How to Treat your Feet!: Michi Mennecke, MPT

Posted 3/20/2015 in Physical Therapy Corner | 721 view(s) | 0 comment(s)

How to treat your feet! 
Michi Mennecke, MPT

After long work hours, a competitive practice or hours of daily rehearsals, your feet are going to need some attention. Injuries can obviously range in severity impacting oneʼs ability to dance, work,or even walk ; however, I would like to provide some helpful tips on how to keep your feet and ankles healthy and strong throughout all of your daily activities.

Considerations for preventing and treating the following injuries include:

-Blisters: Blisters develop because of increased friction (or rubbing) to a specific area. To avoid blisters-do not wear new shoes for long days of conventions, tournament days, or even a long shift at work. For instance, If you dance barefoot for extended periods, calluses will build up preventing the blisters. Calluses build up for a reason and toughen the skin on areas you need and use most.

How to treat: Make sure your shoe is the proper fit-specifically shoes that youʼre wearing most often. It may take some tweaking to find the correct shoe for your foot. If you continue participating in a shoe that does not fit, you may develop a blister. Some get rid of blisters by lancing it with a sterile needle to relieve pain and pressure. If you do not feel comfortable doing this, make sure to cover your blister so if it unexpectedly breaks up, you will be at less risk for infection. Always make sure the area does not become infected and apply antibiotic ointment until the blister is healed. Try to locate problem areas so you can prevent it in the future. See your podiatrist or MD if problems persist.

-Weakened arch A weak lateral (outside border of foot) will lead to sickling and supination; a weak medial (inside border of foot) longitudinal arch will lead to excessive pronation, or falling of the arch. The arch is essential for proper stability and balance,especially seen en releve for dancers. A problem with the arch can lead to problems with alignment which can lead to more serious injuries.

How to treat: Low-dye taping works for immediate relief from a fallen arch. This is not a permanent solution but custom orthotics for walking may be in your future. For long-term benefit, strengthen the muscles that support the arch. Specific exercises to start on both feet include: 1) Toe pick-ups: You can use a towel or small pieces of theraband tied in knots and push heel into floor while picking up towel or theraband with your toes and close your feet into parallel first position. Repeat 3 sets of 15. 2) Dome exercise: Bring the toes of your right foot toward your right heel creating a dome. Hold for 3 seconds and slide toes back to original position. Repeat 3 sets of 15. 3) Castanet exercise: Alternate tapping of great toe with 4 remaining toes, like to the beat of a drum. Repeat 3 sets of 15. 4) Roll ups/downs: Like the ʻwaveʼ, roll from your great toe to small toe and reverse. Repeat 3 sets of 15

-Ankle sprain The most common sprain is the ʻinversionʼ sprain with your foot rolling in beyond itʼs normal range of motion causing the ligaments to stretch beyond normal length; if the force is too strong, the ligament(s) may tear. The most common sprain is to the anterior talofibular ligament.

How to treat: It is important to be seen by your doctor, physical therapist or athletic trainer right away. Special testing can be performed to determine stability of your ankle. An x-ray or MRI may be necessary depending on findings. Ankle theraband strengthening (depending on your specific area of weakness) is a good place to start and your therapist can instruct you on specific strengthening that is necessary for you. Balance and proprioception exercises will be essential for full return to daily activities and to give you controlled challenges before returning to sport specific activities with improved body awareness. Always remember to avoid painful movements and if pain/swelling persist, it is essential to contact your physical therapist or doctor.

-Achilles tendonitis An irritation of the Achilles tendon can be very common in dancers and runners. The Achilles tendon helps to balance forces in the leg and assist with movement in the leg and ankle. Injury occurs when the demand placed on the tendon is greater than itʼs ability to function. In the dancer, pain is the result of repetitive trauma to the tendon and needs to be treated by your PT.

How to treat: It is important to not overstretch the gastrocnemius-soleus (calf) musculature in order to avoid excess irritation/inflammation . It is very important to work on flexibility and strengthening exercises throughout the lower extremities, specifically focusing on the gluteal musculature. Emphasizing strengthening of gluteal muscles will be of significant benefit when fully returning to your dance rehearsals. If trigger points in your calf are an issue, dry needling by your Achieve therapist may be your answer. Per the Myopain website, dry needling is a ʻskilled intervention used by physical therapists that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. Physical therapists utilize dry needling with the goal of releasing/inactivating the trigger points and relieving pain.ʼ

-Plantar fasciitis Inflammation to the plantar fascia can be caused due to weakness in the foot and ankle, poor alignment affecting your arch support and decreased fascial mobility throughout the lower extremity. The plantar fascia stretches along the full length of the foot and is important for successful propulsion in jumps and with ambulation.

How to treat: See your physical therapist for appropriate taping technique to support your arch for ability to mark/fully return to dance. Strengthening the foot/ankle musculature retrains the arch to relieve the stress on the plantar fascia. Achieve therapists are all certified in the Graston technique to treat plantar fasciitis. Per the Graston website, the Graston technique is described as ʻan innovative, evidence-based form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.ʼ

It is important to address the issues even at beginning levels because improper technique due to weakness and an imbalance of structures can make an impact on the athletesʼs body alignment creating long-term problems to the ankle, knee, hip and low back. As more and more athletes are using low profile shoes, or even competing barefoot (dancers), the balance of strength and flexibility from the foot to the core becomes more and more important.

-Rips Keep your feet dry (no hanging out in sweaty dance shoes) to avoid cracks or ʻripsʼ. Rips can occur if skin is not dried properly and wet skin becomes soft; the constant movement of the foot on floor/carpet (often at conventions) can cause a rip if skin is pulled.

How to treat: After speaking with Mary Fugett, D.O. and Medical Director of Little Company of Mary Hospital Care Station, rips can be treated with over-the-counter surgical glue (such as New Skin) and covered with tape (such as leukotape) to avoid further tearing of the rip. When not dancing, Dr. Fugett recommends to try antibiotic ointment and gauze to keep the area dry and then to buddy-tape toes together.

Michi Mennecke is a graduate Northwestern University, Feinberg School of Medicine. Michi has treated athletes of all ages and levels with an emphasis in the Performing Arts with a special interest in Dance. Michi is available for scheduling out of our Naperville Sports Medicine Clinic.

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