1 00:00:09,240 --> 00:00:11,880 Hello everybody, and welcome to the Doctors of Running podcast 2 00:00:11,880 --> 00:00:14,440 where we, a group of doctors of physical therapy, discuss the 3 00:00:14,440 --> 00:00:16,840 art and science of running and the stuff that we put on our 4 00:00:16,840 --> 00:00:18,800 feet. My name is Nathan Brown and I 5 00:00:18,800 --> 00:00:22,080 will be hosting today, and today we have a very exciting guest. 6 00:00:22,080 --> 00:00:25,200 This is somebody who has been on the podcast with us before. 7 00:00:25,440 --> 00:00:28,000 It is Doug Adams. He's a physical therapist, 8 00:00:28,280 --> 00:00:32,840 founder of Run D DNA, and he also was the physical therapist 9 00:00:32,840 --> 00:00:37,080 for Tin Man Elite, has a ton of experience in biomechanical 10 00:00:37,080 --> 00:00:40,120 analysis of runners, has been working in the bio mechanics of 11 00:00:40,120 --> 00:00:43,680 walking as well. I have been having the privilege 12 00:00:43,680 --> 00:00:46,840 to have done a lot of his online courses that he's created. 13 00:00:47,000 --> 00:00:49,120 There's a lot of things for people who want to learn more 14 00:00:49,120 --> 00:00:52,760 about endurance running from a coaching perspective, Endurance 15 00:00:52,760 --> 00:00:54,960 running from a biomechanical perspective. 16 00:00:55,120 --> 00:00:58,320 He's a wealth of knowledge and has found ways to share it with 17 00:00:58,320 --> 00:01:00,720 the world. So take advantage of learning 18 00:01:00,720 --> 00:01:02,760 from today. We're so glad that he joined us. 19 00:01:03,040 --> 00:01:05,120 Doug, thanks for taking time to join us today. 20 00:01:05,640 --> 00:01:06,920 Nathan, thanks for having me here. 21 00:01:06,920 --> 00:01:09,720 Excited to be back. It was a fun conversation last 22 00:01:09,720 --> 00:01:11,320 time and looking forward to this one. 23 00:01:11,520 --> 00:01:13,880 Awesome. And we're lucky because we have 24 00:01:13,880 --> 00:01:16,760 been asked a lot of time by the people who've been following us 25 00:01:16,760 --> 00:01:19,600 on the podcast to have a discussion about plantar 26 00:01:19,600 --> 00:01:23,040 fasciitis, plantar fascia pain. And we know that there's a lot 27 00:01:23,040 --> 00:01:25,880 of complexity in this topic. And we could have just had the 28 00:01:25,880 --> 00:01:28,800 discussion among ourselves. But we thought that bringing 29 00:01:28,800 --> 00:01:32,600 someone else in with another perspective, especially thinking 30 00:01:32,600 --> 00:01:35,960 about biomechanical implications for this condition. 31 00:01:36,000 --> 00:01:39,240 We're excited to dive into everything planner fascia pain 32 00:01:39,240 --> 00:01:43,360 with you today. So before we jump in though, I 33 00:01:43,360 --> 00:01:45,280 would love for you to give people a little bit more 34 00:01:45,280 --> 00:01:48,880 introduction about who you are and kind of what you do and what 35 00:01:48,880 --> 00:01:53,280 has been kind of sparking your passions over the last 6 to 12 36 00:01:53,280 --> 00:01:55,960 months. Oh yeah, All right. 37 00:01:56,240 --> 00:01:58,920 I have lots of soap boxes too, so that's always fine. 38 00:01:58,960 --> 00:02:02,760 But I'm a self-proclaimed gate geek. 39 00:02:03,000 --> 00:02:06,040 I love everything about running, walking. 40 00:02:06,360 --> 00:02:09,759 It's just something that has been so passionate for me, and 41 00:02:09,759 --> 00:02:12,080 I've been very fortunate just to have the opportunity to work 42 00:02:12,120 --> 00:02:15,680 through that in my career. Started off in a little bit on 43 00:02:15,680 --> 00:02:20,320 the academic side and then spend some time on the more commercial 44 00:02:20,320 --> 00:02:22,360 side, working as a physical therapist. 45 00:02:22,720 --> 00:02:25,640 Got kind of frustrated pretty quickly not having resources and 46 00:02:25,640 --> 00:02:28,080 tools. So started teaching courses, 47 00:02:28,080 --> 00:02:31,440 started building technology, and that's kind of what has brought 48 00:02:31,440 --> 00:02:33,720 us here. We've been very fortunate, you 49 00:02:33,720 --> 00:02:37,000 know, in the professional runner space, a lot of adoption there, 50 00:02:37,360 --> 00:02:40,120 in the military space, a lot of adoption there. 51 00:02:40,720 --> 00:02:45,360 So I just spend my days, I get to make up lectures and create 52 00:02:45,360 --> 00:02:48,760 new cool technology and work with the high level professional 53 00:02:48,760 --> 00:02:51,360 runners as well as local recreational runners. 54 00:02:51,960 --> 00:02:54,320 Now, a lot of the stuff that we're talking about today, it's 55 00:02:54,320 --> 00:02:56,680 it's not just for the pros. And I think a lot of people, 56 00:02:57,560 --> 00:03:01,360 they look to emulate the pros at times where I was like, hold on, 57 00:03:01,480 --> 00:03:04,880 you might not want to. They're not perfect. 58 00:03:04,880 --> 00:03:07,760 Sometimes they're professional runners because they're really 59 00:03:07,760 --> 00:03:11,440 good at getting through injuries and they don't necessarily have 60 00:03:11,440 --> 00:03:14,920 perfect bio mechanics. They just have huge engines and 61 00:03:14,920 --> 00:03:16,360 are able to get through some of that stuff. 62 00:03:16,360 --> 00:03:21,800 So as far as what I've been working on last 6 to 12 months, 63 00:03:21,880 --> 00:03:25,120 I think one of the biggest things and I think very relevant 64 00:03:25,120 --> 00:03:29,360 to what we're talking about today is how much we should be 65 00:03:29,360 --> 00:03:33,400 really looking at our walking patterns even as a runner. 66 00:03:33,960 --> 00:03:37,120 And that's something that I think has been huge. 67 00:03:37,120 --> 00:03:39,760 And personally, I had an experience when we were 68 00:03:39,760 --> 00:03:42,920 developing some new technology that my walking made a huge 69 00:03:42,920 --> 00:03:45,960 difference in my running. So that's something I'm excited 70 00:03:45,960 --> 00:03:47,680 to share as well. Fantastic. 71 00:03:48,120 --> 00:03:50,880 Well, when you talk about some of the technology, I'm a 72 00:03:50,880 --> 00:03:54,040 personal beneficiary of the technology that you've worked 73 00:03:54,040 --> 00:03:55,680 on. A lot of people know this 74 00:03:55,680 --> 00:03:59,120 already, but I lead a bio mechanics running lab at our 75 00:03:59,120 --> 00:04:03,240 university with our DPT students and we utilize Run DN as Helix 76 00:04:03,240 --> 00:04:06,880 3D System as a way to bring all of the the runners at our 77 00:04:06,880 --> 00:04:10,320 university through a standardized examination. 78 00:04:10,440 --> 00:04:12,880 We're both doing kind of preventative work, but also if 79 00:04:12,880 --> 00:04:14,640 they've got something going on, we bring them in. 80 00:04:14,800 --> 00:04:17,160 We take a look at mechanics, strength, mobility, all that 81 00:04:17,160 --> 00:04:18,959 stuff. So thanks for creating a 82 00:04:18,959 --> 00:04:22,640 technology that is mobile and small enough to fit into our 83 00:04:22,640 --> 00:04:26,400 spaces because we don't work at an R1 research institution where 84 00:04:26,400 --> 00:04:30,120 we can have this, you know, 20 camera system and we don't have 85 00:04:30,120 --> 00:04:31,800 that sort of funding and resources. 86 00:04:31,800 --> 00:04:34,800 So thank you for the work that you've done over the last 87 00:04:34,800 --> 00:04:39,080 however many, how many years did ago did you establish the Helix 88 00:04:39,080 --> 00:04:43,840 3D system? I think the first version of it. 89 00:04:44,040 --> 00:04:48,640 I started working on it in 2016, and I want to say 2017 was the 90 00:04:48,640 --> 00:04:54,200 first version that weighed about 25 lbs. 91 00:04:54,200 --> 00:04:58,720 And we called it portable. It was milled out of a piece of 92 00:04:58,720 --> 00:05:00,320 aluminum. That's amazing. 93 00:05:00,720 --> 00:05:03,600 So, yeah, portable was a relative term. 94 00:05:03,600 --> 00:05:07,240 But, yeah, so we're, you know, we're getting close to 10 years 95 00:05:07,240 --> 00:05:10,120 of it here. But that was, you know, talking 96 00:05:10,120 --> 00:05:13,280 about soapboxes. And, you know, kudos to you for 97 00:05:13,280 --> 00:05:14,480 doing that. And we're getting a lot more 98 00:05:14,480 --> 00:05:17,000 universities that are starting to use it as a teaching tool. 99 00:05:17,000 --> 00:05:21,120 We talking with couple this week, but it's, it's been really 100 00:05:21,120 --> 00:05:24,480 fun because we, we did, we taught this course this past 101 00:05:24,480 --> 00:05:26,920 weekend. We did a little team after 102 00:05:26,920 --> 00:05:32,080 action review and kind of surprised and I, I see this that 103 00:05:32,480 --> 00:05:36,800 people aren't as knowledgeable about gait as you think that 104 00:05:36,800 --> 00:05:39,440 they would be. And a lot of times I think that 105 00:05:39,440 --> 00:05:42,240 was because we just didn't have a way to objectify it or measure 106 00:05:42,240 --> 00:05:45,960 it before that you couldn't get good data about it. 107 00:05:45,960 --> 00:05:50,080 So why spend a ton of time learning all about the bio 108 00:05:50,080 --> 00:05:53,840 mechanics and how to make interventional changes there if 109 00:05:53,840 --> 00:05:55,640 you can't measure it in the first place? 110 00:05:55,640 --> 00:05:58,360 But now what we're seeing is that as there's more and more 111 00:05:58,360 --> 00:06:02,560 tools and more and more access to that, people are actually 112 00:06:02,560 --> 00:06:04,000 starting to really care about their gate. 113 00:06:04,000 --> 00:06:07,000 Both the runners, like I love that runners are asking for gait 114 00:06:07,000 --> 00:06:09,480 analysis now, right? It's not like, hey, let me tell 115 00:06:09,480 --> 00:06:12,320 you about this cool thing I can do a runners. 116 00:06:12,520 --> 00:06:15,720 Hey do you do analysis? Which is really pretty cool to 117 00:06:15,720 --> 00:06:18,160 say. Absolutely well, here we go 118 00:06:18,160 --> 00:06:20,400 let's start diving into the topic of the day. 119 00:06:20,400 --> 00:06:23,000 We're going to be talking about planner fascia pain. 120 00:06:23,280 --> 00:06:26,600 This is something that I think is so important to talk about 121 00:06:26,600 --> 00:06:30,080 for a few reasons 1 is how common it is in the running 122 00:06:30,080 --> 00:06:32,480 population, but also in the non running population. 123 00:06:32,680 --> 00:06:34,920 And I think that's where some of this conversation maybe about 124 00:06:34,920 --> 00:06:38,560 gate walking gate can come back as well, because I think it's 125 00:06:38,640 --> 00:06:41,120 depending on your statistic and what study you look at somewhere 126 00:06:41,120 --> 00:06:43,640 of like one in 10 people will have planner fascia paint at 127 00:06:43,640 --> 00:06:46,360 some time in their lives. It's one of the more common on 128 00:06:46,360 --> 00:06:48,880 the laundry list of running related injuries. 129 00:06:49,320 --> 00:06:51,600 And in my opinion, it's one of those that's a bit more of a 130 00:06:51,600 --> 00:06:55,080 bugger because there are a lot of things that it could be and 131 00:06:55,080 --> 00:06:59,960 it's sometimes a little bit more stubborn than some other tendon 132 00:06:59,960 --> 00:07:03,080 related issues that are somewhat easier to manage. 133 00:07:03,080 --> 00:07:05,760 So what we want to talk about first is just what is the 134 00:07:05,760 --> 00:07:09,280 plantar fascia and about the anatomy at the bottom of the 135 00:07:09,280 --> 00:07:11,640 foot. Do you mind kind of enlightening 136 00:07:11,640 --> 00:07:15,440 us on some of that? Yeah, especially and, you know, 137 00:07:15,440 --> 00:07:18,000 you could dive deep into this because there's layers of 138 00:07:18,000 --> 00:07:21,800 muscles and there's a third of the bones in our body or in our 139 00:07:21,800 --> 00:07:24,240 feet. So there's a lot of intricacy 140 00:07:24,240 --> 00:07:27,200 with the foot and I think that's where it can be intimidating at 141 00:07:27,200 --> 00:07:29,880 times. But if you just look at it at a 142 00:07:30,040 --> 00:07:34,200 basic level, the plantar fascia is something that is used as a 143 00:07:34,200 --> 00:07:38,880 way to maintain the stability of our arch, which is important for 144 00:07:38,880 --> 00:07:41,480 how we accept load and create forces. 145 00:07:41,800 --> 00:07:45,440 So we basically have this really thick fibrous structure that's 146 00:07:45,440 --> 00:07:48,880 at the bottom of the foot that is just a great way to maintain 147 00:07:48,880 --> 00:07:50,520 it. And you know, the Romans had it 148 00:07:50,520 --> 00:07:53,200 right. Maintaining arches is is a big 149 00:07:53,200 --> 00:07:54,680 part of it. It, it gives us a lot of 150 00:07:54,680 --> 00:07:59,520 stability as well as ability to to adapt to the ground. 151 00:07:59,520 --> 00:08:05,000 So that plantar fascia has a very important role in what we 152 00:08:05,000 --> 00:08:07,520 do, which is probably why we're seeing so many people have it 153 00:08:07,840 --> 00:08:11,560 and 100% agree with it, Nathan, that we see people often these 154 00:08:11,720 --> 00:08:15,320 these symptoms persist for a year or more where people can 155 00:08:15,320 --> 00:08:18,000 even be up to 10 years after they develop it. 156 00:08:18,400 --> 00:08:20,640 Yeah, it's actually interesting. I'm having a little bit of this 157 00:08:20,640 --> 00:08:24,320 pain myself right now. So this was even really relevant 158 00:08:24,320 --> 00:08:29,720 timing for me and reviewing so the doing my own gait analysis, 159 00:08:29,720 --> 00:08:33,240 I was like, Oh yeah, OK, I need to do as I say a little bit 160 00:08:33,240 --> 00:08:34,600 here. That's fantastic. 161 00:08:34,960 --> 00:08:37,840 And when we think about, I would love for you to even go into 162 00:08:37,840 --> 00:08:41,360 some of this complexity of the layers of the foot. 163 00:08:41,360 --> 00:08:43,919 So we've got this plantar fascia, which is kind of that 164 00:08:44,039 --> 00:08:46,720 almost most superficial layer close to the skin. 165 00:08:47,080 --> 00:08:49,720 Talk a little bit more about what's going on underneath 166 00:08:49,720 --> 00:08:50,560 there. Yeah. 167 00:08:50,560 --> 00:08:56,160 So then there's a series of muscles that we refer to as both 168 00:08:56,200 --> 00:09:00,920 intrinsic and extrinsic muscles that contribute to how the foot 169 00:09:00,920 --> 00:09:04,000 functions. So we start to have some of the 170 00:09:04,000 --> 00:09:07,920 muscles of the foot that start to control how we start to flex. 171 00:09:07,920 --> 00:09:10,680 We, we start to see around the plantar fascia, we're going to 172 00:09:10,680 --> 00:09:12,640 start to see some of the the toe flexors. 173 00:09:13,680 --> 00:09:16,920 Then as you get even deeper, you even get into smaller muscles 174 00:09:16,920 --> 00:09:19,440 like the inner eyesight, which start to control the 175 00:09:19,440 --> 00:09:21,840 relationships of the bone as they get to each other. 176 00:09:21,840 --> 00:09:26,320 So there's about 3 or 4 layers that we really go through and 177 00:09:26,360 --> 00:09:30,040 there's all sorts of names and it would, you know, there's a 178 00:09:30,040 --> 00:09:32,920 lot more needling now, which if you get dry needling on your 179 00:09:32,920 --> 00:09:35,440 feet, man, that that feels all sorts of special. 180 00:09:35,440 --> 00:09:40,320 But there there's a bunch of intricacy with that and a lot of 181 00:09:40,320 --> 00:09:45,920 it is to help. I often describe the foot as not 182 00:09:45,920 --> 00:09:48,680 really something that's very strong. 183 00:09:49,080 --> 00:09:52,280 It's something that's very coordinated and it's very smart. 184 00:09:52,640 --> 00:09:56,760 Although I will say Courtney Connolly has got me on to this. 185 00:09:56,760 --> 00:10:02,400 I like, I am doing a lot more of assessing toe flexor strength 186 00:10:02,880 --> 00:10:07,760 and looking at that. I, she and I have kind of 187 00:10:08,080 --> 00:10:10,760 collaborated a little bit more over the past year or so as 188 00:10:10,760 --> 00:10:13,640 well. And she had some interesting 189 00:10:13,640 --> 00:10:18,080 statistics about how much the toe flexors are part of balance 190 00:10:18,440 --> 00:10:22,520 and risk for fall. And an older population starts 191 00:10:22,520 --> 00:10:26,040 to lose a lot of strength in some of those muscles. 192 00:10:26,400 --> 00:10:32,320 So if we look at any population, if we are starting to lose the 193 00:10:32,320 --> 00:10:36,600 strength of those layers of muscles that we're talking 194 00:10:36,600 --> 00:10:39,840 about, what we're going to see is that we're going to rely more 195 00:10:39,840 --> 00:10:43,400 on our passive structures like our plantar Fas fascia. 196 00:10:43,840 --> 00:10:47,640 So that's really where this fascia is, is more of a passive 197 00:10:47,640 --> 00:10:50,600 structure. And we have dynamic structures 198 00:10:50,680 --> 00:10:54,720 with our foot intrinsic and the extrinsic muscles like the 199 00:10:54,720 --> 00:10:57,120 tibialis posterior that supports the arch. 200 00:10:57,560 --> 00:11:01,400 Those muscles, if we start to lose strengthen those, then 201 00:11:01,400 --> 00:11:05,080 there's going to be more mechanical stress at the plantar 202 00:11:05,080 --> 00:11:08,840 fascia. And what they found is that they 203 00:11:08,840 --> 00:11:11,520 used to call it plantar fasciitis, right? 204 00:11:12,320 --> 00:11:16,080 And now they call it more plantar fasciopathy because 205 00:11:16,080 --> 00:11:19,440 they're seeing that there's not actually a lot of inflammation 206 00:11:19,640 --> 00:11:24,840 locally at it, that it's more of a mechanical loading and 207 00:11:24,840 --> 00:11:28,880 mechanical tissue issue for repetitive stress that is 208 00:11:28,880 --> 00:11:32,600 causing changes in the structure of the plantar fascia. 209 00:11:33,040 --> 00:11:37,000 And it doesn't have a lot of the elastic properties that it 210 00:11:37,000 --> 00:11:40,720 normally has when it's a healthy tissue. 211 00:11:41,080 --> 00:11:44,800 So if you don't have have the strength of some of those 212 00:11:44,880 --> 00:11:47,960 intrinsics and extrinsic muscles, you're going to be 213 00:11:47,960 --> 00:11:50,440 putting more strain on your plantar fascia. 214 00:11:50,880 --> 00:11:53,600 And now I don't know if we want to dive into why people start 215 00:11:53,600 --> 00:11:56,400 losing strength here. That might be a little hot 216 00:11:56,400 --> 00:11:58,920 topic. Well, maybe I think, I think 217 00:11:58,920 --> 00:12:01,280 there's some interesting things, especially as we talk about 218 00:12:01,280 --> 00:12:03,600 footwear too there. It would be interesting to go 219 00:12:03,600 --> 00:12:05,920 into some of that. I'm also, I think you've just 220 00:12:05,920 --> 00:12:09,360 hit a couple really important things and one of them was the 221 00:12:09,480 --> 00:12:11,400 passive nature of the plantar fascia. 222 00:12:11,640 --> 00:12:16,200 The other one had to relate with the fact that it doesn't have 223 00:12:16,200 --> 00:12:19,400 these inflammatory markers. Can you tease out for people who 224 00:12:19,680 --> 00:12:22,400 may not be like, OK, why does it matter if it's itis versus 225 00:12:22,480 --> 00:12:25,120 apathy? Can you flush that out in terms 226 00:12:25,120 --> 00:12:29,000 of how treatment then may look different and kind of how we 227 00:12:29,000 --> 00:12:30,960 conceptualize what's actually going to help? 228 00:12:31,880 --> 00:12:34,000 Right. So theoretically in the early 229 00:12:34,000 --> 00:12:36,880 stages and then everyone's a little different and we should 230 00:12:36,880 --> 00:12:41,560 also like maybe for a second also say that not all plantar 231 00:12:41,560 --> 00:12:45,360 foot pain is plantar fasciopathy. 232 00:12:45,680 --> 00:12:49,600 So somebody having pain on the bottom of their foot, that 233 00:12:49,600 --> 00:12:53,240 doesn't mean that you have plantar fascia issues. 234 00:12:53,560 --> 00:12:58,640 There is a whole different level of differential diagnosis that 235 00:12:58,640 --> 00:13:00,960 we can really start to see based off of. 236 00:13:01,360 --> 00:13:05,200 I think it's probably easiest for the runner to think about 237 00:13:05,200 --> 00:13:09,280 the differential diagnosis by the location of it and the 238 00:13:09,280 --> 00:13:12,920 behavior of it. So exactly where you're getting 239 00:13:12,920 --> 00:13:19,840 the pain is a big part of it, because just having pain on the 240 00:13:20,040 --> 00:13:22,960 bottom of your foot doesn't mean that it's necessarily coming 241 00:13:22,960 --> 00:13:26,160 from the plantar fascia. Then the behavior is also an 242 00:13:26,160 --> 00:13:29,200 important thing where we see that the typical behavior of 243 00:13:29,200 --> 00:13:32,600 plantar fascia issues are going to be that first step in the 244 00:13:32,600 --> 00:13:36,480 morning is very painful. You're going to see maybe 245 00:13:36,640 --> 00:13:39,280 especially early on, it does start to get a little bit better 246 00:13:39,280 --> 00:13:41,040 with activity as you loosen things up. 247 00:13:41,640 --> 00:13:44,960 Whereas something like a nerve entrapment is not going to 248 00:13:44,960 --> 00:13:47,240 respond the same way. And we we know that there's a 249 00:13:47,240 --> 00:13:49,800 couple nerves in the area. Baxter's nerve is probably the 250 00:13:49,800 --> 00:13:52,600 one that is most common that we see there. 251 00:13:52,600 --> 00:13:58,760 Where it gets there is a local inflammation around there and 252 00:13:58,760 --> 00:14:02,480 that's causing pressure on the nerve, which is contributing to 253 00:14:02,840 --> 00:14:06,840 pain on the bottom of the foot. But it might feel very different 254 00:14:07,560 --> 00:14:10,080 even though it's in a similar location with it. 255 00:14:10,720 --> 00:14:13,880 So that's kind of a quick aside about that. 256 00:14:14,120 --> 00:14:17,360 Then going back to the inflammation versus non 257 00:14:17,360 --> 00:14:21,840 inflammation and why that really affects the treatment is that 258 00:14:22,000 --> 00:14:25,760 our body heals in the presence of inflammation. 259 00:14:26,440 --> 00:14:30,320 We need inflammation. That is a critical step in the 260 00:14:30,320 --> 00:14:33,240 healing process. And most people don't realize 261 00:14:33,240 --> 00:14:35,000 that. They just think all inflammation 262 00:14:35,000 --> 00:14:39,360 is bad and that's not the case. Inflammation, there's a couple 263 00:14:39,360 --> 00:14:44,320 different stages of healing and what happens is that first 264 00:14:44,320 --> 00:14:48,840 inflammatory process is bringing everything in that is laying the 265 00:14:48,840 --> 00:14:51,640 foundation to rebuild the tissue. 266 00:14:52,000 --> 00:14:55,560 And that's really important. And we're often times we stall 267 00:14:55,560 --> 00:14:59,400 out and we don't get that healing response. 268 00:14:59,720 --> 00:15:02,960 So it becomes more of a fibrotic type tissue a lot of times. 269 00:15:02,960 --> 00:15:05,760 And then if you have inflammation, it's like, OK, 270 00:15:05,760 --> 00:15:09,320 let's manage the inflammation, let it do its thing. 271 00:15:10,360 --> 00:15:13,840 You know, obviously too much of a good thing can not be good. 272 00:15:14,440 --> 00:15:18,440 But in the case of a plantar fascia issue that is maybe more 273 00:15:18,440 --> 00:15:22,520 chronic or has been around for a long time, we need to bring some 274 00:15:22,520 --> 00:15:26,320 information to the area. That's why we're seeing there's 275 00:15:26,320 --> 00:15:29,560 a lot more evidence now and some of the emerging evidence is 276 00:15:29,560 --> 00:15:32,200 really around that extracorprial shockwave therapy. 277 00:15:32,680 --> 00:15:36,680 And we're seeing that that is a big treatment that's gaining 278 00:15:36,680 --> 00:15:40,640 more literature as well as low level light laser therapy. 279 00:15:41,280 --> 00:15:45,360 Those modalities have been seen to have an impact. 280 00:15:45,360 --> 00:15:48,160 And personally, I also see a lot of benefit. 281 00:15:48,160 --> 00:15:51,680 We use like win back TECAR therapy and I've seen that do a 282 00:15:51,680 --> 00:15:54,800 really good job just because of its ability to get certain depth 283 00:15:54,800 --> 00:15:56,800 of tissue. So when we're thinking about how 284 00:15:56,800 --> 00:16:00,440 we get treatment, you know, things like PRP injections, 285 00:16:00,640 --> 00:16:05,160 shockwave, we're looking at those types of things like that. 286 00:16:05,240 --> 00:16:07,960 That needs to be something we consider is we're trying to 287 00:16:07,960 --> 00:16:13,160 bring inflammation and remodel the tissue a bit there so that 288 00:16:13,160 --> 00:16:17,360 we can get that healing response that we're looking for because 289 00:16:17,800 --> 00:16:20,520 it doesn't have the blood supply that we're looking for. 290 00:16:20,520 --> 00:16:24,080 And that's why people have these prolonged symptoms with it. 291 00:16:24,320 --> 00:16:26,440 Yeah. And it's just it's a huge 292 00:16:26,440 --> 00:16:29,720 paradigm shift, you know, when you go from something and it's 293 00:16:29,720 --> 00:16:34,240 like, oh, this has been thought to be the Mal presence of 294 00:16:34,240 --> 00:16:37,920 inflammation for long periods of time, when in reality there's no 295 00:16:37,920 --> 00:16:39,640 real inflammatory markers present. 296 00:16:39,960 --> 00:16:41,680 So you're not trying to treat inflammation. 297 00:16:41,680 --> 00:16:44,200 That isn't the goal. Where I think for a long time 298 00:16:44,200 --> 00:16:47,240 that was the perspective where it was, hey, let's do the things 299 00:16:47,240 --> 00:16:50,120 to quote, get rid of inflammation, let's ice it, 300 00:16:50,120 --> 00:16:53,600 let's whatever it is and take anti inflammatories. 301 00:16:53,600 --> 00:16:56,120 And those things just won't solve the problem with plantar 302 00:16:56,120 --> 00:16:57,880 fascia pain. There's a lot more going on. 303 00:16:58,240 --> 00:17:01,440 So you, you talked about some of the symptoms too and kind of 304 00:17:01,440 --> 00:17:05,160 differentiating the location and when if you had to describe, 305 00:17:05,160 --> 00:17:07,800 because the, the arch of the foot's a pretty big surface, 306 00:17:07,800 --> 00:17:10,200 there's a lot of length there. It's all the way up to the toes, 307 00:17:10,200 --> 00:17:12,000 it's all the way back to the heel. 308 00:17:12,319 --> 00:17:15,400 Where's the most common area along there where people will be 309 00:17:15,400 --> 00:17:18,280 like, oh this is probably a planter fascia related issue 310 00:17:18,280 --> 00:17:21,760 versus something different? So if you're looking at your 311 00:17:21,760 --> 00:17:25,520 heel bone, which is the calcaneus, there is a bit of a 312 00:17:25,520 --> 00:17:28,440 spot that if you find it and you're having plantar fascia, 313 00:17:28,440 --> 00:17:32,560 you'll know right away that calcaneal tuberosity that like 314 00:17:32,640 --> 00:17:35,760 if you get on that medial cocaneal tuberosity, like I'm 315 00:17:35,760 --> 00:17:38,440 poking mine right now and I can feel it and it's tender. 316 00:17:39,000 --> 00:17:42,040 But basically, if you take your fingers and kind of come and run 317 00:17:42,040 --> 00:17:45,280 your fingers alongside the inside of your arch right at the 318 00:17:45,280 --> 00:17:49,600 start of the arch as it's closer to your heel, then run your 319 00:17:49,600 --> 00:17:53,560 finger down towards the bottom of your foot, you'll run over 320 00:17:53,560 --> 00:17:58,040 this Bony spot. And that is an area where the 321 00:17:58,040 --> 00:18:00,680 plantar fascia, the medial aspect of the plantar fascia, 322 00:18:00,680 --> 00:18:03,960 because there is lateral plantar fascia and some different things 323 00:18:03,960 --> 00:18:05,600 too. But most commonly we see medial 324 00:18:06,000 --> 00:18:09,080 now that's where you'll see origin symptoms. 325 00:18:09,360 --> 00:18:13,080 There are there is a a subset of the population that gets it more 326 00:18:13,080 --> 00:18:17,000 mid portion as well. And that's where they'll feel 327 00:18:17,000 --> 00:18:19,560 the symptoms. They I find often they'll 328 00:18:19,760 --> 00:18:22,520 they'll still have have some of that tenderness at the origin, 329 00:18:22,880 --> 00:18:28,280 they'll just notice it more at the mid portion of it. 330 00:18:28,560 --> 00:18:33,120 But I find that group has a lot of soft tissue with some of the 331 00:18:33,200 --> 00:18:36,960 intrinsic muscles of the foot. The toe flexor is quadratus 332 00:18:37,160 --> 00:18:39,800 like. I find that a lot of those are 333 00:18:39,800 --> 00:18:45,600 actually muscular issues as well when it's more mid substance or 334 00:18:45,800 --> 00:18:48,560 mid portion plantar fascia. Perfect. 335 00:18:49,600 --> 00:18:52,960 So let's kind of transition to start talking about how you as a 336 00:18:53,200 --> 00:18:57,000 physical therapist think about kind of diagnosing and treating 337 00:18:57,000 --> 00:19:00,080 this, not diagnosing the condition, but diagnosing the 338 00:19:00,080 --> 00:19:02,680 root of the problem and what needs to be addressed. 339 00:19:02,680 --> 00:19:05,520 So this could be wherever you wanted to go if you want to talk 340 00:19:05,520 --> 00:19:09,320 about clinical exam or mechanics of gait or kind of combine them. 341 00:19:09,320 --> 00:19:12,640 I just want to hear kind of what's the where does Doug Adams 342 00:19:12,640 --> 00:19:17,280 mind go when thinking about how to approach management with 343 00:19:17,440 --> 00:19:18,520 patients that you would work with? 344 00:19:18,960 --> 00:19:22,080 Yeah, it's a great question. We could go a lot of different 345 00:19:22,080 --> 00:19:25,400 places with this. I think it needs to start off 346 00:19:25,400 --> 00:19:30,240 with curiosity and really understanding what led to the 347 00:19:30,240 --> 00:19:36,560 mechanical overload. Was this a issue where there was 348 00:19:36,560 --> 00:19:40,040 excessive tightness in the posterior chain and that was 349 00:19:40,040 --> 00:19:44,440 changing some of the mechanics and that tissue got overloaded? 350 00:19:45,160 --> 00:19:48,680 Are there gait changes? Are there? 351 00:19:49,080 --> 00:19:52,760 Is there inadequate footwear? There's so many different things 352 00:19:52,760 --> 00:19:54,520 that could be contributing to it. 353 00:19:54,520 --> 00:19:58,360 Is the first metatarsophalageal joint like the first ray? 354 00:19:58,360 --> 00:20:01,640 Are we seeing stiffness? Is there limited hallux 355 00:20:01,640 --> 00:20:04,600 extension? The big toe right There are so 356 00:20:04,600 --> 00:20:07,000 many different. Things and everything kind of 357 00:20:07,000 --> 00:20:09,880 meets in the middle right at the plantar fascia. 358 00:20:09,880 --> 00:20:14,680 So if you have a limited big toe motion for people listening out 359 00:20:14,680 --> 00:20:17,400 there, right, what we see is there's this mechanism called 360 00:20:17,400 --> 00:20:21,640 the windless mechanism. When your big toe bends up, we 361 00:20:21,640 --> 00:20:26,680 need to see the arch raise up so that there's limited excursion 362 00:20:26,680 --> 00:20:30,640 of the plantar fascia and it's not mechanically changing as 363 00:20:30,640 --> 00:20:34,000 much. So if we see changes in how 364 00:20:34,000 --> 00:20:37,560 somebody is pushing off or if we're seeing that somebody has 365 00:20:37,560 --> 00:20:41,560 limited toe motion, it's part of our runner readiness assessment 366 00:20:41,560 --> 00:20:45,920 is having somebody do an active Hallux extension, big toe raise 367 00:20:45,920 --> 00:20:47,880 there. And if they're not able to do 368 00:20:47,880 --> 00:20:51,400 that, we might need to look at that as a potential contributing 369 00:20:51,400 --> 00:20:53,800 factor. But you have to be very curious 370 00:20:53,800 --> 00:20:59,720 and try to work backwards and figure out what is the root 371 00:20:59,720 --> 00:21:02,120 cause of it. Like where did it come from? 372 00:21:02,520 --> 00:21:04,680 Do they have limited ankle mobility? 373 00:21:04,840 --> 00:21:07,840 Right. I, I'm a kind of a big joint 374 00:21:07,840 --> 00:21:12,080 mobility person myself here. I find a lot of midfoot foot 375 00:21:12,080 --> 00:21:15,160 limitations, especially in the running population. 376 00:21:15,480 --> 00:21:18,960 What we're seeing is that we have to act as such a rigid 377 00:21:18,960 --> 00:21:23,520 lever with our foot that sometimes if you don't have 378 00:21:23,520 --> 00:21:27,120 strength or if you're not setting your foot up to have 379 00:21:27,120 --> 00:21:30,800 enough feedback, we'll kind of say that way. 380 00:21:30,800 --> 00:21:33,560 If if you're not getting enough feedback and setting your your 381 00:21:33,560 --> 00:21:37,480 foot up in the right position, you're going to start to see 382 00:21:37,480 --> 00:21:39,160 that there's going to be changes. 383 00:21:39,160 --> 00:21:45,080 And a lot of joint mobility issues start as stability issues 384 00:21:45,360 --> 00:21:50,520 where somebody can't control their foot as well and then they 385 00:21:50,520 --> 00:21:55,000 stiffen the foot and it becomes in this naturally stiff position 386 00:21:55,000 --> 00:21:58,000 they don't go through as much excursion because they can't 387 00:21:58,000 --> 00:22:01,720 control it. So we have to take a multi 388 00:22:01,720 --> 00:22:06,560 faceted approach to this where we need to restore normal joint 389 00:22:06,560 --> 00:22:10,600 arthro kinematics. So how your foot joints move, 390 00:22:11,000 --> 00:22:14,880 restore that first. And then we need to start 391 00:22:14,880 --> 00:22:19,480 changing like training the stability and we really have to 392 00:22:19,480 --> 00:22:23,080 look at those two together. Then that doesn't stop there. 393 00:22:23,280 --> 00:22:26,800 Now we have to go to the bio mechanics because if you've 394 00:22:26,800 --> 00:22:30,200 changed your bio mechanics and how you're walking and how 395 00:22:30,200 --> 00:22:33,880 you're running, you're still going to be putting stress on 396 00:22:33,880 --> 00:22:37,640 those tissues in a way that they're not normally designed 397 00:22:37,640 --> 00:22:41,560 to. You know, that's, that's a lot. 398 00:22:41,560 --> 00:22:44,040 I don't I just threw out like I don't know if you want to dive 399 00:22:44,040 --> 00:22:46,000 into one of those things. I'm just going to maybe go into 400 00:22:46,000 --> 00:22:49,640 like the gate stuff or, or you want to talk about some of those 401 00:22:49,640 --> 00:22:51,560 different topics there? I think we could totally 402 00:22:51,560 --> 00:22:54,360 transition into gate because I think what I've, what I heard 403 00:22:54,360 --> 00:22:56,960 you say your first line of defense from not line of 404 00:22:56,960 --> 00:22:59,760 defense, but your first curiosity button sounded like it 405 00:22:59,760 --> 00:23:03,560 was mostly on this idea of mobility across the chain from 406 00:23:03,560 --> 00:23:08,160 toe up through the back of the hip And looking at how's your 407 00:23:08,160 --> 00:23:10,760 hamstring mobility? How's your calf mobility for 408 00:23:10,760 --> 00:23:13,600 like these soft tissues? How's your ankle joint mobility? 409 00:23:13,640 --> 00:23:16,920 How's your foot mobility? Let's get mobility squared away 410 00:23:17,120 --> 00:23:19,400 because if you don't have the mobility, you can't do anything 411 00:23:19,400 --> 00:23:22,000 else with it. So you got to get the mobility 412 00:23:22,000 --> 00:23:24,760 where it needs to be for the tasks of running. 413 00:23:24,880 --> 00:23:26,600 So that was kind of like a step one. 414 00:23:26,840 --> 00:23:28,360 And then it's like, OK, how does that now? 415 00:23:28,360 --> 00:23:31,200 How does this mobility play out when you actually start to move? 416 00:23:31,200 --> 00:23:35,440 So yeah, let's let's go into this bio mechanics talk about 417 00:23:35,800 --> 00:23:38,240 you can talk about running or walking, whichever feels most 418 00:23:38,240 --> 00:23:40,520 appropriate. Talk about what are these common 419 00:23:40,520 --> 00:23:43,640 things that you see for people who have planner fashion pain 420 00:23:43,640 --> 00:23:46,440 that pop up on their running analysis that it's like this 421 00:23:46,440 --> 00:23:49,200 could be a contributing factor? Yeah, yeah. 422 00:23:49,200 --> 00:23:51,920 And just one last kind of note on the mobility. 423 00:23:51,920 --> 00:23:54,600 This might be a little bit of a hot take, but I'm going to 424 00:23:54,600 --> 00:23:55,920 challenge the physical therapist. 425 00:23:56,200 --> 00:23:59,680 There have been few feet that I've met that can't get more 426 00:23:59,680 --> 00:24:03,800 mobile like you. You got to work hard. 427 00:24:04,160 --> 00:24:08,200 It takes a lot of strength and it takes a lot of like joint 428 00:24:08,200 --> 00:24:10,080 mobilization technique and skill. 429 00:24:10,320 --> 00:24:13,920 But there's rarely a foot or an ankle that you can't get a 430 00:24:13,920 --> 00:24:19,120 little bit more motion for here. So I often times when I get 431 00:24:19,120 --> 00:24:22,480 people that come to my practice that haven't gotten results 432 00:24:22,560 --> 00:24:26,640 other where at other places and they say they did some of it. 433 00:24:26,640 --> 00:24:30,080 And I say, well, here tell me if this feels the same, Like no, 434 00:24:30,080 --> 00:24:32,560 this feels entirely different. Yeah. 435 00:24:32,720 --> 00:24:36,240 So develop your manual skills or if you're looking for treatment, 436 00:24:36,480 --> 00:24:40,440 make sure that people are like at least assessing that and 437 00:24:40,440 --> 00:24:43,120 seeing if it's there and and intervening with that, that 438 00:24:43,440 --> 00:24:44,800 people would challenge me on that. 439 00:24:44,880 --> 00:24:48,080 Like by all means, put comments like like let's have a 440 00:24:48,080 --> 00:24:50,760 conversation here because I think that that's important. 441 00:24:50,800 --> 00:24:51,320 Yeah. So. 442 00:24:51,720 --> 00:24:54,000 And actually, before we move on, you're kind of sparking a 443 00:24:54,000 --> 00:24:55,680 thought for me. I think something else that 444 00:24:55,680 --> 00:24:58,800 you're pointing out that I think is important is I think a lot of 445 00:24:58,800 --> 00:25:01,200 times we can talk about this concept more because I know 446 00:25:01,200 --> 00:25:03,120 there's a lot about what I'm about to say. 447 00:25:03,520 --> 00:25:06,520 But I think a lot of times the motion and movement that is 448 00:25:06,520 --> 00:25:10,960 demonized is what people coin as excessive pronation or too much 449 00:25:10,960 --> 00:25:13,840 over pronation. And what you've been talking 450 00:25:13,840 --> 00:25:18,440 about is a lack of mobility for the so far, and I think that's 451 00:25:18,440 --> 00:25:21,800 been borne out in the literature as well as a risk factor for 452 00:25:21,800 --> 00:25:26,240 plantar fascia pain is this lack of mobility and not having 453 00:25:26,240 --> 00:25:29,760 enough pronation because it's such a stiff foot. 454 00:25:29,760 --> 00:25:32,560 And then it's relying on all these passive structures, which 455 00:25:32,600 --> 00:25:35,240 comes into this plantar fascia overload issue. 456 00:25:35,520 --> 00:25:37,800 So I just wanted to throw that out there kind of as a little 457 00:25:37,800 --> 00:25:40,240 bit of a Mythbusters because I think sometimes it's like 458 00:25:40,240 --> 00:25:43,000 pronation's the the demon that we got to get rid of. 459 00:25:43,280 --> 00:25:46,400 But we're talking about the fact that too stiff of a foot is 460 00:25:46,400 --> 00:25:50,400 actually what you're seeing. What the literature bears out as 461 00:25:50,400 --> 00:25:53,200 well like this is that's definitely part of the problem, 462 00:25:53,200 --> 00:25:56,960 is not enough mobility. So we got to start that and 463 00:25:56,960 --> 00:26:01,200 that's a great segue into the bio mechanics of it too, because 464 00:26:01,200 --> 00:26:04,640 now we're starting to think about, let's, let's start first 465 00:26:04,760 --> 00:26:06,960 before we talk about the bio mechanics and how people change 466 00:26:06,960 --> 00:26:08,560 it, Let's talk about the role of it. 467 00:26:08,560 --> 00:26:11,320 We talked about what the plantar fascia is, but let's talk about 468 00:26:11,320 --> 00:26:13,440 the role and what it does. OK. 469 00:26:13,440 --> 00:26:17,320 So with walking gait, we see that it's primarily a 470 00:26:17,320 --> 00:26:20,600 stabilizer, but we're seeing it, it really is. 471 00:26:20,960 --> 00:26:25,160 There's some rockers, if you learn that in school, you know, 472 00:26:25,160 --> 00:26:27,480 the first rocker, the second rocker, the third rocker, it's 473 00:26:27,720 --> 00:26:30,680 like what we see is that that middle rocker, we're trying to 474 00:26:30,680 --> 00:26:34,280 stabilize the arch and we have to lock down that midfoot. 475 00:26:34,320 --> 00:26:37,640 Like we need to be able to progress and bolt ourselves over 476 00:26:37,960 --> 00:26:40,200 as we're walking and progressive body forward. 477 00:26:40,600 --> 00:26:46,080 So in walking, we're seeing it's about one 1 1/2 times body 478 00:26:46,080 --> 00:26:48,560 weight that the strain of the planet factor. 479 00:26:49,480 --> 00:26:53,160 Now when we go to running, what we're seeing is it stabilizes 480 00:26:53,160 --> 00:26:56,880 the arch, but it is actually part of propulsion and an 481 00:26:56,880 --> 00:27:01,320 elastic structure now. So now it's actually going to 482 00:27:01,320 --> 00:27:05,040 contribute to a little bit of the efficiency of our movement. 483 00:27:05,320 --> 00:27:09,080 And I say this, and it's kind of an oversimplification, but 484 00:27:09,080 --> 00:27:12,400 running is largely passive. And what I mean by that is that 485 00:27:12,400 --> 00:27:16,040 if you load your tissues up correctly, we get a lot of 486 00:27:16,040 --> 00:27:21,200 passive benefit, which is what makes us efficient runners as an 487 00:27:21,200 --> 00:27:25,120 animal, As a species, we're efficient with our running 488 00:27:25,120 --> 00:27:28,720 because we've got a lot of these structures that can store and 489 00:27:28,720 --> 00:27:32,920 return elasticity as we go. And the plantar fascia plays a 490 00:27:32,920 --> 00:27:37,120 role with that and it undergoes about two to three times our 491 00:27:37,120 --> 00:27:39,840 body weight because of that increased role. 492 00:27:40,520 --> 00:27:44,240 It also does that in a very short amount of time compared to 493 00:27:44,240 --> 00:27:48,040 walking, where the ground reaction to the ground contact 494 00:27:48,040 --> 00:27:53,160 time for walking is 2 to three times as long. 495 00:27:53,160 --> 00:27:56,680 So not only is it doing more weight, but it's actually doing 496 00:27:56,680 --> 00:28:00,760 it in a shorter amount of time, which is going to put a 497 00:28:00,760 --> 00:28:03,200 significant amount of strain on the plantar fascia. 498 00:28:04,040 --> 00:28:07,000 So what is the literature say and what do we notice and what 499 00:28:07,000 --> 00:28:09,920 do we see a lot when we're doing analysis with this? 500 00:28:11,480 --> 00:28:14,840 It's interesting chicken versus egg and I haven't found a lot of 501 00:28:14,840 --> 00:28:19,760 great prospective studies there about who develops it versus who 502 00:28:19,760 --> 00:28:23,200 doesn't there. But what we know is when 503 00:28:23,200 --> 00:28:26,160 somebody is having plantar fascia issues, our body is 504 00:28:26,160 --> 00:28:29,920 actually pretty good at compensating for it. 505 00:28:30,320 --> 00:28:33,080 But what they're finding in the literature is that a lot of 506 00:28:33,080 --> 00:28:37,480 those compensations and those pain modulating activities that 507 00:28:37,480 --> 00:28:44,240 we do might be contributing to why these last for so long, why 508 00:28:44,240 --> 00:28:49,320 people are having a year to 10 years of symptoms with this. 509 00:28:49,720 --> 00:28:52,480 That's what we're really noticing is that some of these 510 00:28:52,480 --> 00:28:55,120 modifications might actually be contributing to that. 511 00:28:55,720 --> 00:28:59,920 So you mentioned pronation. What we see is, is when they 512 00:28:59,920 --> 00:29:03,160 look at it and some of these studies are really hard to do 513 00:29:03,400 --> 00:29:09,960 because getting very finite foot mechanics, it almost requires 514 00:29:09,960 --> 00:29:13,720 you to put a marker directly into the bone and to be able to 515 00:29:13,720 --> 00:29:15,800 see some of that on a very large system. 516 00:29:15,800 --> 00:29:19,840 And that's, that's challenging to do so and a more clinical 517 00:29:19,840 --> 00:29:22,760 side, we're looking at the rear foot, we're seeing what we can 518 00:29:22,760 --> 00:29:27,160 do and and rear foot inversion and E version, which is also 519 00:29:27,160 --> 00:29:30,160 called supination of pronation. And that's what we're seeing. 520 00:29:30,160 --> 00:29:35,040 But the what we see in this plantar fascia population is not 521 00:29:35,040 --> 00:29:38,880 necessarily that they're always over pronating, but their 522 00:29:38,880 --> 00:29:46,600 excursion from supination of pronation is a higher range that 523 00:29:46,600 --> 00:29:49,200 they're starting a little bit more inverted. 524 00:29:49,200 --> 00:29:51,960 So they're landing, excuse me, a little bit more on the outside 525 00:29:51,960 --> 00:29:54,720 of their heel. And then they're still going 526 00:29:54,720 --> 00:29:58,440 into pronation, but they're starting from a little bit out 527 00:29:58,440 --> 00:30:02,800 here to try to avoid pressure directly on that medial aspect 528 00:30:02,800 --> 00:30:05,600 of it. So to modulate pain, they stay a 529 00:30:05,600 --> 00:30:08,120 little bit more on the outside, even though that's a little bit 530 00:30:08,120 --> 00:30:13,160 more rigid structure, which maybe is the long part of the 531 00:30:13,160 --> 00:30:17,280 long term effects of that that they're we're putting more 532 00:30:17,280 --> 00:30:19,280 stress on it because we're going longer through. 533 00:30:19,520 --> 00:30:22,720 But they just our body naturally doesn't want to put pain 534 00:30:22,720 --> 00:30:26,320 directly on that. So it's not even always over 535 00:30:26,320 --> 00:30:30,400 pronation that's the issue. It's that we're landing a little 536 00:30:30,400 --> 00:30:34,440 bit more supinated and then we're going into normal maybe 537 00:30:34,440 --> 00:30:39,360 slightly excessive pronation. But the range of that is a lot, 538 00:30:39,480 --> 00:30:42,560 lot and that causes a lot of stress on it. 539 00:30:42,560 --> 00:30:45,200 You know, then we start having to engage our tibialis posterior 540 00:30:45,200 --> 00:30:47,400 more. We're looking at how our 541 00:30:47,400 --> 00:30:49,960 abductor hallises, we're looking at all these muscles that are 542 00:30:49,960 --> 00:30:53,080 going to have to do a lot more work and putting more mechanical 543 00:30:53,080 --> 00:30:56,480 stress on the area. Yeah, so that's one interesting 544 00:30:56,480 --> 00:30:57,600 one. There's another one too. 545 00:30:57,600 --> 00:31:00,560 But like, I know that was some of your thoughts with that too. 546 00:31:00,560 --> 00:31:02,760 I don't know if you have thoughts on that as well. 547 00:31:02,800 --> 00:31:05,720 No, I think, I think that just makes a lot of sense. 548 00:31:05,720 --> 00:31:10,040 And I think it it puts the idea of pronation for people who have 549 00:31:10,040 --> 00:31:12,720 just automatically put that in a bad category. 550 00:31:12,920 --> 00:31:17,720 It brings some nuance to to it. It's not just how much movement 551 00:31:17,720 --> 00:31:22,080 you have in your your ankle and how far your foot is flattening 552 00:31:22,080 --> 00:31:23,600 out or how much your arch flattens. 553 00:31:23,600 --> 00:31:28,000 It's not that it's how are you moving, how much total motion is 554 00:31:28,000 --> 00:31:30,880 going through there is kind of what you're saying and is that 555 00:31:32,040 --> 00:31:35,560 amount in a very short amount of time increasing the total load 556 00:31:35,560 --> 00:31:38,680 through that structure. So and and then the solution is 557 00:31:38,680 --> 00:31:42,520 not avoid pronation. The solution is different than 558 00:31:42,520 --> 00:31:44,040 that. And it probably has to do with 559 00:31:44,200 --> 00:31:46,960 things that are not just changing how you run, but the 560 00:31:46,960 --> 00:31:50,360 underlying purposes underneath. So feel free to go into the next 561 00:31:50,360 --> 00:31:53,880 one, but. Yeah, it's a great point with 562 00:31:53,880 --> 00:31:56,600 that too. You know, we just, we have to 563 00:31:56,600 --> 00:31:59,760 consider some of the nuances with it and the velocity. 564 00:32:00,000 --> 00:32:03,840 So one of those things, I don't think a lot of Helix users look 565 00:32:03,840 --> 00:32:05,480 at this. So if they're listening like 566 00:32:05,480 --> 00:32:07,880 challenge yourself a little bit, but looking at angular 567 00:32:07,880 --> 00:32:11,240 velocities and angular accelerations, and if you look 568 00:32:11,240 --> 00:32:15,600 at the amount of angular velocity and acceleration on 569 00:32:15,600 --> 00:32:18,800 somebody that's having plantar fascia apathy, you're going to 570 00:32:18,800 --> 00:32:20,880 see a lot of times they're elevated. 571 00:32:20,880 --> 00:32:23,920 So it's a lot of tissue structure in a short amount of 572 00:32:23,920 --> 00:32:27,000 time. And the reason that is, is we 573 00:32:27,000 --> 00:32:29,440 strive for symmetry when we walk. 574 00:32:29,640 --> 00:32:33,600 So if you're going through longer excursions, but you're 575 00:32:33,600 --> 00:32:37,040 keeping the same amount of ground contact time in the same 576 00:32:37,520 --> 00:32:40,520 like I think what I found with doing a lot more walking gait 577 00:32:40,520 --> 00:32:45,680 analysis now is that people tend to try to keep the same step 578 00:32:45,680 --> 00:32:49,560 length. Step length seems to be the the 579 00:32:49,640 --> 00:32:51,720 default that we're noticing here. 580 00:32:51,720 --> 00:32:54,960 And I don't have a lot of literature or I haven't seen 581 00:32:54,960 --> 00:32:57,080 studies that specifically have looked at that. 582 00:32:57,880 --> 00:33:03,080 But it seems to be that if walking at least step length is 583 00:33:03,080 --> 00:33:05,800 everyone's trying to preserve that with, but they're going to 584 00:33:05,800 --> 00:33:08,400 change how how they do it. Sometimes they're taking a 585 00:33:08,400 --> 00:33:10,720 longer swing phase, sometimes they're doing quicker on the 586 00:33:10,720 --> 00:33:13,680 ground. You know, a planar fasciopathy 587 00:33:13,680 --> 00:33:16,800 patient might try to really limit the amount of time that 588 00:33:16,800 --> 00:33:19,760 they're on the ground and then they're coming down hard on the 589 00:33:19,760 --> 00:33:22,280 other side, which is why eventually they get bilateral 590 00:33:22,280 --> 00:33:26,280 symptoms with it here. So that's just a little side 591 00:33:26,280 --> 00:33:29,960 note. But the other, the other thing 592 00:33:29,960 --> 00:33:35,560 that we see people do is they tend to land and this is 593 00:33:35,800 --> 00:33:38,120 definitely the studies are a little bit more limited this 594 00:33:38,120 --> 00:33:40,280 because it's hard to see and not everyone can do the studies. 595 00:33:40,520 --> 00:33:43,760 But they tend to land in a little bit more of a higher arch 596 00:33:43,760 --> 00:33:49,320 position to see if they've got a little bit of a buffer to get in 597 00:33:49,320 --> 00:33:52,640 that position. But then what happens is they're 598 00:33:52,640 --> 00:33:56,280 going through more mechanical load because they're trying to 599 00:33:56,280 --> 00:33:58,680 modulate pain at initial contact. 600 00:33:58,920 --> 00:34:03,480 So they found that the first metatarsophalangeal joint, the 601 00:34:03,480 --> 00:34:07,360 knuckle joint at your big toe is often a little bit more plantar 602 00:34:07,360 --> 00:34:11,320 flexed as a way to try to elevate the arch a bit more. 603 00:34:11,560 --> 00:34:14,639 So then that's going to just give a, they're trying to steal 604 00:34:14,639 --> 00:34:18,679 a little stability, but then it goes through more deformation 605 00:34:18,679 --> 00:34:20,880 and now you're seeing more strain on it. 606 00:34:21,239 --> 00:34:25,320 So both of those things are actually, if you're really 607 00:34:25,320 --> 00:34:29,480 effective at treating plant and fascia pain, whether you're a 608 00:34:29,480 --> 00:34:32,639 runner or a Walker. Like I have to stress that 609 00:34:32,880 --> 00:34:37,159 runners need a walking gait analysis too, because you might 610 00:34:37,159 --> 00:34:40,920 get your pain at certain points. But I think a lot of people 611 00:34:40,920 --> 00:34:43,360 would agree with me, and this is what I'm experiencing right now 612 00:34:43,360 --> 00:34:45,840 with planter fascia pain. I'm fine running. 613 00:34:46,280 --> 00:34:49,960 It's those steps when I'm done running that like I start 614 00:34:49,960 --> 00:34:53,360 walking and do my cooldown and I'm like, oh, now my foot hurts, 615 00:34:53,360 --> 00:34:56,480 but it doesn't hurt when I'm running as much here. 616 00:34:57,560 --> 00:35:01,240 But usually really get a walking analysis too, because what's 617 00:35:01,240 --> 00:35:04,920 happening is we're taking a lot more steps when we're walking. 618 00:35:05,360 --> 00:35:08,080 And each one of those steps could be helping or harming us. 619 00:35:08,640 --> 00:35:13,080 And if you have some of these deviations in your gate, you are 620 00:35:13,080 --> 00:35:17,320 putting cumulative stress on your tissues that then when you 621 00:35:17,320 --> 00:35:22,560 go run, you're going to exceed that structures capacity because 622 00:35:22,560 --> 00:35:27,720 it is more stress, faster, larger excursions, everything 623 00:35:27,720 --> 00:35:30,920 that we already talked about. But it's every step that you 624 00:35:30,920 --> 00:35:34,480 took leading up to that that really contributed to why 625 00:35:34,880 --> 00:35:38,600 running is something that they say, oh, well, I'm fine. 626 00:35:38,600 --> 00:35:41,320 If I go run, then the next day I really start to have a lot of 627 00:35:41,320 --> 00:35:42,920 pain when I get out of bed. Yeah. 628 00:35:43,960 --> 00:35:47,960 Well, outside of those two, are you seeing anything else with 629 00:35:48,320 --> 00:35:51,320 amount of dorsiflexion or knee mechanics, hip mechanics, is 630 00:35:51,320 --> 00:35:53,800 there anything else that you're seeing lining up for folks? 631 00:35:53,800 --> 00:35:56,240 Are those kind of the primary ones that you've been? 632 00:35:57,200 --> 00:35:59,960 Those are the big ones that I lock in on, but there are some 633 00:35:59,960 --> 00:36:02,800 other ones. Ankle dorsiflexion is often 634 00:36:02,800 --> 00:36:04,960 limited. We're going to see that that 635 00:36:05,280 --> 00:36:07,680 ankle dorsiflexion and then there's going to be a bit of an 636 00:36:07,680 --> 00:36:11,360 early heel rise. A lot of the other biomechanical 637 00:36:11,360 --> 00:36:15,600 literature talks about there's a lot less ground reaction forces. 638 00:36:15,600 --> 00:36:18,320 Like kinetically we've been talking about kinematics, but 639 00:36:18,320 --> 00:36:21,560 kinetically there's a lot less push off there. 640 00:36:22,040 --> 00:36:26,000 So that's going to change some of the other structures and how 641 00:36:26,000 --> 00:36:29,240 they contribute to gait. We mentioned with the mobility, 642 00:36:29,240 --> 00:36:32,920 I like that you keyed in on we have to check out the whole 643 00:36:33,120 --> 00:36:36,240 posterior chain, like we have to look at the hip, we have to look 644 00:36:36,240 --> 00:36:39,200 at the pelvis. I have found like this is kind 645 00:36:39,200 --> 00:36:46,480 of a cool bio mechanic thing that is not often looked at, but 646 00:36:46,480 --> 00:36:50,560 something that I look at a ton with our Helix 3D system is 647 00:36:50,560 --> 00:36:53,520 pelvic rotation. OK, We've talked about pelvic 648 00:36:53,520 --> 00:36:56,840 rotation before, but I don't think a lot of people realize, 649 00:36:57,200 --> 00:37:02,760 you know, our foot and ankle and our shin are linked and it's 650 00:37:02,760 --> 00:37:05,040 like a mitered hinge joint it's called. 651 00:37:05,280 --> 00:37:08,000 So the two are linked with a lot of this. 652 00:37:08,320 --> 00:37:11,520 So when we land, we land on the outside of our foot and then we 653 00:37:11,520 --> 00:37:14,360 roll towards the inside pronation, then we have to roll 654 00:37:14,360 --> 00:37:17,920 back to the outside. That is another way to think 655 00:37:17,920 --> 00:37:20,840 about that is thinking about external rotation. 656 00:37:20,880 --> 00:37:24,240 We are externally rotating. So we're coming out of hip 657 00:37:24,240 --> 00:37:27,360 adduction, hip internal rotation, pronation. 658 00:37:27,520 --> 00:37:30,560 As we're in mid stance, as we get towards the end of our 659 00:37:30,560 --> 00:37:33,680 stance phase, walking and running, we have to kind of 660 00:37:33,680 --> 00:37:36,240 externally rotate. So somebody that doesn't have 661 00:37:36,240 --> 00:37:38,640 enough ankle dorsiflexion, which is going through this, what are 662 00:37:38,640 --> 00:37:40,080 they going to do? They're going to really turn out 663 00:37:40,080 --> 00:37:42,080 the foot. Now they're loading up the 664 00:37:42,080 --> 00:37:45,680 tissue in a torsional manner and they're actually like putting a 665 00:37:45,680 --> 00:37:49,120 lot more stress on that medial side of the foot because they 666 00:37:49,120 --> 00:37:50,640 don't have the ankle dorsiflexion. 667 00:37:51,440 --> 00:37:54,320 Now one of the other things getting back to pelvic rotation, 668 00:37:54,480 --> 00:37:57,440 this is kind of a cool thing that not a lot of people key in 669 00:37:57,440 --> 00:38:03,800 on here is that your swing limb actually helps to externally 670 00:38:03,800 --> 00:38:07,440 rotate your stance limb. And if you're having trouble 671 00:38:07,680 --> 00:38:11,480 like visualizing that, stand up and try it, right? 672 00:38:11,680 --> 00:38:15,320 So stand and let your leg kind of collapse in and then bring 673 00:38:15,320 --> 00:38:19,000 your other leg forward. And what you'll see because the 674 00:38:19,040 --> 00:38:24,000 adductors on the leg that is in swing are connected to your 675 00:38:24,000 --> 00:38:27,080 pelvis. As you're rotating your pelvis 676 00:38:27,080 --> 00:38:30,560 forward, that's bringing the pelvis forward and it's rotating 677 00:38:30,560 --> 00:38:34,080 the opposite side back, which is externally rotating from the 678 00:38:34,080 --> 00:38:37,720 proximal aspect of it. So starting from the hip down, 679 00:38:37,720 --> 00:38:40,720 we're starting to see that as that swing limb comes forward, 680 00:38:41,000 --> 00:38:45,800 the other side starts to go back, rotate out, gets us out of 681 00:38:45,800 --> 00:38:48,600 that pronation back in the supination. 682 00:38:48,880 --> 00:38:52,640 And now we're seeing that that is going to put us in that rigid 683 00:38:52,640 --> 00:38:55,560 lever that we need to push off. OK. 684 00:38:55,560 --> 00:39:01,440 So if you are not having good pelvic rotation on your swing 685 00:39:01,440 --> 00:39:07,000 limb side, you're asking for a lot more work, but to externally 686 00:39:07,000 --> 00:39:11,920 rotate a lot more manually and having to do a lot more activity 687 00:39:12,200 --> 00:39:15,600 with it, whereas it should be a passive type thing, which is why 688 00:39:15,600 --> 00:39:20,000 we don't see a lot of glute Max, you know, which is an external 689 00:39:20,000 --> 00:39:22,200 rotator. We don't see a lot of activity 690 00:39:22,240 --> 00:39:25,840 of that latent stance, but you will see sometimes activity of 691 00:39:25,840 --> 00:39:29,560 that overactive glute sometimes if we're not getting some of 692 00:39:29,560 --> 00:39:32,760 that pelvic rotation. So that's a little different one 693 00:39:32,880 --> 00:39:35,600 that's pretty in the weeds. And I'm sorry for everyone 694 00:39:35,600 --> 00:39:38,120 that's not like a bio mechanics person. 695 00:39:38,120 --> 00:39:41,000 Sorry for I might have lost a few people there. 696 00:39:41,000 --> 00:39:44,120 So come back, we'll get more relevant. 697 00:39:44,120 --> 00:39:46,160 But that is a cool biomechanical thing. 698 00:39:46,240 --> 00:39:48,680 I think to bring it home, you know, like we just talked about 699 00:39:48,680 --> 00:39:51,440 some pretty in depth bio mechanics that some of us 700 00:39:51,440 --> 00:39:53,720 followed and some of us didn't, but that's okay. 701 00:39:54,080 --> 00:39:55,520 What the heck do you do about it? 702 00:39:55,520 --> 00:39:58,720 So if you're working with the PT who's seen these things, like 703 00:39:58,720 --> 00:40:01,120 what do you do? Like is this a change your gate? 704 00:40:01,120 --> 00:40:03,400 Is this a work on mobility? Like what's the? 705 00:40:03,400 --> 00:40:06,840 What's the solution? This is like gait retraining and 706 00:40:06,840 --> 00:40:10,280 I am totally biased with this because I've made a career 707 00:40:10,320 --> 00:40:14,600 around gait retraining, but I've helped first timers to 1st place 708 00:40:14,600 --> 00:40:17,400 in the world, right? Like these are gold medalist to 709 00:40:17,400 --> 00:40:20,360 1st timers. Gait retraining is a huge aspect 710 00:40:20,360 --> 00:40:22,480 of this. And here's the important part. 711 00:40:22,480 --> 00:40:26,520 I'm glad you said let's bring it back because this is not hard to 712 00:40:26,520 --> 00:40:29,600 fix if you've identified the root cause. 713 00:40:30,280 --> 00:40:33,600 We talked about that pelvis. You just need to do like a 714 00:40:33,600 --> 00:40:36,480 little bit more arm swing that's going to get your pelvis moving 715 00:40:36,480 --> 00:40:38,840 a little bit better. That like simple. 716 00:40:38,840 --> 00:40:42,520 OK, so we're seeing that the foot is landing a little bit 717 00:40:42,520 --> 00:40:45,000 like plantar factor, right? We're going to say, hey, focus 718 00:40:45,000 --> 00:40:47,480 on knee, drive the knee a little bit more and relax your foot. 719 00:40:48,640 --> 00:40:54,080 It doesn't have to be extremely difficult changes with this. 720 00:40:54,400 --> 00:41:00,600 The secret sauce is in figuring out what's the primary thing 721 00:41:00,600 --> 00:41:04,200 that I can really focus on. And that's where a truly 722 00:41:04,200 --> 00:41:07,800 objective gait analysis is going to help you to figure out what's 723 00:41:07,800 --> 00:41:10,800 the chicken, what's the egg? Where do I need to focus on? 724 00:41:11,160 --> 00:41:15,680 And getting a gait analysis is going to be a big part of that. 725 00:41:15,680 --> 00:41:19,720 But the fix is relatively easy once you've identified it. 726 00:41:20,280 --> 00:41:23,280 Like the mobility. OK, hey, like you're going to 727 00:41:23,280 --> 00:41:26,040 start doing some calf raises with your toes elevated. 728 00:41:26,040 --> 00:41:29,640 That's, that's an exercise that's been studied very well. 729 00:41:30,800 --> 00:41:34,640 You know, a heel raise in toe dorsiflexion, right? 730 00:41:34,640 --> 00:41:38,160 You basically roll up a towel, make your toes kind of come off 731 00:41:38,160 --> 00:41:41,240 the ground and you do a heel raise where you're doing coming 732 00:41:41,240 --> 00:41:45,160 up and working at your calf. That's a pretty well documented 733 00:41:45,160 --> 00:41:48,560 exercise that works well for plantar fascia patients. 734 00:41:48,560 --> 00:41:54,360 So these fixes aren't hard. It's knowing when to do them, 735 00:41:54,480 --> 00:41:57,840 who for what type of plan of foot paid. 736 00:41:57,840 --> 00:42:02,160 It all comes back to that personalization where there's no 737 00:42:02,160 --> 00:42:07,200 one thing that can fix everyone. Well, I think, I think I'm glad 738 00:42:07,200 --> 00:42:09,680 you said some examples of what it looks like to gate retrain 739 00:42:09,680 --> 00:42:13,160 because what it does not look like is saying, hey, you're 740 00:42:13,200 --> 00:42:17,440 landing a little, you know, 7° out on the outside of your foot. 741 00:42:17,600 --> 00:42:20,480 Make that like 4. That's not the queue there. 742 00:42:20,480 --> 00:42:24,840 It's the queues are so much more intuitive and understandable. 743 00:42:24,840 --> 00:42:28,000 And it takes trying the queue and seeing did the queue 744 00:42:28,000 --> 00:42:31,080 accomplish the goal, which means you have to reassess the gate 745 00:42:31,080 --> 00:42:33,880 again. And so it's, you know, if 746 00:42:33,880 --> 00:42:37,120 you're, if you're someone who has access to APT who's doing 747 00:42:37,120 --> 00:42:40,840 this kind of stuff, it's not going to be you learning how to 748 00:42:40,840 --> 00:42:43,040 understand the difference between 7 and 4°. 749 00:42:43,040 --> 00:42:45,200 You're going to get cues that actually make sense to you, 750 00:42:45,200 --> 00:42:47,360 which is great. But I want to kind of push. 751 00:42:47,640 --> 00:42:50,080 Great point there. Sorry, what's it like the 752 00:42:50,080 --> 00:42:52,640 reassessment? I want to like hone in on that 753 00:42:52,640 --> 00:42:56,720 because you're 100% right, a gait analysis isn't a one time. 754 00:42:56,760 --> 00:43:01,280 Oh, I here's what I'm doing. I suck at walking or I suck at 755 00:43:01,280 --> 00:43:03,120 running. The gate analysis is like, 756 00:43:03,120 --> 00:43:06,320 here's our first plan of attack. Let's see how we can fix this. 757 00:43:06,320 --> 00:43:08,520 Let's see how we can do it. So it's not a wanna dot. 758 00:43:08,520 --> 00:43:10,920 So sorry to interrupt, but I just, I love that you brought 759 00:43:10,920 --> 00:43:14,360 that point up. So here's kind of the next part 760 00:43:14,360 --> 00:43:17,240 I want to bring back. You talked about this toe flexor 761 00:43:17,240 --> 00:43:20,160 strength. I think mechanics are one part 762 00:43:20,160 --> 00:43:22,480 that we can change, which sometimes take some guidance 763 00:43:22,480 --> 00:43:24,320 from someone who really understands what you're looking 764 00:43:24,320 --> 00:43:26,480 at. Something like strength people 765 00:43:26,480 --> 00:43:30,240 typically engage in regularly. They're often strength training, 766 00:43:30,240 --> 00:43:33,200 they're doing all these things. What have you seen about kind of 767 00:43:33,200 --> 00:43:36,080 decreased toe strength? Maybe some perspectives on 768 00:43:36,080 --> 00:43:38,320 footwear and how that plays into things. 769 00:43:38,560 --> 00:43:42,680 I think that plantar fascia, plantar fasciopathy, plantar 770 00:43:42,760 --> 00:43:47,960 fasciitis, plantar foot pain and the orthotics world are one of 771 00:43:47,960 --> 00:43:52,960 my biggest soap boxes that I could also go up on and I will 772 00:43:52,960 --> 00:43:55,520 hold my tongue until it's appropriate timing and then I'll 773 00:43:55,520 --> 00:43:58,280 jump in too. But what has been your, what's 774 00:43:58,280 --> 00:44:02,440 your perspective on kind of what you've learned about this foot 775 00:44:02,440 --> 00:44:06,160 strength and how we can think about that if we're dealing with 776 00:44:06,680 --> 00:44:10,040 plantar fasciopathy? Yes, great. 777 00:44:10,040 --> 00:44:13,800 But it's also funny, you and I, like I'm older than you, but 778 00:44:13,960 --> 00:44:16,920 like when we were in school, even, it was like plantar 779 00:44:16,920 --> 00:44:17,920 fasciitis. Yeah. 780 00:44:18,000 --> 00:44:20,560 So both of us have a little hesitation. 781 00:44:20,560 --> 00:44:27,840 Plantar fascia. Yeah, we like not itis we like. 782 00:44:27,920 --> 00:44:31,280 I find both of us like stopping ourselves there, like I want to 783 00:44:31,280 --> 00:44:35,600 say the right thing. But anyway, So to answer your 784 00:44:35,600 --> 00:44:39,840 question, a little bit of a oversimplification, but a key 785 00:44:39,840 --> 00:44:43,960 take away about the role of strengthening your foot in 786 00:44:43,960 --> 00:44:48,800 treating plantar fascia pain is it should just be part of your 787 00:44:48,800 --> 00:44:51,480 everyday routine. And it doesn't always 788 00:44:51,480 --> 00:44:55,920 necessarily have to be a set group of exercises that you're 789 00:44:55,920 --> 00:44:58,840 doing in order to strengthen the foot. 790 00:44:59,760 --> 00:45:05,480 Now, yes, you go to, you have an injury, you go to physical 791 00:45:05,480 --> 00:45:08,560 therapy, you might be doing specific exercises. 792 00:45:08,800 --> 00:45:13,120 The role of those exercises is to increase the connection 793 00:45:13,120 --> 00:45:19,520 between your brain and your foot and enable you to correctly 794 00:45:19,960 --> 00:45:24,120 recruit and use the muscles that we're talking about here. 795 00:45:24,840 --> 00:45:29,920 However, true tissue capacity, that was was what we're kind of 796 00:45:29,920 --> 00:45:32,160 talking about here. So the ability of the tissue to 797 00:45:32,160 --> 00:45:37,160 absorb forces and generate forces, what we really see is 798 00:45:37,160 --> 00:45:39,320 that it has to be part of your daily routine. 799 00:45:40,000 --> 00:45:44,120 So this is where footwear does come in and this can be 800 00:45:44,120 --> 00:45:47,320 something that you can do with your everyday routine. 801 00:45:47,320 --> 00:45:50,640 I know most gyms won't let you do this, but doing your strength 802 00:45:50,640 --> 00:45:56,280 training routine in barefoot or at least minimalistic shoes can 803 00:45:56,280 --> 00:45:59,840 be a huge benefit for developing foot strength. 804 00:46:00,240 --> 00:46:03,400 You start doing, you're doing lunges at the gym, you start 805 00:46:03,400 --> 00:46:07,800 doing them in a pair of 0 shoes and all of a sudden you're going 806 00:46:07,800 --> 00:46:11,920 to get a lot more benefit for what you're seeing. 807 00:46:12,000 --> 00:46:14,920 The recruitment of those muscles that we've been talking about 808 00:46:14,920 --> 00:46:18,240 here. Now, like we said, some of the 809 00:46:18,240 --> 00:46:21,240 banded exercises that you're doing, you might need to learn 810 00:46:21,480 --> 00:46:25,760 how to reduce tenicity, right? A muscle that is not healthy 811 00:46:26,080 --> 00:46:29,400 might not have the right firing patterns where it doesn't fully 812 00:46:29,400 --> 00:46:31,640 relax in between each contraction and you need to 813 00:46:31,640 --> 00:46:35,800 teach it how to do that. But the long term plan is you 814 00:46:35,800 --> 00:46:38,560 need to incorporate this into everything that you're doing. 815 00:46:39,480 --> 00:46:40,800 You know, this is something that I do. 816 00:46:40,800 --> 00:46:46,360 I wear a minimalistic low drop or shoe all the time. 817 00:46:46,440 --> 00:46:50,160 I am using that on a on a daily basis. 818 00:46:50,600 --> 00:46:54,960 It is something that you have to transition to appropriately and 819 00:46:54,960 --> 00:46:58,080 you have to make sure that you are the correct person to 820 00:46:58,080 --> 00:47:00,040 transition to some of these things. 821 00:47:00,760 --> 00:47:03,160 And along those same lines, like one of the tough parts about 822 00:47:03,160 --> 00:47:09,520 what we're talking to is there is a train of thought that 823 00:47:09,520 --> 00:47:12,360 sometimes doing the opposite of what I just said when you're 824 00:47:12,360 --> 00:47:16,800 having plantar fascia pain can be a temporary. 825 00:47:16,880 --> 00:47:21,560 Yes, that's the. Key temporary keyword a way to 826 00:47:21,560 --> 00:47:25,600 help reduce the strain on it to allow the tissues to heal a 827 00:47:25,600 --> 00:47:28,040 little bit better. Whereas if you're having some of 828 00:47:28,040 --> 00:47:31,240 these symptoms, if you're really you're at your wit's end, you've 829 00:47:31,240 --> 00:47:34,840 been dealing with plantar fascia pain for a long time, you might 830 00:47:34,840 --> 00:47:38,080 not want to just run out and buy the 1st minimalistic pair of 831 00:47:38,080 --> 00:47:41,920 shoes that you can get and just start wearing them 24 hours a 832 00:47:41,920 --> 00:47:45,000 day. That is not going to work well 833 00:47:45,000 --> 00:47:47,480 for you. You're going to need to allow 834 00:47:47,480 --> 00:47:52,600 the body to adapt to that and it might be a six week, 6 month 835 00:47:52,600 --> 00:47:55,760 process to get to that depending on there. 836 00:47:56,400 --> 00:48:00,320 You mentioned orthotics. Orthotics may be again a 837 00:48:00,760 --> 00:48:06,400 temporary way to shift some of the load away from the tissue 838 00:48:06,400 --> 00:48:10,600 that is not doing a great job at absorbing the forces that it 839 00:48:10,600 --> 00:48:14,160 should. It is not intended to be a long 840 00:48:14,160 --> 00:48:20,320 term solution that I can't function without my insults. 841 00:48:21,040 --> 00:48:25,120 We get people like that. And yes, there are it's never 842 00:48:25,240 --> 00:48:27,800 always situation. There are people that do need 843 00:48:27,800 --> 00:48:29,680 it. But I'd ask yourself to be 844 00:48:29,680 --> 00:48:34,280 honest with you, with yourself. Do you actually have a rigid 845 00:48:34,280 --> 00:48:38,120 foot that's fused and can never move again and you need an 846 00:48:38,120 --> 00:48:40,560 orthotic? There's very few people that I 847 00:48:40,560 --> 00:48:42,920 think fit that bill. That's goes back to my earlier 848 00:48:42,920 --> 00:48:46,000 point, like there's not many feet that I've met that I can't 849 00:48:46,000 --> 00:48:50,200 increase mobility. But we see that, you know, 850 00:48:50,200 --> 00:48:51,880 there's kind of the two ends of the spectrum. 851 00:48:52,000 --> 00:48:57,320 Short term, we can shift loads and use our tools. 852 00:48:57,720 --> 00:49:00,360 There's taping techniques. Some of them have proven 853 00:49:00,360 --> 00:49:02,720 effective, some of them have not proven effective. 854 00:49:02,720 --> 00:49:05,200 There. There are different things that 855 00:49:05,200 --> 00:49:07,760 we can do to just shift that load and let the tissue get 856 00:49:07,760 --> 00:49:10,120 healthy. And hey, you're a couple weeks 857 00:49:10,120 --> 00:49:12,920 out from a marathon, you're in the middle of the training 858 00:49:12,920 --> 00:49:16,760 program, let's do it, let's go for it, right? 859 00:49:17,160 --> 00:49:20,440 But the long term solution is then get you out of those 860 00:49:20,880 --> 00:49:24,280 strength in the foot, get you down, you know, reducing some of 861 00:49:24,280 --> 00:49:28,240 the heel to toe drop that you're in at getting in a lower shoe 862 00:49:28,240 --> 00:49:32,760 like a mid range here. Like I tend to run in a topo 863 00:49:32,760 --> 00:49:38,400 that is A3 to A5 drop, which is a nice sweet spot for me. 864 00:49:38,400 --> 00:49:43,920 And some of my planet flash after they came on because I, we 865 00:49:43,920 --> 00:49:48,040 sell some shoes in in my clinic and we didn't have my normal 866 00:49:48,040 --> 00:49:52,080 shoes and I went to a zero drop and I just kind of went in full 867 00:49:52,080 --> 00:49:54,840 force into it because it was like, I don't feel like ordering 868 00:49:54,840 --> 00:49:57,920 them right now. And and that part of the reason 869 00:49:57,920 --> 00:50:02,440 that I developed it is because I am my own worst patient with 870 00:50:02,440 --> 00:50:07,480 that. But yes, but we can see that 871 00:50:07,480 --> 00:50:12,200 there is a lot that you can do from it from a shoe standpoint, 872 00:50:12,200 --> 00:50:14,040 thinking about that and that one other thing. 873 00:50:14,040 --> 00:50:15,960 And then I'd love to hear your thoughts on this too. 874 00:50:16,000 --> 00:50:22,480 And then but I find with picking shoes that one of the most 875 00:50:22,480 --> 00:50:28,880 important things with this plan or fascia patient is making sure 876 00:50:28,880 --> 00:50:31,960 that they're tying their shoes correctly and that the shoe has 877 00:50:31,960 --> 00:50:35,880 the appropriate fit. We want it to be tight around 878 00:50:35,880 --> 00:50:39,080 the midfoot, like around the like 4 foot midfoot. 879 00:50:39,080 --> 00:50:42,440 And we wanted to have it loose at the toes to let the toes do 880 00:50:42,440 --> 00:50:45,400 what they need to do. Here there are. 881 00:50:45,400 --> 00:50:48,080 You and I even had a conversation before you can. 882 00:50:48,120 --> 00:50:52,360 We can also talk about plates and rockers, and there's lots of 883 00:50:52,360 --> 00:50:54,520 other things here. But I think the number one thing 884 00:50:54,520 --> 00:50:57,080 is just make sure that your foot's not like pistoning back 885 00:50:57,080 --> 00:51:03,080 and forth in the shoe, that your foot is secure in there, but it 886 00:51:03,080 --> 00:51:05,480 has room to do what it's supposed to do. 887 00:51:05,640 --> 00:51:07,520 Yeah. So let's hear your thoughts, 888 00:51:07,520 --> 00:51:09,440 Nathan, on this, too. I'll flip it back on. 889 00:51:09,440 --> 00:51:12,960 You I, I just want to start by saying I agree with everything 890 00:51:12,960 --> 00:51:14,920 that you said. Like there isn't anything that 891 00:51:14,920 --> 00:51:17,560 I'm, I'm on a different side of the, the fence on this. 892 00:51:18,240 --> 00:51:22,280 The part that gets me is that I think that in the running shoe 893 00:51:22,280 --> 00:51:25,600 world and just footwear world in general, when it comes to 894 00:51:25,600 --> 00:51:30,160 marketing, the most highly marketed thing is arch support 895 00:51:30,160 --> 00:51:33,640 to help with plantar fasciitis. That is the most kind of thing 896 00:51:33,640 --> 00:51:35,920 that you're going to see out there and that's going to be in 897 00:51:35,920 --> 00:51:38,600 your inserts. That's going to be about the the 898 00:51:38,600 --> 00:51:41,040 footwear itself, if it has some arch support. 899 00:51:41,760 --> 00:51:45,480 And I think a lot of that came because there's some literature 900 00:51:45,480 --> 00:51:50,200 that shows that short term orthotic use just like prefab, 901 00:51:50,200 --> 00:51:52,640 nothing fancy. Some kind of cushioning in the 902 00:51:52,640 --> 00:51:55,600 heel can give short term pain relief for people with planter 903 00:51:55,600 --> 00:51:57,440 fascia pain. And that's a great thing. 904 00:51:57,760 --> 00:52:00,520 Like you said, it's this short term temporary thing that can 905 00:52:00,520 --> 00:52:02,360 help decrease your symptoms for a little bit. 906 00:52:02,600 --> 00:52:05,120 And then companies take that and they say, look, we've created 907 00:52:05,120 --> 00:52:07,400 the shoe for planter fascia pain. 908 00:52:07,400 --> 00:52:10,040 Now this is going to be the thing that's going to help you 909 00:52:10,040 --> 00:52:13,960 forever when really the literature shows it's like a two 910 00:52:13,960 --> 00:52:16,160 to three-week benefit. That's what it's for. 911 00:52:16,160 --> 00:52:18,000 It's this short term thing. Same with taping. 912 00:52:18,120 --> 00:52:21,960 It's a short term fix to help decrease irritability and then 913 00:52:21,960 --> 00:52:23,680 actually address the actual issues. 914 00:52:25,080 --> 00:52:26,920 So I don't even know where I was going to go from there, but I 915 00:52:26,920 --> 00:52:30,920 think it's the most highly marketed thing that is doing the 916 00:52:30,920 --> 00:52:33,120 exact opposite of what you need long term. 917 00:52:33,120 --> 00:52:37,720 Because the footwear is designed in a way to take the stress off 918 00:52:37,720 --> 00:52:40,480 of your plantar fascia, puts you a little bit, maybe more to the 919 00:52:40,480 --> 00:52:43,120 outside of your foot, stops your foot from moving. 920 00:52:43,120 --> 00:52:44,920 That's the idea of some of these footwear too. 921 00:52:44,920 --> 00:52:47,400 It's like, hey, let's butt up against the arch that it can't 922 00:52:47,400 --> 00:52:49,520 go through its mobility. And then it becomes a 923 00:52:49,520 --> 00:52:53,080 perpetuating cycle for people who are trying to improve from 924 00:52:53,080 --> 00:52:55,920 this condition. So the, the claims that this is 925 00:52:55,920 --> 00:53:00,160 helpful actually can be long term detrimental to what you're 926 00:53:00,160 --> 00:53:04,880 doing because in a good way, I have a pair of vivo next to me 927 00:53:04,880 --> 00:53:07,120 and I've got my zeros upstairs that I wear to work. 928 00:53:08,120 --> 00:53:10,920 As you kind of said, in knowing that there's a complete, there's 929 00:53:10,920 --> 00:53:13,600 complexity and it's not an always or nothing like you said, 930 00:53:14,240 --> 00:53:16,360 but if you can transition to a point where you can teach your 931 00:53:16,360 --> 00:53:19,880 foot to move, you can teach your different tissues to handle 932 00:53:19,880 --> 00:53:23,640 stress and strain, share it among muscles and tendons and 933 00:53:23,640 --> 00:53:26,080 your planner fashion, all these different things, get the right 934 00:53:26,080 --> 00:53:27,840 mobility. That's going to be the way 935 00:53:27,840 --> 00:53:31,920 forward. And so I, I have so much beef 936 00:53:31,920 --> 00:53:35,400 with marketing that goes towards helping planter fascia pain in 937 00:53:35,440 --> 00:53:38,320 from footwear and especially just this whole concept of arch 938 00:53:38,320 --> 00:53:40,640 support. It's going to feel good 939 00:53:40,640 --> 00:53:42,480 temporarily, but it's not the long term fix. 940 00:53:42,480 --> 00:53:44,880 I'll pause. I have more to say, but I'll 941 00:53:44,880 --> 00:53:46,800 pause there and see if you have anything to respond. 942 00:53:46,800 --> 00:53:50,640 You know, I wonder it I'm trying to look this up real real 943 00:53:50,920 --> 00:53:56,520 quickly now, but how much do you think people spend on planner 944 00:53:56,520 --> 00:53:59,800 fascia gadgets and tools and things every? 945 00:53:59,800 --> 00:54:01,320 Year. Oh my gosh. 946 00:54:02,480 --> 00:54:04,200 Like even just in the United States. 947 00:54:04,880 --> 00:54:06,760 Yes. Let's see if you can find this. 948 00:54:07,600 --> 00:54:12,520 I'm, I'm asking ChatGPT here see what chat has to say yeah, let's 949 00:54:12,520 --> 00:54:14,640 see if there's any statistics with this. 950 00:54:14,640 --> 00:54:17,680 It says searching the web, but while it's searching and while 951 00:54:17,680 --> 00:54:20,320 we're looking for that answer here to fact, we don't have our 952 00:54:20,320 --> 00:54:23,880 own Fact Check here. Oh, here it is approximately 953 00:54:23,880 --> 00:54:31,040 $284,000,000 a year yeah. Now this includes some like 954 00:54:31,040 --> 00:54:34,000 physician visits and medication and things like that and 955 00:54:34,000 --> 00:54:36,520 orthotics and some of those other things. 956 00:54:36,520 --> 00:54:41,440 But I think there's a strong amount of people that are 957 00:54:41,440 --> 00:54:47,040 actually, you know, buying the gadgets, the socks, the, you 958 00:54:48,240 --> 00:54:51,520 know, the the all the straps, everything that they're buying 959 00:54:51,520 --> 00:54:52,960 with that. But what I wonder with what 960 00:54:52,960 --> 00:54:56,320 you're saying is maybe part of the progression of the shoe 961 00:54:56,320 --> 00:54:58,920 industry, right? They said Archip work great. 962 00:54:59,160 --> 00:55:01,880 Well, that pushes everyone to the outside and doesn't let 963 00:55:01,880 --> 00:55:04,040 everyone naturally absorb the forces. 964 00:55:04,400 --> 00:55:08,440 So next they had to increase the cushion because everyone's on 965 00:55:08,440 --> 00:55:11,280 this rigid foot. So now they need to make it feel 966 00:55:11,280 --> 00:55:12,960 comfortable because it's jarring. 967 00:55:13,360 --> 00:55:15,360 And you know, same kind of thing. 968 00:55:15,360 --> 00:55:21,040 Hey, like you put a very soft shoe under somebody with plantar 969 00:55:21,040 --> 00:55:24,480 fascia, they're going to feel great for the first couple steps 970 00:55:24,480 --> 00:55:27,200 in the store. And then all of a sudden they're 971 00:55:27,200 --> 00:55:31,400 realizing how much they have to control that motion by the high 972 00:55:31,400 --> 00:55:33,680 stack height. They're in that position. 973 00:55:33,680 --> 00:55:35,520 They're going to have to really control their hips. 974 00:55:35,920 --> 00:55:37,680 We're going to control a lot of these different things. 975 00:55:37,680 --> 00:55:43,200 And you know, it's unfortunately we've gone like, I think we've, 976 00:55:43,800 --> 00:55:47,520 it's that saying like if you're digging a hole in the wrong 977 00:55:47,520 --> 00:55:50,240 place, digging deeper doesn't help, right? 978 00:55:50,480 --> 00:55:55,360 I think we're digging deeper in this hole of like art support. 979 00:55:55,440 --> 00:55:58,400 And I see patients do this all the time where they come in. 980 00:55:58,760 --> 00:56:01,080 I, I need a shoe with really high art support. 981 00:56:01,480 --> 00:56:04,520 I have to have a shoe with high art support, like, OK, let's 982 00:56:04,520 --> 00:56:07,760 talk about that, but let's see it's it might not be true. 983 00:56:07,760 --> 00:56:12,480 And the shoe that feels best in the store might not always be 984 00:56:12,480 --> 00:56:15,400 the best one for you. I think the shoe fitting 985 00:56:15,400 --> 00:56:17,680 process, this is another hot take here. 986 00:56:18,040 --> 00:56:21,840 The shoe fitting process is really missing out on how shoes 987 00:56:21,840 --> 00:56:28,920 affect your bio mechanics. We added a score to our gait 988 00:56:28,920 --> 00:56:33,440 analysis system because we were seeing that we needed a quick 989 00:56:33,440 --> 00:56:37,520 way to show people, hey, how does this gate Q change your 990 00:56:37,520 --> 00:56:39,400 form? How does this shoe change your 991 00:56:39,400 --> 00:56:41,600 form? And people when they're buying 992 00:56:41,600 --> 00:56:45,720 their shoes, are buying them. And then because running 993 00:56:45,720 --> 00:56:49,000 injuries have this four to six week delay, they're getting in 994 00:56:49,000 --> 00:56:51,000 like, well, I've had these shoes for four weeks. 995 00:56:51,000 --> 00:56:53,720 This can't be the shoes. Guess what? 996 00:56:54,120 --> 00:56:55,760 It might be the shoes a bit here. 997 00:56:55,880 --> 00:56:57,760 Injuries. Take time to build up. 998 00:56:58,960 --> 00:57:03,560 They do, They really do. So I think we went on a bunch of 999 00:57:03,560 --> 00:57:06,360 tangents and soapboxes of mine there here, but. 1000 00:57:06,840 --> 00:57:11,360 I think to wrap up some shoe thoughts for me at least is when 1001 00:57:11,360 --> 00:57:14,760 it comes to planter fascia pain, your long term solution won't be 1002 00:57:14,760 --> 00:57:17,840 shoes. We're also not saying that oh, 1003 00:57:17,840 --> 00:57:21,320 everyone should ditch their arch support that you do have in your 1004 00:57:21,320 --> 00:57:24,560 shoes and just transition to something that has no support or 1005 00:57:24,560 --> 00:57:26,600 just like going to barefoot. That's also now what we're 1006 00:57:26,600 --> 00:57:28,080 saying. We're also not saying that's 1007 00:57:28,080 --> 00:57:30,680 also automatically going to make you feel better right away. 1008 00:57:31,080 --> 00:57:34,920 I think we're trying to say that the the underlying issues are 1009 00:57:34,920 --> 00:57:37,680 more important to address than finding footwear to match you. 1010 00:57:38,080 --> 00:57:42,240 And the last thing I will say is a nice short term thing 1011 00:57:42,240 --> 00:57:48,160 sometimes are utilizing I'm and I'm even stepping back a little 1012 00:57:48,160 --> 00:57:52,360 bit, but sometimes having a rockard shoe with a little bit 1013 00:57:52,360 --> 00:57:55,200 of a more rigid platform, whether that's plated or not 1014 00:57:55,200 --> 00:57:58,800 plated rigidity can be helpful in this short term process too. 1015 00:57:58,800 --> 00:58:01,880 If you're in a place where shoes can be a tool for you in a short 1016 00:58:01,880 --> 00:58:04,480 term space, like having something that's going to 1017 00:58:04,480 --> 00:58:07,160 decrease overall load on the planner surface of the foot 1018 00:58:07,480 --> 00:58:10,320 could help you get through some of this irritability or get 1019 00:58:10,320 --> 00:58:13,040 through the race that you're going into or whatever as you 1020 00:58:13,040 --> 00:58:16,560 then go and address kind of these these deeper levels of 1021 00:58:16,560 --> 00:58:20,760 things. So as we kind of wrap things up 1022 00:58:20,760 --> 00:58:24,040 here, Doug, I think the last conversation I want to hear from 1023 00:58:24,040 --> 00:58:27,280 you is just kind of what are your biggest tips for people 1024 00:58:27,440 --> 00:58:30,840 who've been dealing with plantar fascia pain where if you're by 1025 00:58:30,840 --> 00:58:32,640 yourself, you don't have a physical therapist you're 1026 00:58:32,640 --> 00:58:34,360 working with. It's been something that's 1027 00:58:34,360 --> 00:58:37,920 bugging you for five to 10 years or even just like 6 months. 1028 00:58:38,400 --> 00:58:41,080 Where would you start if you were just by yourself? 1029 00:58:41,240 --> 00:58:42,920 What would be the things you would try to attack? 1030 00:58:43,960 --> 00:58:47,240 Yeah, wow, That's a great question here because I mean, my 1031 00:58:47,240 --> 00:58:50,680 first response would be like, talk to a physical therapist or 1032 00:58:50,680 --> 00:58:55,800 even like get on, get on a virtual visit with somebody. 1033 00:58:55,800 --> 00:58:58,840 And that could actually even assess some of these things. 1034 00:58:58,840 --> 00:59:00,760 But it goes back to what you were just saying. 1035 00:59:00,760 --> 00:59:03,720 It's got to be personalized and you got to get to the root cause 1036 00:59:03,720 --> 00:59:05,800 of it. Throwing a bunch of things to 1037 00:59:05,800 --> 00:59:08,640 the wall and seeing what sticks is going to lead to more 1038 00:59:08,640 --> 00:59:12,560 frustration where, you know, the rocker Bob, shit like that could 1039 00:59:12,560 --> 00:59:16,640 be great for somebody. But you spend $160 on that pair 1040 00:59:16,640 --> 00:59:22,520 of shoes and you might have really good hallux dorsiflexion 1041 00:59:22,520 --> 00:59:24,720 and maybe that's not going to help you as much as somebody 1042 00:59:24,720 --> 00:59:31,320 else that has very limited ankle dorsiflexion because the rigid 1043 00:59:31,320 --> 00:59:34,520 and rocker is going to prevent some of that toe extension. 1044 00:59:34,520 --> 00:59:38,560 But maybe that's fine for you. And that's not symptom provocate 1045 00:59:38,560 --> 00:59:41,600 provocation for you. And you've got motion and you've 1046 00:59:41,600 --> 00:59:45,320 got control over it. So having somebody quarterback 1047 00:59:45,320 --> 00:59:49,600 the care and look at it is really going to be helpful. 1048 00:59:49,600 --> 00:59:52,280 And I think most people are going to have access and you're 1049 00:59:52,280 --> 00:59:55,560 going to have to figure out what you really, what's this worth to 1050 00:59:55,560 --> 00:59:58,080 you, right? I think if you start asking 1051 00:59:58,080 --> 01:00:00,440 yourself, what am I really willing to do? 1052 01:00:00,600 --> 01:00:04,240 To get rid of this foot pain. What actually am I willing? 1053 01:00:04,240 --> 01:00:07,160 Like am I willing to throw resources at this or not? 1054 01:00:07,600 --> 01:00:09,760 Because you might try things like, you know, we said 1055 01:00:09,760 --> 01:00:13,080 shockwave, like we're seeing that it can be really helpful 1056 01:00:13,080 --> 01:00:16,280 and short term and some of the longer term benefits or there's 1057 01:00:16,280 --> 01:00:18,840 some debate about that in the literature, but there's there's 1058 01:00:18,840 --> 01:00:22,520 good reports of of helping out in the short term at least. 1059 01:00:22,880 --> 01:00:25,440 So if you do have a race coming up, you might want to explore 1060 01:00:25,440 --> 01:00:28,160 some of those things, but realize that there's cost 1061 01:00:28,160 --> 01:00:30,160 benefit. You might not want to run for 1062 01:00:30,160 --> 01:00:33,400 two days after you get a shockwave treatment here. 1063 01:00:33,400 --> 01:00:36,000 So you have to look at some of the that, which is why we've 1064 01:00:36,000 --> 01:00:40,880 tended to go towards the the winback Techer therapy because 1065 01:00:40,880 --> 01:00:43,520 you can run right after it and there's not as much and we're 1066 01:00:43,520 --> 01:00:47,520 still seeing changes about that. So now to answer the question 1067 01:00:47,520 --> 01:00:51,080 more of like, hey, yeah, you're on an island and you've got 1068 01:00:51,080 --> 01:00:52,960 nobody. You got no communication. 1069 01:00:53,960 --> 01:00:58,200 I would just really do some simple assessments just to see 1070 01:00:58,200 --> 01:01:00,960 and and here's some some quick things that you can check to see 1071 01:01:00,960 --> 01:01:06,120 how you're doing. So first I would look at like a 1072 01:01:06,120 --> 01:01:09,720 dorsiflexion motion here because that could be a really huge 1073 01:01:09,720 --> 01:01:13,000 thing that you need to get. So the easiest way to self check 1074 01:01:13,000 --> 01:01:17,680 this is just to kneel in a position and take your hand. 1075 01:01:17,840 --> 01:01:22,760 So go put your toes a hand width away from the wall and see if 1076 01:01:22,760 --> 01:01:26,920 you can kneel forward and get your kneecap to touch the wall 1077 01:01:26,920 --> 01:01:29,720 without twisting your body and without the heel coming up. 1078 01:01:30,360 --> 01:01:33,320 If you're limited in some ankle range of motion, I would start 1079 01:01:33,320 --> 01:01:37,920 working on getting that motion back, doing calf raises, working 1080 01:01:37,920 --> 01:01:41,080 on the soft tissue structures. If you can get somebody to 1081 01:01:41,080 --> 01:01:43,200 mobilize the joint, that would be great too. 1082 01:01:44,040 --> 01:01:45,880 Then I would. The next thing I would do is 1083 01:01:45,880 --> 01:01:52,160 assess your your arch and your hallux at the same time. 1084 01:01:52,160 --> 01:01:54,720 Your big toe. I would just ask you to sit with 1085 01:01:54,720 --> 01:01:58,720 your knees and hips bent 90° and I would say lift your big toe 1086 01:01:58,720 --> 01:02:00,800 up. Can you lift your big toe up 1087 01:02:00,800 --> 01:02:02,720 keeping the little toes on the ground? 1088 01:02:03,200 --> 01:02:06,800 That's going to tell if you're able to stabilize the arch in 1089 01:02:06,800 --> 01:02:09,800 order to raise that big toe. And it's also going to give us 1090 01:02:09,800 --> 01:02:12,520 an idea of how much motion you have. 1091 01:02:13,640 --> 01:02:15,440 So that would be something I really look at. 1092 01:02:15,440 --> 01:02:19,120 And then I'd probably look at calf strength as well and look 1093 01:02:19,120 --> 01:02:22,560 at somebody doing a single leg calf phrase and watch that 1094 01:02:22,560 --> 01:02:25,800 person that like goes excessively out to the side, 1095 01:02:26,080 --> 01:02:29,240 making sure that you can do a calf raise nice and tall. 1096 01:02:29,480 --> 01:02:32,200 You can do 10 of them on single leg and you're feeling pretty 1097 01:02:32,200 --> 01:02:35,280 good. If you can do those three things 1098 01:02:35,280 --> 01:02:37,920 well, I probably had one more. I probably had balance too. 1099 01:02:38,280 --> 01:02:42,440 I would do a balance test and I would watch while I'm doing 1100 01:02:42,440 --> 01:02:45,760 balance. And am I able to keep the foot 1101 01:02:45,760 --> 01:02:49,240 tripod during balance, Right. And if you're not familiar with 1102 01:02:49,240 --> 01:02:52,080 that, do we, is there video with this? 1103 01:02:52,240 --> 01:02:55,400 I keep doing hand gestures, so I want to yeah. 1104 01:02:55,680 --> 01:02:59,720 So basically like the foot tripod is underneath of your big 1105 01:02:59,720 --> 01:03:02,920 toe, underneath of your little toe and, and kind of in the 1106 01:03:02,920 --> 01:03:07,800 center, like not exactly those points, but make a triangle here 1107 01:03:08,120 --> 01:03:13,520 and see if you're able to put weight fairly evenly distributed 1108 01:03:13,720 --> 01:03:17,400 between those three points. A lot of people that have poor 1109 01:03:17,400 --> 01:03:21,560 balance, when I look at them, I see what happens when they come 1110 01:03:21,560 --> 01:03:24,000 on to that medial spot. And most of the time you're 1111 01:03:24,000 --> 01:03:27,240 going to see people are just going to fall right over here. 1112 01:03:27,680 --> 01:03:30,160 And if you have trouble with things like that, there's lots 1113 01:03:30,160 --> 01:03:33,280 of great tools out there. Jada Sherry's mobile board, 1114 01:03:33,280 --> 01:03:37,120 great way to work on some of the stability with that and learn 1115 01:03:37,120 --> 01:03:40,600 how to bear weight through that first ray. 1116 01:03:40,600 --> 01:03:44,960 So I would say those four things for self-assessment would be 1117 01:03:44,960 --> 01:03:48,840 where I would start to see if you can just find out, maybe 1118 01:03:48,840 --> 01:03:52,000 address some of those mobility restrictions first and foremost. 1119 01:03:52,560 --> 01:03:55,680 And then when you're walking, you know, try to walk as 1120 01:03:55,680 --> 01:03:58,160 symmetrically and even as you can. 1121 01:03:59,400 --> 01:04:02,880 If you're on an island, I guess there's five things that you can 1122 01:04:02,880 --> 01:04:07,800 do that will help you at least start to progress towards 1123 01:04:07,880 --> 01:04:09,480 getting over some of these symptoms. 1124 01:04:09,880 --> 01:04:12,920 Fantastic. Well, Doug, thank you for all of 1125 01:04:12,920 --> 01:04:15,560 your time. And before we wrap up, can you 1126 01:04:15,560 --> 01:04:18,760 just tell people where they can find you and what sort of 1127 01:04:18,760 --> 01:04:22,040 resources they could access through you and through Run DNA? 1128 01:04:23,240 --> 01:04:25,600 Yeah, I think we talked a lot about gait analysis tonight. 1129 01:04:25,600 --> 01:04:29,280 So I would say if you're a runner or looking to get a gait 1130 01:04:29,280 --> 01:04:32,520 analysis, you should have it over to run dna.com and go to 1131 01:04:32,520 --> 01:04:35,960 resources and find a provider. This is one of the things that 1132 01:04:35,960 --> 01:04:40,000 we have trained thousands of people in our education, 10s of 1133 01:04:40,000 --> 01:04:43,600 thousands in our education, and then we have hundreds of sites 1134 01:04:43,600 --> 01:04:46,000 that are doing our 3D technology. 1135 01:04:46,320 --> 01:04:49,680 So finding somebody that can help you out and be that guide 1136 01:04:49,680 --> 01:04:52,960 is a big part of it. And then while you're there, you 1137 01:04:52,960 --> 01:04:57,120 can sign up for a newsletter or you can check out our Instagram, 1138 01:04:57,120 --> 01:05:02,560 which is run DNA system, I want to say for Instagram, you can 1139 01:05:02,560 --> 01:05:05,800 check that out as well. But we're very engaged and open 1140 01:05:05,800 --> 01:05:08,720 and both for the medical community, the fitness 1141 01:05:08,720 --> 01:05:11,880 community, but as well as just runners and walkers. 1142 01:05:11,880 --> 01:05:16,040 I think a lot of this can make a big impact on, on that. 1143 01:05:16,040 --> 01:05:19,200 And we, we try to put up resources all the time to help 1144 01:05:19,200 --> 01:05:21,280 people out with this stuff. Fantastic. 1145 01:05:21,280 --> 01:05:24,280 Well, thank you again for all of your time we record on Sunday 1146 01:05:24,280 --> 01:05:26,520 nights, so thank us. Thank you for giving us your 1147 01:05:26,520 --> 01:05:29,400 Sunday night and for all the ways to be shared with us today. 1148 01:05:30,200 --> 01:05:33,360 I really appreciate you having me on this was another great fun 1149 01:05:33,360 --> 01:05:37,200 conversation and enjoy the time and and thank you for your your 1150 01:05:37,200 --> 01:05:39,400 opportunity here to to be here. Absolutely.