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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.

 

Video Tutorial # 159 – Foot Lock! What You Get From Standing Too Long And How To Prevent It

I have been standing in these shoes all day! My Feet Hurt! Maybe the pain will go away……. Those are six very dangerous words, maybe the pain will go away…. An activity as simple as standing all day can lead to pain in your feet. So you need to know how to protect your feet when you’re stuck […]

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I have been standing in these shoes all day! My Feet Hurt! Maybe the pain will go away…….

Those are six very dangerous words, maybe the pain will go away….

An activity as simple as standing all day can lead to pain in your feet. So you need to know how to protect your feet when you’re stuck standing for hours on end, especially on a hard surface.

Besides the stress of prolonged standing, the architecture of the foot can also increase the symptoms from pre-existing conditions: Plantar fasciitis refers to the inflammation of the fascia under the heel. Flat or tilted feet (from heel pronation) and bony spurs in the base of the ankle may make the condition worse. Achilles tendonitis results from over stretching of the Achilles tendon. Bunions at the side of the big toe may arise because of heel pronation and may be aggravated by narrow shoe boxes (the area in front of the shoe) and prolonged standing. Corns on top of the toes may be aggravated by scraping against the inside of your shoe.

WHAT ARE POSSIBLE HEALTH SYMPTOMS FROM STANDING ON YOUR FEET TOO LONG?

The most common symptom from prolonged standing on your feet, and usually the first to occur, is discomfort and fatigue in the legs.

The closer the body part is to the ground, the more likely it will be affected by prolonged standing (i.e. the feet are most often affected, followed by the shins and calves, followed by the knees, thighs, hips and low back). However, symptoms from working on your feet may reach to the top of your body. In some studies neck pain symptoms have been related to prolonged standing at work!

Beyond simple fatigue and discomfort, more serious health effects can result from working on your feet for long hours.

In lab experiments people could not distinguish fatigue in their legs from whole-body fatigue. Therefore, that whole-body fatigue feeling could be related to working on your feet.

Some of these are: Low Back Pain, Painful feet and other foot problems, Plantar Fasciitis and Heel Spurs, Orthopedic changes in the feet (e.g. flat feet), Restricted blood flow, Swelling in the feet and legs, Varicose veins, Increased chance of arthritis in the knees and hips

WHAT CAUSES THESE PROBLEMS?

Joint compression: Gravity squeezes your joints under the weight of your body. Each body part is compressed by all of the sections of the body above it. (For example, your hips are compressed by your head, arms and torso, but your feet are compressed by the weight of your whole body!)

Compressing a joint is like squeezing a sponge – body fluids are squeezed out of the space in the joint. Without body fluids and circulation, your joints become malnourished, and cannot continue to support the weight of your body. Wear and tear of body parts occurs.

Postural muscle fatigue: Postural muscles keep your body from falling over while you’re standing. Standing for a long time forces these muscles to work without a rest. Without rest these muscles become exhausted, resulting in pain.

These effects are like working without lunch. Joints and muscles get their “lunch” from circulation, and need rest breaks to recoup from bouts of work. Think how you would feel without lunch!

Insufficient venous blood return in the legs: Gravity pulls blood down into your feet. One way that blood is pushed back up to your heart is through cyclic muscle contractions, often called a “muscle pump“. If the muscles are engaged in one long contraction (sustained contraction) to keep you standing, they cannot produce a ‘muscle pump” effect. Continuous muscle contractions also hinder circulation of body fluids.

Keeping the body in an upright position requires considerable muscular effort that is particularly unhealthy even while standing motionless. It effectively reduces the blood supply to the loaded muscles. Insufficient blood flow accelerates the onset of fatigue and causes pain in the muscles of the legs, back and neck (these are the muscles used to maintain an upright position).

Standing too long not only produces muscular strain but other discomforts also. Prolonged and frequent standing, without some relief by walking, causes blood pooling in the legs and feet. When standing occurs continually over prolonged periods, it can result in inflammation of the veins. This inflammation may progress over time to chronic and painful varicose veins. Excessive standing also causes the joints in the spine, hips, knees and feet to become temporarily immobilized or locked. This immobility can later lead to rheumatic diseases due to degenerative damage to the tendons and ligaments (the structures that bind muscles to bones)

In my practice, I work 90 hours a week on average.  What is worse is that I am standing on my feet the entire time.

How do I do that and still run barefoot?

Dr James Stoxen DC at Team Doctors

If someone should have an excuse for why they can’t run or run barefoot it should be me.

This is my typical week:

I practice about 12 hours a day from 9:00am in the morning to 9:00pm at night, minimum five days a week.  At least 3 nights a week I am working on my feet until midnight on a VIP client.  I work at least one full day if not two on my feet on the weekends.

When you’re on your feet for an extended period of time, the muscles that suspend your feet or the spring suspension system muscles are in a sustained contraction that has to be maintained for a certain amount time.

What is sustained contraction and how does it lock your joints and specifically the human spring?

An example would be holding a glass of water in my hand. Although I can do this easily.

If I hold it for too long in a sustained contraction I am going to get tired.  My arms will have an inflammatory reaction and be stiff.  The stiffness can even lock up your joints.

What is foot lock?

The foot and ankle has 33 movable joints to allow the force of the landings to be spread out over these joints for a smoother landing.

When the foot locks in any one of the 33 joints this causes a less smooth landing and a compensation for the normal motion.  Any abnormal motion in the foot will cause an abnormal motion in the entire flooring system of the 7 floors of human spring which eventually locks.

Do we see this clinically?  Of course!

To think any different defies the laws of gravity, engineering and physics.

Can weakness in the suspension system muscles lead to a locked human spring?

  • Standing on your feet all day leads to fatigue of the spring suspension system muscles which determines your ability to resist impacts of walking, recycle energy through the spring and provides for healthy movement.
  • Stiffness in the spring suspension system muscles eventually leads to stiffness or locking of some of the 33 joints of the foot and ankle.
  • When the human spring is locked at the foundation, the body compensates with abnormal motion through the entire seven floor human spring.
  • Abnormal motion in moving parts leads to stress and strain of the muscles, ligaments and tendons that guide the movement of the bones and joints.
  • Abnormal stress and strain leads to wear and tear of the joints.
  • Wear and tear leads to the release of inflammation.
  • The release of inflammation leads to pain, fatigue and accelerated aging of the musculoskeletal system and other systems of the body.
  • High levels of inflammation (cytokines) have also been strongly linked to feelings of depression. 

This is true when YOU stand too long.

The sustained contraction can lock the spring mechanism.  The spring mechanism loses spring mobility and may not be as effective in springing our bodies off the ground upon impact from the forces of the landings.

We were designed to function optimally if we keep moving so that the spring suspension doesn’t settle, drop and lock.

The theory states that once your foot and kinematic spring chain lock then the body bangs into the ground instead of springing off the ground. The landing becomes a bang and twist instead of a spring and roll. (see below)

 

Locked Spring and Spring Walking

When you stand too long your muscles have a sustained contraction similar to what happens when you hold anything in one position with your muscles contracted continuously.

What happens next is your arch linkage drops and eventually can lock. What I have found is that the arch drops and locks primarily at the second metatarsal cuneiform joint and the third. For those of you who are not doctors that is around the middle of the foot.

People know me as the “anti-shoe” doctor and the “barefoot running” doctor.

Ideally we should be shoeless and constantly moving like our ancestors were.

Click here to read Was My Chronic Pain, Fatigue, Fibromyalgia Cured with a Pair Of Shoes? NO! 

So why does a barefoot running doctor recommend shoes in some instances?

That’s because we are supposed to keep moving for optimal use of our spring mechanism. When we keep moving we keep springing.

Some of us might think that healthy movement for the human spring mechanism is in the direction that stimulates development of the spring muscles that spring you forward as in running straight. This would be similar to someone doing the bench press and curls in weightlifting.

We used to see athletes only doing bench press and curls in the gym and we know what happened to those athletes.  They got shoulder, back and neck conditions as well as injuries.

Then someone came up with the bright idea that we had to exercise muscles that control the movements of all the joints in all ranges of motion. That way we could develop a more balanced joint motion and strength.

Running training in my opinion is still in the dark ages of development. Many of us still run straight ahead with little to no directional changes. That is, in my opinion, why many of you have conditions related to imbalances of strength in the spring suspension system.

Experts throw the concept of over pronation (over rolling of the foot into the unsafe range inward) and over supination (over rolling of the foot into the unsafe range outward) What is actually being described is the position of the foot at the impact point and through the point when it pushes off.

For those who understand training bone and joint position is controlled by muscle strength.

muscle strength is important to maintain the bones in the position during standing, walking impact forces, running impact forces and endurance strength for many impacts.

If you are running you must run drills in all directions the foot and body moves for a balanced spring mechanism to withstand the impact forces.

This comes directly from the book Supertraining by Siff and Verhkoshansky:

MECHANICAL LOADING OF COLLAGENOUS TISSUE:

(page 41)Since stretching is a particular type of mechanical loading, application of stretching can be more effectively applied if the effects of the loading on collagen are studied carefully.  In fact physiological stretch of this possible because collagen and is a viscoelastic material that is, under rapid loading it behaves elastically while under gradual loading it is viscous and can deform plasticity.

(page 42) Since tendons and ligaments are viscoelastic, they also exhibit sensitivity to loading rate, and undergoes stress relaxation, creep and hysteresis.   Prolonged and excessive stretching of this type encourages joint mobility at the expense of its stability sold at a joint then has to rely more on its muscles for stability. Despite the widespread opinion that the muscles act as efficient synergistic stabilizers, it should be remembered that the musculature cannot respond quickly enough to protect a joint against injury if large impacts are applied rapidly, particularly Lee if they are torsional since joint stability involves three-dimensional actions over several degrees of freedom, the necessity for appropriately conditioned in all the interacting soft tissues becomes obvious.

 

Plasticity defined in physics from Wikipedia below:

In physics and materials science plasticity describes the deformation of a material undergoing non-reversible changes of shape in response to applied forces.[1] For example, a solid piece of metal being bent or pounded into a new shape displays plasticity as permanent changes occur within the material itself. In engineering, the transition from elastic behavior to plastic behavior is called yield.

Plastic deformation is observed in most materials including metals, soils, rocks, concrete, foams, bone and skin. However, the physical mechanisms that cause plastic deformation can vary widely. At the crystal scale, plasticity in metals is usually a consequence of dislocations. In most crystalline materials such defects are relatively rare. In brittle materials such as rock, concrete, and bone, plasticity is caused predominantly by slip at microcracks.

For many ductile metals tensile loading applied to a sample will cause it to behave in an elastic manner. Each increment of load is accompanied by a proportional increment in extension, and when the load is removed, the piece returns exactly to its original size. However, once the load exceeds some threshold (the yield strength), the extension increases more rapidly than in the elastic region, and when the load is removed, some amount of the extension remains.

However, elastic deformation is an approximation and its quality depends on the considered time frame and loading speed. If the deformation behavior includes elastic deformation as indicated in the adjacent graph it is also often referred to as elastic-plastic or elasto-plastic deformation.

Perfect plasticity is a property of materials to undergo irreversible deformation without any increase in stresses or loads. Plastic materials with hardening necessitate increasingly higher stresses to result in further plastic deformation. Generally plastic deformation is also dependent on the deformation speed, i.e. usually higher stresses have to be applied to increase the rate of deformation and such materials are said to deform visco-plasticity.

Flow Plasticity theory, uses a set of non-linear, non-integrable equations to describe the set of changes on strain and stress with respect to a previous state and a small increase of deformation.

If the stress exceeds a critical value, as was mentioned above, the material will undergo plastic, or irreversible, deformation. This critical stress can be tensile or compressive. The Tresca and the von Mises criteria are commonly used to determine whether a material has yielded.

DEFORMATION THEORY:

There are several mathematical descriptions of plasticity. One is deformation theory (see e.g. Hookes Law where the stress tensor (of order d in d dimensions) is a function of the strain tensor. Although this description is accurate when a small part of matter is subjected to increasing loading (such as strain loading), this theory cannot account for irreversibility.

Ductile materials can sustain large plastic deformations without fracture. However, even ductile metals will fracture when the strain becomes large enough – this is as a result of work hardening of the material, which causes it to become brittle. Heat treatment such as annealing can restore the ductility of a worked piece, so that shaping can continue.

Science tells us that standing for a long time and even slowly delivered impacts can stress tendons, joints and other tissues to deform their shape weakening the stability and performance.  They can be referred to as plastic deformity vs elastic deformity.

In fact sports research found that the shorter the contact time of your foot or bodyweight on the ground the more it improves performance.

Its obvious that standing for a long time is really damaging to our joints!

If the muscles which maintain the foot in the safe range from supination to pronation are not able to maintain them in the safe range then we have to strengthen them.

You would think that athletes would be able to maintain the foot in the safe range during standing for long periods of time.

IN other words if an athlete works all day standing as a teller in a bank they could do it no problem.

If you gave a typical woman’s purse to an athlete and told him to hold it in the 90 degree curl position for 20 minutes he or she would be feeling the strain of the constant contraction burning in the muscles and the strain on the joints as they compressed from the constant pulling and the attachment of the tendons to bones. Pretty soon if it was left long enough they would end up with a condition that had to be treated.

There is no difference with constant contraction related to standing in one position for too long.

Ok, we understand that and I realized long ago this was a problem for me as I stand for long periods of time in one position treating patients. This is especially true when I’m performing one of my pain exorcisms which is body work to release spasms that compress joints from the foot to the head lasting sometimes 2 – 10 hours on one patient.

Tip One:

– Rock and Roll The Feet – What I try to do is rock back and forth into supination and pronation.  This keeps your muscles contracting and not stagnating into fatigue.  Sometimes I get distracted and forget.

When I forget then the fatigue sets in and my foot starts rolling out of the safe range.

Supination to Pronation, Safe and Unsafe Range

What I have found is that once the spring suspension system muscles fatigue on me my foot will roll either in or out of the safe range either over pronation (85% of the population) or over supination (15% of the population) as a compensation and due to weakness.

What I found as the best way to balance this negative is to find a shoe that kept my foot in the safe range as long as possible until I could get off my feet and release the muscle tension and fatigue.

Tip Two:

- I wear a shoe with a very strong reinforced counter support.

Shoe Safe and Unsafe Zone

I have also found some footwear with an extended medial counter support that may extend 2 – 4 inches across the sides of the heel to keep the heel from rolling out of the safe range.

The other important feature I like in my shoes are those with a hard plastic encased inside the leather as a reinforcement.

This is especially important for those who are on their feet for a long time, those of you who see their feet roll out of the safe range or have been told they have over pronation of the feet or over supination of the feet.

Also, many of you who are a  little or a lot bigger (you know who you are) and those who have big feet, should seek out the extended medial counter shoe.

It’s interesting that shoe companies design shoes of a size 8 with the same counter support material as a shoe size 14.  Dont they realize that a man or woman with a size 14 impacts the ground with more force than a person with a size 8 even if they are an ideal body weight?

This is just poor engineering.  If I had my own shoe company I would change that but until then you can use the tips here to do what you can to avoid illness and injury from standing on your feet too long.

Tip Three:

– Release your feet and legs when you get home with the spring release techniques I give you below in tutorial 77 – 89:

Video Tutorial #77 How to Self Adjust Your Toes   
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 #84 Scissor Stretching Of The Feet
Video Tutorial #85 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 Deep Tissue Of The Ankle Mortise
Video Tutorial #88 Stretching Of The Foot While Sitting At Your Chair
Video Tutorial #89 A Stretch To Increase The Flexibility Of The Arch Of Your Foot

Tip Four:

– Walk, Jog or Run Barefoot in zig zag, circle and figure eight directions to release the human spring and strengthen it in a balanced range of motion

Watch this video 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.


 

Disclaimer

I Have Heel Pain. Should I Give Up On Barefoot Running?

Heel Pain ICD-9 719.47  Heel Spur ICD-9 726.73 I Have Heel Pain. Should I Give Up On Barefoot Running? Tips For Better Health Ask the doctor, Dr. James Stoxen DC Whatever your level of running, regular racing, fitness running, or occasional jogging, aches and pains are a part of the sport. While aches and pains should […]

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

I Have Heel Pain. Should I Give Up On Barefoot Running?

Tips For Better Health

Ask the doctor, Dr. James Stoxen DC

Whatever your level of running, regular racing, fitness running, or occasional jogging, aches and pains are a part of the sport. While aches and pains should never be ignored, some are more significant than others because they signify chronic running injury.

The most commonly injured areas include the arch and heel region, lower leg, knee, Achilles tendon, and forefoot.

Running injuries are usually caused by muscle overuse, faulty biomechanics, and lack of flexibility.

Pain in the heel or pain in the arch area can often lead to plantar fascitis, or heel spur syndrome.

This is an inflammation of a fibrous band of tissue, which stretches from the heel to the toes. There may be pain in the morning, pain after rest, and pain after running; the worst is pain when you wake up and pain at the start of a run.

Chronic plantar fascitis may lead to the formation of heel bone spurs.

You may be wondering to yourself why do my heels hurt? or do I have a bruised heel?

Heel pain, not to be confused but can feel like hell pain and having a swollen foot or swollen feet.

The pain symptoms can be quite severe and disabling in some cases.

What are the Causes of Heel Pain?

  • The cause of the heel pain can be corrected easily with a correction of your running form and technique.
  • Heel pain is generally the result of a problem in the way that you are walking (your gait) that causes you to place too much stress on the heel bone and the soft tissues surrounding your heel (heel tendons). 
  • Heel pain can also be caused by wearing poorly constructed or poorly fitting shoes, foot injury, broken foot, ankle injuries, or heel bruising. 
  • Heel pain may be caused by being overweight.

I will explain these changes more in detail in this post.

If you cannot reduce the pain with the recommendations I am making in your running form and technique, you may need see a foot specialist to review your heel symptoms, have a full examination, and possibly x-rays to determine the cause of your heel pain and to go over appropriate treatment for heel pain.

Heel pain is commonly associated with plantar fasciitis.

Plantar fasciitis, inflammation of the connective tissue on the bottom of your foot. The characteristic of this condition is pain in your heels first thing in the morning when you put weight on your feet.

The fascia is a band of tissue that runs from the base of the toes to the heel, along the arch of the foot. Heel Pain can also be caused by heel spurs, which occur when the plantar fascia pulls on the heel long enough to cause the bone to grow abnormally.

I have a very detailed article on plantar fasciitis and heel spurs in this blog that you need to read to really expand your knowledge of this condition so you have the best shot at eliminating it.

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

Another ailment, nerve irritation, is called calcaneal nerve entrapment. Pain on the back of the heel stems from Achilles tendonitis, or when the large calf muscle tendon gets inflamed, or swells, where it attaches to the heel.

The relationship of muscles and joints to how you run is called biomechanics.

Faulty biomechanics greatly increase your risk of injury. The most common example is over pronation of the joint below the ankle (the sub-talar joint), which may be noticed as partial or complete collapsing of the arch and rolling in of the ankle as your foot lands. I will discuss this further in the article below.

In this post I will answer a question regarding Heel Pain and a heel injury during running and weather or not the patient should give up on barefoot running.

You asked the question, “Did you start off too strong?”

My answer to that question is…. Not exactly…

Why do I say that?

You started off at the right pace for your right foot but too fast for your left foot? NAHHHH!

If you SIMPLY started off too strong you would have symptoms and signs on both the right and left foot. That is a simple deduction because it seems like your right foot can handle the force of the landing and the amount of landings but your left foot, cannot.

So, we deduct your left foot cannot handle the force of the impacts (weak landing mechanism) or it’s locked somewhere not allowing the force to be distributed across the 33 joints or your form and technique is off or all three, maybe something unknown we can only determine after careful examination.  Lets face it, the docs here are doing their best with minimal information.

We need some WIGGLE ROOM here. I am a fan of the blue wiggle. ;-)

Ok lets go with common sense advice that could help you or anyone else across the board here. Maybe your left foot has one or more of the 33 joints locked.

ITS STIFF IN SOME AREAS AND LOOSE IN OTHERS AREAS

The locking of any one or more of these joints does not allow the force of the landing to spread over the 33 joints for a smooth landing.  This can force an excessive movement of the subtalar joint or as we say in medicine, hypermobility of the subtalar joint. Excessive movement in a joint can cause pain.  IT COULD BE THAT BECAUSE THAT IS COMMON AND MAKES SENSE. Your foot has been in a shoe for years.

When you take any body part out of a brace it is weaker than it was when training without the brace—

They call this a ‘PRINCIPLE OF TRAINING’

That is how we base our coaching or doctoring advice on.  I will chose principles over studies performed on SHOD ATHLETES when determining what to do with BAREFOOT ATHLETES.

SELF HELP – MUSCLE FOOT LOCK:

Force Of Impact/Energy Stored And Released

When the foot moves abnormal, not according to the way it was designed, the brain senses this and creates what we call “tonic (constant) protective spasms”  That means it stiffens the area. When you are running you need the foot to be a spring mechanism to deform it’s shape, to load the force of the landing into the mechanism, store the energy in the deforming process then reform back to its EXACT original shape releasing the energy. (see illustration above)

When the mass hits the foot with the heel first the “landing muscles”of the pereoneal, soleus and tibialis posterior lower the forefoot down similar to when you bench press. The weight is lowered into position then we push up.  That landing can be smoooth, aligned and springy when these muscles are working correctly and all the joints are released to allow this mass to enter into the spring safely.

When the foot is stiff, when the muscles that lower the foot eccentrically into position are strong (landing muscles) then you are in a good position to spring off the ground.   If the foot (spring) is preloaded with muscle tension and or the muscles are weak, then the abnormal motion occurs to move around the locked weak mechanism or the path of least resistance.

Safe and Unsafe Zone

We cannot examine you so we have to go with statistical probabilities to see if we can get closer to the target so maybe we can help you with the answer to this post. Statistically the tibialis posterior is the muscle I find to be the most commonly weaker than others, which means that the foot is weakest in absorbing the forces of the landings. The heel rolls out of the safe range inward.  That over rolling outside the safe range makes the subtalar joint hypermobile or stretches the joint.

Over Pronation and Supination of the foot safe range by Dr James Stoxen DC

Over Pronation and Supination Of The Foot Safe Range

What you seem to be describing is the front of your subtalar joint (the point at the bottom of the heel at the arch) and the rear of the subtalar joint (the area in front of the Achilles tendon in the fleshy part behind the heel) this is a common place for pain. This is a common occurrence.

If we release the stiffness from the surrounding joints, more forces can be taken up in these joints lessening the stress on the subtalar joint.

The most common muscles to stiffen in my 26 years of examining gait, manually checking and manipulating, rehabilitating patients and athletes are:

  1. The muscles under the second toe
  2. The muscles under the big toe
  3. The muscles on the medial or inner edge of the big toe.(see below)

    muscles on the medial arch

  4. The muscles between the first and second toe
  5. The tibialis posterior muscle

Watch the Video Tutorials below of how to release the foot with the deep tissue techniques that I developed, which work great!

I did these tutorials in Malaysia last summer (2011) after a barefoot race and they are great.

Be sure to start on Video Tutorial # 77 and go through Video Tutorial #89:

Video Tutorial #77 How to Self Adjust Your Toes   
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 (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 #84 Scissor Stretching Of The Feet
Video Tutorial #85 Great Stretch For Mortons Neuromas And Narrow Heels
Video Tutorial #87 Deep Tissue Of The Ankle Mortise
Video Tutorial #88 Stretching Of The Foot While Sitting At Your Chair
Video Tutorial #89 A Stretch To Increase The Flexibility Of The Arch Of Your Foot

Now on to the tougher part…….

SELF HELP – JOINT FOOT LOCK 

What I recommend for those who are untrained in foot manipulations is first work on the areas of pain with deep tissue then wiggle loose the 33 joints of the foot the best you can. When I manipulate a stiff or locked foot its like taking a piece of frozen steak out of the freezer and trying to thaw it out with my bare hands.  When people watch me do this they are a bit shocked at the sheering force it takes to get the joint play back in the foot. However, I remind them that the human foot can take force.  For example if you are 150 pounds running full speed it could be 450 – 600 pounds of force on one foot.

CLICK HERE TO WATCH HOW TO WIGGLE LOOSE THE 33 JOINTS OF THE FOOT

RUNNING FORM AND TECHNIQUE

If your running form and technique is off, your joints will be effected. You never talk about that but obviously this is important.  You can say that you work on your running form and technique but you really dont know what is going on unles you evaluate it.  What I have found to be the best way to evaluate it is to get a simple Flip Video camera or similar and videotape yourself running.  I did it with myself by having someone in the back of an suv while I ran behind A truck.  We brought the video home and put it in the computer and moved the curser across to evaluate the movement patterns of my form and technique frame by frame. You should do that.  Then you will get a huge education on how your human spring mechanism is taking up the forces of the landings.

CLICK HERE TO WATCH CHRISTIAN MEDIAN (TWO TIME USA TAEKWONDO CHAMPION AND MYSELF (I’M 50) RUNNING BAREFOOT

Move the curser slowly to see the orientation of the ankle over the foot to see the alignment of the ankle.  You should see the alignment is straight. Take a video of your running (must be barefoot) with NO minimals no shoes and look at the way your left foot lands. (Im a little bloated here  :)

  1. Is there a difference between your right and left foot landing?
  2. Is the foot landing with the second toe towards the target?
  3. When your bodyweight is over the foot is the ankle straight or collapsed?
  4. Do you land on your heel or mid-forefoot?

You can even post this video on youtube and send us a link and we will evaluate it for you on video and post it back up here for you and others to learn from.

In the meantime review the video tutorials to release the spring mechanism of your feet, ankles and lower extremities.

HOW LONG DO YOU REST TO HEAL?

Rule of thumb

If you have a sprained wrist it’s a minimum of  2 – 3 weeks for the inflammation, the sprained ankle is a minimum of  2 – 3 weeks, the sprained subtalar joint is 2 – 3 weeks.  You should not be running on a sprained anything.

JUST BECAUSE YOU HAVE NO PAIN IN THE LEFT FOOT DOESN’T MEAN RUN DOWN THE ROAD BAREFOOT AGAIN

Why can’t the left foot handle the landings? Figure it out……

  • No, you don’t quit running
  • No, you don’t quit barefoot running.

That is not a winning attitude.

Figure this out and get it together. You are trying to reverse the negative effects of exercising with a brace-binding device on your joints so…

YOU CAN RECLAIM WHAT YOU COULD DO EASILY AS A YOUTH.  RECLAIMING YOUR YOUTH IS WORTH THE EXTRA WORK.

Running involves tendon elastic recoil. Tendons and other connective tissue demands 20 weeks to strengthen, while muscles can strengthen in weeks according to research.

WHAT ARE YOU DOING OUTSIDE YOUR RUNNING ROUTINE?

It is hard to say but we can proceed logically. We are just hearing about your symptoms, we don’t know what kind of shoes you are wearing outside of your training and that is HUGE. It doesnt matter if you are barefoot or minimals in training if the shoes you wear are not maintaining your foot in the safe range when you have long periods or sustained contraction to fatigue in the landing muscles.  So, the arch spring drops and locks.  If your footwear is weak when you are standing a long time you will never be able to run barefoot safely.

We were not meant to be standing in one place for a long period of time. Originally we had to run in multiple directions chasing the animal- or our meal that was running in multiple directions.  Now our meals stand still on shelves.

Subtalar Joint Outside Deep Tissue Release Point

I stand on my feet 12 hours and I work on my feet with a giant vibration machine and do these soft tissue treatments to INSURE my feet are totally released before I go off on my barefoot runs. Also if I feel the least bit of tenderness anywhere I stop and do the deep tissue points until the pain is GONE.  You run through the pain knowing your form and technique isn’t good because you don’t run the same form when you have pain as you do pain free. The brain makes sure of that.

When you run I suggest you run in zig zag patterns to evenly develop the tendons on both sides of the foot, as it is a 3 dimensional structure.  We train back, shoulders, chest, biceps, triceps, neck when we do upper body so we don’t have imbalance of development but when we run we have different principles?

NO  The same principles that apply to the other body parts of the body apply to the feet except the foot has to take up impact forces.  That means we need to do impacts into the feet in multiple directions to strengthen tendons and connective tissue to absorb and spring back impact forces.  You use it or you lose it.

I ran an entire 6 mile course in 4 foot wide zig zags.

Minimalist SHOES – They are shoes-BRACES

I started running barefoot.  I guess I am not a paying member of the “almost barefoot” club.  When it got chilly in Chicago I thought I would get a pair for cold days.  It took me only 10 minutes and when I finally had them on I felt like they were more binding than shoes. I took them off because I KNEW they were compressing my joints and preventing the maximum plantar flexion recoil of my forefoot on toe off.

I COULD FEEL IT

The sole is not flexible in that direction. It was enough for me and the material. It BRACED my foot. UGH

The MINIMALS are another variable.  Lets see… Is it the minimals, my technique, the stiff foot, locked joints, weak landing muscles?  Eliminate one of those variables and NOW you have less to louse up your running and you can get down to the nitty gritty.

I know you feel like you are barefoot because they are less of a shoe than the clunkers you are wearing but you are NOT BAREFOOT RUNNING.

YOU ARE RUNNING WITH SHOES……if you ask anyone that runs “bare” they will tell you there is a big difference.

I am not against minimal shoes.

I advised Converse in Japan to develop the ‘NAKED” SHOE in 2007 after a lecture in Tokyo before this whole minimalist shoe craze started.  I will never forget the reaction of their CFO/CEO when he exclaimed in Japanese.  ”I asked the Product Development Manager Dan Weiss what he said about my naked shoe minimalist shoe idea” and he said  ”They were SHOCKED”

I say go bare.  DUMP THE SHOES   You are not running barefoot if you are running with shoes which will get you on a safer pace (speed)

Take the time to prepare your feet maximally and release all the muscles and joints for 30 minutes before you run.

Then run zig zags for a mile at a pace that impacts your joints at 2 – 3x bodyweight or a  slow cool jog to loosen your feet and legs so loose that your legs are like ‘cold spaghetti, cold spaghetti’. ‘HOT POTATO HOT POTATO’  whoa stop (getting carried away with a Wiggle Song)

IF YOU FEEL EVEN MINIMAL PAIN ANYWHERE…  STOP!   DO THE DEEP TISSUE IN THAT AREA AND SURROUNDING AREA TILL ALL PAIN IS GONE IN THE MUSCLES WITH DEEP TISSUE PRESSURE

One time this patient-runner was advised to do this and she said some trainer for an NFL football team told her not to do deep tissue before running. SO WRONG!   I asked her why but she could not come up with an explanation because its RIDICULOUS.

So she asks me “what do I do if i’m at mile 13 and I feel pain?

I said,  The Trainers way would be you get out your cell phone and call your husband to take you home.

My way is to do deep tissue like I taught you and run when the tenderness is out.

She stopped by at the office the next day after the race with the ribbon of completion and said……

“I had pain in my calf and foot at mile 14 and thought about quitting then I did the deep tissue and felt great finishing with miles faster on the second half of the race than the first half.”

Why are you running through a sprained joint in your foot?  That is just not wise.

Force of Landing = Weight x Speed

Increase speed to see if your landing muscles can handle it.

In fact when you run with the cameras rolling you can run at different paces to see how your landing gear is responding. You can set up cones and pick up the pace at different sections.

I hate treadmills because you cannot zig zag run on a treadmill therefore…….

YOU CANNOT GET COMPLETE TRAINING OF YOUR THREE DIMENSIONAL FOOT AND ANKLE ON A TREADMILL. THAT ONLY ALLOWS A FORWARD RUNNING DIMENSION

Then as weeks go by increase the speed to 4x bodyweight.  One does not go in a gym and pick up a 80 pound dumb bell and curl it 10 x just as you don’t introduce impact forces of 1000 pounds on a foot that just came out of a cast (shoe!)

I can’t understand why people are shocked if people have difficulty running barefoot when they have had a cast on their foot for 30 years. THAT IS EXPECTED Principles!

When we take a brace off of a wrist, neck or an ankle, do we just go all out right away?  Use common sense.

Barefoot running is not bad for the world.  It’s only ill advised if your not conditioned for the landings and that is more likely when you have been wearing a brace or device on your joints for years.

You can’t do anything at full capacity when the area has been braced or you have been training with a binding device or brace for 8-12 hours a day for 30 years. Embrace the simple common sense principles of adaptation…..

That is what we base our advice on and not what someone else thinks

Well what this shoe company foot expert says is barefoot running is bad and he is a consultant for a shoe company.

Really?  Im shocked!

DR STOXEN PREDICTS MINIMALIST SHOES IN 2007

I know this is a lot but you need to know what you are doing or you will fail and go back to the Barefoot to Bedridden path.

You are trying to recapture the acitvity of your youth running barefoot and its WORTH IT!!!!

DONT GIVE UP!  Make it happen!  Read Anthony Field’s story in How I Got My Wiggle Back. He was worse than you and he found the answer and he never gave up…..to get a copy of the book, click here

You gotta love the blue Wiggle. ;-)

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