| Did you know that pain in the ball of the foot may | | | | compensations disrupt the normal biomechanics of |
| be due to an inability to fully bend your ankle joint? | | | | walking. When the biomechanics is disrupted the |
| Did you also know that the type of shoes that you | | | | joints are not loaded as they should, the muscles, |
| wear (i.e. high heels) may be at the root of the | | | | tendons and ligaments are strained. Strained muscles, |
| cause of the pain? Don't despair. There are some | | | | tendons and ligaments cause pain. |
| simple exercises that may help to relieve the pain in | | | | People with equinus deformity may experience pain in |
| the ball of the foot. | | | | the ball of the foot because they tend to toe walk |
| Pain-free walking requires the precise integration of | | | | and overload the front of the foot. They may |
| numerous joints, muscles, tendons and ligaments. One | | | | develop pain in the mid foot from compensating by |
| of the most critical and complex joints involved this | | | | flattening out the foot and overstretching the plantar |
| process is the ankle joint. The ankle joint is required | | | | fascia, the may develop heel pain by the tight Achilles |
| to bend the foot downward, toward the floor, | | | | pulling the at its insertion point on the heel. |
| (plantar flexion), upward toward your head | | | | In order to properly treat the pain associated with |
| (dorsiflexion), rotate inward (inversion) and outward | | | | equinus it is first necessary to determine the cause. |
| (eversion). For this discussion we are going to focus | | | | Obviously if the problem is due to a piece of |
| on problems caused by the limitation of ankle joint | | | | fractured bone blocking motion at the ankle joint or a |
| dorsiflexion during walking. | | | | congenitally short Achilles tendon, this would require |
| Inability to fully dorsiflex the foot results in a | | | | an evaluation by an orthopedist for possible surgery. |
| condition referred to as ankle equinus. It is called | | | | However if the ankle equinus is caused by tightness |
| equinus from the term equine which refers to a | | | | of the calf muscles, which is often the case, this can |
| horse. I am not implying that a person with ankle | | | | usually be treated conservatively. |
| joint equinus has a hoof. However if you notice a | | | | The goal of treatment for someone with tight calf |
| horse's hoof, the front of the foot points in a | | | | muscles is to first reduce the strain in the calf |
| downward direction; it appears to be plantar flexed | | | | muscles and bring the floor up to meet the heel. This |
| (pointed down toward the floor). The person with | | | | is usually accomplished with a heel lift inside the shoe |
| ankle joint equinus may appear to have a plantar | | | | that is used temporarily as the calf muscles are |
| flexed foot and may have a tendency to walk more | | | | slowly being stretched thru exercises. The patient |
| on their toes. | | | | may also require a custom orthotic to support the |
| Rarely, ankle equine is caused by a piece of bone | | | | arch. The orthotic may incorporate what is called a |
| from an old fracture blocking the proper motion of | | | | metatarsal pad that fits just behind the heads of |
| the ankle or by a congenitally short Achilles tendon | | | | metatarsal bones (long bones of the foot) to take |
| that prevents full dorsiflexion of the ankle. Ankle joint | | | | the load off of the ball of the foot. The long term |
| equinus may also be caused by arthritis that results in | | | | treatment however involves stretching exercises and |
| deformity of the bones of the joint that interferes | | | | making sure the patient is placed into appropriate |
| with the full dorsiflexion of the joint. Most commonly | | | | footwear. In addition your doctor may prescribe |
| ankle joint equinus is caused by tight calf muscles. If | | | | what is called a dorsal night splint which holds the |
| the calf muscles are too tight the ankle is not able to | | | | foot in a dorsiflexed position as you sleep to facilitate |
| fully dorsiflex the ankle. | | | | stretching of the calf muscles. Let me describe some |
| Spending too much of your day in high heels can | | | | simple techniques that are used to stretch the two |
| result in tight calf muscles and subsequently ankle | | | | main calf muscles, the soleus (sole-ee-us) and the |
| joint equinus. The body adapts to the demands that | | | | gastrocnemius (gas-trock-knee-me-us). |
| are placed upon it. If you wear high heels the | | | | To stretch the gastrocnemius muscle you stand |
| distance between the heel and knee is decreased | | | | facing the wall with your feet about 12 inches from |
| and the calf muscles will contract in order to | | | | the wall. Step back about 6 inches with one leg. Then |
| compensate for this shorter distance. Then when | | | | while keeping your rear knee straight, your forward |
| you put on your flatter shoes and try to walk the | | | | knee slightly bent, your back straight and both heels |
| tight calf muscles interferes with the ability of the | | | | on the floor, lean into the wall. When you feel the |
| ankle joint to function as it should to provide | | | | muscle start to stretch hold the position for 10 |
| pain-free walking. | | | | seconds. Do this stretch ten times in a row for each |
| The person with ankle equinus has a tendency to | | | | foot and repeat 3 times per day. |
| walk on the ball off the foot. They have difficulty | | | | To stretch the soleus muscle stand facing the wall as |
| keeping the heel on the ground as they walk and | | | | described above for stretching the gastrocnemius |
| raise the heel off the ground early in the step cycle. | | | | with one foot further back. However this time squat |
| Ankle joint equinus causes the normal biomechanics | | | | down as if in a seated position while keeping your |
| of walking to get all screwed-up. When humans have | | | | hands on the wall for balance. When you start to feel |
| biomechanical problems that interfere with the normal | | | | the muscle stretch as you lean toward the wall, hold |
| biomechanics of walking they compensate. People | | | | the position for 10 seconds. Do this stretch ten times |
| with equinus compensate by walking on their toes. | | | | in a row for each foot and repeat 3 times per day. |
| They may lift up their heel early in the step that | | | | These stretching exercises together with a |
| makes them appear as if they are bouncing along as | | | | temporary heel lift and possibly a dorsal night splint |
| they walk. They may compensate by flattening out | | | | will reduce the pain in the ball of the foot as our |
| their arch in order to take some of the load off the | | | | biomechanics improve. If however these measures |
| front of the foot. Sometimes they turn their feet to | | | | do not improve your symptoms you may want to |
| the outside as they walk and contact the ground | | | | consider a custom foot orthotic. |
| with the inside part of the heel. All of these | | | | |