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Posted by Sharon W on 6/17/02 at 18:35 (087842)

I know I'm 'sticking my neck out' here, but I think this article is something that should be made available for those on the board to see (and some excerpts are printed below):

http://www.myorehab.com/joggers_heal.htm

--------------------

'Jogger's Heel'

by Vicki Magown, CMTPT and George Pellegrino, CMTPT

On our morning drive to work, we often see joggers running in the parks and along the bike trails. Often times, we'll see them on the side of the runing path nursing what appears to be a pain in the foot, ankle, or claf. Many muscles can contribute to pain in these areas.

Runners often treat 'Jogger's Heel' by putting softer, cushioned inserts in their joggin shoes or by spending more money on air soles or gel soles. But the pain does not always come from the heel. It can be sent to the heel by a muscle called the soleus... The soleus is the muscle underneath the gastrocnemius, the big muscle that gives the calf its shape.

The gastrocnemius... is the 'Calf Cramp' muscle. When this muscle harbors trigger points, the pain is felt behind the knee and in the arch of the foot. Runners who suffer with foot pain experienced in the arch of the foot often times blame faulty shoes or arch supports, but this is rarely the case, since runner's shoe technology has evolved to such an advanced level.

The tibialis posterior muscle, found under the soleus and the gastrocnemius, is referred to as the 'Runner's Nemesis'. This muscle is responsible for pain felt all over the Achilles tendon. All three muscles; the gastrocnemius, soleus, and tibialis posterior, can cause pain when they become tight and shorten...

There are several possible causes for this problem. Insufficient warm up and not stretching AFTER jogging is often the case. Also, wearing high heels, even one inch, keep these muscles shortened all day. Tucking the feet under a chair raises the heels, thus shortening the calf muscles, as if standing on five-inch high heels.

A casual runner hwo came in for treatment of pain in the big toe and top of the foot said she thought the problem was that her running shoes fit too tightly. She had purchased a size larger and this had begun to cause blistering of her feet. Looking at the pain pattern and examining the muscle in the front of her leg beside the shinbone, revealed the true cause of her problem. The tibialis anterior... was the culprit and not the shoe size.

------------------------------------

The article goes on to give more examples like this, and to explain which calf muscles are involved in creating which different types of pain felt in the feet. It seems quite informative, especially for anyone who has unexplained symptoms, or pain in both the feet and leg muscles.

-- Sharon

Re: Article

Ed Davis., DPM on 6/17/02 at 19:16 (087848)

They are absolutely correct about the role of a tight gastrosoleus achilles complex in PF! Keep in mind that not all PF is associated with a tight heel cord but a lot is. This is the first thing that we look for when examining a patient with PF. I have a local physical therapist who is a manual therapist and does a lot of good hands on myofascial release work. His skills have allowed me to avoid surgical heel cord lengthening in literally hundreds of patients. One reason that some plantar fascial releas surgeries fail is due to a tight heel cord. Most of my PF patients are find resolution of symptoms via conservative care but of those who go on to surgery, I will lengthen the heel cord surgically about 50% of the time.
Ed

Re: Article

Julie on 6/18/02 at 01:52 (087867)

Here is a further exerpt from this interesting article:

'When treating Myofascial Pain, we take a thorough history of all trauma. When Trigger Points are laid down through injury, repetitive motion, occupation and disease, muscles shorten and become tight. Eventually, without specific treatment, tightness and stiffness becomes constant.

The therapists at MyoRehab often treat patients who make the common assumption that the source of the problem is at the site of the pain. As Myofascial Trigger Point Therapists, we are trained to recognize heel, arch or toe pain as the distinct signature of Trigger Points in the calf muscles.'

We know that the shortened, tight heel cord is one of the main causes of PF. The interesting point this article makes is that, of the 'several possible causes for tight heel cords', the laying down of trigger points may be one.

If myofascial treatment of trigger points where they are contributing to tight heel cords can help people avoid surgery, this would appear to be a fruitful line of investigation.

Re: Article

Suzanne D on 6/18/02 at 06:17 (087874)

Thank you, Sharon, Dr. Ed, and Julie for sharing this article and your comments.

I believe what I read applies to me, and I had no idea that tucking my legs under a chair could be contributing to my problems! Unlike the patient whose legs were not long enough to reach the floor, mine are long -and much too long when I sit beside a first grader in a small chair at school. So, what to do with long legs? Pull them back under the chair with my heels elevated as I rest on my forefeet. I will consciously stop that!

I have been stretching every day since I learned of its importance - especially before getting out of bed - but not enough, I don't think. Two times stand out in my mind when I had unusual relief from tightness and stiffness behind my knee and in my feet.

The first time was on a long 12 hour bus trip with my daughter's choir. Concerned about stiffness after riding so long, I luckily ended up on the front seat next to the aisle and alternated between stretching one leg, then the other, against the metal pole in front of me.

Then last Saturday, my daughter and I waited for my other daughter at a university where she took a teacher's exam. We read and worked at a table, and I continually stretched my legs by stretching them out and pressing against the leg of her chair.

Both times after long times of sitting, I felt so much better than I usually do after a mere 20 minute ride to town.

I had gone to the doctor in February concerned about possible arthritis in my knees, but upon examination and manipulation of the joints, he did not think there was significant arthritis. This seems to point to the shortened muscles as being the cause rather than the joints as I had thought.

I am wondering, just how much stretching must I do to make a lasting difference? Obviously I can't stretch for hours like I did in the above situations I described. But what I have been doing is not enough, or not done well enough.

Thank you for your help.

Suzanne :-)

Re: Article

Julie on 6/18/02 at 06:50 (087875)

Suzanne, what this suggests to me is that you might benefit from the gentle, continuous-over-many-hours stretching that a night splint would provide.

Perhaps it would also be useful to look into myofascial release. The point of the article was that if 'trigger points' are the cause of tightness in the calf muscles and achilles tendons, massage and release of these points, rather than or in addition to stretching, may be the key - in some cases.

The authors were careful to point out that there can be several causes of tightness in these structures. This particular cause hasn't been much aired or discussed here, and it seems worthy of investigation.

Re: Article

Sharon W on 6/18/02 at 10:25 (087900)

Julie,

You are right about the importance of the authors' comment that there can be SEVERAL causes of tightness in these structures. Perhaps it is because this board has such a strong focus on the podiatric approach, rather than the orthapedic one. Unless the podiatrist is a specialist on orthopedic podiatry, I would venture to say that orthopods have far more training and knowledge in how all the muscles and skeletal structures, etc. of the body work together. I have long believed that the FEET, since they are the part of our bodies that we put our weight on, tend to be the part that HURT the most, even if they are only one part of the problem. Because of that, it unfortunately makes sense that feet would be blamed sometimes for problems that actually originate in other areas.

That is NOT to say that if you have PF (for example), there is nothing wrong with your feet, and it is NOT to say that your feet do not need to be treated.

And I am CERTAINLY NOT criticizing podiatrists or comparing them unfavorably with orthopods!! I am just acknowledging that while pods are THE ultimate experts on FEET, a good orthopod who is more extensively trained in biomechanics (an ortho who is NOT contemptful toward feet, as some of them appear to be) might be the appropriate medical specialist to identify problems elsewhere in the legs or body.

-- Sharon

Re: PS

Sharon W on 6/18/02 at 11:55 (087905)

An ortho is certainly qualified to identify which muscles are too tight, etc. -- but they may harbor prejudices against trigger point therapy. A physiatrist might be more open-minded. While I've never seen one (there are none in our area), what I have learned about their approach suggests that some physiatrists might be quite knowledgable about the formation of trigger points and how best to treat them. A chiropractor may likewise have knowledge about this subject, or a skilled skilled physical therapist. For anyone who that suspects myofacial pain syndrome may be part of their problem, it might be worth looking into which professionals are available locally who can DO trigger point therapy.

-- Sharon

Re: Article

Suzanne D on 6/19/02 at 09:50 (087994)

Thanks, Julie. I think I will buy a Night Splint and try to get used to it while out of school. That seems to make sense to me.

And I am going to continue to try to learn more about myofascial release as well.

Suzanne :-)

Re: Article

Ed Davis., DPM on 6/17/02 at 19:16 (087848)

They are absolutely correct about the role of a tight gastrosoleus achilles complex in PF! Keep in mind that not all PF is associated with a tight heel cord but a lot is. This is the first thing that we look for when examining a patient with PF. I have a local physical therapist who is a manual therapist and does a lot of good hands on myofascial release work. His skills have allowed me to avoid surgical heel cord lengthening in literally hundreds of patients. One reason that some plantar fascial releas surgeries fail is due to a tight heel cord. Most of my PF patients are find resolution of symptoms via conservative care but of those who go on to surgery, I will lengthen the heel cord surgically about 50% of the time.
Ed

Re: Article

Julie on 6/18/02 at 01:52 (087867)

Here is a further exerpt from this interesting article:

'When treating Myofascial Pain, we take a thorough history of all trauma. When Trigger Points are laid down through injury, repetitive motion, occupation and disease, muscles shorten and become tight. Eventually, without specific treatment, tightness and stiffness becomes constant.

The therapists at MyoRehab often treat patients who make the common assumption that the source of the problem is at the site of the pain. As Myofascial Trigger Point Therapists, we are trained to recognize heel, arch or toe pain as the distinct signature of Trigger Points in the calf muscles.'

We know that the shortened, tight heel cord is one of the main causes of PF. The interesting point this article makes is that, of the 'several possible causes for tight heel cords', the laying down of trigger points may be one.

If myofascial treatment of trigger points where they are contributing to tight heel cords can help people avoid surgery, this would appear to be a fruitful line of investigation.

Re: Article

Suzanne D on 6/18/02 at 06:17 (087874)

Thank you, Sharon, Dr. Ed, and Julie for sharing this article and your comments.

I believe what I read applies to me, and I had no idea that tucking my legs under a chair could be contributing to my problems! Unlike the patient whose legs were not long enough to reach the floor, mine are long -and much too long when I sit beside a first grader in a small chair at school. So, what to do with long legs? Pull them back under the chair with my heels elevated as I rest on my forefeet. I will consciously stop that!

I have been stretching every day since I learned of its importance - especially before getting out of bed - but not enough, I don't think. Two times stand out in my mind when I had unusual relief from tightness and stiffness behind my knee and in my feet.

The first time was on a long 12 hour bus trip with my daughter's choir. Concerned about stiffness after riding so long, I luckily ended up on the front seat next to the aisle and alternated between stretching one leg, then the other, against the metal pole in front of me.

Then last Saturday, my daughter and I waited for my other daughter at a university where she took a teacher's exam. We read and worked at a table, and I continually stretched my legs by stretching them out and pressing against the leg of her chair.

Both times after long times of sitting, I felt so much better than I usually do after a mere 20 minute ride to town.

I had gone to the doctor in February concerned about possible arthritis in my knees, but upon examination and manipulation of the joints, he did not think there was significant arthritis. This seems to point to the shortened muscles as being the cause rather than the joints as I had thought.

I am wondering, just how much stretching must I do to make a lasting difference? Obviously I can't stretch for hours like I did in the above situations I described. But what I have been doing is not enough, or not done well enough.

Thank you for your help.

Suzanne :-)

Re: Article

Julie on 6/18/02 at 06:50 (087875)

Suzanne, what this suggests to me is that you might benefit from the gentle, continuous-over-many-hours stretching that a night splint would provide.

Perhaps it would also be useful to look into myofascial release. The point of the article was that if 'trigger points' are the cause of tightness in the calf muscles and achilles tendons, massage and release of these points, rather than or in addition to stretching, may be the key - in some cases.

The authors were careful to point out that there can be several causes of tightness in these structures. This particular cause hasn't been much aired or discussed here, and it seems worthy of investigation.

Re: Article

Sharon W on 6/18/02 at 10:25 (087900)

Julie,

You are right about the importance of the authors' comment that there can be SEVERAL causes of tightness in these structures. Perhaps it is because this board has such a strong focus on the podiatric approach, rather than the orthapedic one. Unless the podiatrist is a specialist on orthopedic podiatry, I would venture to say that orthopods have far more training and knowledge in how all the muscles and skeletal structures, etc. of the body work together. I have long believed that the FEET, since they are the part of our bodies that we put our weight on, tend to be the part that HURT the most, even if they are only one part of the problem. Because of that, it unfortunately makes sense that feet would be blamed sometimes for problems that actually originate in other areas.

That is NOT to say that if you have PF (for example), there is nothing wrong with your feet, and it is NOT to say that your feet do not need to be treated.

And I am CERTAINLY NOT criticizing podiatrists or comparing them unfavorably with orthopods!! I am just acknowledging that while pods are THE ultimate experts on FEET, a good orthopod who is more extensively trained in biomechanics (an ortho who is NOT contemptful toward feet, as some of them appear to be) might be the appropriate medical specialist to identify problems elsewhere in the legs or body.

-- Sharon

Re: PS

Sharon W on 6/18/02 at 11:55 (087905)

An ortho is certainly qualified to identify which muscles are too tight, etc. -- but they may harbor prejudices against trigger point therapy. A physiatrist might be more open-minded. While I've never seen one (there are none in our area), what I have learned about their approach suggests that some physiatrists might be quite knowledgable about the formation of trigger points and how best to treat them. A chiropractor may likewise have knowledge about this subject, or a skilled skilled physical therapist. For anyone who that suspects myofacial pain syndrome may be part of their problem, it might be worth looking into which professionals are available locally who can DO trigger point therapy.

-- Sharon

Re: Article

Suzanne D on 6/19/02 at 09:50 (087994)

Thanks, Julie. I think I will buy a Night Splint and try to get used to it while out of school. That seems to make sense to me.

And I am going to continue to try to learn more about myofascial release as well.

Suzanne :-)