Ideal feet positioning

When we walk a lot of us have a flat arch or pronate our feet excessively. This can lead to a lot of problems with the feet, knees, and hips.

Some of the common problems are:

Plantar fascitis

Inner knee pain/meniscus irritation, patella femoral dysfunction

IT band tightness/pain

One possible way to help this is to try standing in a subneutral position.

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Low back pain missing link

The iliopsoas muscle is the missing link in a lot of people that have low back pain.

The iliopsoas muscle attaches from the hip to the lumbar spine/low back region. When it is too tight from prolonged sitting it pulls the lumbar spine/low back region into excess extension.  Prolonged extension of the spine can irritate and compress the intervertebral discs.

To feel relief from back pain a great treatment strategy may be to stretch the iliopsoas muscles on both sides.

Image result for hip flexor stretch image

This is called the hip flexor/or iliopsoas stretch. Perform 3 x 60 seconds ,  2 x a day, 5 x a week 8 weeks.  Try to warm up the muscles first by doing a bike exercise  or jogging for 15 minutes.


A case study on the ankle

A friend of mine stepped off of a surfboard into some water she did not know the height of.  She rolled her ankle into eversion. This is where the outside of the ankle rolls outward.  This is unusual because the inside of the ankle usually rolls inward with an ankle injury.  For about a year her ankle has been quite sore limiting her in running on the beach, riding a bike, and running on the road.  Her outside ankle region/big toe region are sore with standing, walking, riding a bike and running.  Her ankle feels stiff and pulling on it gives her relief.

She had an X-ray and there was no fracture. An MRI showed the talus had inflammation. She had a stem cell injection and it seemed to improve the feeling of the inside of the ankle by about 50%.  That is cutting edge technology for a treatment.  That stem cell injection can differentiate cells into whatever cells are needed for tissue repair and healing.  She had ultrasound treatment from a physical therapist and some manual stretching and exercises for the foot- it helped but her insurance ran out and she needed a home exercise program.

Upon examination the salient findings are:

  • Both feet had moderate to maximal pronation at midstance of walking.
  • Left foot dorsiflexion was limited to 5 degrees, normal is 20 degrees
  • Flexor hallicus longus weakness significant/big toe flexor muscle ( a major stabilizer of the arch and 1st ray (big toe bone region)
  • Posterior tibialis region signficantly weak (the muscle that helps the foot in and down and helps stabilize the arch in walking)
  • Palpation of the outside of the ankle minor pain at talus laterally


Her treatment impairments would be summarized:

Compression injury to talus due to eversion injury of foot first metatarsal joint pain

  • Insoles and huge arched shoes (Asix or Brooks)
  • Calf stretching aggressively- When one area of the body is really tight commonly another area of the body will have to move more to achieve the desired movement of the body– so for this patient there was tightness of the capsular tissue and limited her dorsiflexion or upward movement of the ankle. This is a problem because now there was more movement at the first ray and it was a bit hypermobile and the flexor hallicus muscle was weak/and there was pain at the big toe region
  • Husband distraction of ankle and aggressive PROM stretching and distraction at the same time
  • Strengthening of the posterior tibialis with theraband aggressively
  • Strengthening of the posterior tibialis in standing and eccentrically going down slowly with calf raises

Image result for spenco arch support image

This is a picture of Spenco arch supports that can be bought for about 25 dollars


Image result for standing calf stretch with wedge image

Calf stretch with wedge 3 x 60 seconds 3 x a day 6 to 8 weeks

Image result for posterior tibialis strengthening theraband image

Posterior tibialis strengthening down and in resistance with band 3 x 15 2 x a day 8 weeks

Image result for standing heel raise exercise image

Up with the heels, down slowly 3 sets 15 x 4 x a week 8 weeks for posterior tibialis (calf too)

Image result for big toe flexor theraband strengthening image

big toe flexion exercise with resistance 3 sets 10 x 4 x a week 8 weeks- you could consider this 1st ray or part of the big toe bone a truss support for the whole foot



Stem cell injections for knee arthritis

Stem cell injection into knee for cartilage growth and knee pain reduction for knee osteoarthritis

Stem cell injections into the osteoarthritic knee is showing promising results. It helps with building up cartilage that has been degenerated and reducing pain levels in patients.

The picture above is from the website is

The picture below is from the website:

Image result for image of stem cells

In the American Journal of Sports Medicine 2014 it showed that stem cell injections showed cartilage repair tissue and subchondral bone were analyzed and shown to have statistically significant improvement.
The tissue is usually taken from the bone marrow in the hip. It then can be taken and placed in a laboratory and increased in number. Then it is injected into the knee.
Am J Sports Med. 2014 Jan;42(1):158-65. Epub 2013 Oct 10.Clinical results and MRI evolution of a nano-composite multilayered biomaterial for osteochondral regeneration at 5 years.Kon E1, Filardo G,et al.


Injection of isolated bone marrow-derived MSCs219222 or of marrow aspirates via arthroscopic debridement223 allowed improvement in visual analog scale pain scores and range of motion219223 as well as osteoarthritis outcome scores223 in patients at 6–12 months postoperatively. Furthermore, increases in cartilage growth and thickness with decreases in the size of poor cartilage and edematous subchondral (layer of bone just under the cartilage) bone were documented on MRI and by T2 relaxation measurements.219,221,222

Injection of adipose-derived (fat)  stem cells using platelet-rich plasma and arthroscopic debridement224,225 or platelet-rich plasma with hyaluronic acid226 yielded improved clinical outcomes using the Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm, and visual analog scale pain score in patients between 16 months and 2 years, with an enhanced whole-organ cartilage MRI score224,225 and improved subjective pain score and functional status in patients 3 months postoperatively, along with increased cartilage thickness on MRI.226

Stem Cells Cloning. 2014; 7: 1–17.Published online 2014 Jan 16. Patrick Orth,1 Ana Rey-Rico Current perspectives in stem cell research for knee cartilage repair


Outside foot pain/Metatarsal #5 stress fracture?

The picture above is from the website

What does one do if they have pain on the outside of the foot? It could be a 5th metatarsal stress fracture. How does this occur?

It usually occurs with long distance runners and repetitive stress and trauma to the outside of foot. What is the evidence to treat this condition?

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