Understanding Foot, Ankle & Heel Pain
Foot and ankle structures may not be the command center of our Central Nervous System but they definitely play a major role in our survival and over-all functioning. Just one of your feet is comprised of 100 muscles, tendons and ligaments, 33 joints and 26 bones. That means both our feet have a total of 52 bones…which is 25% of the bones in our entire body. These small joints carry the entire burden of our body weight…accounting for our incredible agility and range of motion and agility (think of a gymnast or a tap dancer).
That same range of motion often also leads to instability and injuries that can cause foot, ankle or heel pain.
“…over 20% of the time in my practice, the cause of chronic foot pains has nothing to do with the foot or ankle at all.” – Dr. Sam Nijmeh
A thorough doctor first starts an evaluation by understanding the mode of injury. Did the foot pain, ankle pain, or heel pain begin by a sudden trauma or a slow onset of chronic injuries such as running using bad shoes or doing Zumba dance without warming or stretching (these are some common ones in my office)? After the mode of injury is understood, a very precise diagnosis is essential for a successful treatment plan. With over 20 joint articulations, it is easy for a chiropractor to focus the treatment on a wrong region of the foot.
A Proper Diagnosis Must Consider these Facts:
- Is this a bone problem?
- Bunion(s) or malformation of bones due to poor foot ergonomics
- Tumor, or systemic bone diseases, including Gout, osteoarthritis, RA
- Is this a muscle problem?
- Muscle sprain
- Spasms, or hypertonic muscles
- Is this a tendon problem?
- Tendon tear
- Special attention must be put on Achilles’ tendon
- Is this a ligament problem?
- Ligament strains or tear
- Special attention must be put on Deltoid ligament
- This ligament is almost always injured in ankle inversion sprains
- Is this a nerve problem?
- Tarsal Tunnel Syndrome
- Nerve damage due to trauma
These are just some of the basic diagnostic questions a good chiropractic clinician must answer before rendering treatments.
To make it more complicated, I have noticed that over 20% of the time in my practice, the cause of chronic foot pains has nothing to do with the foot or ankle at all. A misaligned hip or sacroiliac joint can cause internal or external rotation of the entire leg, leading to pronation (inward tilt) or suppination (outward tilt) of the foot. Such lack of alignment causes the weight of the patient to fall upon joints that may not be designed for long term weight-bearing function. Thus, ligaments start to fatigue, tendons start to inflame and swell, muscles start to tighten up or even scar due to micro-tears, and voila!!! we have ourselves a full-blown problem such as “plantar fasciitis” or “tendonitis”, or just simple calcification of the tendon under the heel bone, also called “heel spur”.
A good chiropractic treatment plan must first decrease pain and discomfort of the patient and then stabilize the ankle and foot region for fast recovery. Ankle braces or wraps can produce excellent stability and ensure significant healing. If present, it is imperative to decrease lower limb inflammation by utilizing rest, ice, and elevation and compression treatments, also known as “RICE”.
After this stage is completed, I like to begin foot adjustments to align and release any joint fixations to improve overall foot function. Home exercises and rehabilitation are essential to a fast and lasting foot or ankle injury recovery. A good foot evaluation at our office takes about 20-30 minutes and the treatment plan may be as short as one visit to 4-6 weeks of adjustments and rehab work. In the case of rare, severe or progressive diseases, MRIs and second opinions from orthopedic medical doctors may be necessary.
We look forward to helping you get relief from your ankle pain, foot pain, or heel pain.