend deep tissue massage treatments.  This will help but to get maximum medical benefit you MUST be specific with your application and location of the massage around the tibialis posterior, the muscles surrounding the first second and third metatarsal cuneiform joints (arch muscles) and the muscles above like the TFL, gluteus medius, adductors and other stiff sore spasmed muscles.
  • Doctors and trainers recommend stretching exercises and specifically stretching the calf muscle thinking that the calf (Achilles tendon – gastrocnemius and soleus) is pulling the heel up causing more tension on the fascia.

What if the Achilles muscle and tendon complex is tight because it is overloaded because the muscles that normally work with the Achilles are not doing their job (tibialis posterior).

Science has found that the plantar fascia only provides 14% of the support of the arch.  If the arch is under stress then there are other structures that provide the other 86% of the support to focus on

Therefore, if you only stretch the Achilles as your approach to releasing stress on your plantar fascia, its usually ineffective.

  • Many doctors and trainers recommend shoes that are softer.  They seem to think that the soft shoe will be like a pillow for the spur.  We already know that it is NOT the spur that is causing the pain.  The abnormal stress on the heel area is causing the pain.  If the shoe is too soft it cannot prevent the over rolling of the foot into over pronation which is what most researchers feel is what causes most abnormal stress on the tissues of the foot and above.
  • Some recommend taping the foot.  We all know that when athletes play football they are taped before the game and then again at halftime because the sweat and movement weakens the support function of the tape.  In fact many trainers think tape is only good for a half hour of rigorous activity.  Are you going to keep replacing the tape every hour of the day?
  • Doctors and trainers recommend shoe inserts or orthotics.  Doesn’t it seem like the arch support-orthotic would actually inhibit the spring loading shock absorption you need to resist the impact force safely into the arch of your foot that would protect your fascia from stress?
  • Some doctors and web sites recommend a night splint.  Splints put a constant stress on tissues.  Researchers found that constant stress on tissue leads to plastic deformity over time.  Tissues like the stress to be on and off as in a healthy contraction of the muscle.  Tissues respond to constant strain by plastic deformity.  These splints are uncomfortable and the theory behind them goes against the laws of nature.  I have never heard of a patient improving with these devices.  
  • Some surgeons do low-dose radiotherapy- A total of 502 patients treated between 1990 and 2002 with low-dose radiotherapy (RT) for painful heel spurs were analyzed for prognostic factors for long-term treatment success. Overall 8-year event-free probability was 60.9%.  Overall low-dose RT is a very effective treatment in painful heel spurs. (3) Does this treatment address the cause of the additional damaging stress in the area of the heel?  No
  • Some doctors surgically remove the spurs. I really don’t know why they remove the spur when it is believed it is a sign of chronic inflammation but not the cause of chronic inflammation and pain.  I guess they have some way to know that this is one of those rare instances where the spur must be removed.  I have never recommended this procedure.
  • Some surgeons recommend surgery called a plantar fascia release if the condition does not resolve when all else fails.  Who knows what was done before the surgery to determine what ‘all else‘ is.

I’ve seen where the doctors gave up and did the fascia release after a few cortisone injections with little to no physical therapy and recommendations that would actually increase stress to the area rather than decrease it.

Why plantar fascia release could be a very bad idea? 

Science has found that the plantar fascia could provide 14% of the strength to support the arch.  We already know there isn’t enough support for the arch because we have too much stress on it.  Why would you cut a structure that is assured to make the area even weaker?  Plus, you will not be able to walk normally for a few months making the area even weaker.

My warning to you is that fascia release surgery, cutting the plantar fascia, leaves the arch of the foot with less support leaving it at risk to drop causing more complications not only in the foot but up all 7  floors of the spring.

The plantar fascia serves an important function!

Complete rupture or surgical release of the plantar fascia leads to a decrease in arch stiffness and a significant collapse of the longitudinal arch of the foot. By modeling it was predicted such conditions would result in a 17% increase in vertical displacement and a 15% increase in horizontal elongation of the foot when it was loaded at 683 newtons (154 lbf).[1] Surgical release also significantly increases both stress in the plantar ligaments and plantar pressures under the metatarsal heads. Although most of the figures mentioned above are from either cadaver studies or investigations using models, they highlight the relatively large load the plantar fascia is subjected to while contributing to the structural integrity of the foot.

The plantar fascia also has an important role in dynamic function during gait.  It was found the plantar fascia continuously elongated during the contact phase of gait. It went through rapid elongation before and immediately after mid-stance, reaching a maximum of 9% to 12% elongation between mid-stance and toe-off. (2)

During this phase the plantar fascia behaves like a spring, which may assist in conserving energy. In addition, the plantar fascia has a critical role in normal mechanical function of the foot, contributing to the “windlass mechanism”. When the toes are dorsiflexed in the propulsive phase of gait, the plantar fascia becomes tense, resulting in elevation of the longitudinal arch and shortening of the foot (see 3A). One can liken this mechanism to a cable being wound around the drum of a windlass (see 3B); the plantar fascia being the cable, the metatarsal head the drum, and the handle, the proximal phalanx. Therefore, the plantar fascia has a number of roles, the most important of these including supporting the arch of the foot and contributing to the windlass mechanism.

  1. ^ G. A. Arangio, C. Chen and W. Kim (June 1997). “Effect of cutting the plantar fascia on mechanical properties of the foot”. Clinical orthopedics and related research (339): 227–231. PMID 9186224.
  2. ^ Amit Gefen (March 2003). “The in vivo elastic properties of the plantar fascia during the contact phase of walking”. Foot & ankle international 24 (3): 238–244. PMID 12793487.

There are too many things in these approaches that don’t add up.

First, can bone spurs go away? 

Second, do I need surgery to remove the spur from my foot?

The answer to both of these questions is NO!

The spurs wont go away and because the spur is not the cause of the pain.  We do not have to remove or dissolve them for your pain to go away.

The spur, itself, does not require treatment.

Many doctors say heel spurs come from a constant stress pulling on the fascia.  This may be true but it doesn’t explain some unexplained mysteries of this stress on the fascia and how it creates bone spurring.

Also the approach to treatment may not be the ideal approach for you.

What is interesting is that doctors find these heel spurs mostly on the medial or inner portion of the attachment of the plantar fascia to the heel.  If the entire plantar fascia was stressed the heel spur would span the inner (medial), central and outside (lateral) portions of the fascia attachment of the heel(see illustration)  

If the medial portion is more associated with the first, second and third toes then what is the connection between plantar fasciitis and these toes?  This could solve part of the mystery why the spur is mostly in the medial area and allow us to be more specific with our treatment and prevention.

How The Human Spring Model Explains Plantar Fasciitis and Heel Spurs

In order to understand what I am proposing, we have to understand the body as a human spring vs a human lever.

We also have to understand two simple principles of the physics of materials specifically, human tissue to “get this.”

There is the school of thought that the body moves through a series of levers.

Then there is the model I developed, the Human Spring Model which says the body moves, recycles energy and protects itself as a giant integrated spring mechanism

This article will explain the differences the human spring and human lever model.

Many “lever model only” thinkers believe impacts will injur the body.

That is why they recommend cushioned shoes for all running activities.

First, I will agree with the human lever model school of thought that the abnormal impact stress is what leads to plantar fasciitis and heel spurs.

The key word is “abnormal” impact stress.

Normal impact stress is good for the body.  We adapt to it and that is how we get stronger.

In fact, elite athletes and even students in grade schools are now doing high impact training to bolster explosive power by conditioning the body to react elastically.

They call it plyometrics and it’s employed at every training center in the world from the Olympic training center and currently the grade schools. I learned the principles of plyometrics from the father of modern plyometrics, Yuri Verkhoshansky, at the Central Institute of Physical Culture and Sports Sciences, in Moscow, USSR, in 1989, when I was 27 years old.

You can read about it in the Post Video Tutorial #3 – The Human Spring Approach – Developed From Studying Yuri Verkhoshansky Plyometrics Training In Moscow 1987-89, click to view

Why have we been brainwashed into thinking impacts are bad for us and why are we paying huge dollars for impact resistant soles for running shoes, orthotics, gel inserts etc?

If these impact resistant soles are required to protect you from impacts then how would you explain why this 50 year old doctor who stands on his feet all day, night and on the weekends, runs barefoot on solid concrete or asphalt for 6200 impacts (6.2 miles 10 K) of 560 pounds per impact routinely with no shin splints?

To understand why I run barefoot,  click here

In fact, I run barefoot on hard surfaces to strengthen my human spring mechanism to be more capable of handling greater impact forces safely, resist aging and prepare my body for my later years.

Human spring model thinkers, believe impacts strengthen the body.

Watch the video above as Dr. Stoxen explains How the spring suspension system muscles help you spring off the ground!

In reality, impacts strengthen the spring as long as the spring is intact and can handle the force of the impact.

What causes the abnormal stress that leads to the heel spurs?  

This is the key to eliminating them!  

The reason why you have stress on your shin muscles and shin bone causing shin splints and stress fractures is because there is too much stress there.

Can we agree to that profound statement?

When I examine patients with plantar fasciitis and/or heel spurs the first thing I notice is the over pronation landing or a rolling from supination (outside of the foot) to pronation (inside of the foot)

What protects barefoot runners from impacts?

Its the same thing that protects shod runners!

______________________________________________________________________________________

Allow me to introduce you to your human spring.

What is the difference between an intact or locked spring?

  • When your spring mechanism is intact, you spring off the ground.
  • When your spring mechanism is locked, you bang into the ground!

The natural spring mechanism is integrated into all 7 floors of the human body.

Essentially, the human body is a giant spring with 7 floors of springs;

  1. The arch
  2. The subtalar joint
  3. The ankle mortise
  4. The knee
  5. The hip
  6. The spine
  7. The head-neck

________________________________________________________________________________________

The plantar fascia is a fibrous gristle-like tissue with three portions—medial (inside), central, and lateral (outside).

The plantar fascia contributes to support of arch of the foot by acting as a tie-rod, where it undergoes tension when the foot bears weight. One biomechanical model estimated it carries as much as 14% of the total load of the foot.

What provides the remaining 86% of the load of the foot?

There are two mechanisms that allow the body to function as a spring:

  • The configuration of the arch with the 26 bones and the ligament attachments, which includes the plantar fascia.
  • The spring suspension system which is composed of the muscles and tendons that attach on the under surface of the arch.

The human spring model states that the body is protected by a spring mechanism that can absorb high force impacts through positive adaptation (training).

This can be done through the combined training approach of the body as a lever mechanism through progressive resistance exercises of the spring suspension system and as a spring through spring training such as multi-direction running drills, jumping drills and/or plyometrics.

First we have to agree that impact stresses are good for the body as long as we have an intact spring mechanism.

When are they not? – when the forces are taken up by tissues and not the spring.

This would be the plantar fascia and specifically the inside portion of the fascia that attaches to the first 2 or 3 toes.

For your foot-human body to absorb the force of the landing must function via elastic deformity vs plastic deformity.

Don’t worry this is not complicated and in fact it’s a simple concept that will help you make sense of all this.

Elastic Deformity vs Plastic Deformity

Define elastic deformity 

  1. The foot and body deforms it shape to accommodate the force of the impact into the spring mechanism
  2. While it is deforming its shape it is also storing energy in the elastic elements and the shape change
  3. Then when all forces are fully absorbed and the spring reaches maximum depth it begins its return to its EXACT ORIGINAL SHAPE. The ability to reform back to its EXACT ORIGINAL SHAPE is important because this is the key to being able to walk, run and perform sports for a lifetime
  4. As it fully reforms it fully releases the stored energy
  5. Elastic deformity of your body is how you recycle energy and maximum protection from impacts and the preservation of your joints for a lifetime
  6. If your spring is fully released of muscle tension and joint stiffness or locking, fully flexible, strong enough, to absorb the impact force with enough endurance enough to absorb the amount of impacts you are using then you achieve 3 things:

When you exercise with a healthy spring mechanism, you cannot get shin splints. In fact here are the benefits to living with an intact healthy spring.

  1. Each impact stress will make the spring stronger
  2. You are at maximum performance efficiency (using spring elastic elements vs muscle lever pushing elements)

Yield

Notice on this graph ELASTIC DEFORMITY vs PLASTIC DEFORMITY how there is a point the body gets to a yield point. The yield strength or yield point is defined in in engineering where the amount of stress or kind of stress on the material begins to deform it plastically (permanently)

Prior to the yield point the material will deform elastically (snap back) to its EXACT original shape when the applied stress is removed (When you toe off). Once the yield point is passed, some fraction of the deformation will be permanent and non-reversible. We call this aging.

  • True elastic limit – Up to this amount of stress, stress is proportional to strain your human spring can handle without remodeling your tissues. This means below this level you don’t get enough stress to improve your tissue strength
  • Elastic limit (yield strength training zone) – This point and up to the deformity is when your muscles, ligaments, tendons and bones reorganize into a stronger mechanism. This is the zone you want to train in.
  • Yield point – This is when your tissues damage by a negative stress It is a negative plastic deformity permanent damage occurs with every step or impact – ligaments stretch, discs weaken and bulge, discs degenerate, scar tissue infests elastic elements and muscles, spurs form, bones bend (bunions), micro stress fractures, shins splint, muscles ligaments tendons strain or pull, things start to stiffen and hurt.
  • Failure Strength – this is when bones break, discs instantly herniate, meniscus tears, ankles sprain, muscles rip, tendons avulse or tear, ligaments tear

What is a plastic deformity that results from stress that overloads the arch and plantar fascia that attaches around the heel?

            A heel spur!

Spurs form as a natural process of repair from repeated abnormal stress or stress when the human spring is not functioning in elastic deformity state.

The body lays down extra calcium at the site of the stress deforming it permanently or causing a plastic deformity.

Here are the various impact forces of landings:

  • Walking (1.25 x bodyweight)
  • Jogging 1.25 – 3x bodyweight
  • Running (3x bodyweight)
  • Plyometrics (3-5x+ bodyweight)

If you want to avoid heel spur pain you must make sure your spring suspension muscles are strong enough to absorb the forces of the impacts at the speed you want to travel.

You will learn how to test for this in the post below;

Video Tutorial #12 Is Running Bad For Your Knees? How Does The Body Spring Back Safely From Impacts Of Running and Walking?, click here

Video Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running. click here

Examining a Patient For Heel Spurs with The Human Spring Approach

I start my examination of the painful foot with an inspection of the patient’s foot while they are lying down.

Im looking for swelling in the foot, deformities such as bunions, calcium deposits, specifically above the metatarsal cuneiform joint of the first toe area, discoloration such as brown patches, bruises or cuts.

Then I ask the patient to come out to our gait evaluation walkway and I video tape them in a weight-bearing positions such as standing, walking at a normal pace, walking fast and for some, running speeds.

I review the walking pattern on the video on the computer by moving the video frame-by-frame discussing with them how the force of the impact and transfer of weight into the legs is accepted by the feet and legs.

When you observe your walk you can check for abnormal pronation from rolling too far from supination to pronation or if the foot lands in an over pronated position.

You can also check for other biomechanical irregularities. Observation of your foot while walking may allow you to understand obvious clues to why there is too much stress in your heel.

This may seem very difficult to understand but it is really not. That is because often times the painful foot moves far different from the non-painful foot on impact.  Many patients pick up on the abnormal stressful landing before I even point it out.

When the foot strikes the ground all 33 joints must have full springiness, joint play and mobility.  Any excessive movement, stiffness or locking of any one of these joints can lead to abnormal stress on the area.

After we evaluate your walk we go into the room and evaluate the motion of all 33 joints to see if any of them are stiff, locked or moving too much.

Here is what I have observed clinically in patients with plantar fasciitis and heel spurs:

What I find over and over with patients with painful heel spurs:

  1. A stiffness or locking of the inside portion of the first metatarsal cuneiform joint, the second and third metatarsal cuneiform joints or what I call the arch spring!
  2. A weakness in the middle spring suspension system muscle of the arch spring of the foot (the tibialis posterior muscle).
  3. The weakness of this middle spring suspension system muscle causes the foot to either roll too far out of the safe range into over pronation or it lands in the already over pronated position.

This bang of the foot with the medial portion locked is what I feel causes the plantar fascia structure to become inflamed with constant standing, walking and running.

The first recommendation I have for you is to take a careful look at your walking form and technique to see if there are any signs of weakness or locking in the human spring mechanism.

Make your video of you walking towards and away from the camera for 10 feet or so at a normal walking pace then a second pass at the fastest walking pace you can do without running.

Watch it back advancing the movie slowly frame by frame.  What do we see?

  1. Tension On The Arch And Limb On Impact – Are your feet, shins and legs relaxed prior and during impact?  At impact and while transferring the weight across the planted foot are any of your toes pulled back before impact or after impact are any of the toes not touching the ground?  Does your calf shake when it hits the ground (from the back)?  Do you push or pull your body across the ground or spring your body off the ground?
  2. Foot Misalignment – Does your foot land with the second toe pointing the direction you are going?
  3. Foot/Heel Rolling Into an Unsafe Stressful Position Are your shin, ankle and foot in alignment or do you have weak or weak ankles? (Over pronation / over supination).  Does your foot land in the already pronated position?
  4. Do you walk heel-toe or land heel first?  There is no spring there.  The impact goes bone (heel) to bone (talus) to bone (shin) the spring suspension system is in the middle/front of the foot!

What maintains the spring in the arch are:

  1. The spring suspension system muscles that support the arch mechanism as a sling from above and the intrinsic muscles of the foot that maintain the arch.
  2. The 26 bones and 33 joints and their connecting elastic ligaments that make up the arch configuration.
  3. The fascia – Remember that fascia does not have contractile elements.  Therefore they are only stretched with the first and second line of defenses being the arch spring and the spring suspension system muscles have been exhausted.

Gait corrections

If you see any flaws in your walk or run then you MUST work on your walking and running form and technique.

#1   Tension On The Arch And Limb On Impact   Use Mind Body Relaxation – prior to landing your foot, relax the muscles of the shin and the rest of the limb so that the impact can enter the spring mechanism of your body without internal compressive force on it from tension.

The lack of spring in the arch causes an abrupt impact, which may be the source of the stress that leads to the inflammation and pain in your heel.   Because the spur is mostly found in the medial aspect of the plantar fascia it makes sense to unlock or loosen up the metatarsal cuneiform joints of metatarsal one, metatarsal two and metatarsal three.

What I have found is that fascia can be treated just like muscles and ligaments with deep tissue work.  I recommend the deep tissue spring release techniques to release the muscle around the first second and third metatarsals as well as all the stretches of the foot

In younger people the plantar fascia is also intimately related to the Achilles tendon with a continuous facial connection between the two from the distal aspect of the Achilles to the origin of the plantar fascia at the calcaneal tubercle.

Nevertheless, there is an indirect relationship whereby if the toes are dorsiflexed the plantar fascia tightens via the windlass http://en.wikipedia.org/wiki/Windlass mechanism. If a tensile force is then generated in the Achilles tendon it will increase tensile strain in the plantar fascia.

Clinically, this relationship has been used as a basis for treatment for plantar fasciitis, with stretches and night stretch splinting being applied to the gastrocnemius/soleus muscle unit.

Just stretching one muscle all night or just stretching of the Achilles consisting of the gastrocnemius and soleus muscles and not all muscles around the three dimensional foot may actually put you at a higher risk for injury than lower.

The Academy of Sport Medicine has found that runners who do excessive stretching tend to have a
higher incident of accidents. The
reason for this is simple— muscles
are like twine and not like a rubber
band. That is that they twist open
or shut and don’t stretch like
rubber

Dr. Stoxen’s best stretches for Heel Spur video tutorials;

Video Tutorial #84 Dr James Stoxen DC Demonstrates Scissor Stretching Of The Feet
Video Tutorial #85 Dr James Stoxen DC Demonstrates Stretching Great For Morton’s Neuromas
Video Tutorial #88 Dr James Stoxen DC Demonstrates Stretching Of The Foot While Sitting 
Video Tutorial #89 Dr James Stoxen DC Demonstrates A Stretch To Increase The Arch

Don’t do too much stretching of the wrong muscles such as the Achilles. Remember the foot is a three dimensional springy platform so you MUST stretch the foot in all directions to make sure it is as flexible as possible to comfortably absorb the force of the impact without abnormal stress on the fascia.

View the links below to Dr. Stoxen’s self help video tutorials for Heel Spurs;

Video Tutorial #78 Deep Tissue Treatment Of The Knee Popliteus Muscle
Video Tutorial #79 Deep Tissue Treatment Of The Gluteus Medius Muscle of the Hip
Video Tutorial #80 Deep Tissue Treatment Of The Subtalar Joint Of The Ankle On The Inside
Video Tutorial #81 Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside) 
Video Tutorial #82 Deep Tissue Treatment Under 
Video Tutorial #83 Deep Tissue Treatment Above 
Video Tutorial #87 Deep Tissue Of The Ankle Mortise

#2 Foot Misalignment – Practice walking with the foot landing with the second to pointing towards the target.

#3 Foot/Heel Rolling Into an Unsafe Stressful Position – Any weakness in the spring suspension system- Make sure the spring suspension system muscles are strong enough to support the force of the loading directly on them and strong enough to maintain the foot in the safe range between supination and pronation.

If your muscles are not strong enough to maintain the foot in the safe range you cannot strengthen them overnight so it’s strong enough to keep the foot in the safe range.  For some of you it would take months and for some of you it means a combination of losing a lot of weight and a lot of training.   Either way we need to keep the foot in the safe range without putting something in the way of the natural spring mechanism like an arch support or orthotic.

What are the best Shoes for Heel Spurs / Shoes for Heel Pain?

Extended Medial Counter The Best Shoes For Heel Spurs

My solution is a shoe that has an extended medial counter support to maintain the heel in the safe range. Because the arch is an interconnecting mechanism of bones and elastic ligaments and because you have already released all the spasms around it, it should spring up and down now without abnormal stress on the heel and fascia.  The trick is to just maintain the foot in the safe range and this shoe design does that.

#4 How do we correct the form and technique of your walk

  • Land with foot-leg-hip directly more perpendicular to earth gravity and body
  • When you are perpendicular to the pull of gravity is when your spring should be loaded at full depth.
  • It shouldn’t be when you hit your heel first

Regardless, it is impossible to walk or run with perfect stress free form and technique without all restrictions removed from the spring and for it to be strong enough to handle the impact forces of movement at the speed you want to travel, walking, jogging, running and/or plyometrics.

 

#5 Heel Spur Preventive Exercises – You must develop the spring suspension system muscles to support the arch so there is not a lot of load dumped on the plantar fascia.

This requires you to:

movement training to prevent Heel Spurs and Heel Pain

SPRING RESISTANCE TRAINING– Strengthen the spring suspension system muscles like a lever. Train with resistance exercises adding cuffs strapped to the foot moving it in a variety of directions such as eversion, inversion, abduction, adduction, pronation and supination.

SPRING IMPACT TRAINING – Strengthen the spring like a spring.  I restore the spring suspension system muscles ability to resist impacts with barefoot drills like zigzag patterns, circular patterns, shuffle patterns as well as doing multi direction plyometric drills with graduated increased speeds starting with walking, jogging, running plyometrics.

Because we are going to release our natural spring mechanism, artificial spring protection like heavy cushioned soles wont is necessary. In fact, we should set a goal to get back to walking and running barefoot like we did as a youth.

Why?

The inability to walk or run barefoot safely is one of the first signs of aging ”

Are we running to slow the aging process or speed it up?

Then when you’re in the competition you can cheat by putting shoes on that allow for additional recoil of the elastic of the shoe!

Can I still run with painful heel spurs?

NO WAY!

Can I walk or run with non-painful heel spurs?

Of course!

How do you know when it is safe to run again?

You just don’t go out and run and see what happens!

You have to videotape yourself walking, jogging and running at increased speeds, which test the impact resistance of the spring suspension system to maintain the foot and limb in the safe range.

Watch this video below of national champion taekwondo, Christian Medina and Dr. Stoxen running barefoot down the street.  One of our staff was in the back of an SUV videotaping through the window while another staff member was driving.

These are the snapshots taken from the video analysis.

Dr. James Stoxen Dc barefoot running training with Christian Medina

As you can see we ran the entire run in zig-zag patterns. This forces the foot to land in positions that naturally release the 33 joints from different angles and strengthens the suspension system muscles equally from the inside and the outside.

That is how I have been able to run barefoot on solid concrete and asphalt streets without Thoracic Outlet Syndrome, Heel Spurs,  Morton’s Neuromas, shin splints, or other impact related conditions.

You would think that running and jumping as in plyometrics would make one more susceptible to heel spurs due to the stresses of the landings.  This is only true if you have a weak, stiff or locked spring mechanism at the time of the training.

Joint subjected to heavy impact are relatively free from osteoarthritis in old age and that those subjected to much lower loading experience a greater incidence of osteoarthritis and cartilage fibrillation (5) (6)

Conclusion

There is no one perfect approach. However, we should approach to heel spurs and other conditions with logic that follows the laws of physics and nature.

I have tried my best to present to you my best recommendations based on these laws, the prevailing scientific literature and my many years of clinical experience.

You may not rush off to your family chiropractor or alternative medical center for this but I have found that conservative treatment at our chiropractic center with an integrative medical approach.

Please feel free to share your Heel Spur story in complete anonymity in the comments below. I will advise the best I can.

Thank you for sharing this article with those you feel it can help!

Research Articles

1.  Weiss E. Calcaneal spurs: examining etiology using prehistoric skeletal remains to understand present day heel pain. Foot (Edinb)2012 Sep;22(3):125-9. doi: 10.1016/j.foot.2012.04.003. Epub 2012 May 3. [PUB MED]

2.  Li J, Muehleman C. Anatomic relationship of heel spur to surrounding soft tissues: greater variability than previously reported.  Clin Anat. 2007 Nov;20(8):950-5. [PUB MED]

3.  Muecke R, Micke O, Reichl B, Heyder R, Prott FJ, Seegenschmiedt MH, Glatzel M, Schneider O, Schäfer U, Kundt G.  Demographic, clinical and treatment related predictors for event-free probability following low-dose radiotherapy for painful heel spurs – a retrospective multicenter study of 502 patients.   Acta Oncol. 2007;46(2):239-46. [PUB MED]

4.  Kumai T, Benjamin M.  Heel spur formation and the subcalcaneal enthesis of the plantar fascia. J Rheumatol. 2002 Sep;29(9):1957-64.

5.  Tweed JL, Barnes MR, Allen MJ, Campbell JA. Biomechanical consequences of total plantar fasciotomy: a review of the literature.   J Am Podiatr Med Assoc. 2009 Sep-Oct;99(5):422-30.


 

Disclaimer

All content on teamdoctorsblog.com, including without limitation text, graphics, images, advertisements, videos, and links (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical treatment, advice, or diagnosis. Please remember to always seek the advice of a qualified physician or health professional with any questions you may have regarding any medical concerns. Dr James Stoxen DC and Team Doctors does not recommend or endorse any specific treatments, physicians, products, opinions, research, tests, or other information it mentions. Said Content is also not intended to be a substitute for professional legal or financial advice. Reliance on any information provided by Team Doctors is solely at your own risk.

 

Chondromalacia Patella / Cracking Knees or Runners Knee, Treatment and Prevention Tips from The Barefoot Running Doctor

Chondromalacia Patella ICD-9 733.92 Chondromalacia Patella / Cracking Knees or Runners Knee, Knee Cap Pain! Treatment and Prevention Tips from The Barefoot Running Doctor Tips For Better Health Ask the doctor, Dr James Stoxen DC Do you experience knee pain when running? Do you have knee pain when bending? Does your knees crack when going up the […]

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Chondromalacia Patella ICD-9 733.92

Chondromalacia Patella / Cracking Knees or Runners Knee, Knee Cap Pain! Treatment and Prevention Tips from The Barefoot Running Doctor

Tips For Better Health

Ask the doctor, Dr James Stoxen DC

Do you experience knee pain when running?

Do you have knee pain when bending?

Does your knees crack when going up the stairs?

You may have what athletes call Runners Knee, what non-athletes call Cracking Knees and what doctors call, Chondromalacia Patella.

I have found the usual cause of this infra patellar pain is an abnormal foot plant.

To view the original post, click here

Question:

I haven’t run in weeks and i decided to go out for a jog. Ended up doing 5k and giving up before my knee gave out.
Should I be running that much? Maybe i should be doing 1k a day and start building up?
What do you think is the best way to recover from this? And to eventually raise mileage to marathon training. (in long future of course)

Dr. Stoxen’s Answer:

patella pulley example

I’m assuming you are talking about pain under, below or around the knee cap. This can be called chondromalacia patella or cracking knee. You may hear it crack or click more often when you go up the stairs.

As you know, the patella is a pulley mechanism (see picture to the right). The trochlear groove is the concave surface where the patella (kneecap) makes contact with the femur (thighbone). Also called the ‘trochlea’.The foot adjusts for the impacts of running with two main spring mechanisms:

1. The Arch Leaf Spring – There have been studies on the arch with all muscles removed leaving just the bones and ligaments. These were extracted from               cadavers. What the study showed was that the arch complex itself has the ability to spring back forces without the aid of the muscles.

“If any of these 33 joints are locked then the foot cannot absorb the impact force smoothly. The foot will either roll into over supination or over pronation to compensate to roll around these locked joints.”,  Dr. James Stoxen DC

2. The Spring Suspension System Muscles – I coined these muscles as the spring suspension system muscles, the landing muscles or the pronation-supination cuff muscles. When this happens the impact is received as a “negative” by the tendons of the landing muscles.

“If any of these muscles and tendons are too weak to handle the impact force, the foot can roll into over supination or over pronation.”, Dr. James Stoxen DC

In my model the body moves as a lever and a spring

The foot rolls from supination to pronation. Have you ever heard of over pronation? That is when the foot rolls too far inward. When this happens, the limb internally rotates on impact. For more information read this article:  What Is Foot Pronation And Foot Supination? Is It Good Or Bad?

Safe and Unsafe Range

That does not put the patella in a good position to allow for stress and strain free motion.

Therefore, if the foot rolls outside the safe range (green-black-green) then the limb rolls in or outside the safe range this causes the knee to be in a position where the knee cap will grind against the pulley mechanism gro0ve (trochlear gro0ve) This can cause irritation to the cartilage, inflammation and pain.

Over Pronated Foot

Not only that but this misalignment of the limb can cause spasms of the muscles from toe to head. The reason is because the body senses the abnormal movement of the limb and reacts with a spasm called a “tonic protective spasm”.

This can lead to various changes in the knee and other joints that make runners uncomfortable and unhappy…..

  1. When muscles spasm on many sides of a joint it cause inhibition of others opposite them called reflexive inhibition. That is a fancy term for shutting down muscles. Sometimes we feel our leg go out from under us in a split second.
  2. Since the abnormal movement pattern starts at the foot and goes to the head it can compress every joint from foot to head. This can cause abnormal internal compressive forces on not only the knee but the arch, ankle, knee, hip and spinal discs.

Internal External Forces Conditions

What we do is a gait evaluation to check how your foot is landing and how it interacts with earth

How does it land…

  1. Does it land with the second toe towards the target, pointing inward or pointing outward?
  2. Does the foot bang when it lands and twist when its lifting off or does it spring down and up?

The intricacies or nuances of how your foot lands during walking or running can be difficult to see when you are moving so quickly. Also, if you have never studied walking or running forms and technique it’s difficult to pick up the details. I still urge you to study your walk and running form and technique so you can get a better feel for how your body is interacting or impacting the earth and how to improve it.

The reason is because your body will impact with the earth 270,000,000 or so times in a lifetime.

  • what shoes you wear outside running training – a poorly constructed shoe can be used for 6 months adding up to 1,850,000 abnormal movements burning the pattern into your brain for a poor landing in running.
  • a stressful time in your life – stress causes people to tense up the entire body leading to more of a bang and twist running impact rather than a spring and roll running impact

How to do your own gait evaluation:

  1. Get a $140 HD flip video camera.
  2. Video yourself walking barefoot 10 steps toward the camera and back. Do this while walking, fast walking, and running.
  3. Download it
  4. Watch the video frame by frame to see how the foot lands and you will see why the patella is not in the groove. It is obvious and enlightening.

Here is a blog post you may like that talks about “foot lock”, which is when joints of the foot are locked causing abnormal movement patterns (compensations) which effect patella position and a lot more! click here to view

Next, I developed a 3 step self-help approach to helping align the foot on impact and improve the spring loading capacity of the limb. The three steps to my human spring approach are:

  1. Release the stiffness or locking of the joints of the spring mechanism so the muscles can pull through full range of motion to maximize development.
  2. Strengthen the pronation supination cuff, landing muscles AKA spring suspension muscles with lever resistance exercises.
  3. Strengthen the pronation supination cuff, landing muscles AKA spring suspension muscles with spring impact exercises.

This three step approach will help you expand the force loading capacity of your human spring to better spring off from impacts, to have maximum performance and reduce risk of injury.

In running as you know there is simplistically the “take off” and the “landing”

When you run with braces (shoes), your body has an artificial support and an artificial landing gear that most think will keep the foot centered. You know that the muscles to do that.

This is what is unique and cool about barefoot running training is:

  1. When you are barefoot running you aren’t copping out on strengthening by putting a brace on your foot to try to hold it in the safe range like a motion control shoe or an orthotic like the doctors who can’t get their runners out of their braces recommend. You really have no choice but to strengthen the landing gear so that the muscles will maintain your foot in the safe range.
  2. When you are barefoot running you don’t have the artificial spring (cushioned sole) to absorb the impact like the doctors who recommend more cushion so you really have to have a springy foot. While it might seem like heavily-cushioned shoes would be the answer, they are in fact, likely doing more damage as they dramatically affect the arch spring’s ability to appropriately absorb, store, then release the energy from each step.
  3. When you train in multiple direction movements you can get your foot in many other landing configurations which stimulate more muscle development through adaptation to create a stronger landing gear.

Rather than strapping five-inch ‘pillows’ to your feet, the best solution is to repair the spring mechanism in the arches by following the procedures and exercises in this article.

Most runners strengthen the take off muscles thinking the artificial support and think that their artificial landing gear (shoe cushion) will do the trick. We all know the majority of injuries occur in the landings

The key is to strengthen the muscles that resist the over rolling of the foot outside the “safe range between supination to pronation (rolling from the outside to the inside) during impacts. If the foot rolls to an unsafe position then the knee rolls to an unsafe position.

 

Logical so far?

 

I call these muscles the landing muscles, the spring suspension system muscles or the pronation supination cuff muscles

 

Introducing…  The Pronation Supination Cuff Training

 

The muscles that prevent over pronation and over supination of the foot consist of the tibialis posterior, tibialis anterior, peroneus longus, and peroneus brevis.

 

The strength of these muscles, supination and pronation as well as the spring suspension system are not covered much in bodybuilding, fitness magazines, training routines etc., but of all the muscles, in fact these are THE most important muscles in the body to work.

Why?

  • These muscles suspend your foot as a leaf spring so it can bounce your body off the ground instead of bang your body into the ground.
  • They store FREE elastic energy when your mass impacts the ground when they stretch. This storage of energy is what allows your body to move more efficiently as a spring mechanism rather than an inefficient lever mechanism.
  • These muscles, which I also refer to the pronator supinator cuff muscles, maintain the foot and lower limb in the safe range between supination and pronation

Below are my last two articles you might find helpful to release the tension on the spring and strengthen the landing gear muscles so that your limb will land straight, spring off the ground with the knee cap and other joints in good alignment with little to no abnormal compressive forces as the goal.

How Does The Body Spring Back Safely From Impacts Of Running and Walking?, click here to view

Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running, click here to view

I recommend you do the Human Spring release exercises, video tutorials #77 – 89 on my before every run and when you take off your shoes at night, see below:

Video Tutorial #78 Dr James Stoxen DC Demonstrates Self-Help, Deep Tissue Treatment Of The Knee Popliteus Muscle

Video Tutorial #79 Dr James Stoxen DC Demonstrates Self-Help, Deep Tissue Treatment Of The Gluteus Medius Muscle of the Hip

Video Tutorial #80 Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Subtalar Joint Of The Ankle On The Inside

Video Tutorial #81 Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside) 

Video Tutorial #82 Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Treatment Under The Big Toe And Second Toe

Video Tutorial #83 Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Treatment Above The Big Toe And Second Toe 

Video Tutorial #84 Dr James Stoxen DC Demonstrates Scissor Stretching Of The Feet

Video Tutorial #85 Dr James Stoxen DC Demonstrates Stretching Great For Mortons Neuromas And Narrow Heels

Video Tutorial #86 Dr James Stoxen DC Recommends The Best Shoes To Prevent The Foot From Deforming

Video Tutorial #87 Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Of The Ankle Mortise

Video Tutorial #88 Dr James Stoxen DC Demonstrates Stretching Of The Foot While Sitting At Your Chair

Video Tutorial #89 Dr James Stoxen DC Demonstrates A Stretch To Increase The Flexibility Of The Arch Of Your Foot

The key training I do to strengthen my landing gear is run the entire training session in zig zag patterns

Watch this video below to see two time Taekwondo National Champion Christian Medina and Dr. Stoxen run barefoot in zig zag patterns.

I also suggest you read Anthony Field’s book, How I My Wiggle Back.  He is an entertainer who followed my approach and it helped him change his life. The book has over 200 tips for you in the 100 pages of content that are on the Human Spring Approach.

Be sure to check out The Barfoot Runners Society to learn more about barefoot running and find a chapter near you., click here


 

Disclaimer

All content on teamdoctorsblog.com, including without limitation text, graphics, images, advertisements, videos, and links (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical treatment, advice, or diagnosis. Please remember to always seek the advice of a qualified physician or health professional with any questions you may have regarding any medical concerns. Dr James Stoxen DC and Team Doctors does not recommend or endorse any specific treatments, physicians, products, opinions, research, tests, or other information it mentions. Said Content is also not intended to be a substitute for professional legal or financial advice. Reliance on any information provided by Team Doctors is solely at your own risk.

 

  • Fever: When you have a fever, your body is trying to isolate and expel an invader of some kind. Massage increases overall circulation and could therefore work against your body’s natural defenses.
  • Inflammation: Massage can further irritate an area of inflammation, so you should not administer it. Inflamed conditions include anything that ends in itis, such as phlebitis (inflammation of a vein), dermatitis (inflammation of the skin), arthritis(inflammation of the joints), and so on. In the case of localized problems, you can still massage around them, however, avoiding the inflammation itself.
  • High blood pressure: High blood pressure means excessive pressure against blood vessel walls. Massage affects the blood vessels, and so people with high blood pressure or a heart condition should receive light, sedating massages, if at all.
  • Infectious diseases: Massage is not a good idea for someone coming down with the flu or diphtheria, for example, and to make matters worse, you expose yourself to the virus as well.
  • Hernia: Hernias are protrusions of part of an organ (such as the intestines) through a muscular wall. It’s not a good idea to try to push these organs back inside. Surgery works better.
  • Osteoporosis: Elderly people with a severe stoop to the shoulders often have this condition, in which bones become porous, brittle, and fragile. Massage may be too intense for this condition.
  • Varicose veins: Massage directly over varicose veins can worsen the problem. However, if you apply a very light massage next to the problem, always in a direction toward the heart, it can be very beneficial.
  • Broken bones: Stay away from an area of mending bones. A little light massage to the surrounding areas, though, can improve circulation and be quite helpful.
  • Skin problems: You should avoid anything that looks like it shouldn’t be there, such as rashes, wounds, bruises, burns, boils, and blisters, for example. Usually these problems are local, so you can still massage in other areas.
  • Cancer: Cancer can spread through the lymphatic system, and because massage increases lymphatic circulation, it may potentially spread the disease as well. Simple, caring touch is fine, but massage strokes that stimulate circulation are not.Always check with a doctor first.
  • Other conditions and diseases: Diabetes, asthma, and other serious conditions each has its own precautions, seek a doctor’s opinion before administering massage.
  • Pregnancy: No deep tissue work. Be aware: danger of triggering a miscarriage by strong myofascial work is greatest during the first 3 months (especially through work around the pelvis, abdomen, adductors, medial legs, or feet)

Morton’s Neuroma – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors

Morton’s Metatarsalgia ICD-9 355.6 Morton’s Neuroma – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors  Tips For Better Health Ask the doctor, Dr. James Stoxen DC In this article is everything you ever wanted to know about Morton’s neuroma and more! Is your foot hurting? Do you have tingling […]

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Morton’s Metatarsalgia ICD-9 355.6

Morton’s Neuroma – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors 

Tips For Better Health

Ask the doctor, Dr. James Stoxen DC

In this article is everything you ever wanted to know about Morton’s neuroma and more!

Is your foot hurting?

Do you have tingling in the feet or burning feet?

Do you have foot aches and do you have toe numbness?

The “Morton’s Metatarsalgia ICD-9 355.6” (pain between the toes) was first observed in 1835 by Filippo Civinini (1805-1844) (1)

Morton’s neuroma is a common cause of metatarsal swelling and pain – on the bottom of the foot that radiates from between the third and fourth metatarsals, which may cause extreme pain and disability.

Morton’s neuroma, also known as Mortons toe, is one of the most common disorders encountered in the foot (2) and a common cause of metatarsalgia or pain between the third and fourth toes. (3)

Although Morton neuroma is a common diagnosis, debate exists as to the best surgical and nonsurgical treatments. This article discusses the cause, how to diagnose it, nonsurgical and surgical management, and surgical complications of Morton’s neuroma (4) as well as how to avoid it.

What is a Morton’s Neuroma?

Most neuromas, 53%, are located in between the third and fourth toes (metatarsal heads) where the branches of the medial and lateral plantar nerves join. (2) However, neuromas have been found in between the second metatarsal bone and third metatarsal bones in 25% and 22% between the fourth and fifth toes. (2)

The fibrous neuroma develops when the area around the nerve is inflamed and heals itself with scar tissue, which leads to an enlargement of the nerve. This enlargement gets compressed with every step causing it to get bigger and bigger.

When it flares up, Morton’s neuroma creates a sensation of burning or sharp pain and numbness on the front part of the foot (forefoot). These symptoms radiate foot pain in the front of the foot.

“Why do my feet hurt?”

I did not have any injury so how did I get this?

Morton’s neuroma is different from a traumatic neuroma as it happens over time. It starts like a random common pain in the foot. People say, “The bottom of my foot hurts when I walk” They should say, “The bottom of my foot hurts when I walk in these pointy toe high heel shoes.

Why don’t men get it as often?

Morton’s Neuroma occurs more often in women than men, and particularly in those who wear narrow, high-heeled shoes. (5) Men do wear shoes that are too narrow but not on the same scale as the narrow pointed shoes that women wear, plus lifting the heel slides the foot down into this narrow point further squeezing the toes pinching the nerves.

Morton’s neuroma is not a true neuroma. A true neuroma is a tumor of nerves.

Morton’s Neuroma Diagnosis is instead a condition which, “consists of scar tissue and blood vessels that infiltrate the nerve fibers and cause further damage to the nerve and its covering” (6)

Aren’t Morton’s Neuroma Only For Middle Aged Women who wear high heel pointy-toed shoes? No!

The female-to-male ratio for Morton’s neuroma is 5:1 and up to 10:1 (7) however some as young as 15 have got them and men get them too.

How do you get Morton’s neuroma? What causes Morton’s neuroma?

Don’t all Morton’s neuroma’s hurt? Will I know when I have them?

No! You can be checked for the risk factors in a few minutes by a few easy tests and by watching yourself walk.

Then you can make the adjustments I recommend in this article to reduce the risk before your feet start swelling and you have pain.

If you know the cause of a condition you can treat and prevent it.

There could be several causes of a Morton’s neuroma. So, if you are looking for a magic cure, there is not one single remedy.

What are the causes of the Morton’s neuroma?

The neuroma pain is caused by over use stress and strain in the area that leads to the release of inflammation. When an area has chronic inflammation, it doesn’t necessarily cause a swollen foot, but over time, it leads to a constant layering of scar tissue in the area.

That is what doctors and scientists feel cause the neuroma.

Some doctors and scientists believe this abnormal over use stress comes from an abnormal or poor walking form such as overpronation (foot over rolls when it plants), the combination of hypo mobility and hyper mobility where the bones of the foot are both stiff or locked and others move excessively to make up for the locked ones, and of course the obvious, narrow or high heel shoes.

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You don’t have to have chronic pain in the area to have a constant layering of scar tissue. Only when the inflammation gets high enough do you have a swollen foot and feel pain. Inflammation can stay under the brains radar as “silent inflammation” or “low grade inflammation” but still over years do its damage. Inflammation in the foot can get pretty high without you feeling pain.

Some people have pain in their feet every day and think its normal. They don’t realize that part of the inflammatory process is the layering down of scar tissue. Chronic low grade inflammation increases the risk for many diseases of aging so don’t let this chronic foot pain go on.

For more information on the damaging effects of inflammation read these articles:

The Inflammation-Depression Connection Approach and The Science Based Natural Approach to Depression, click here

Video Tutorial #37 Aches, Pains, Allergies, Fatigue, Brain Fog, Diseases of Aging Have One Common Thread… INFLAMMATION, click here

Don’t wait until you have a painful swollen foot and a thick fibrous neuroma between your toes because then it is more difficult to treat.

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What is the standard examination in a doctor’s office to confirm a Morton’s neuroma?

Morton’s Neuroma Tests

Web Space Compression Tenderness Test – Doctors push their thumb between the 3rd and 4th toes (metatarsals). If there is pain there they suspect a Morton’s neuroma.

Foot Squeeze Test – Doctors squeeze the foot from the sides and if it hurts between the bones, they suspect a Morton’s neuroma. (8)

Gauthers Test - involves squeezing the metatarsals together and moving them up and down for 30 seconds, which leads to pain.

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Morton’s Neuroma Diagnosis

How do I know it’s not a foot stress fracture?

The Morton’s pain and foot symptoms are different from a foot stress fracture symptoms in that it feels like there is a ball or stone in the bones of the foot. Patients feel as if they have a bruise causing pain and swelling under the third or fourth toe or line a stone impact bruise where the bottom of the foot hurts between the second metatarsal bone and third metatarsal bone but primarily between the third toe and fourth toe and knuckle joints of the toes.

What else could this pain be?

With such a limited physical examination, doctors are unable to rule out other conditions that may be causing the pain. This might be a stress fracture of the neck of the metatarsal, a neoplasm or cancer, Freiburg osteochondrosis, ganglion cysts, a true neuroma, a neurofibroma, a schwannoma or a locked and misaligned, metatarsal.

The foot has 33 joints to absorb the impact forces of over 3,500,000 impacts or steps from walking or running per year. If one or two toes are locked other toes may have to move excessively to take up the impact forces. It is important for doctors to check for these abnormal movement patterns of the toes to see if this is the cause of a Morton’s neuroma.

In my office I find most patients have a locked and misaligned metatarsal, which is part of a more complex locking of many bones of the foot. Read on…

Because most doctors do not check for joint play or abnormal movement patterns in the 33 joints of the foot a lot of them miss this. Also because doctors are not taught how to manipulate the foot they wouldn’t think to look for it.

You check for locked or excessively moving bones in the foot with the foot wiggle test. It wasn’t invented by one of the Wiggles but I have checked the Wiggles with this test.

Morton’s Neuroma Vs Metatarsalgia – Diagnostic Tests Diagnostics

Diagnostic Imaging

The first step is to make sure you have a Morton’s neuroma and not some mystery condition or misdiagnosed!

I think you will be amazed at what the research reveals about how often Morton’s neuroma is misdiagnosed and how often it is actually seen on MRI and sonography.  You still have to question if the bulged bundle of nerve and fibrous tissue is the cause of your pain.

What I want you to get out of this section is this:

Even though you have evidence of a neuroma it does not mean the pain is coming from the neuroma and it doesn’t mean you still cant avoid surgery by opening some additional space for what ever is being pinched causing the pain. I do it all the time!

X-rays Are No Benefit!

The usual route for a foot injury is to take radio-graphs of the entire foot however this is not an injury and x-rays are no help determine a positive Morton’s neuroma diagnosis vs metatarsalgia (simple pain in the toes).

This is because the neuroma is a soft tissue and you usually cannot see these soft tissue neuromas on x-rays. They are best for bones and joints. A doctor may take x-rays because every case is different and it’s hard to determine if they are medically necessary without knowing all the variables in your case. It’s safe to say you cannot see a neuroma on an x-ray.

How do I know it’s not a foot stress fracture?

The Morton’s pain, foot symptoms can different from symptoms of a stress fracture in that they feel there is a ball or stone in the bones in the foot. Patients feel as if they have a bruise causing pain and swelling under the third or fourth toe or line a stone impact bruise where the bottom of the foot hurts between the second metatarsal bone and third metatarsal bone but primarily between the third toe and fourth toe and knuckle joints of the toes.

If the pain is in the second metatarsal it could be a locking of that bone. Also you would treat a neuroma almost the same way as a stress fracture so its not critical if its hard to distinguish between the two.

For more information on stress fractures of the foot, read this article I wrote:

Stress Fracture Of the Second Metatarsal – Self Help Tips to Treatment and Prevention from The Barefoot Running Doctor, click here to view

MRI or Ultrasonography?

For many soft tissue conditions, the Morton’s neuroma MRI is the diagnostic test of choice. However, for Morton’s neuroma MRI can is good for large neuromas but the ultrasonograph is best if the neuroma is less than 5 mm.

In a study of 25 patients with confirmed Morton’s Neuroma Diagnosis, 88% were picked up by the MRI scan and 96% were picked up by the ultrasonograph. Of those 4 that were missed by the MRI and caught by the ultrasonograph, 4 of 5 were smaller than 5 mm. So for smaller neuromas, the ultrasonograph may be more sensitive. (9)

Sonography is good to differentiate between a Morton’s Neuroma Diagnosis 15.2%, an inflammation of the bursa between the toes 20.5%, and just simple swelling of the toe joints 11.7%. (10)

However, just because there is evidence of a neuroma on ultrasonography, it does not mean that the pain is coming from the neuroma. So if your doctor finds a neuroma on an MRI and ultrasonography, do not assume this is where the pain is coming from and rush off for surgery. Read on!

Not All Mortons Neuromas Are Painful Conditions

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In a study, researchers did ultrasonography on 96 feet with no pain. In this observational prospective study, patients with asymptomatic forefeet (they had no foot pain!) who were seen by two foot and ankle surgeons for unrelated mid- or hind foot pathology were examined clinically and sonographically for the presence of interdigital nerve thickening (a fibrous neuroma). (11)

Fifty-four percent of the volunteers (26 of 48) had sonographic nerve thickening and in 17 cases (35.4%) enlarged nerves were found bilaterally. (11)

Ultrasound, even in highly skilled hands, has a high rate of incidental finding of an asymptomatic inter-digital nerve enlargement (painless Morton’s neuroma), which can lead to a false diagnosis of a Morton’s neuroma. Sonographic evidence of Morton’s neuroma per se is unreliable unless it is correlated with an equivocal clinical examination. Clinical examination is still the gold standard for the diagnosis of a Morton’s neuroma. (11)

The physical exam done by someone who has reversed the symptoms of metatarsalgia where there was evidence of a Morton’s neuroma is your best physician for this.

If you go to a surgeon, what are you more likely to get? Surgery So if you go to a surgeon and he recommends surgery you should not be surprised.

While more research has been conducted since these reviews, Morton’s neuroma continues to be a complex condition with a wide variety of conservative and surgical interventions.

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The Typical Conservative Standard Treatment Protocol For Those Who Evaluate And Treat You As A Lever Mechanism

The pain caused by Morton’s neuroma is typically associated with standing activity and may be linked to wearing heels or tight shoes that compress the toe box. (12)

This is normally what doctors quote as the cause of Morton’s neuroma. If this is what they think the cause is then they are limited to changing your footwear, standard physical therapy, drugs and surgery.

There are three stages to this lever method treatment approach, which involve progressively more invasive and expensive treatment approaches.

1. The first stage consisted of

  • Patient Education
  • Footwear Modifications and
  • Metatarsal Inflammation Relief with Physical Therapy (13)

2. The second stage consists of a steroid/local anesthetic injection into the affected interspace.

note; Stage one and two conservative treatments include footwear changes, steroid injections, physical therapy, and topical or NSAID pain reliever.(13)

3. The third stage is surgical excision of the inflamed interdigital nerve. (13)

What is interesting is 79% got better even with this very weak treatment approach. With this course of care, (21%) of the patient’s eventually required surgical excision of the nerve (13).

Just think how many may more of the 21% would have avoided surgery with a more aggressive treatment approach outlined later in this article.

Stage 1. Typical Footwear Modifications for Morton’s Neuroma

Conservative measures such as footwear modification and targeted injection of the hot spot are attempted before considering surgical intervention. (14)

The usual patient education varies depending on the depth of knowledge of the physician, how much time he or she has to educate you and the variables in your case. You may be asked to lose weight, don’t stand a lot and maybe some instructions on how to walk with less stress on your toes.

The typical footwear recommendations they make are:

  1. Do not to wear pointy toed or narrow toed shoes.
  2. Do not wear high heel shoes.
  3. Wear footwear that is of a soft material. I disagree with this!
  4. Get custom fit orthotics. I disagree with this!

I never recommend orthotics!
I never recommend a softer material for footwear!
(I explain this later)

Stage 2. Steroid/Local Anesthetic Injection for Morton’s Neuroma

Some doctors have such little faith in physical therapy, footwear modifications etc that they just recommend an injection into your foot right away the first day.

A single ultrasound-guided corticosteroid injection resulted in generally short-term pain relief for symptomatic Morton’s neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm. (3)

Ultrasound guided alcohol ablation of Morton’s neuroma may offer an alternative to surgery. In this study, 32% had complete resolution of pain, 66% improved but 20% went on to have surgery because of continuing pain (1)

After doctors see that conservative measures fail, surgical treatment can be indicated.

If all you had was injections before surgery you haven’t done all you can to treat this condition to prevent surgery.

Stage 3. Surgical Excision Of The Morton’s Neuroma This is what the surgery looks like

Morton’s Neuroma Surgery

There are two approaches to surgery to neuroma removal. There is the plantar approach and the dorsal approach.

The Plantar Approach – The plantar approach neuroma removal, can leave a painful scar on the weight bearing area; hence, some prefer the dorsal approach. (16)

The Dorsal Approachneuroma removal is associated with better rehabilitation and less scar problems. There can be residual numbness after surgery. (16)

Most studies reveal the outcome of Morton’s neuroma excision in the treatment of metatarsalgia with a postoperative success rate of 80 – 90%.

After neuroma excision, numbness in the web space postoperative is very common but most patients are unaware of the sensory loss.

After neuroma excision surgery you could be left with a stump neuroma. A stump neuroma is a stump from a severed nerve. In some patients it causes no symptoms but with others it is extremely painful.

Keh et al. who reported a 93% long-term subjective relief from neurectomy (surgically remove the nerve)

However, the authors report that many patients complain of some residual discomfort in the region of the surgery and 70% still have some degree of footwear restriction. (17)

After surgery can I wear my heels again? Most likely, NO!

So many ladies think that once they operate to remove the neuroma they can eventually go back to the high heels again. Not so!

Footwear problems in patients may affect the outcome of neuroma removal surgery in spite of providing good pain relief. In our series, the majority (71%) had problems wearing fashionable shoes even though they were happy with the surgery. Only 29% of patients had no footwear restriction (2)

Some women resist footwear modifications or the footwear modifications of any kind. In my opinion of those I have seen where the footwear modifications were a softer shoe with an orthotic make the overall mechanics of their condition were worse.

I feel the footwear I am recommending is more effective because of the common sense reasoning behind it and because more there are more attractive style options to choose from with these recommendations.

A big applause from the shoe fan-addicts

Surgeons don’t want to admit that the surgery for Morton’s Neuroma does not always work 100% of the time!

The excision of plantar neuromas is not always successful. Publications show failures as high as 14–21%. (18)

These are the studies the surgeons do not want published. Not all studies get to the public for obvious reasons.

Do you think a clinic would publish a study with poor outcomes? Who would recommend their center if they published a study saying they had poor outcomes?

If after surgery you still have pain, what is the course of care for now?

Wasn’t surgery the LAST resort?

Spinal Cord Stimulator? I call this a radical option!

Spinal cord stimulators are used when all avenues of controlling chronic debilitating pain are exhausted. It is like a tens unit that is implanted in the abdomen which has wires that run up inside your spinal cord and deliver a current to the cord area. The patient can increase or decrease the impulse from a remote they carry around with them.

Usually these stimulators are implanted when patients have a failed back surgery syndrome. Doctors rationalize this surgery because the alternative is prescription drugs, most commonly narcotic painkillers. Because patients tend to increase the dosage as years go by the risk for overdose is greater.

I had 2 patients that had spinal cord stimulators surgically implanted in their bodies. Interesting enough, the patients had to have a psychological exam before the surgery to see if they could handle the stimulator permanently implanted in their spinal cord area.

After care at Team Doctors, because of the relief they had from the treatment approach, both patients decided to have these stimulators surgically removed.

However, in one study, SCS immediately abolished pain of the Morton’s neuroma and the patient was able to perform her normal daily activities within 1 month. (19)

The Team Doctors Human Spring Model and Approach to Mortons Neuromas

The cause and development of Morton’s Neuroma remain controversial. (20)

Although the pathology of Morton’s neuromas is understood the development or causes of Morton’s neuroma are less agreed upon.

Why?

Because doctors cannot agree on the cause of Morton’s Neuroma it makes it difficult for physicians to treat this common injury until it is too late, requiring surgery.

I explain why in this post…

What causes the abnormal nerve to become inflamed  between the 3rd and 4th metatarsal heads that leads to Morton’s neuroma?

The first thing we have to understand is that chronic trauma has been proposed as possible factor in the cause of thickening of the nerve and pain described as Morton’s neuroma. (20) The nerve can thicken from a chronic inflammatory process that happens without pain.

So if we can isolate the sources of the chronic trauma and address it, we may be able to tone down the inflammation enough to reduce the pain thus save you from unnecessary pain and suffering and importantly unnecessary surgery.

This is the most sensible plan!

What can cause chronic trauma to the toes of the foot?

First we need to address the footwear cause of chronic trauma.

I agree with abstaining from pointy-toed shoes, narrow shoes and high heel shoes. If the toes are jammed together by the shoe then the toes will damage the nerve between them.

You MUST have a shoe with an open toe box. Don’t worry ladies, there are some really sharp shoes with open toe box styles.

I do not agree with wearing shoes with soft material. Here is why.

First, soft materials allow the foot to collapse into the material destabilizing the foot position. The pressure of the body weight can cause the foot to sink in at the ball of the foot so that there is the unequal weight distribution leading to a collapse of the toes together, increasing pressure between the toes.

Orthotics, Inserts and Arch Supports

Apart from the etiology, increased load, which is transferred to the central metatarsals, some doctors feel Morton’s neuroma can be treated successfully with orthotic devices. (21)

I remove orthotics and take a different approach for many reasons:

We already know that the nerve is pinched from pressure on the toes. So, then further jamming the toes in the bound shoe with a space occupying shim that doesn’t allow the bones to move? How do you approach the orthotic concept when you are barefoot?

There are easier and more long-term ways to transfer the load off the sore toes without a shim (orthotic) you have to put in every shoe.

Orthotics vs. Spring Down Motion

So many scientists now believe that footwear is the leading cause of deforming foot conditions. What I recommend is that children and adults walk, run and work out the barefeet as much as possible.

Zipfel, B. & Berger, L.R. Shod versus unshod: the emergence of forefoot pathology in modern humans. Conclusions: The pathological lesions found in the metatarsals of the three recent human groups generally appeared to be more severe than those found in the pre-pastoral group. This result may support the hypothesis that pathological variation in the metatarsus was affected by habitual behavior including the wearing of footwear and exposure to modern substrates. (22)

When does this scar tissue formation start?

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There is plenty of evidence that the irritation that could be the initial stages of development of Morton’s neuroma starts in childhood.

According to the results of a study presented at the 2009 American Association Orthopedic Surgeons Annual Meeting, many young children are wearing shoes that are too small. As a result, these children may be at high risk for having serious foot deformities.

Improper footwear is well recognized to be an extrinsic factor regarding the development of forefoot deformities. Small forefoot boxes in children’s footwear could impair toe function and proper development and promote early establishment of forefoot deformity,” said lead author Norman Espinosa, MD, of the University of Zürich.

The study, which took place in Switzerland, included 128 boys and 120 girls from age 5 to age 10. Researchers measured the children’s feet as well as their indoor and outdoor footwear to determine whether the children were wearing properly sized shoes. They also compared their footwear measurements to the sizes given on the manufacturers’ labels to see if the shoes were marked properly. Finally, they measured the angles of the children’s toes to learn whether any of the subjects were developing hallux valgus.

The study found that most of the children tested were wearing the wrong size shoes. “We defined fitting as perfect when the inner shoe length surmounted the foot length by at least 10 mm (optimal 12 mm),” explained Dr. Espinosa.

More than half (52.8 percent) of the children had outdoor shoes that were too small; 13.3 percent of children were wearing outdoor shoes that were too large for them. A similar pattern was seen with children’s indoor shoes or slippers. Six in 10 children (61.6 percent) were wearing indoor shoes that were too small; 1 in 10 (10.2 per­cent) were wearing shoes that were too large.

In part, the problem may arise because parents buy shoes based on the size marked by the manufacturer, perhaps without even having the child present to try on the shoe. When researchers compared the size marked on the shoe to the actual size of the shoe, they found that more than 90 percent of both indoor and outdoor shoes were smaller than the manufacturer’s marked size. Indoor shoes were almost always (97.6 percent) smaller than the manufacturer’s marked size.

“It was a truly striking finding,” says Dr. Espinosa. “The shoe sizes given by the manufacturers almost never matched with the true sizes measured by our group.”

To prevent these problems, Dr. Espinosa makes the following recommendations for parents:

  • Measure the child’s feet every time new footwear is purchased.
  • Consider the actual size of the shoe rather than just the number marked on the inside of the shoe or the box.
  • Check for shoe fit every month or so, especially during times of a growth spurt. Many children will outgrow shoes long before the shoes wear out.

“We truly did not expect such a large percentage of incorrectly declared shoe sizes,” he says. “We now know that we should focus on parental education to help prevent early onset of juvenile foot deformity.” (23)

American Academy of Orthopedic Surgeons
American Association of Orthopedic Surgeons

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What are other causes of stress on the metatarsals and surrounding tissues? What causes the irritation that leads to inflammation and scar tissue formation?

Morton’s neuroma is known to develop as a result of chronic nerve stress and irritation, particularly with excessive toe dorsiflexion.

One researcher describes it like this, Most likely a mechanically induced degenerative neuropathy that has a strong predilection for the third common digital nerve in middle aged women. (24)

Excessive motion between the third and fourth metatarsals

This explanation is made simpler by a review of the anatomy of the foot, muscles of the foot, ligaments of the foot, the foot tendons their strategic attachment and function to suspend in the foot as an integrated spring.

The answer I am providing gives us additional options for more innovative and common sense examination approaches, preventive maintenance and treatment options you and your doctor can explore.

Landing With Excessive Pronation dorsiflexion

Excessive Foot Pronation Theory

A biomechanical theory of causation involves the mechanics of the foot and ankle that excessively pronates the foot may compensate by dorsiflexion of the metatarsals subsequently irritating of the nerve between the bones.

Pronation, Neutral and Supination Landing

Excessive Dorsiflexion Theory

So mechanically it is most common with women who lift their toes up and those who’s foot rolls from the outside to the inside outside the safe range.

Dorsiflexion of toes

A foot that is mechanically unstable – weakness in the spring suspension system The tibialis posterior lifts and locks digit 1-3 leaving an abnormal movement between 3 and 4.

Excessive motion between the third and fourth metatarsals and metatarsal heads, the tethered third common digital nerve in the third web space, the third and fourth metatarsal heads flanking the third common digital nerve, the excessive weight bearing over use stress on the forefoot, particularly by wearing pointed and high-heeled shoes. (24)

Micro damage to the third common digital nerve causes inflammation, then scar tissue then repeats to layer scar tissue over and over again. Nerve fiber degeneration and excessive intraneual fibrous tissue formation resulting in an excessively large nerve. The enlargement can cause further trauma making it hurt more. (24)

First, you have to ask yourself this. If the cause is narrow footwear that squeezes the toes together, why is it mostly between the 3rd and 4th toes?

You would think that there would be an equal distribution of neuromas between all the toes in the foot.

The answer I am providing gives us additional options for more innovative and common sense examination approaches, preventive maintenance and treatment options you and your doctor can explore.

The answers lie in something you do every day without thinking. The answers lie in the way you walk.

Simply by closely observing your walking patterns we can see where the chronic damage is coming from. Which is causing the accumulation of fibrous scar tissue, the Morton’s neuroma and high levels of inflammation and pain in the toes, called metatarsalgia.

The Gait Evaluation – A more Thorough Examination

Videotape your walk—-

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Allow me to introduce you to your human spring.

What is the difference between an intact or locked spring?

  • When your spring mechanism is intact, you spring off the ground.
  • When your spring mechanism is locked, you bang into the ground!

This should make sense

The natural spring mechanism is integrated into all 7 floors of the human body.

Essentially, the human body is a giant human spring. The body is a giant spring with 7 floors of springs: 

  1. The arch
  2. The subtalar joint
  3. The ankle mortise
  4. The knee
  5. The hip
  6. The spine
  7. The head-neck
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There are two mechanisms that allow the body to function as a spring:

  • The configuration of the arch with the 26 bones and the ligament attachments.
    • All 33 joints must have complete inner-joint mobility for the foot to roll from the outside to the inside without stress on any of the metatarsals.
  • The spring suspension system which is composed of the muscles and tendons that attach on the under surface of the arch.
    • The balance of strength in your suspension system muscles determine if your foot rolls within the safe range between rolling from the outside (supination) to the inside (pronation)
    • The muscles that prevent over pronation and over supination of the foot consist of the tibialis posterior, tibialis anterior, peroneus longus, and peroneus brevis.

The strength of these supination and pronation spring suspension muscles and tendons are not covered much in bodybuilding or fitness magazines, training routines etc. but of all the muscles, in fact these are THE most important muscles in the body to work.

Why?

  • These muscles suspend your foot as a leaf spring so it can bounce your body off the ground instead of bang your body into the ground.
  • They store FREE elastic energy when your mass impacts the ground when they stretch. This storage of energy is what allows your body to move more efficiently as a spring mechanism rather than an inefficient lever mechanism.

These muscles, which I also refer to the pronator supinator cuff muscles, maintain the foot and lower limb in the safe range between supination and pronation.

When your foot lands it absorbs the force of the impacts two ways:

  1. It loads the impact force in the arch mechanism
  2. It rolls the impact force gradually from the outside to the inside.

The Tibialis Posterior Muscle (below) (blue tendon) This is the tibialis posterior (blue tendon) that supports the first metatarsal-cuneiform, second and third. You can also see the tibialis posterior (blue tendon), which attaches at the mid-arch at the first second and third metatarsal cuneiform joints where the spring action happens on impact.

What I have found consistently in patient after patient is a weakness in the tibialis posterior muscle. When it is weak it cannot stop the foot from over rolling into an unsafe position. When this happens the arch drops and locks in the first, second and third metatarsal cuneiform joints.

If this joint area is stiff or locked then the tibialis posterior cannot contract maximally against this joint. It’s impossible if the joint is locked. I find this muscle to be the weakest of the cuff.

When the persons walk compensates for this arch collapse drop and lock the patient has to roll the foot outward (toe out) to roll the foot around the locked arch area the foot rolls over the tibialis posterior tendon.

This abnormal stress on the tendon leads to a painful spasm of the tibialis posterior muscle-tendon that further compresses the first, second and third metatarsals together. (see blue tendon attachment)

Spasms in the muscles that cross a joint or two joints cause the joints to become compressed and when we apply this understanding to the human spring model, spasms cause a preload internal compressive force on the human spring. This preload internal compressive force reduces the overall force of impact capacity you can load into the spring mechanism.

  • When your spring mechanism gets weak your spring mechanism collapses into a lever mechanism.
  • When it collapses, the brain senses the abnormal movement patterns of walking as a lever and tries to protect you from the over use stress and strain by tripping spasms.
  • Spasms compress the spring further.

Why is there hypermobility between the 3rd and 4th metatarsals?

If you look at the attachment of the tibialis posterior (blue), the tendons attach strategically on the first metatarsal bone, second metatarsal bone and third metatarsal bone and not the fourth metatarsal bone or fifth metatarsal bone.

The fourth and fifth metatarsals are not controlled by this tendon. They typically remain freely moving. In fact they must move more to make up for a lack of movement in the first second and third metatarsals.

When you have locking of the second and third toes at the arch joint spring (metatarsal-cuneiform) joints the foot can no longer push off straight with the second toe pointing towards the target.

The way the foot compensates for this locking is when you point the foot out like a duck walk or slew foot so you can roll around the locked joint.

So you have a complex of three metatarsals that are locked or stiffer than normal and between the 3rd and 4th metatarsals an excessive motion.

One study stated the cause of the neuroma fibrous formation was from an increased load transferred to the middle metatarsals on weight bearing. (26)

Any motion of a joint or complex of joints outside its normal range lead to abnormal movement patterns that can cause stress and strain, wear and tear, widespread silent inflammation, which starts as an invisibly swollen foot, which can lead to scar tissue development and later painful inflammation and a visibly swollen foot.

This excessive motion is what I feel causes the excessive irritation to the nerve that leads to the accumulation of fibrous scar tissue formation.

Foot Lock

When your body impacts the ground, the force of the impact is spread across 33 joints of the foot and ankle.

I do what is called motion palpation of all 33 joints of the foot to screen for any locked joints that could be preventing the safe and full loading of the stress of impacts into the body.

If any of these 33 joints are locked the stress of this impact will not be absorbed by the protective mechanism, the arch spring and the human spring suspension system, it will be transferred to the tissues leading to any number of impact stress related conditions:

Some call this an over use injury but in reality it is an injury where stress is not distributed evenly due to some joints in the foot locking and others moving too much.

The spring suspension system of the arch and its suspension system muscles and tendons protects your body from abnormal stress that leads to conditions When this drops and locks it creates over use stress through the entire body in a pattern that is predictable. Its just like a machine.

The over use stress on the other structures could manifest as over use injuries such as:

  • Plantar Fasciitis
  • Heel Spurs
  • Heel Pain
  • Foot Pain
  • Morton’s neuromas
  • Tibialis Posterior Tendon Dysfunction (see below)
  • Ankle Sprain
  • Shin Splints
  • TFL & Illiotibial Band Syndrome
  • Gluteus Medius Pain
  • Lower Back Pain
  • Mid Back Pain
  • Neck Pain Syndromes 
  • Headaches

In his book, How I Got My Wiggle Back, Anthony Field talks about how his wife had chronic debilitating pain from Morton’s neuroma’s in both feet for 9 years. She had the MRI and the doctor said she needed surgery to remove the neuromas in both her feet. I treated her with this approach or 4-5 hours for 4 days and she was pain free which made the surgery medically unnecessary. (30)

So if you feel you have metatarsalgia or Morton’s neuroma from a weak dropped and locked spring mechanism then you should evaluate yourself for other conditions that may be developing up the pattern.

 

To think you wont get these actually does not abide by the laws of physics and nature. So more often than not you will see these conditions in your future if these abnormal mechanics are left untreated.

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High Heels

Also, another study determined that high heels increased pressure on the 3rd and 4th metatarsals. The aggravation and possibly the etiology of these forms of forefoot pain may be related to acute or chronic extrinsic pressure to the forefoot.

The role of non-weight bearing, compression of the metatarsal heads, weight bearing, and toe-stance (on the metatarsal heads) on the intermetatarsal pressure of the third interspace was measured in eleven asymptomatic volunteers.

Intermetatarsal pressures for

  • Non weight bearing 21mm Hg
  • Non weight bearing with medial-lateral compression of the metatarsal heads 21mm Hg
  • Weight bearing 29mm Hg
  • Toe Stance 36 mm Hg

These findings support the proposition that increases in forefoot plantar pressures convey greater pressures to the inter metatarsal space and metatarsal heads (27)

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The Combined Effect

If you look at the combination of the high heels elevating pressures between the toes in the forefoot, the rolling of the compressive force of the landings from the inside to the outside with over pronation combined with the locking of the first 3 toes and a excessively moving 4th toe you have a bigger picture of the full cause of this scar tissue formation between the toes.

Now we have a more thorough approach with more options to reverse this mechanical abnormality to reverse this condition with conservative care.

The Gait Evaluation – A more Thorough Examination

Simply by evaluating the gait (shown by example above in this post) you can watch it back advancing the movie slowly frame by frame to look for the conditions that might lead to Morton’s Neuroma below;

  • Are your feet, shins and legs relaxed prior and during impact?
  • At impact and while transferring the weight across the planted foot are any of the toes off the ground?
  • Does your calf shake when it hits the ground (from the back)?
  • Do you push or pull your body across the ground or spring your body off the ground?
  • Does your foot point straight with the second toe being the pointer toe towards the direction you are going or do you point your toe outward like a duck walk?
  • Is your shin, ankle and foot in alignment or do you have a weak or weak ankles? (over pronation)
  • Do you walk heel-toe or land heel first? There is no spring there. The impact goes bone (heel) to bone (talus) to bone (shin) The spring suspension system is in the middle/front of the foot!

How do we correct the form and technique of your walk?

  1. Relax your foot on impact. Do not pull your toes up (dorsiflexion) prior to landing and as you transfer the weight onto your foot. This causes increased pressure when has been shown to increase the risk of Morton’s neuroma.
  2. Plant the foot with the second metatarsal toe pointing to the direction you are going. If half of the weight is on the big toe and the other half on toes 3-5 then the weight is equally distributed across the foot. This will reduce the over use stress on the third metatarsal bones and fourth metatarsal bones.
If you have a visible weakness in your tibialis posterior it is impossible for us to strengthen it within a few weeks to keep the foot from over rolling into an unsafe position to cause damage to the body. Therefore we need to check this over rolling movement with some form of shoe. However we have to accomplish this without locking up the arch, as we know this leads to stress in the metatarsals.

The answer is to control the over rolling at the heel which still allows the body to be protected from the impacts by the spring mechanism because there is nothing inhibiting the healthy rolling and loading of the arch mechanism.

Safe and Unsafe Zone

Shoes – What are the best shoes for walking or running with Morton’s Neuroma?

If your muscles aren’t strong enough to hold the foot from rolling too far to the inside you wont be able to strengthen them fast enough to maintain them in the safe range between supination to pronation (outside foot to inside foot).

So you will have to get a shoe that prevents the over rolling. Here is where other doctors and I differ.

Many doctors insist on putting an orthotic or arch support to keep the arch from over rolling.

What already explained was that there was too much pressure on these joints causing the neuroma.

Why add another space occupying shim in the already confining shoe to potentially squeeze it down further.

If you inhibit spring movement with the orthotic the muscles cannot get stronger because you inhibit the spring loading down.

I never recommend orthotics for this purpose.

For more information I recommend viewing Tutorial #97 On Your Feet All Day? Fatigued? Achy? Over Pronation? I Recommend Footwear with Extended Medial Counters, click here 

Human Spring Approach to Morton’s neuroma

I have developed a 3-step approach to restoring safer, spring loading capacity:

  1. Phase I – Release the spring from forces that create compressive forces on the human spring from muscle spasms.
  2. Phase II – Strengthen the spring suspension system muscles
  3. Phase III – Impact train the spring suspension system

Phase Ia Morton’s Neuroma Stretches treatment:

    •  Morton’s Neuroma Stretches – Remove restrictions from the spring mechanism in the 33 joints of the foot with stretching and mobilization of all 33 joints of the foot specifically those of the hypo-mobile (stiff or locked) digit 1, 2 and 3.
    • You will be physically separating all the bones of the forefoot with the same muscle and tendon stretching and joint manipulation I do in my office to allow more room for the nerve to pass between the joints. This spreads out the stress to all the 33 joints lessening the stress on specifically (the third metatarsal and fourth metatarsal).

Dr Stoxen’s best stretches for Morton’s Neuroma, video tutorials:

Video Tutorial #84 Scissor Stretching Of The Feet
Video Tutorial #85 Stretching Great For Morton’s Neuromas And Heels
Video Tutorial #88 Stretching Of The Foot While Sitting At Your Chair
Video Tutorial #89 A Stretch To Increase The Flexibility Of Your Foot

Phase Ib – Morton’s Neuroma Deep Tissue Treatments:

      • These treatments are focused on relaxing the painful spasms in the tense muscles of the spring suspension system primarily the tibialis posterior that are compressing the arch spring. Essentially you are releasing the over use stress from the metatarsals with a stiff or locked spring.
      • One massage therapist noted positive results with massage to reverse a Morton’s neuroma (28) I suggest you read this article.
      • When you do the deep tissue treatments below, the purpose is to release the compressive forces from your entire lower body to allow the bones to move more freely the way they were designed to move and not compressed with abnormal restrictive and excessive movements that cause inflammation and scar tissue formation between the toes.

View the Links below to Dr Stoxen’s self help video tutorials for Morton’s Neuroma:

Video Tutorial #78 Deep Tissue Treatment Of The Knee Popliteus Muscle
Video Tutorial #79 Deep Tissue Treatment Of The Gluteus Medius Muscle of the Hip
Video Tutorial #80 Deep Tissue Treatment Of The Subtalar Joint Of The Ankle On The Inside
Video Tutorial #81 Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside) 
Video Tutorial #82 Deep Tissue Treatment Under 
Video Tutorial #83 Deep Tissue Treatment Above 
Video Tutorial #87 Deep Tissue Of The Ankle Mortise

Watch above as Dr. Stoxen demonstrates the deep tissue treatment he uses to release the muscles under the toes. Specifically pay attention to the pain under the 3rd and 4th metatarsal. pictured is the deep tissue point.

Deep Tissue Release Point for Morton’s Neuroma

 

Watch above as Dr. Stoxen demonstrates a great stretch for Morton’s Neuroma!

Probe your body with deep pressure for pain and sore ropy spasms outlined in these video tutorials.

      • If you feel them treat them at the same time with the technique I recommend in the video tutorial.
      • Release all preload tension on the spring for maximum safe deep loading of the spring mechanism.
      • Now lets release the abnormal over use stress from the foot muscles that is causing the over use stress on the body by releasing the entire integrated spring mechanism from toe to head.

Manipulative Therapy

In one review of research on the efficiency of manual therapies on many different musculoskeletal disorders, the evidence was inconclusive, but favorable toward the use of manipulation and mobilization of the foot to decrease pain associated with Morton’s neuroma. (29)

We need to spread out the forces on the landings across all the toes. We also need to keep the pressure off the toes from landing the foot on the side or rolling the weight over the foot so it compresses the bones together.

I adjust the metatarsal cuneiform joints of all toes and spend approximately 10 – 30 hours stretching, doing deep tissue on compressive painful muscle spasms and manipulating patients feet to normalize the movement and mechanics.

Patients will tell you I really aggressively work on these muscles and joints the entire time and that this is a grueling process for not only the patient but for the doctor as well. In fact, patients have described this as a ‘pain exorcism’ or an overhaul, which addresses the accumulation of 40- 60 years of stiffness, inflammation and deformation of the body.

Dr. James Stoxen DC Shares About ‘THE PAIN EXORCISM in detail in his interview on BFM 89.9 The Business Station, From Kuala Lumpur, May 25, 2012, click here to listen now

You may think this is a long time to spend on treating the feet however remember that these patients have had their feet locked in a leather or rubber-binding device squeezing the toes for decades.

If you wear sandals all summer, that is 4 months or about 1,000,000 impacts with the foot in a dorsiflexed locked position as this is required to keep sandals on the feet.

Some female patients have to wear high heels every day for work and therefore are working in heels for 3 decades by their 55th birthday.

If the doctor is right that the deformities start in childhood with shoes that are ill fitting  that means that by age 55 each patient has the damaging forces from between 100,000,000 – 130,000,000 abnormal impacts on this 33 joint complex to accumulate deformities and scar tissue which therefore stiffens the mechanism and scar tissue surrounding the nerves between the bones.

When they come to me the analogy is like trying to thaw out a piece of frozen steak with my bare hands. That is how stiff these feet are.

Morton’s Neuroma Exercises

Phase II and III – Strengthen the spring suspension system, primarily the tibialis posterior muscle with lever system training or strength training and later spring mechanism training with running, jumping and plyometric drills.

Treating the client’s muscular imbalances was an important step in combating compensation patterns the client had adopted to avoid painful motions of the foot.

You must develop of the spring suspension system muscles! This requires;

movement training

SPRING RESISTANCE TRAINING– Strengthen the spring suspension system muscles like a lever. Train with resistance exercises adding cuffs strapped to the foot moving it in a variety of directions such as eversion, inversion, abduction, adduction, pronation and supination.

SPRING IMPACT TRAINING – Strengthen the spring like a spring. I restore the spring suspension system muscles ability to resist impacts with barefoot drills like zigzag patterns, circular patterns, shuffle patterns as well as doing multi direction plyometric drills with graduated increased speeds starting with walking, jogging, running plyometrics.

Because we are going to release our natural spring mechanism, artificial spring protection like heavy cushioned soles wont be necessary. In fact, we should set a goal to get back to walking and running barefoot like we did as a youth.

Why?

The inability to walk or run barefoot safely is one of the first signs of aging ” Dr. James Stoxen DC

Are we running to slow the aging process or speed it up? Then when you’re in the competition you can cheat by putting shoes on that allow for additional recoil of the elastic of the shoe!

Please read these articles which discuss the training of the body to improve impact resistance.

      • Video Tutorial #12 Is Running Bad For Your Knees? How Does The Body Spring Back Safely From Impacts Of Running and Walking?, click here to view
      • Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running , click here to view

Can I wear high heels with Morton’s neuromas? NO!

Can I still run with Morton’s neuromas?

Hey, I have seen women run at high speeds down the street in high heels. Would I recommend it? No way!

If you cannot walk without banging into the ground you have no business running!

How do you know when it is safe to run again?

You just don’t go out and run and see what happens!

You have to videotape yourself walking, jogging and running at increased speeds, which test the impact resistance of the spring suspension system to maintain the foot and limb in the safe range.

Watch this video below of national champion taekwondo, Christian Medina and Dr Stoxen running barefoot down the street. One of our staff was in the back of an SUV videotaping through the window while another staff member was driving.

These are the snapshots taken from the video analysis.

Dr. James Stoxen Dc barefoot running training with Christian Medina

As you can see we ran the entire run in zig-zag patterns. This forces the foot to land in positions that naturally release the 33 joints from different angles and strengthens the suspension system muscles equally from the inside and the outside.

That is how I have been able to run barefoot on solid concrete and asphalt streets without Morton’s Neuromas, shin splints or other impact related conditions.

In conclusion…

There is no one perfect approach. However, we should approach Morton’s neuromas and other conditions with logic that follow the laws of physics and nature.

I have tried my best to present to you my best recommendations based on these laws, the prevailing scientific literature and my many years of clinical experience.

You may not rush off to your family chiropractor or alternative medical center for this but I have found that conservative treatment at our chiropractic center with an integrative medical approach.

Please feel free to share your Morton’s Neuroma story in complete anonymity in the comments below. I will advise the best I can.

Thank you for sharing this article with those you feel it can help!

References – Morton’s Neuroma

1.  Pasero G, Marson P.  [Filippo Civinini (1805-1844) and the discovery of plantar neuroma].  Reumatismo. 2006 Oct-Dec;58(4):319-22. [PubMed]

2.  Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia.  Int Orthop. 2010 Apr;34(4):511-5. doi: 10.1007/s00264-009-0812-3. Epub 2009 May 30.  [PubMed]

3.  Fazal MA, Khan I, Thomas C. Ultrasonography and magnetic resonance imaging in the diagnosis of Morton’s neuroma. J Am Podiatr Med Assoc. 2012 May-Jun;102(3):184-6. [PubMed]

4.  Adams WR 2nd.  Morton’s neuroma. Clin Podiatr Med Surg. 2010 Oct;27(4):535-45. doi: 10.1016/j.cpm.2010.06.004.  [PubMed]

5.  Summers A. Diagnosis and treatment of Morton’s neuroma. Emerg Nurse. 2010 Sep;18(5):16-7. PubMed]

6.  Quinn TJ, Jacobson JA, Craig JG, et al. Sonography of Morton’s neuromas. AJR. 2000;174(6):1723–1728.  [PubMed]

7.  Summers A. Diagnosis and treatment of Morton’s neuroma. Emerg Nurse. 2010;18(5):16–17. [PubMed]

8.  Owens R, Gougoulias N, Guthrie H, Sakellariou A. Frimley Morton’s neuroma: clinical testing and imaging in 76 feet, compared to a control group. Foot Ankle Surg. 2011 Sep;17(3):197-200. doi: 10.1016/j.fas.2010.07.002. Epub 2010 Sep 17. [PubMed]

9.  Fazal MA, Khan I, Thomas C. Ultrasonography and magnetic resonance imaging in the diagnosis of Morton’s neuroma. J Am Podiatr Med Assoc. 2012 May-Jun;102(3):184-6. [PubMed]

10.  Iagnocco A., Coari G., Palombi G., Valesini G.  Sonography in the study of Metatarsalgia, J Rheumatol 2001 Jun;28(6);1338-40  [PubMed]

11.  Symeonidis PD, Iselin LD, Simmons N, Fowler S, Dracopoulos G, Stavrou P.  Prevalence of interdigital nerve enlargements in an asymptomatic population.   Foot Ankle Int. 2012 Jul;33(7):543-7. doi: 10.3113/FAI.2012.0543.  [PubMed]

12.  Peng H, Swierzewski SJ., III Morton’s Neuroma [PubMed]

13. Bennett GL, Graham CE, Mauldin DM.  Morton’s interdigital neuroma: a comprehensive treatment protocol.  Foot Ankle Int. 1995 Dec;16(12):760-3.  [PubMed]

14. Hassouna H, Singh D.  Morton’s metatarsalgia: pathogenesis, aetiology and current management.  Acta Orthop Belg. 2005 Dec;71(6):646-55.  [PubMed]

15.  Fazal MA, Khan I, Thomas C. Ultrasonography and magnetic resonance imaging in the diagnosis of Morton’s neuroma. J Am Podiatr Med Assoc. 2012 May-Jun;102(3):184-6. [PubMed]

16.  Faraj AA, Hosur A. The outcome after using two different approaches for excision of Morton’s neuroma.   Chin Med J (Engl). 2010 Aug;123(16):2195-8.  [PubMed]

17.  Keh R, Ballew K. Long term follow-up of Morton’s neuroma. J Foot Surg. 1992;31(1):93–95. [PubMed]

18.  Johnson JE, Johnson KA, Unni KK. Persistent pain after excision of an interdigital neuroma. Results of reoperation. J Bone Joint Surg Am. 1988;70(5):651–657.  [PubMed]

19.  Spinal cord stimulation for recurrent painful neuromas of the foot. Neurol Sci. 2011 Aug;32(4):723-5. doi: 10.1007/s10072-011-0649-6. Epub 2011 Jun 16.  Messina G, Nazzi V, Sinisi M, Dones I, Pollo B, Franzini A[PubMed]

20.  Hassouna H, Singh D.  Morton’s metatarsalgia: pathogenesis, aetiology and current management.  Acta Orthop Belg. 2005 Dec;71(6):646-55.   [PubMed]

21.  Fuhrmann RA, Roth A, Venbrocks RA. [Metatarsalgia. Differential diagnosis and therapeutic algorithm].  Orthopade. 2005 Aug;34(8):767-8, 769-72, 774-5.  [PubMed]

22.  Zipfel, B. & Berger, L.R. Shod versus unshod: the emergence of forefoot pathology in modern humans. (The Foot:  The International Journal Of Foot Science – Volume 17, issue 4 – December  (2007)  [PubMed]

23.  Norman Espinosa, MD, American Academy of Orthopedic Surgeons AAOS Now
March 2009 Issue  [PubMed]

24. Wu KK, Mortons Interdigital Neuroma: a clinical review of its etiology, treatment and results. J Foot Ankle Surg 1996 Mar-Apr;35(2):112-9; discussion 187-8.  [PubMed]

25.  Rattray F, Ludwig L. Clinical Massage Therapy: Understanding, Assessing And Treating over 70 Conditions. Elmira, ON: Talus Incorporated; 2000.  [PubMed]

26.  Symeonidis PD, Iselin LD, Simmons N, Fowler S, Dracopoulos G, Stavrou P.  Prevalence of interdigital nerve enlargements in an asymptomatic population.   Foot Ankle Int. 2012 Jul;33(7):543-7. doi: 10.3113/FAI.2012.0543.  [PubMed]

27.  Holmes GB Jr. Quantitative determination of intermetatarsal pressure.  Foot Ankle. 1992 Nov-Dec;13(9):532-5.  [PubMed]

28.  Berry K, Gonzalez P, Bowman RG. Physical Medicine and Treatment for Morton Neuroma. Medscape  [PubMed]

29.  Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. [Accessed January 24, 2012];Chiropractic & Osteopathy. 2010 18(3):1–33.  [PubMed]

30.  Field A., Truman G. How I Got My Wiggle Back, Wiley Publishing (2012)  [Amazon.com]

 


 
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Shin Splints – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors

Shin Splints – ICD-9 844.9 Shin Splints – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors Tips For Better Health Ask the doctor, Dr James Stoxen DC In this article is everything you ever wanted to know about shin splints and more! Shin Splits ICD-9 844.9 are one of the most […]

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Shin Splints – ICD-9 844.9

Shin Splints – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors

Tips For Better Health

Ask the doctor, Dr James Stoxen DC

In this article is everything you ever wanted to know about shin splints and more!

Shin Splits ICD-9 844.9 are one of the most common causes of overuse leg injuries are also known as medial tibial stress syndrome (MTSS), soleus syndrome, tibial stress syndrome, periostitis, exercise induced leg pain and chronic exertional compartment syndrome.  (1)

Some say shinsplints when it is really shin splints. I have even seen it spelled chin splints which should be reserved for boxing. ha ha

What are shin splints?

People come in with sore shins or pain in the shins, which is described as pain along the inner (medial) edge of the shin bone of the leg.  Some complain of shin pain, inner (medial) calf and shin pain.

Shin splints are achy pain areas that occur with during or after over exertion or exercise and are aggravated by sticking your thumb into the shin bone and pressing down.

The symptoms of shin splints are not like that of the shin injuries you get from getting kicked in the shin.

Shin splints or the medical term, medial tibial pain that’s why they call it tibial medial stress syndrome because there is too much medial tibial stress.

Aren’t Shin Splints Only For Athletes?  No!

When I tell patients this pain in the front lower leg is shin splints they ask me what is a shin splint? The say, “I thought you only get shin splints from running.”

Most think shin splints are more common in sports like track and field, distance running, basketball, soccer and dance (2) because of the repetitive high intensity training.

I have worked with the cast and crew from ‘Dancing With the Stars’, ‘So You Think You Can Dance’, Broadway national tours, track and field events and soccer teams.  Many think it’s primarily a running injury because many get shin splints while running, or pain in the tibia after running.

More non athlete, everyday people have shin splints than athletes?

The problem is that not many doctors routinely screen for shin splints.  

I screen every patient!

Most don’t know they have them, as they are not painful until you press down on the bone, then the pain is severe.

For some people simple standing or basic walking is stressful enough on the shin area to cause shin splints. If they walked without their cushioned shoes for a while, with sandals all summer or ran a block or two even with cushioned shoes, that would be enough stress to cause the shin splints to fill up with more inflammation fast, and hurt.

Many people have shin splints but the inflammation is not high enough to cause pain until you press down on the shin.  That is how you screen for shin splints.

How do you get shin splints?    What causes shin splints?

The medial tibial pain is caused by stress and strain in the area, that leads to the release of inflammation and when the inflammation gets high enough you feel pain.

Although the pathology of shin splints is understood the development or causes of shin splints are less agreed upon.

Why?

Because doctors cannot agree on the cause of shin splints it makes it difficult for physicians to diagnose and treat this common injury.

I explain why in this post…

If you are looking for a magic cure for shin splints there is not one single remedy.

That is because there are many causes of shin splints and to get rid of shin splints you MUST determine the cause or you are wasting your time with therapies.

Does the body move as a lever (them), a spring (Dr Stoxen) or both (Dr Stoxen)?

There are two schools of thought with respect to bio-mechanics and the causes of impact related injuries like plantar fasciitis, shin splints and other injuries.

There is the school of thought that the body moves through a series of levers.

Then there is the model I developed, the Human Spring Model which says the body moves, recycles energy and protects itself as a giant integrated spring mechanism.

This article will explain the differences in approach of the human spring and human lever model.

Many “lever model only” thinkers believe impacts will injure the body.

That is why they recommend cushioned shoes for all running activities.

First, I will agree with the human lever model school of thought that the abnormal impact stress is what leads to shin splints.

The key word is “abnormal” impact stress.

Normal impact stress is good for the body.  We adapt to it and that is how we get stronger.

In fact, elite athletes and even athletes in grade schools now do high impact training to bolster explosive power by conditioning the body to react elastically.

They call it plyometrics and its employed at every training center in the world from the Olympic training center and currently the grade schools.  I learned the principles of plyometrics from the father of modern plyometrics, Yuri Verkhoshansky, at the Central Institute of Physical Culture and Sports Sciences, in Moscow, USSR, in 1989, when I was 27 years old.    Read the story here

Why have we been brainwashed into thinking impacts are bad for us and paying huge dollars for impact resistant soles for running shoes, orthotics, gel inserts etc?

If these impact resistant soles are required to protect you from impacts then how would you explain why this 50 year old doctor who stands on his feet all day then at night and on the weekends, runs barefoot on solid concrete or asphalt for 6200 impacts (6.2 miles 10 K) of 560 pounds per impact routinely with no shin splints?

To understand why I run barefoot read this article, click here

In fact, I run barefoot on hard surfaces to strengthen my human spring mechanism to be more capable of handling greater impact forces safely, resist aging and prepare my body for my later years.

Human spring model thinkers believe impacts strengthen the body.

In reality, impacts strengthen the spring as long as the spring is intact and can handle the force of the impact.

That is why top athletes do plyometrics or impact training to prepare for elite sports.

You would think that doctors are the ones we should trust when we are looking for advice on this, however we also have to think of what perspective they have when dishing out this advice.

If someone is running pain free, would they go to a bone doctor?

Of course not.

Few doctors examine joints that don’t hurt.

Most lever model doctors only examine the part that hurts.  

Even fewer examine the normal joints of elite athletes.

Most doctors ONLY see injured patients.

When patients get injured the brain responds by stiffening up the area with spasms. So injured patients that see doctors have stiff or locked springs that have turned into levers.

They think everyone ambulates as a lever because all they see are levers. Few ever examine babies or top athletes so they don’t understand how patients (lever mechanisms) can absorb impacts without permanent damage.

Dont blame them. They just dont understand human spring. Help them by emailing them this article.

How do doctors who understand your body as a lever system examine and treat you for shin splints?

What causes the abnormal stress that developed the shin splints?  

This is the key to eliminating them!  

The reason why you have stress on your shin muscles and shin bone causing shin splints and stress fractures is because there is too much stress there.

Can we agree to that profound statement?

Over Pronation & Over Supination

One of the most significant factors leading up to stress fractures doctors should look for is the over rolling of the heel outside the safe range between rolling from the outside (supination) to the inside (pronation) when you are walking or standing. (21)

Why can some people walk, run and even run barefoot on solid concrete for miles without developing abnormal damaging stress in the shins and others cannot?

Its because whatever reduces impact forces that cause abnormal stress isn’t doing its job.

Safe and Unsafe Range

The mechanism that absorbs this stress to keep it from reaching your shin bone and other tissues is the human spring mechanism. One way you can get abnormal stress on your shin bone is when the heel bone rolls outside the safe range between rolling from the outside (supination) to the inside (pronation) on landing when you are standing, walking or running. (5)

They say this causes too much stress on your shins and other places.  I agree with this!

The problem is that they cannot seem to argue on what causes the over rolling.  If you don’t believe me jump into a professional forum with the subject of the cause of over pronation/supination and listen to them argue with each other. Yet, this problem is one of the must common causes of the majority of lower body pain conditions.

Since they cannot come to an agreement on what causes the over rolling, most of them just give you orthotics.  Doesn’t it seem like the arch support-orthotic would actually inhibit the spring loading shock absorption you need to resist the impact force safely into the arch of your foot that would protect your shins from stress?

For more information, read this article I wrote:  What Is Foot Pronation And Foot Supination? Is It Good Or Bad?

Orthotics vs. Natural Spring Down Motion

Since they believe in the lever model they cannot see how the body resists impacts as a giant spring, the spring model so they a shoe with an inch thick cushion.

How can a lever resist impacts without a cushion?  Its impossible.  

In reality your body has a natural spring mechanism which absorbs the impacts!

So, you walk out of the 15-minute office visit with $500.oo worth of shims that prop up your arch, a leather or rubber device that binds your natural spring mechanism that has an artificial spring-cushion mechanism that makes up for the natural one they took away.

A lot of you buy into this approach because it seems like it makes sense.

Why do a lot of people who wear cushioned shoes all day long, get shin splints?

Maybe if we strap pillows to our feet they would be even more protected!

Let me explain why this does not make sense.

What science has found is that surfaces that are too soft can actually weaken us.

Many people don’t have a lot of faith in their own bodies to protect itself.

Instead of restoring the spring in your step you had as a child that allowed you to run around barefoot its better to bind your natural spring and use this artificial one designed by the shoe company!

How does a 50-year old doctor who stands on his feet 10 – 15 hours a day and I run on the solid concrete street completely barefoot (no “barefoot” shoes), with no shin splints.

I don’t own a single pair of running shoes!

I’ve challenged this lever mechanism vs spring mechanism theory to 50,000 doctors and scientists speaking at medical conferences in Tokyo, Monte Carlo, Hangzhou, Guangzhou, Beijing, Kuala Lumpur, Frankfurt, Dusseldorf, London, Cambridge, Sao Paulo, Bogota, Mexico City, Capetown and others.

In fact, the most recent scientific presentation I did, Walk and Run For Life! Through Lever Mechanisms or Spring Mechanisms? in Shanghai was selected by the China government  to be broadcast live on the governments official news portal, the China Peoples Daily.  Enough doctors and scientists have heard the science and yet no one has refuted the new model.

Can levers spring you back from the 250,000,000 collisions you have with the earth over a lifetime? No way!

For more information on why your body is a spring mechanism read these articles;

Video Tutorial #12 Is Running Bad For Your Knees? How Does The Body Spring Back Safely From Impacts Of Running and Walking? click here to view

Video Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running. click here to view

Video Tutorial # 162 How does the Human Spring Work to Absorb Impacts Without Cushion Footwear? My Research. click here to view

Why is there stress on the tibia and surrounding tissues?

What I have found is the spring mechanism that protects you from this stress is weak, stiff  or locked completely.  

a diagram of a mid-foot landing

What protects barefoot runners from impacts?

Its the same thing that protects shod runners!

Allow me to introduce you to your human spring.

What is the difference between an intact or locked spring?

  1. When your spring mechanism is intact, you spring off the ground.
  2. When your spring mechanism is locked, you bang into the ground!

That should make sense.

Human Spring Model

The natural spring mechanism is integrated into all 7 floors of the human body.

Essentially, the human body is a giant human spring. The body is a giant spring with 7 floors of springs: 

  1. The arch
  2. The subtalar joint
  3. The ankle mortise
  4. The knee
  5. The hip
  6. The spine
  7. The head-neck

 

 

 


 

 

supportive cuff muscles

There are two mechanisms that allow the body to function as a spring:

  1. The configuration of the arch with the 26 bones and the ligament attachments.
  2. The spring suspension system which is composed of the muscles and tendons that attach on the under surface of the arch.

The cause of shin splints according to the human spring model.

The spring model says the cause of the abnormal stress on your shin area is

  1. Weakness in your spring suspension system causing stressful landings
  2. footwear that bind your natural spring causing stressful landings
  3. a stiffening or locking of the natural spring leaving you unprotected from the impact forces thus transferring the stress to the shins.

Think of how you would feel if you had no shocks in your car.  Your bones and the cars frame/engine would rattle from the stress.

Why do most doctors think you are a lever mechanism not capable of absorbing impacts without an artificial cushion?

  1. When your spring mechanism gets weak your spring mechanism it drops and locks into a lever mechanism.
  2. When you move through levers vs spring mechanics, the brain senses the abnormal movement patterns  stiffening up the body in a predictable pattern of spasms.
  3. This pattern of spasms compress the spring even further.
  4. Left unchecked and untreated, you spiral into a jail cell of chronic pain, chronic fatigue, often times misdiagnosed fibromyalgia and accelerated aging occur.

That is when you go to the doctor!

So most doctors only see levers in their office.  

Also, insurance companies have developed codes for “regional examinations”.  Some insurance companies and regulators may even consider punishing a doctor for a full examination of the entire spring mechanism when the patient presents with “regional pain” like shin splints.  Its not the standard of care.  In my opinion its pretty standard care.

These are the fundamental causes of weakness in the spring suspension system muscles.

  1. The spring suspension system muscles are not completely developed by running straight ahead. You must move the foot in all ranges of motion against resistance.
  2. You must develop the foot in these ranges of motion with impact forces that are equal to the amount of impact forces you plan on absorbing. That means if you are planning on running you must run drills in all ranges of motion so that the spring suspension system muscles are able to move and develop.
  3. In my opinion, binding footwear inhibit the movement of the bones making it difficult for the muscles to fully develop. So training must be done with bare feet.

Could you see how a weakness, stiffening and or locking of the human spring mechanism could, not only cause shin splints but widespread chronic pain, chronic fatigue, misdiagnosed fibromyalgia and inflammatory diseases of aging?

I recommend you read Anthony Fields book, How I Got My Wiggle Back to see how we treated his shin splints and many other conditions with this approach.

For more information look at Video Tutorial #157 Barefoot Running Is Normal. Shod Running Is Abnormal? Rationale Based On Solid Training Principles, click here to view

In this post I will explain how the body can spring back from impacts of running and walking.

Bouche and Johnson concluded that distal facial traction is generated by contraction of the superficial and deep posterior compartment muscles and this tension contributes to the development of MTSS (7)

Many say the stress that causes shin splints comes from stress and strain from the tibialis posterior, flexor digitorum longus and soleus muscles (8).  Its interesting that when your spring mechanism locks these muscles are tight and tender.

In my opinion and the opinion of other researchers, most shin splints come from training errors and footwear. (6)

The human spring model states that the body is protected by a spring mechanism that can absorb high force impacts through positive adaptation (training).

This can be done through the combined training approach of the body as a lever mechanism through progressive resistance exercises of the spring suspension system and as a spring through spring training such as multi-direction running drills, jumping drills and/or plyometrics.

First we have to agree that impact stresses are good for the body as long as we have an intact spring mechanism.

When are they not? – when the forces are taken up by tissues and not the spring

Force Of Impact/Energy Stored And Released

The deeper the spring can load the impact forces or load safely, the more energy you will recycle through the spring with every step. This allows for maximum efficiency

The deeper the spring can load the impact forces or load safely, the more protected you are at higher speeds

If your human spring abides by hookes law it must function via elastic deformity vs plastic deformity. Don’t worry this is not complicated and in fact it’s a simple concept that will help you make sense of all this.

Elastic Deformity vs Plastic Deformity

Define elastic deformity 

  1. The foot and body deforms it shape to accommodate the force of the impact into the spring mechanism
  2. While it is deforming its shape it is also storing energy in the elastic elements and the shape change
  3. Then when all forces are fully absorbed and the spring reaches maximum depth it begins its return to its EXACT ORIGINAL SHAPE. The ability to reform back to its EXACT ORIGINAL SHAPE is important because this is the key to being able to walk, run and perform sports for a lifetime
  4. As it fully reforms it fully releases the stored energy
  5. Elastic deformity of your body is how you recycle energy and maximum protection from impacts and the preservation of your joints for a lifetime
  6. If your spring is fully released of muscle tension and joint stiffness or locking, fully flexible, strong enough, to absorb the impact force with enough endurance enough to absorb the amount of impacts you are using then you achieve 3 things:

When you exercise with a healthy spring mechanism, you cannot get shin splints. In fact here are the benefits to living with an intact healthy spring.

  1. Each impact stress will make the spring stronger
  2. You are at maximum performance efficiency (using spring elastic elements vs muscle lever pushing elements)
  3. You are protected for impacts at higher speeds.

Yield

Notice on this graph ELASTIC DEFORMITY vs PLASTIC DEFORMITY how there is a point the body gets to a yield point. The yield strength or yield point is defined in in engineering where the amount of stress or kind of stress on the material begins to deform it plastically (permanently)

Prior to the yield point the material will deform elastically (snap back) to its EXACT original shape when the applied stress is removed (When you toe off). Once the yield point is passed, some fraction of the deformation will be permanent and non-reversible. We call this aging.

  1. True elastic limit – Up to this amount of stress, stress is proportional to strain your human spring can handle without remodeling your tissues. This means below this level you don’t get enough stress to improve your tissue strength
  2. Elastic limit (yield strength training zone) – This point and up to the deformity is when your muscles, ligaments, tendons and bones reorganize into a stronger mechanism. This is the zone you want to train in.
  3. Yield point – This is when your tissues damage by a negative stress It is a negative plastic deformity permanent damage occurs with every step or impact – ligaments stretch, discs weaken and bulge, discs degenerate, scar tissue infests elastic elements and muscles, spurs form, bones bend (bunions), micro stress fractures, shins splint, muscles ligaments tendons strain or pull, things start to stiffen and hurt.
  4. Failure Strength – this is when bones break, discs instantly herniate, meniscus tears, ankles sprain, muscles rip, tendons avulse or tear, ligaments tear

Here are the various impact forces of landings:

  1. Walking (1.25 x bodyweight)
  2. Jogging 1.25 – 3x bodyweight
  3. Running (3x bodyweight)
  4. Plyometrics (3-5x+ bodyweight)

The trick for athletes coaches and trainers is to stress your tissues enough beyond the elastic limit to begin to positively deform your tissues as much as possible without exceeding the yield point when you cause damage.

What is plastic deformity?

The foot and body deforms it shape to accommodate the force of the impact into the spring mechanism

Because of weakness in the spring suspension system, stiffness in the spring suspension system or spring mechanism or locking of the spring mechanism, or poor form and or technique in loading the mechanism the way it was designed, The body cannot store the maximum impact force in the elastic elements, your balance and performance is effected the body deforms but does not snap back to its original shape leading to permanent visible deformities. Also, it cannot fully protect you from the forces of the impacts. Instead of the force of the impacts being absorbed into the spring protecting the floors above from this stress, the stress is absorbed into the tissues as damaging stress. This leads to wear and tear, release of inflammation and inflammation leads to pain as well as accelerated aging and risk for diseases of aging.

Because all forces cannot be fully absorbed and into the the spring at full depth it cannot store maximum potential stored energy. Essentially your spring locks and turns into a lever. Instead of the tendons and spring of the arch complex springing you off the ground efficiently you morph into an inefficient poor impact protector, a lever which bangs into the ground then muscles have to push you across the ground.

Plastic or permanent deformity happens when:

  • Your spring is locked you and you are constantly exceeding the yield point with every step.
  • For some of you, forces of simple walking impacts exceed your springs yield point. That is because your springs are weak or your load exceeds the springs yield (overweight or obese) or both.
  • Some athletic and tone runners spring exceeds the yield point because they run for cardio only forgetting that at a certain point in the training the fatigue of the muscles leave the tissues without support causing abnormal stress on the area leading to plastic deformity.

These are potential causes of a fatigued, weak, locked spring suspension system

  1. Standing on your feet all day? for more information read Video Tutorial # 159 – Foot Lock! What You Get From Standing Too Long And How To Prevent It, click here to view
  2. Wearing binding shoes that don’t allow your spring to load and unload to stimulate positive adaptation to get stronger.
  3. Because you have to wear shoes you have to constantly release the locking of the 33 joints of your feet. I work on my feet every day. You can stretch while you are sitting in a chair at work. Watch this tutorial where I show you how. Video Tutorial #88 Dr James Stoxen DC Demonstrates Stretching Of The Foot While Sitting At Your Chair, click here to view
  4. If you don’t strengthen the spring suspension system in all directions. Running only straight ahead neglects the spring suspension system muscles. You have to work your spring in all directions.
  5. You must walk and run with correct form so the spring is worked like a tool the way the tool is designed to be used. This is your human spring owners manual.
  6. Mental stress tightens muscles which, restrict the spring.
  7. All of the above

So when your spring is locked you are actually accelerating the aging process rather than slowing the aging process.

Video Tutorial #68 The Exercise Your Doing Could Be Aging You Faster!, click here

Examples of chronic plastic deformities (minor form flaw over millions of impacts)

  • Muscle Strain/Pain, Aches
  • Bunions
  • Plantar Fasciitis
  • Heel spur
  • Shin Splints
  • Degeneration of Joints (knee and hip replacements)
  • Ligament, muscle and tendon scar tissue infestation – Poor performance from a loss of elastic efficiency
  • Stress fractures the tibia, fibula, femur, pelvis, spine (2)
  • Degenerated discs

Examples of instantaneous plastic deformities

  • Acute Fracture
  • Ruptured Tendon
  • Meniscus Tear
  • Muscle Pull/Tear
  • Herniated Disc

Shin splints never exist alone. To think you have stress in ONLY one linkage point of the body defies the laws of physics, nature, and a few other laws. The abnormal stress and strain is negatively aborbed into the tissues through the entire flooring sustem of the bodyDoctors and therapist dont get arrested for violating these laws so you have to police their efforts yourself.

You need to be checked for:

Floor one – foot lockplantar fasciitis, bunions, heel spurs

Floor Two: subtalar (heel pain), subtalar joint laxity and subtalar locking

Floor three: Ankle mortice locking

Floor Four: adductor (groin) strain or pull, Illiotibial band syndrome

Floor Five: Hip Strain/Pain, Hip degeneration

Floor six: lumbar facet syndrome, piriformis syndrome, disc irritation, disc herniation/bulge

Floor seven: Headaches, neck spasms and pain

for more information read Video Tutorial # 159 – Foot Lock! What You Get From Standing Too Long And How To Prevent It, click here to view

How do you diagnose shin splints?  How do you know you have shin splints?

Most doctors don’t find the diagnosis of shin splints too difficult.

  1. Many just do a skin palpation test (SPT) , which is pressing on the skin around the shin checking for pain.
  2. Then there is the shin oedema test (SOT), which involves pressing into the shin to indent the skin to see if the indentation remains.

That is how many doctors examine you to see if you have pain and inflammation of the shins.  (3) Its a good screen but wont give you the insight on how to reverse them.

Not all pain in the lower leg is a shin splint. In fact you are taking a risk by doing the self-help tips in this article for shin splints you may have any of the following which mimic shin splints:

In fact, tendinopathy, compartment syndrome, (2) calf strain, muscle tears, peripheral vascular disease, fracture, an infection, neoplasms (cancer), DVT venous thrombosis, peripheral nerve entrapment, popliteal artery entrapment, and stress fractures all mimic shin splints. (4)

If you are unsure if you have shin splints consult with your doctor to rule out these other conditions before you make a mistake and this gets worse rather than better.

Here are some pointers…

Shin Splints Vs Stress Fractures – Diagnostic Tests

Some think shin splints are tiny stress fractures of the shin (tibia). Shin splints are different from stress fractures. A stress fracture is a tiny crack or cracks in the tibia bone.

A bone scan is a good way to find a hot spot for a stress fracture.  For 99% of you this test is medically unnecessary. Don’t you want to know exactly what it is? Yes but if it won’t change the way you treat the condition, then there is no need to order it.

The incidence of stress fractures is 23% tibia, tarsal navicular 17.6% , metatarsal 16.2%, fibula 15.5%, femur 6.6%, pelvis 1.6% and the spine .6%. (2)

The MRI is only for significant pathology. A doctor may order an MRI only after a few weeks of treatment where all recommendations are followed to the tee and still there is no progress.

The MRI scan may find periosteal edema or inflammation of the covering of the bone, fracture lines and even edema or swelling in the bone marrow. (9)

I have never had the need to order an MRI because I insist my patients follow my recommendations to the tee and so far all of them have recovered from shin splints.

I feel these tiny stress fractures and shin splints are treated pretty much the same so maybe you can get away with treating a shin splint not knowing it was a stress fracture.

They know you have shin splints but… dont do the more advanced evaluations you wont have the deeper insight as to what caused them or how to reverse them.

If all you know is that you have inflammation of the shins you are left with the same old song and dance treatments:

Shin Splint Treatment

Orthotics

Doctors that see your foot rolls too far out of the safe range between pronation and supination without knowing the cause will give you these.

The Standard of Care for Shin Splints (13)

  • The standard ice the shins to decrease inflammation. I agree with that.
  • Some prescribe anti-inflammatories. Does that stop the inflammation from flowing? NO There are more effective natural ways to reduce shin splint inflammation.
  • Some fit you with arch supports. Your spring turned into a stiff lever so now you jam a support into the confined area of the shoe which may jam and or inhibit the movement of the 33 joints of the spring more.
  • Some professionals recommend shoes with even more cushion. Your natural spring cannot handle the impact forces from the landings so instead of releasing and strengthening the natural spring they bind it down with a shoe and give you a thicker artificial spring to make up for the one that is getting progressively weaker because it is bound. I see people walking around with running shoes on all day. I don’t recommend this.
  • Some recommend sports compressive stockings or neoprene sleeves. I have no idea how these would lessen the negative stress on your shins.
  • They give you a walking cast when shin splints are bad or when they suspect a stress fracture. The boot casts your foot and turns your spring into a giant lever heavy lever. Now you have more weight on one side of the body than another. You are at risk for breakdown of the other floors due to this imbalance of load.
  • Some recommend braces. – Most have found these comfortable for walking. (10) Your optimum support for the human spring are the spring suspension system muscles.
  • Some recommend taping for shin splints or strapping for shin splints. I can understand shin splint taping in the heat of a competitive environment as a temporary measure to get you through but it is not practical for a long term solution. It is something I never do because I cannot stop by to change the tape when it weakens all the time. Did you ask the doctor if he could come by every few hours to change the tape?
  • Surgery - Surgery is so rare for shin splints.  In fact I have never heard of anyone having surgery for shin splints.  Of those who had surgery, what ever surgery they did decreased pain in 72% but only 41% returned to their original training (11) What do you operate on? I would never recommend surgery for shin splints no matter how bad they are unless you had a compartment syndrome that was worsening.
  • They recommend specific supplements to support tissue health. – A study in Finland found people with shin splints and stress fractures had lower levels 25-hydroxyvitamin D. The study also recommended supplementing with 2000 mg calcium and 800 IU of Vitamin D. (2) Of course, this would depend on if you were getting enough 25-hydroxyvitamin D and calcium in your diet. I’m in favor of all supplements that improve your bodies chemistry to promote healing and optimum tissue health and metabolism.

The Gait Evaluation – A more Thorough Examination

Do you know the proper abnormal stress and strain free form and technique of walking or running?

If you get a pogo stick it comes with a manual to teach you how to use this spring device. If you don’t read the manual how do you know how to use it properly?

Have you ever read a manual on how to use your human spring for safe and effective walking and/or running?

This is your manual!

Do you absorb impact stress through your spring when you walk or is your spring locked leading to abnormal stress in your tissues instead?

Videotape your walk—-

Watch it back advancing the movie slowly frame by frame.  What do we see?

  • Are your feet, shins and legs relaxed prior and during impact?
  • At impact and while transferring the weight across the planted foot are any of the toes off the ground?
  • Does your calf shake when it hits the ground (from the back)?
  • Do you push or pull your body across the ground or spring your body off the ground?
  • Does your foot land with the second toe pointing the direction you are going?
  • Is your shin, ankle and foot in alignment or do you have a weak or weak ankles? (over pronation)
  • Do you walk heel-toe or land heel first?  There is no spring there.  The impact goes bone (heel) to bone (talus) to bone (shin)  The spring suspension system is in the middle/front of the foot!

Heel, Neutral, Forefoot Landing

If any of these are true, you must work on relaxing your walking form and technique to lessen the impact force.

How do we correct the form and technique of your walk?

  1. Land with foot-leg-hip directly more perpendicular to earth gravity and body
  2. When you are perpendicular to the pull of gravity is when your spring should be loaded at full depth.
  3. It shouldnt be when you hit your heel first

Regardless, it is impossible to walk or run with perfect stress free form and technique without all restrictions removed from the spring and for it to be strong enough to handle the impact forces of movement at the speed you want to travel, walking,  jogging, running and/or plyometrics.

I have developed a 3-step approach to restoring safer, spring loading capacity:

  1. Release the spring from forces that create compressive forces on the human spring from muscle spasms
  2. Strengthen the spring suspension system muscles
  3. Impact train the spring suspension system

This three step approach will help you expand the force loading capacity of your human spring to better spring off from impacts, to have maximum performance and reduce risk of shin splints even at higher impact forces such as running and even running barefoot on solid concrete.

It is critical for you, your coach and your doctor to:

  1. Understand what causes the breakdown of the spring mechanism. It starts with weakness in the spring suspension system, that leads to a drop and lock in the spring suspension system, that causes abnormal stress and strain which leads to wear and tear, inflammation and pain.
  2. Learn how to check for abnormal movement patterns with gait evaluations (evaluations of walking or running movement patterns).  Many, including myself feel that biomechanics is the most accurate predictor of the risk of shin splints (14)
  3. Learn how to check for the specific patterns of abnormal internal forces with hands on deep tissue palpation.
  4. Learn how to remove the abnormal internal compressive forces on the human spring caused by spasms that compress the human spring (joints). This is done with muscle spindle work and specific adjustments of the feet, ankles, knees, hips and spine.

What are the best shoes for walking or running with shin splints?

Most would think heavy cushioned running shoes are best.

Shoes with cushions dont absorb the stress to prevent shin splints, your natural spring does.

Weak Spring Suspension System Muscles - If our spring suspension system muscles are too weak to maintain the foot in the safe range between rolling from supination to pronation we must have a shoe with a counter mechanism strong enough and durable material to maintain the heel in the safe range to stop the abnormal stress.

I never put a patient in a running shoe to reverse shin splints! It doesnt work.  They are too soft to stop the rolling out of the safe range from supination to pronation that leads to the abnormal stress that causes the shin splints!

The Best Shoes For Shin Splints will help keep the foot in the safe range

The best shoes for shin splints – Shoes with extended medial counter stabilizers. I opt for a leather shoe with a stiff counter support.  No, they arent uncomfortable.  Shin splints are!  

For more information read Video Tutorial #97 On Your Feet All Day? Fatigued? Achy? Over Pronation? I Recommend Footwear with Extended Medial Counters, click here to view

For more information read Was My Chronic Pain, Fatigue, Fibromyalgia Cured with a Pair Of Shoes? NO!, click here to view

Releasing the abnormal stress from the shins with a stiff or locked spring

If you have a stiff or locked spring, you cannot run or walk without stress on your shins before you have released all the internal muscle and joint tension from your spring mechanism. Instead of running you should be spending the time preparing for better runs.

I spend at least 30 minutes doing the deep tissue treatments on my feet and legs before I run.

I dont want to find out I have a pattern of spasm from my foot to my spine that will inhibit the safe loading of the impact of my bare foot on the solid concrete.

Probe your body with deep pressure for pain and sore ropy spasms outlined in these video tutorials.  

If you feel them treat them at the same time with the technique I recommend in the video tutorial.

Release all preload tension on the spring for maximum safe deep loading of the spring mechanism.

Now lets release the abnormal stress from the shins that is causing the shin splints by releasing the entire integrated spring mechanism from toe to head.

Watch above as Dr. James Stoxen DC Demonstrates the deep tissue release he uses to relieve shin splints.

Do all of these to start the day and before every run 

Links to Dr Stoxen’s self help video tutorials for shin splints:

Video Tutorial #78 Deep Tissue Treatment Of The Knee Popliteus Muscle
Video Tutorial #79 Deep Tissue Treatment Of The Gluteus Medius Muscle of the Hip
Video Tutorial #80 Deep Tissue Treatment Of The Subtalar Joint Of The Ankle On The Inside
Video Tutorial #81 Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside) 
Video Tutorial #82 Deep Tissue Treatment Under The Big Toe And Second Toe
Video Tutorial #83 Deep Tissue Treatment Above The Big Toe And Second Toe 
Video Tutorial #87 Deep Tissue Of The Ankle Mortise

Dr Stoxen’s best stretches for shin splints, video tutorials:

Video Tutorial #84 Scissor Stretching Of The Feet
Video Tutorial #85 Stretching Great For Mortons Neuromas And Heels
Video Tutorial #88 Stretching Of The Foot While Sitting At Your Chair
Video Tutorial #89 A Stretch To Increase The Flexibility Of Your Foot

Shin Splint Exercises

You must develop the spring suspension system muscles!

This requires you to:

SPRING RESISTANCE TRAINING– Strengthen the spring suspension system muscles like a lever. Train with resistance exercises adding cuffs strapped to the foot moving it in a variety of directions such as eversion, inversion, abduction, adduction, pronation and supination.

SPRING IMPACT TRAINING – Strengthen the spring like a spring.  I restore the spring suspension system muscles ability to resist impacts with barefoot drills like zigzag patterns, circular patterns, shuffle patterns as well as doing multi direction plyometric drills with graduated increased speeds starting with walking, jogging, running plyometrics.

Because we are going to release our natural spring mechanism, artificial spring protection like heavy cushioned soles wont be necessary. In fact, we should set a goal to get back to walking and running barefoot like we did as a youth.

Why?

The inability to walk or run barefoot safely is one of the first signs of aging ”

Are we running to slow the aging process or speed it up?

Then when you’re in the competition you can cheat by putting shoes on that allow for additional recoil of the elastic of the shoe!

Please read these articles which discuss the training of the body to improve impact resistance.

Video Tutorial #12 How Does The Body Spring Back Safely From Impacts Of Running and Walking?, click here to view

Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running , click here to view

Can I still run with shin splints? NO WAY!

If you cannot walk without banging into the ground you have no business running!

How do you know when it is safe to run again?

You just don’t go out and run and see what happens!

You have to videotape yourself walking, jogging and running at increased speeds which test the impact resistance of the spring suspension system to maintain the foot and limb in the safe range.

Watch this video below of national champion taekwondo, Christian Medina and Dr Stoxen running barefoot down the street.  One of our staff was in the back of an SUV videotaping through the window while another staff member was driving.

These are the snapshots taken from the video analysis.

Dr. James Stoxen Dc barefoot running training with Christian Medina

There is no one perfect cure. However, we should approach heel spurs and other conditions with logic that follows the laws of physics and nature.   I have tried my best to present to you my best recommendations based on these laws, the prevailing scientific literature and my many years of clinical experience.

You may not rush off to your family chiropractor or alternative medical center for this but I have found that conservative treatment at our chiropractic center with an integrative medical approach.

 

Please feel free to share your shin splint story in complete anonymity in the comments below. I will advise the best I can.

Thank you for sharing this article with those you feel it can help!

References

1.  Reshef N, Guelich Medial tibial stress syndrome, DR. Clin Sports Med. 2012 Apr;31(2):273-90. doi: 10.1016/j.csm.2011.09.008. [PubMed]

2.  Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician. 2011 Jan 1;83(1):39-46. [PubMed]

3.  Patel DS, Roth M, Kapil N. Two simple clinical tests for predicting onset of medial tibial stress syndrome: shin palpation test and shin oedema test. Br J Sports Med. 2012 Sep;46(12):861-4. doi: 10.1136/bjsports-2011-090409. [PubMed]

4.  Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Oct 7;2(3):127-33. doi: 10.1007/s12178-009-9055-6.  [PubMed]

5.  Raissi GR, Cherati AD, Mansoori KD, Razi MD. The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes.  Sports Med Arthrosc Rehabil Ther Technol. 2009 Jun 11;1(1):11. doi: 10.1186/1758-2555-1-11.  [PubMed]

6.  Jogging – Overuse injuries at the locomotor system, SPORTVERLETZ SPORTSCHADEN 1991; 5(1):  22-26 DOI: 110.1055/S-2007-993559

7.  Reinking MF, Exercise Related Leg Pain (ERLP): a Review of The Literature.  N Am J Sports Phys Ther. 2007 Aug;2(3):170-80.  [PubMed]

8.  Bouché RT, Johnson CH  Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction. Am Podiatr Med Assoc. 2007 Jan-Feb;97(1):31-6.  [PubMed]

9.  Mammoto T, Hirano A, Tomaru Y, Kono M, Tsukagoshi Y, Onishi S, Mamizuka N., High-resolution axial MR imaging of tibial stress injuries. Sports Med Arthrosc Rehabil Ther Technol. 2012 May 10;4(1):16. doi: 10.1186/1758-2555-4-16. [PubMed]

10.  Moen MH, Bongers T, Bakker EW, Weir A, Zimmermann WO, van der Werve M, Backx FJ.  The additional value of a pneumatic leg brace in the treatment of recruits with medial tibial stress syndrome; a randomized study.  J R Army Med Corps. 2010 Dec;156(4):236-40.  [PubMed]

11.  Yates B, Allen MJ, Barnes MR. Outcome of surgical treatment of medial tibial stress syndrome.  J Bone Joint Surg Am. 2003 Oct;85-A(10):1974-80.  [PubMed]

12.  Rathleff MS, Kelly LA, Christensen FB, Simonsen OH, Kaalund S, Laessoe U.  Dynamic midfoot kinematics in subjects with medial tibial stress syndrome. J Am Podiatr Med Assoc. 2012 May-Jun;102(3):205-12.  [PubMed]

13.  Moen MH, Holtslag L, Bakker E, Barten C, Weir A, Tol JL, Backx F. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. [PubMed]

14.  Sharma J, Golby J, Greeves J, Spears IR. Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait Posture. 2011 Mar; 33 (3):361-5. doi: 10.1016/j.gaitpost.2010.12.002. Epub 2011 Jan 17. [PubMed]

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  • Fever: When you have a fever, your body is trying to isolate and expel an invader of some kind. Massage increases overall circulation and could therefore work against your body’s natural defenses.
  • Inflammation: Massage can further irritate an area of inflammation, so you should not administer it. Inflamed conditions include anything that ends in itis, such as phlebitis (inflammation of a vein), dermatitis (inflammation of the skin), arthritis(inflammation of the joints), and so on. In the case of localized problems, you can still massage around them, however, avoiding the inflammation itself.
  • High blood pressure: High blood pressure means excessive pressure against blood vessel walls. Massage affects the blood vessels, and so people with high blood pressure or a heart condition should receive light, sedating massages, if at all.
  • Infectious diseases: Massage is not a good idea for someone coming down with the flu or diphtheria, for example, and to make matters worse, you expose yourself to the virus as well.
  • Hernia: Hernias are protrusions of part of an organ (such as the intestines) through a muscular wall. It’s not a good idea to try to push these organs back inside. Surgery works better.
  • Osteoporosis: Elderly people with a severe stoop to the shoulders often have this condition, in which bones become porous, brittle, and fragile. Massage may be too intense for this condition.
  • Varicose veins: Massage directly over varicose veins can worsen the problem. However, if you apply a very light massage next to the problem, always in a direction toward the heart, it can be very beneficial.
  • Broken bones: Stay away from an area of mending bones. A little light massage to the surrounding areas, though, can improve circulation and be quite helpful.
  • Skin problems: You should avoid anything that looks like it shouldn’t be there, such as rashes, wounds, bruises, burns, boils, and blisters, for example. Usually these problems are local, so you can still massage in other areas.
  • Cancer: Cancer can spread through the lymphatic system, and because massage increases lymphatic circulation, it may potentially spread the disease as well. Simple, caring touch is fine, but massage strokes that stimulate circulation are not.Always check with a doctor first.
  • Other conditions and diseases: Diabetes, asthma, and other serious conditions each has its own precautions, seek a doctor’s opinion before administering massage.
  • Pregnancy: No deep tissue work. Be aware: danger of triggering a miscarriage by strong myofascial work is greatest during the first 3 months (especially through work around the pelvis, abdomen, adductors, medial legs, or feet)

Cracking Achy Knee Pain or Chondromalacia Patella – Treatment and Prevention Tips from The Barefoot Running Doctor

  Chondromalacia Patella ICD-9 733.92 What is chondromalacia patella? Athletes and trainers call it runners or jumpers knee. Non-athletes call it cracking knees. Doctors call it chondromalacia patella. It has many names which confuse people.  Some people even split up the word as chondro malacia patella but it should be chondromalacia patella. chondromalacia patella or CMP, sometimes called anterior knee […]

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Chondromalacia Patella ICD-9 733.92

What is chondromalacia patella?

Athletes and trainers call it runners or jumpers knee.

Non-athletes call it cracking knees.

Doctors call it chondromalacia patella.

Knee Pain

It has many names which confuse people.  Some people even split up the word as chondro malacia patella but it should be chondromalacia patella. chondromalacia patella or CMP, sometimes called anterior knee pain; patellofemoral pain syndrome; patellar tendinitis; patellar tracking dysfunction; patella femoral syndrome; tendonitis of the knee; patellar dysfunction; patellofemoral arthralgia and chondromalacia patellae, is the softening and breakdown of the tissue (cartilage) that lines the underside of the kneecap (patella).

People come into Team Doctors and say “My knee hurts” or “I have a swollen knee, a bad knee, achy knees or bad knees.”  

Patients ask questions like:

Why is my knee sore and especially pain behind, under or below the knee cap?

Why do I have a sore knee cap and when is it chronic, why is my knee swelling?

Why is my knee popping or why do I have cracking in the knees?

Why is it my knee hurts when I bend it?

Why does my knee hurt when I squat down?

Why do I have, after running, knee pain?

When patients ask these kind of questions I am always thinking chondromalacia knee.

What is chondromalacia patella (walkers) or runners knee (runners)?

Patello-Femoral Syndrome or Chondromalacia Patella (of Greek origin meaning “softening of the cartilage”) or “Runner’s Knee”

Runners Knee refers to pain on the inside of the knee, although pain on both sides  of the knees or pain beneath the kneecap can also occur. It is more commonly seen in runners as opposed to walkers due to a higher level of activity, particularly mileage.

The key element in this injury is due to over pronation causing a repeated stress of the patella bone moving abnormally from side to side over the groove of the thigh bone (femur), gradually softening the cartilage under the kneecap.

The result is the surface of the joint can become rough. Kneecap pain may be just a prelude to further destruction of the surface (traumatic arthritis). This injury can be confused with “Patella tendonitis” which is usually pain beneath the patella bone. In either case it is the “tracking” of either the bone or tendon which needs to be addressed.

The patient commonly has no history of a knee injury like a twisted knee, nor can they pinpoint any particular event that initiated the pain in the knee cap.

Do you have patella pain,  achy knee pain or cracking or popping in the knee? Is your knee swollen or do you haven chronic knee pain? Do you have patella groove pain or patellar joint pain?  has your knee doctor or knee surgeon told you that you need knee surgery or injections for knee pain?

If you hear your knee cracking or if you have knee pain when you walk up the stairs, knee pain after running, knee pain while running, knee pain when getting up from a chair or knee pain when bending, infraptatellar pain, you might have chondromalacia patella.

Some other symptoms of chondromalacia patella are;  knee pain when you do lunges, knee pain when squatting, knee pain when doing extensions, a feeling of water on the knee, dislocated knee cap or dislocated patella.

What I have found in treating patients with pain in the knee is that knee inflammation and  intense knee pain could be caused by a locking of the Human Spring. Over pronation could be a factor so LOOK AT THE FEET FIRST!

The first thing we need to do is look at the anatomy of the knee.

What tendons are in the knee?

As you know, the patella is a pulley mechanism. (see picture to the right)  I observe many coaches looking at hamstring and quad strength as the key to patella motion in the patellofemoral groove or the trochlear grove.

note: The trochlear groove is the concave surface where the patella (kneecap) makes contact with the femur (thighbone). Also called the ‘trochlea’.

The way I see it is that the hamstrings and quads are in the middle of the kinematic chain or spring mechanism of the body. So therefore, they don’t influence. They are influenced by the way the mass transitions across the foot spring mechanism.

The answer to your Cracking Achy Knee Pain is not to pop an advil, ice pack or to do some hamstring stretches. That is like putting a bandaid over a bullet wound.

React!

What is chondromalacia?

chondro malacia patella; Anatomy of Chondromalacia Patella:

  • Chondro = cartilage
  • Malacia = softening of tissues
  • Patella = knee cap

Chondromalacia patella is abnormal softening of the cartilage of the underside the kneecap (patella) or patellar joint. It is a cause of pain in the front of the knee (anterior knee pain). Chondromalacia patella is one of the most common causes of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap (patella) as it slides over the lower end of the thighbone (femur). This process is sometimes referred to as patellofemoral syndrome.

What causes chondromalacia patella?

I have treated thousands of patients with chondromalacia patella. A patient might come in with complaints of  knee cap pain or knee osteoarthritis. The pain in the knee cap goes away without any training of the quads or hams. What I find is that on the involved side of infra patellar pain is an abnormal foot plant (over supination/ over pronation).

When transitioning the impact forces of the landing, the foot adjusts for the impacts two ways:

The 33 joints of the foot and ankle spread across the force of the landing. When this happens the impact is received as a “negative” by the tendons of the landing muscles.

The problem with the current mechanical model being used for the study of biomechanics (the lever system)–the way most podiatrists, etc., look at the body–is they look at it as a rigid lever when it is not rigid at all.

Assuming the human body ambulates, protects itself from impacts and recycles energy through a lever system is illogical and actually defies the laws of physics. A lever cannot protect an object from a lifetime minimum of 250,000,000 collisions with the earth. The body must be a spring mechanism.

The Human Spring

The body springs off the ground when its working the way its designed. The natural spring mechanism occurs at the arch and transfers its protection and spring energy through the 7 floors of the human spring.

The body is a giant spring with 7 floors of springs:

  1. The arch
  2. The subtalar joint
  3. The ankle mortise
  4. The knee and the knee cap
  5. The hip
  6. The spine
  7. The head-neck

When your spring mechanism is weak it collapses into a lever mechanism. When it collapses, the brain senses the abnormal movement patterns and tries to protect you from the stress and strain by muscle spasms. spasms compress the spring further.

Weakness, stiffening and or locking of the human spring mechanism could cause widespread chronic pain, chronic fatigue, misdiagnosed fibromyalgia, chronic inflammation as well as Chondromalacia Patella, knee cap pain, knee osteoarthritis and knee inflammation.

We must first gain an understanding of overpronation and oversupination

 

Safe and Unsafe Range

The foot rolls from supination to pronation. Have you ever heard of over pronation?  That is where to foot rolls too far inward outside the green safe range for foot rolling in the graphic above.

When this happens, the limb internally rotates on impact. That does not put the patella (knee cap) in a good position to allow for stress and strain free motion.

What is a knee cap?

A knee cap is like a wire in a pulley mechanism.  So the key to understanding this is simple. If the foot rolls out of the safe range the knee cap will also rotate out of the safe range in its grove as well.  Does that make sense?

If I have an athlete with patella groove pain or infra patellar pain I always do a simple gait study.

During a normal gait cycle, the femur and the tibia (thigh bone and shin bone) rotate together (i.e. outward when your foot first lands on the outside then inward when it rolls to the inside).

However, chondromalacia occurs when a person over-pronates (over rolls the foot out of the safe range) because the tibia (shin bone) is locked into the talus (ankle bone) and therefore continues to rotate inward the femur receives its orders from the brain and begins to rotate outward when your foot is planted.

This seems complex but simply stated patellar tendon pulls the knee cap out of the groove it is supposed to be in causing grinding of the undersurface cartilage leading to pain in the knee cap, patella pain, knee pain below the knee, and just general pain around the knee.

The resulting counter rotation of the femur and the tibia causes the patella to rub against the cartilage in the grove instead of moving smoothly up and down in its normal track, which causes the pain felt by the patient and the damage to the cartilage.

Over Pronated Foot

Therefore, if the foot rolls outside the safe range (green-black-green) then the limb rolls in or outside the safe range this causes the knee to be in a position where the knee cap will grind against the pulley mechanism gro0ve (trochlear gro0ve) This can cause irritation to the cartilage, chronic inflammation and knee pain.

Pain at the front/inner side of the knee is common in young adults, especially soccer players, gymnasts, cyclists, rowers, tennis players, ballet dancers, basketball players, horseback riders, volleyball players, and runners.

Knee Pain

The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so it is also called “movie sign” or “theater sign.” Snowboarders and skateboarders are prone to this injury, particularly those specializing in jumps where the knees are under great stress.

Skateboarders most commonly receive this injury in their non-dominant foot due to the constant kicking and twisting that is required of it during skateboarding. The condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during motion of the knee.

Other possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.

Chondromalacia Treatment

The problem with trying to adjust the position of the patella with the training of muscles above the patella is that the most common abnormalities of limb position that effect the glide of the patella come from below, in the foot and ankle.

We all know that if we have poor posture it is because the muscles don’t have a balance of strength with respect to what role they are supposed to play. Obviously you know long term chondromalacia treatment involves chondromalacia exercises to strengthen the muscles so there is a balance of strength in the foot rolling mechanism so the foot, shin bone and thigh dont over rotate causing chondromalacia symptoms.

However, patients with a sore knee cap dont want to exercise because some exercises like knee extensions actually track the knee cap leading to under the kneecap pain the next day.

We know that we can change the position and motion of bones by training. Is it possible to train muscles when the joints they affect are locked? Its not safe for many reasons

.

That is why we must first stabilize the foot rolling within the safe range to stop the stress and strain that is leading to the wear and tear under the knee cap that is leading to the sore knee cap.

We do this with a shoe that has a strong medial extended counter support.

Safe and Unsafe Zone

I have treated some of the most amazing dancers from Dancing with the Stars, So You Think You Can Dance, national broadway touring companies and over 100 other tours of top entertainers.  Many are fitted for $500 custom shoes for performances and wonder why they are still in pain.

What did you do Saturday after rehearsal?

I went shopping on the sidewalk with flip flops for four hours.

Oh!  Well why do you wonder why your knee hurts?

Read these video tutorials to understand what shoes are required and why:

Video Tutorial #97 On Your Feet All Day? Fatigued? Achy? Over Pronation? I Recommend Footwear with Extended Medial Counters

Video Tutorial #86 Dr James Stoxen DC Recommends The Best Shoes To Prevent The Foot From Deforming

Why is it any different from the elbow joint where we demand form and technique be perfect during exercise to maintain limb alignment and prevent stress or strain?

If I have an athlete with patella groove pain or infra patellar pain you should do a simple gait study.

watch above as Dr. Stoxen evaluates a gait study with a patient at Team Doctors

Get a $140 HD flip video camera. Video the athlete walking barefoot 10 steps toward the camera and back. Do this while the athlete is walking, fast walking, and running. Download it and watch the video frame by frame and you will see why the patella is not in the groove. It is obvious and enlightening.

 Here is a blog post you may like that talks about “foot lock” which is when joints of the foot are locked causing abnormal movement patterns (compensations) which effect patella position and a lot more! click here to view

If you hold a curl at 90 degrees of flexion for 30 minutes the muscles go into a spasm, the joints stiffen and sometimes there is pain and altered motion. Why wouldn’t you think this same locking would happen in the foot and ankle spring when you stand for 30 minutes?

It does!

The next step in the protocol for the human spring model is the release the tension on the human spring suspension system and the mechanism throughout the entire flooring system of this integrated spring mechanism.  We start at the foot and work out way up.

watch the video tutorials below to release the human spring with my deep tissue release tips:

Be sure to start on Video Tutorial # 78 and go through Video Tutorial #89:

Watch above as Dr James Stoxen DC Demonstrates Self-Help, Deep Tissue Treatment Of The Knee Popliteus Muscle

Watch above as Dr James Stoxen DC Demonstrates Self-Help, Deep Tissue Treatment Of The Gluteus Medius Muscle of the Hip

Watch above as Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Ankle (Subtalar Joint Inside)

Watch above as Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside)

Watch above as Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Treatment Under The Big Toe And Second Toe

Watch above as Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Treatment Above The Big Toe And Second Toe

Watch above as Dr James Stoxen DC Demonstrates Scissor Stretching Of The Feet

Watch above as Dr James Stoxen DC Demonstrates Stretching Great For Mortons Neuromas And Narrow Heels

Watch above as Dr James Stoxen DC Recommends The Best Shoes To Prevent The Foot From Deforming

Watch above as Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Of The Ankle Mortise

Watch above as Dr James Stoxen DC Demonstrates Stretching Of The Foot While Sitting At Your Chair

Watch above as Dr James Stoxen DC Demonstrates A Stretch To Increase The Flexibility Of The Arch Of Your Foot

What exercises strengthen the knee?

Chondromalacia Exercises - People are always asking about what exercises strengthen the knee when it is really what exercises strengthen the feet and ankles.  The position of the 3 dimensional foot determines how the knee tracks.  In other words the knee is a victim of foot and ankle react to the landings.

The next step is to train the foot and lower extremities as lever systems in all ranges of motions with strength training 

To learn more about strengthening the human spring mechanism please read these two tutorials:

Video Tutorial #12 Is Running Bad For Your Knees? How Does The Body Spring Back Safely From Impacts Of Running and Walking?

Video Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running

The foot is a 3-dimensional structure that has to be trained in all ranges of motion and without a binding or motion altering device.

This article and the articles that are linked to this article will give you a step by step action plan to reducing chondromalacia patella or cracking knee pain.  In order to get the best results you need to do all the steps and not miss any.

In patients with obvious over pronation I have not been able to resolve their choncromalacia pain without counter support footwear.  You can try it but I will save you the effort of making the mistake. I have never been able to do it and I doubt you will either.

Good luck treating the snap crackle pops of the cracking knee syndrome. If you need any help, please contact me in the comments section of this article and I will do my best to help you.

Thank you for sharing this article with your friends!  Dr James Stoxen DC

Disclaimer

 

 

What Songs Do You Listen To When Running?

    What are the top three songs you listen to when running? When you run barefoot, part of the analysis of form and technique is to hear the sound your foot makes on impact. By listening very carefully and making adjustments to the tension of your landing gear you can soften up your landing […]

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What are the top three songs you listen to when running?

When you run barefoot, part of the analysis of form and technique is to hear the sound your foot makes on impact. By listening very carefully and making adjustments to the tension of your landing gear you can soften up your landing from a bang and a twist to a spring….

When it comes to running efficiency and reduction of injurious conditions…

The “SPRING IS THE THING”

As a reporter I met from the ‘Malaysia Star’, Jaya J says, “Footwear is comparable to mothers who smother. You know, you have all good intention of protecting and giving your feet the best care, but what you’re actually doing is smother those feet by binding them in that cushion so much that they lose their natural sustainability, which is the Human Spring.” To here more of what Jaya J says on her blog, click here 

So protecting them from the impacts you can no longer tell if you are impacting with spring or bang because the cushion fools you into thinking your spring is working when its really a cushioned, bang and twist.

Then you further isolate youself from hearing how hard your foot impacts with music you make it more difficult to fine tune your landing as a spring and not a bang.
BANG! BANG! BANG!

The next music you will here will be coming from the reception area of Team Doctors, Treatment and Training Center or worse the hospital.

Im sure some sweet lady is going to flip out on me with a comment. :)

I like to listen to music to relax or I use the beat of the music 180/min to pace my run cadence!

hahaha

Im cool with that. Dont break a nail!

I listen to the pitter patter of springy bare feet.

Its a new song I hope to be a big hit!

Seriously, feel free to post comments below on what music you like.

Barefoot Running Doctor

THE BAREFOOT DOCTOR: ARTICLE IN MALAYSIAN BUSINESS MAY 16TH, 2012

  Interview by Sharmila Valli Narayanan May 16, 2012 Dr James Stoxen is a well-known figure among rock stars and celebrities in the United States. He is a star in the world of chiropractors and an advocate of running barefoot. Sharmila Valli Narayanan meets up with the man with the magic touch who literally brings back the spring […]

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Interview by Sharmila Valli Narayanan
May 16, 2012

Dr James Stoxen is a well-known figure among rock stars and celebrities in the United States. He is a star in the world of chiropractors and an advocate of running barefoot. Sharmila Valli Narayanan meets up with the man with the magic touch who literally brings back the spring to your step.

Chiropractor Dr James Stoxen DC is a strong advocate of running barefoot. According to him, most of us walk wrongly, which, in turn, causes all kinds of problems to crop up from knee and joint pains to backache.One of the Malaysian reporters whocame to interview him had over the past year developed a mysterious condition in her legs that caused this once-fit runner unable to run.

Worse, her left leg had become numb. She had consulted many specialists and podiatrists but to no avail. Most of them said that she would eventually have to undergo surgery to get some relief from the pain. They also told her that her running days were behind her.

Stoxen, who has been an ‘on-site chiropractor’ for American A-List stars’ concerts since 2003, listened to her complaints and videotaped her walking. He studied the video recording of her gait and said there was no problem with how she walked.

He asked her to come in for a consultation where for about two-and-a-half hours he used his hands to do some deep tissue massaging on her left leg. To the pleasant surprise of the journalist, she actually began to experience sensation in her leg after enduring numbness for more than a year. He told her in order for her to be fully recovered, she would need a series of treatment for both her legs.

He also gave her the book How I Got My Wiggle Back by Anthony Field, ‘the founder and co-star of the world’s most popular children’s musical group, The Wiggles’. The book chronicles Field’s long struggle to battle chronic pain (among other things) to get back his health and vigour. Field’s life took a turn for the better after meeting Stoxen and he credits Stoxen for helping him get back on the road to wellness.

Dr. James Stoxen DC with Anthony Fiel

Over the years, Stoxen has helped many of his patients, some of whom were scheduled for hip replacement, recover from their pain without resorting to drugs or surgery.

The barrel-chested Stoxen is a picture of health and vitality himself at 50. It is a difficult task to get him to steer away from one of his favourite topics: the advantages of running barefoot or going shoeless. Not for nothing is he known in the US as the anti-shoe doctor.

Shoes, even the best designed or most expensive ones, give an artificial spring to the feet, while going barefoot is more natural and it actually develops the feet’s natural cushion,’ he claims. Stoxen has been running barefoot for three years and even has taken part in races – barefoot of course. ‘As children, we ran barefoot but we can’t seem to do it as adults. That’s one sign of ageing.’

He cautions again embracing barefootedness immediately. The feet have to be conditioned first by exercises (prescribed in Field’s book) and runners are urged to try running barefoot on grassy surfaces first before
graduating to hard surfaces.

Stoxen: Shoes give an artificial spring to the feet, while going barefoot is more natural and it actually develops the natural cushion.

The man who is in great demand among the rich and famous comes from a humble background. He grew up in South Side, Chicago, a working- class neighbourhood.

He credits his parents for helping to instill in him the idea of having a dream. He describes an incident from his childhood: ‘My parents took me with them when they wanted to buy an apartment. We saw a lot of luxury apartments that were clearly beyond my parents’ budget. Later on, when I was older, I realised why my parents went to look at these expensive apartments. They wanted me to have a dream or vision of the kind of apartment I wanted to live in. They were indirectly letting me know that if I wanted to stay in places like this, I had to make good in life. And that meant getting a good education and working hard.’

He recalls another incident when he was 17 that had a powerful influence on him. ‘My mom came to me with a piece of paper and told me to write down what I wanted to do with my life.’ Stoxen listed down his loves. ‘I love exercise and sports. I wanted to travel around the world like my idol James Bond. I wanted to go to concerts and the ultimate dream was to rub shoulders with the stars.’ His mother told him to look for a job that would combine all this.

Stoxen decided to become a chiropractor because he was attracted by the concept of healing using one’s hands. ‘In my line of work, there is no need for medicine or surgery to heal people; just the hands do all the work.’

Today, Stoxen is living his dream. His job involves all that he loves. ‘I have a life that people only dream about. Everywhere I go, I am treated like a king,’ says Stoxen, who was in Kuala Lumpur recently to give a talk.

Stoxen has toured with all the big names such as Justin Timberlake, Beyonce, Mariah Carey, the 2008 American Idols Tour and Cirque De Soleil. On these tours, he works on the back-up dancers, musicians and any other members who need help with pain and adjustments. He has also personally attended to many top celebrities whom he does not name because of confidentiality issues.

Working with celebrity and concerts is not glamorous at all, says Stoxen. It’s a lot of hard work: working 12 hours days until the wee hours of the morning is the norm, as most concert crew come to see him after the concert.

Dr. James Stoxen DC

Stoxen has not forgotten his humble background. Unlike many other celebrity doctors who have their clinics in Beverly Hills, Stoxen’s centre is in a working-class area in Chicago with a high crime rate. ‘Doctors who treat celebrities need not always be based in Beverly Hills. If you give quality service, people will come to you. I can treat patients everywhere,’ he says.

Being in this neighbourhood, besides giving him a level of comfort, also provides him with an opportunity to help the community. His centre has given away more than US$1 million worth of free treatment to the people in the area. ‘You get more out of life when you give to others,’ he philosophises.

When asked on how to find a good chiropractor, he says, ‘A good chiropractor’s reputation precedes him. Find a chiropractor that approaches your body as a spring mechanism that is capable of healing itself.’
Stoxen hopes to teach more about this healing technique in the future.

‘I hope to have doctors change their model of evaluating treating, training and maintaining the human body from a lever system to a spring mechanism. Basically, I’d like to only teach this new standard of care in medicine to healers around the world,’ he says. mb

 

 

 

The Barefoot Doctor: Article in Malaysia Business, May 16th, 2012 Page 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Barefoot Doctor: Article in Malaysian Business, May 16th, 2012 Page 2

Video Tutorial #175 Barefoot Running? What If I Step On Something? part 2

  As you can see in the video when I was barefoot running on the trail I was meandering around the rocks.  This adds another dimension to the barefoot running. When you are running barefoot you have to watch where you step. This adds an extra dynamic to the ‘running training’ What that means is […]

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As you can see in the video when I was barefoot running on the trail I was meandering around the rocks.  This adds another dimension to the barefoot running.

When you are running barefoot you have to watch where you step. This adds an extra dynamic to the ‘running training’

What that means is if you have shoes on you don’t pay much where you are stepping or the environment. Just running perhaps listening to your ipod and the latest music.

I try to get into the training aspect of barefoot running. Where I can increase my coordination, balance and agility.

Dr. James Stoxen steps around the rocks

When I am meandering around the rocks I have to place my foot around the rock and it might be placed in the position above.

tibialis anterior muscle

My next step I might need to use my balance to go around as you can see in the picture above. (notice the tibialis anterior muscle) I use my balance to keep my body mass over my foot and avoid the rocks.

I don’t ever think of running barefoot on rocks as a negative. I look at it as a positive as an added dimension, variable to improve:

  • Agility
  • Balance
  • and Coordination

 

 

Why Do I Run Barefoot…

  Dr Stoxen, How Did You Discover the Human Spring Model and Why Do You Run Barefoot? When I first opened my practice, I wanted to be able to heal people and, at the same time, train sports champions. I went on a personal and professional mission not to only build a complete knowledge of […]

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Dr Stoxen, How Did You Discover the Human Spring Model and Why Do You Run Barefoot?

When I first opened my practice, I wanted to be able to heal people and, at the same time, train sports champions.

I went on a personal and professional mission not to only build a complete knowledge of the human body – the way we move and why – but to uncover the secrets of elite performance.

My first decade in practice, I volunteered to treat athletes at every possible sports event, including 50 national and international championships. I traveled to the former Soviet Union to study plyometrics and plyometric training (high impact training drills that enhance the effects of traditional resistance exercises). I also observed elite track and road training as well as competitions around the world. The athletes benefited from the on – site treatments and at the same time I was learning the secrets of how to achieve elite level performance from the best doctors, coaches and athletes in the world.

There is a large gap between what coaches require for athletes to perform at the elite level and what most doctors are recommending.

Many doctors tell us that high impacts are bad for us

yet…

When you ask a top coach what to do to achieve in sports they recommend plyometrics.

Plyometrics involves high impact drills.

Who is Correct?

This misunderstanding is easily cleared up with this statement.

If your body can resist the impacts then impacts are good for the body.  The whole complex design of the human body that allows you to absorb impacts is somewhat complex so I just call this an intact impact resistance or “spring mechanism”

When we discuss this impact resistance or “spring mechanism” (or Human Spring model) Looking at the body as a spring rather than the lever it makes it easy to understand better why in some cases impacts are bad and in other cases why impacts improve health and human performance.

Here are the important questions that needed answers:

  • If high impact training like running, plyometrics or spring training develops a stronger spring, giving athletes more speed, quickness, balance, coordination, agility and efficiency then – are reduced performance levels, loss of balance, poor coordination, less agility and an overall weakened performance the result of weakened human spring strength?
  • If the spring mechanism serves as a buffer between joints, protecting the body from injuries and allowing for stress – and strain – free motion, then could it be that the reason some patients have injuries that won’t heal is because they have a locked spring mechanism?
  • If spring strength is the secret to optimum performance then is the loss of human spring the secret to the decline of health?
  • If spring defines our youth then does a loss of spring in the step define aging?

The impact resistance or “spring mechanism” (or Human Spring model) can perhaps help to better understand or explain many mysteries about human suffering for us.

If we look at the body is like a giant spring composed of millions of springs which are muscles, ligaments, tendons and even spring mechanisms (the feet) that absorb shock and recycle energy through the elastic recoil mechanism. This elastic recoil spring mechanism allows sports to be more efficient in movement.  If we think of walking or running as a spring off the ground rather than banging into the ground then we can see how come plyometrics work for some and others it causes injuries.  For that matter we can see how even simple walking can cause joint pain as well.  The mechanism can’t even handle these light impacts.

Human Spring Model, click to enlarge

These studies, my observations and my hands-on work have led me to develop a new way of looking at the human body that I feel could help us understand why it breaks down, doesn’t heal and degenerates.

Simply put, every movement we make has assisted by elastic recoil mechanisms.  If two objects collide millions of times like the human body and the earth they should damage each other.  The ground is damaged.  We call that a path.  The body should be damaged but it somehow stays in tact even after 100 million impacts.  This is common to have this many impacts by your 30th birthday.

(The American Podiatry Association says the average person takes 5000 – 15000 steps a day x 365 days a year x 30 years is 54M – 150M impacts in 30 years)

How does it do that?  The footwear industry says we need a cushion or a shock absorber between us and the ground to absorb the impacts however there are people in third world countries that live their entire life barefoot or with no shock absorption.  So how do we absorb so many millions of impacts safely?

I theorized that one of the most logical explanations is that the entire body is engineered as a giant spring mechanism.  A human spring mechanism that runs from toe (the master spring is in the arch of the foot) to head.

How do you explain why we cannot run barefoot as easy as an adult as we can as a child.  When the supportive mechanism weakens it stiffens.  The stiffened spring mechanism is not so springy.  We need it to be springy so it can flex with forces of the landings.  If it cannot flex with the landings it makes sense that stress and strain free running is impossible.  Also a stiff abrupt landing causes a shock to the skeleton and stress and strain can interfere with the healing process.

By releasing this stiffness, and by strengthening and plyometrically training the impact resistance (spring) mechanism of  the body, we may be able to restore the ability to take impacts better.

What do I feel makes our body weak at resisting impacts.  I feel that there are many causes but I feel the main culprit is unnatural movement while we are walking and running. What causes unnatural movement? One cause could be ill fitting footwear which act as binding or restrictive devices on the body.

If you understand that the body is a giant spring like I suggest you do, you will now see the cause of some very common unexplained conditions and afflictions in a different light

  1. When we look at the body as a impact resistant (spring) mechanism rather than a (push) lever mechanism it allows us to understand why I recommend barefoot running vs shod or restricted spring running (shod running).
  2. What is even more exciting is it allows us to have a rationale explanation for why many have unexplained chronic pain as it relates to a break down of the spring protective mechanism that protects us from the landings not allowing our bodies to heal. The abnormal foot landing with the different arrays of footwear styles start to take their toll on the muscles and joints leading to stress and strain, wear and tear, the release of inflammation and pain.  Lets face it, we seldom select shoes based on their ability to provide us with a precise foot plant to maintain stress free walking.  In my opinion so many people have misdiagnosed fibromyalgia because the doctors don’t do gait studies on you while you barefoot walk.  I recommend you get a second opinion on conditions that do not heal after 2-3 weeks of progressive therapy and especially on a quick diagnosis of fibromyalgia.
  3. The human spring model could provide a rational for why so many have chronic fatigue.  If it is true that we are a giant spring then we know springs recycle energy when the impact force is loaded.  The spring deforms its shape, stores energy then reforms back to its exact original shape releasing the energy.  That storing and releasing recycling of energy with every step happens with some allowing them to have energy and with those who have a stiff, weak or locked spring they don’t recycle energy.

If your blood work and all other tests are normal and the doctor cannot find a reason for your chronic pain go to an expert on gait and have them do a gait study on you.  Your doctors have to watch you walk to see if you bounce off the ground or bang into the ground.  This is an oversimplified explanation.  This is called a gait analysis.  Not all doctors have expertise in this area so maybe it is best to seek out a specialist for this study.

The elite level sports training world changed their protocols back in the 70′s with the advent of plyometric training.  This involves training with high impacts to bolster the ability to spring off the ground better.

Plyometrics, in my opinion, is training the human body as a spring mechanism.  This method of training invented by famed Russian sports scientist, Yuri Verkhoshansky involves high impacts into the human spring to bolster human performance by creating a positive adaptation of the spring mechanisms in the joints, ligaments and tendons.  I met and studied his ideology directly with him during with several trips to Moscow back in 1987-89.   This human spring training is currently the most widely accepted approach to high level training in the world.

The founder of this approach to training Verkhoshansky talk about Hookes Law of physics when referencing the training approach.  This is a law of physics related to the function of a spring.  

Dr James Stoxen DC at the 1988 All African Track and Field Championships

In 1988 I was invited to work at the fifth All African Track and Field Championships in Annaba, Algeria. The most extreme difference between the African athletes and my patients back home, I found was the spring in their feet and legs.

Their tibialis posterior, tibialis anterior and peroneal muscles (I call the landing or spring suspension system muscles) I noticed were highly developed. What I discovered was that some of these athletes trained at high speeds in shoes that were more like slippers with no cushion and many trained barefoot.

That fueled my desire to change my approach to care for patients suffering from a wide variety of ailments. I believe the reason for why my patients were not performing at optimum potential and why their bodies were not injury resistant was attributable to a weakness in these musles. Lets face it, how many training programs involve specific training of the tibialis posterior, tibialis anterior and peroneal muscles without shoes on?  You cannot even go to a fitness center and take off your shoes without getting kicked out.

After reading every piece of relevant scientific literature I could find and years of clinical studies with thousands of patients, I hypothesized that walking and running with footwear without balanced training the tibialis posterior, tibialis anterior and peroneal muscles without shoes on was one of the main causes of the acceleration of the aging process in the musculoskeletal system.  It is the foundation of the body from which all movement is determined as it is interconnected. 

Invitations to lecture

I was invited to address the Tenth International Congress on Anti-Aging &. Biomedical Technologies, in Las Vegas entitled Faulty Biomechanics of the Lower Extremities, A Presentation of how Simple Biomechanics Dysfunction Accelerates the Aging Process. This same lecture went through an evolutionary process through my clinical experiences and scientific studies, while preparing for lectures such as “walking biomechanics, how abnormal movement patterns accelerate the aging process” at the Royal College of Physicians in London England, medical conferences in Bali Indonesia, Kuala Lumpur, Malaysia,Tokyo Japan, Hangzhou, China, Cape Town, South Africa, Monte Carlo, Principality of Monaco, and Guang Zhou, China.

Dr James Stoxen DC lectures at the World Congress of Anti-Aging Medicine and Regenerative Biomedical Technologies in Chicago 2007

This evolution of my theory and approach compelled me to submit an abstract for a lecture entitled Elastic Recoil Mechanisms – How Footwear Accelerates Aging Process. In August 2007, the medical commission of the 15th Annual World Congress of Anti-Aging Medicine and Regenerative Biomedical Technologies in Chicago approved the abstract.

Close to 2000 doctors and scientists heard the scientific rational argument for why walking and other forms of exercise, including running, should be performed barefoot. To my knowledge, this was the first time the concept of ‘shoe-less’ exercise including barefoot running had been presented to an international audience of physicians. (Pre-dating Born To Run and the Harvard Barefoot study published in Nature).

If you could run barefoot as a child but cannot do it now, is this the first sign of aging?

Some doctors advise against striving for a barefoot lifestyle.  Why do they hold you back from striving to do the activities you could easily do as a youth?

That lecture evolved through preparations in 2007 for lectures in Florida, Columbia, Germany and Japan. Certainly, at the time, it seemed as though I was the only one telling the medical establishment that footwear should not be worn during walking or running and the body should be trained while barefoot.

In 2008-2009, it gained speed when I switched the focus of the biomechanics from walking to running speeds with the lecture series Run For Life! New Innovative Examining Procedures to Determine the Effects on the HUMAN SPRING from Variable Forces on Lower Extremities during Multiple Speed Ambulation for lectures in Beijing, Dubai, Seoul, Sao Paulo, Cambridge (SENS), Frankfurt and in Mexico City (2010)

In spring of 2010 I took the next logical step in developing my theory – I prepared my body for the cardio workout that was optimal for my health, barefoot running.

I released, strengthened and trained my body like a spring mechanism in preparation for the experience. My first run was a route on concrete pavement on the Chicago lake front – and because I had prepared my body for the impacts, studied and practiced the proper form and technique, I eased into running 5 – 7 miles, 3 days a week with no complications whatsoever.

I finished off 2010 barefoot running in the AIDS Walk Run 10K and the Susan G. Komen Run for the Cure in honor of my mother, Lydia Stoxen, who died of breast cancer in 1995.

By the end of the year I had run 350 miles and experienced all the predicted improvements in my health. . My goal is to compete in a half marathon and possibly a marathon for 2012.

In September, 2010, I launched my next lecture series around the world, Run for Life, Barefoot at the 2nd annual Bangkok Congress on Anti-Aging and Regenerative Medicine.

Dr James Stoxen DC Running Barefoot

The following day I ran barefoot in the 14th Annual Electricity Generating Authority of Thailand’s Minimarathon (10K) held on the streets of the Ministry of Health in the Thai capital.

This lecture was also presented in Mexico City in February and in Kuala Lumpur, Malaysia.

I have been invited to discuss the Human Spring Approach to preventive medicine in Shanghai, China in 2012.

I am honored to have been able to spread the word regarding the benefits of barefoot running to medical physicians and scientists at ACME medical conferences as part of detailing my theories and practices.

How I Got My Wiggle Back

In February 2012, Anthony Field from the famed ‘Wiggles’ children’s group released the book, ‘How I Got My Wiggle Back’, A Memoir of Healing. Chapter Seven is entitled Barefoot and Lovin’ It.  In the book Anthony discusses the barefoot lifestyle that I recommended for him in 2007.

Shoe companies say we need an artificial spring between these two colliding objects, our human spring bodies and the earth.

In reality, all we really need to do is find a way to absorb the impact into our human spring that the cushion represents and we can do away with these artificial supports and protective devices and run barefoot for life.

Thank God I found a way to do this for myself at age 50.  I don’t want to be on the path from barefoot to bedridden by constantly adding additional supports to my body to help it to function.

There is no challenge to that!

Challenge your doctor and trainer to help you reestablish the human spring you had in your youth.

Raising Awareness Of Barefoot Training and Running

I plan on giving away all my knowledge, advice and self – help tips here in this blog site. I look forward to addressing visitors questions to the best of my ability. If I cannot provide the appropriate answer I will find the leading experts in the world who can.

I know some people live to run. We all should be running, barefoot – to live a long healthy, active and fulfilling life.

Dr James Stoxen DC

RACE RESULTS: Dr. James Stoxen DC Ran Barefoot in the AIDS 10K Run Chicago 2010

Dr. James Stoxen DC ran barefoot in the AIDS 10K Run Chicago 2010 held on Saturday, October 2, 2010 in Grant Park. His time was 1:00.19

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Dr. James Stoxen DC ran barefoot in the AIDS 10K Run Chicago 2010 held on Saturday, October 2, 2010 in Grant Park. His time was 1:00.19

RACE RESULTS: Dr. James Stoxen DC Runs Barefoot in the Susan G Komen Race for the Cure for Breast Cancer

Dr. James Stoxen DC ran barefoot in the Susan G Komen 10K Race for the Cure for Breast Cancer. He placed 13th in his age bracket and 133rd overall. He was the only barefoot runner in this race. His mother, Lydia Stoxen, died of breast cancer in 1995. Race results can be found here.

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Dr. James Stoxen DC ran barefoot in the Susan G Komen 10K Race for the Cure for Breast Cancer. He placed 13th in his age bracket and 133rd overall. He was the only barefoot runner in this race.

His mother, Lydia Stoxen, died of breast cancer in 1995.

Race results can be found here.

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