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With inside tracker, visit 
inside tracker.com doctors are 

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running. 
Hey there everyone and welcome 

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to the docks running podcast 
where we a group of doctors to 

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physical therapy, discuss the 
Art and Science of running and 

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the stuff that we put on our 
feet today at the round table. 

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We have dr. 
Matthew Klein dr. 

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David Salas and I'll be your 
host Nathan Brown. 

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We're excited to be together 
again and talking about 

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something very in our 
wheelhouse. 

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When it comes to what we do day 
today and working with people 

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with different sort of pain 
conditions, and we're going to 

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be talking about something in 
the foot. 

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So we'll get to that. 
At in a minute. 

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But before we do that we are 
going to be trying out something

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new today. 
This is going to be a new 

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segment that we might continue 
through our time. 

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Recording the podcast as long as
you all think it's a good idea. 

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We also don't have a name for 
this segment so if you hear what

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we're doing and you have an idea
for it, let us know. 

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You can comment in the video 
below, you can send us an email 

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at doctors running podcast at 
gmail.com. 

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Let us know what you think. 
We should name this segment but 

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what we really want to do we get
a lot of people asking us about 

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what shoes are you testing? 
What do you About them. 

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We just wanted to take a minute 
where we can eat. 

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You talk about a shoe. 
That's not fully brought through

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our testing protocol and done 
with our testing process, but 

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one that we've been starting to 
test and we could just give some

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initial thoughts. 
So here we go. 

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Let's start with you, David? 
What's a shoe that you've been 

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just starting to get on your 
feet? 

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And what are some initial 
thoughts about it? 

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Yeah, so I mean I'm still coming
back from the marathon. 

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So I haven't done a whole lot of
speed work or anything yet. 

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I probably will this next coming
week. 

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But when looking at the shoes 
that we're testing, Lee, I did 

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some strides in it yesterday. 
I've been doing some strides 

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throughout the last week so kind
of get in the legs back into 

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turning over. 
I did 13 as the maiden voyage, a

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little over that in the New 
Balance. 

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SEL eat today, version 3, yeah, 
SEO Elite 3. 

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Yep. 
So new design, you could sell 

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deep Groove. 
Kind of looks a little bit. 

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Like the SE Pacer, but more 
stacked up. 

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And yeah, more built for the 
marathon distance. 

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It feels. 
Pretty good. 

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I some of the things I've been 
noticing the Rockers, much more 

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balanced than some of these 
other shoes, which I like it's 

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not as aggressive on the toast. 
Bring up front so it feels like 

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something that I can probably 
have a little bit more 

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variability with Pace on feels 
nice. 

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And slow pace has, which is 
good. 

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Feels good at faces. 
So it's nice and versatile from 

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a paste and point haven't taken 
to the track, but I probably 

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will this week, I did notice in 
the upper a little bit like the 

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I think some people have been 
talking about the lacing system 

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a little bit and I felt it a 
little as well, it just bites a 

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little bit and sometimes the top
outside eyelet like the first 

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one up kind of cinches into the 
top of my ankle a little bit and

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that's not the most comfortable,
but then it kind of goes away 

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and then sometimes they're 
sometimes it's not, it's 

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something I can kind of look 
past though, for for this model,

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but something that can 
definitely clean up in the 

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future. 
But for the most part that 

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transitions are actually pretty 
balanced, like it's not like as 

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dramatic of a rocker as some of 
the other shoes. 

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So it's like, Definitely there. 
It's definitely noticeable but 

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it feels much more balanced 
Under Foot. 

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Nice. 
Matt, what about you? 

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What are you? 
Testing lately to do, one or 

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two? 
Let's pick one. 

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Let's pick one. 
All right. 

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I'm gonna have to I want to do 
other things. 

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Sorry to be so racing Focus. 
But the Saucony terminal V. 

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T this bike. 
You already see. 

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It will be available fairly soon
but it's a distance bike from 

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soccer to using their power run,
HG foam, and I'll be honest I've

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been testing some track spikes 
and every time I get on the 

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track I'm like oh here go. 
My calves would be a little 

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worried. 
This is actually been pretty 

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nice. 
You still need good cap strength

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but what I really love it's his 
Getting back to being super 

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wait. 
This thing is 3.7 ounces for 

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What men's size-nine. 
So it is super light and foot. 

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It goes back to the like hey I 
want that. 

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I want just as light as possible
still it's not soft cushioning. 

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It's with this much here. 
There's still plenty underfoot 

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but it's got some nice bounce 
without being crazy. 

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There's no plate. 
There's still flexibility. 

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It's just a fun shoe that you 
could just put on forget about 

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and go run fast. 
So I've enjoyed doing a couple 

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track workouts in this. 
I'll continue getting some stuff

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on here and get a review soon, 
but it's been really nice. 

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Is really, really nice. 
Good fit, really snug like a 

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typical spy. 
Yeah. 

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It's very classic for attract 
Spike where I can't. 

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It's very true to size. 
I can't wear socks or it's too 

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big sockless no chafing at all. 
It's you just strap it on very 

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comfortable but yeah, very snug 
definitely. 

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This is not for white-footed 
people. 

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Cool. 
Well mine, I'll take us away 

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from racing a little bit unless 
it's a different kind of racing 

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but I got 15 miles in this shoe 
this morning. 

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It's the Salomon Glide 2. 
I will you know I wasn't going 

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to take it out but we've been 
getting a lot of snow this week 

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so it's a lot of snow for March.
We just got probably the last 

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couple weeks we've gotten like 
12 to 18 inches and then we got 

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another like for last night so 
it was a run in the snow. 

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Took it for 15 miles. 
A couple of unique things to 

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Solomon. 
Is there kind of quick lace 

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system, it's kind of that bungee
system not bungee because it's 

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not stretchy, but it's got that 
slide lace that can tuck into 

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the to the Hyung, you know what,
it felt fine. 

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I didn't have to adjust it all. 
I didn't feel like it was loose.

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I, I do kind of, I'm curious how
it's going to last over time, if

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it'll slip it all, but it didn't
today and just having to tuck it

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up in the top part of the 
tongue, I did feel like the 

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tongue was a little high so I 
could feel a little bit of 

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rubbing on the front of my 
ankle, but besides that it was 

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good underneath though. 
It felt great. 

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I mean, I have to keep in mind 
that this run was on top of like

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inches of snow. 
So That changes the experience 

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of the ride completely. 
But it's operating on a kind of 

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semi rigid just no plate or 
anything from what I understand,

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but just a semi-rigid for foot. 
But it's got this full rocker 

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design, really smooth rocker and
I felt like the cushioning was 

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great, it's a firmer foam as is 
typical with a lot of Solomon 

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stuff, but not not rock hard. 
It has a little bit of give to 

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it, felt super comfortable. 
I didn't it kind of just 

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disappeared for me today and it 
was a non-event in a really good

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way for a like a long easy slow.
Long run. 

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So I'm excited to get more miles
on this and I'm going to be 

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working on the Ice Age Trail 
which is 1,000 some Mile Trail 

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in Wisconsin so that's where 
I'll take this out but so it 

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might take me a little bit 
longer to get this review out 

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depending on what sort of 
conditions we have because we're

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still getting tons of snow but I
did get good good amount of time

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on my feet on it today and I 
thought it thought of perform 

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well really cushioned upper like
the heel is really stuffed so I 

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did find that. 
It got a little wet because of 

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all the slush and stuff but it 
wasn't uncomfortable and I've I 

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just appreciate it. 
I'm excited to get more miles so

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that's kind of where I'm at with
it. 

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So all these shoes that we just 
talked about, if you keep 

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tracking on our website they 
will, you know, be released full

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reviews with thoughts from 
either just one of us or 

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multiple be from the people from
the team. 

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So, keep an eye out again, if 
you have an idea for a name for 

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the segment, let us know. 
And we might take it and use it 

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for the podcast. 
But now we're going to 

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transition into the topic for 
the day. 

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Again, it's a foot-related, 
pathology Or issue a lot of 

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people call it plantar 
fasciitis. 

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We'll talk about what that term 
means and if it's the most 

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appropriate term to use in y, 
but we're going to be talking 

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about plantar fasciitis. 
So our subjective of the day is 

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have you ever had plantar 
fasciitis? 

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And what did you do about it? 
Because this is one of those 

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where there's a lot of myths, 
that permeate conversations. 

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There's a lot of shoe Tech that 
says, oh, if you have plantar 

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fasciitis, you should have arch 
support. 

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You should have all these 
things. 

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So we just want to talk about 
those. 

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Where's the Merit? 
Where isn't the Merit and And as

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always, we do that through a 
little bit of a deep dive. 

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So David I'm going to pitch the 
first question to you. 

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If you're up for it, can you 
just tell us about what is the 

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plantar fascia from? 
An anatomy perspective? 

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What's it function? 
And that kind of thing. 

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What is it? 
What's kind of structure? 

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Yeah, when we take a look at the
plantar fascia from an 

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anatomical standpoint, it's 
essentially a band of thick 

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tissue that's passive. 
It goes from the heel. 

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Bone connects all the way up 
through the bridge to the 

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basically to your forefoot. 
And it goes underneath there and

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you have all your intrinsic foot
muscles, everything underneath 

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and kind of gives you a little 
passive sort of support there. 

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It ends up being a little bit 
more Dynamic than it sounds 

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because it is not a contractile 
tissue. 

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But at the same time, things 
like the calves or the intrinsic

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muscles can greatly affect how 
this is moving. 

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Stretch tensioned slackened, all
of the above including some 

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things further up the chain. 
But essentially it's a passive 

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support structure that acts like
a little Bridge Under the foot. 

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And so when people have plantar,
fasciitis itís in the medical 

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world, kind of means 
inflammation, they usually get 

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it right at the base of the 
heel. 

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Sometimes it's kind of cooped up
on the inside a little bit, kind

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of underneath, and on the inside
of the heel on the medial aspect

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and usually it's irritated with,
you know, when it's inflamed, at

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least things like running, 
pushing off walking 

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weight-bearing using your leg. 
So yeah, a great mat. 

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00:10:02,900 --> 00:10:04,300
You want to add anything to 
that? 

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00:10:04,500 --> 00:10:09,400
All know, I think they'll great.
Great DJ hit, now the park. 

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00:10:09,600 --> 00:10:13,200
So let's talk about a little bit
about Matt, you know, David just

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talked about what plantar 
fasciitis is. 

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We talked about inflammation, 
another term that's used is 

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fashio. 
Apathy some people say plantar, 

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fascia pain, what's the 
difference between those two 

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terms and why are they used? 
Yeah, it's a great question. 

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I think very commonly in the 
medical community, fasciitis. 

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So, itís always means acute 
inflammation, right. 

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This thing just got irritated. 
You've got a traditional 

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inflammatory response or bars. 
Like, oh my gosh, this is her 

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with, there's damage here. 
We got to go fix this, kind of 

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stuff. 
And yeah, that's how a lot of 

225
00:10:44,800 --> 00:10:48,300
things are coin, right? 
So, patellar, tendonitis, 

226
00:10:48,300 --> 00:10:52,800
achilles tendonitis and the 
plantar fascia is very much like

227
00:10:52,800 --> 00:10:54,100
his other things. 
There's actually some 

228
00:10:54,100 --> 00:10:58,000
interesting arguments of the 
plantar fascia, may not be just 

229
00:10:58,100 --> 00:10:59,700
a ligament or other type of 
issue. 

230
00:10:59,700 --> 00:11:02,600
It might be actually considered 
similar to a tendon because a 

231
00:11:02,600 --> 00:11:04,300
lot of the pathologies in the 
way response. 

232
00:11:04,400 --> 00:11:05,900
Actually very similar to 
attendance. 

233
00:11:05,900 --> 00:11:08,600
So some theories that it might 
be an extension of Achilles 

234
00:11:08,600 --> 00:11:10,100
tendon. 
That's a different story, but 

235
00:11:10,100 --> 00:11:12,400
going back to the question and 
staying on topic. 

236
00:11:12,400 --> 00:11:15,600
Fasciitis would refer to like 
hey this just happened. 

237
00:11:15,600 --> 00:11:18,200
The challenge with this is and 
we know this from some of the 

238
00:11:18,200 --> 00:11:22,100
exploratory literature out there
that it usually didn't just do 

239
00:11:22,100 --> 00:11:24,700
it, just got hurt. 
This thing has gotten loaded for

240
00:11:24,700 --> 00:11:27,300
a long time and there may have 
been an inflammatory response a 

241
00:11:27,300 --> 00:11:30,400
long time ago and you may not 
have known, you can have an 

242
00:11:30,400 --> 00:11:32,700
irritation and not have pain. 
That's a whole different 

243
00:11:32,700 --> 00:11:35,000
discussion. 
On what pain is But what we're 

244
00:11:35,000 --> 00:11:37,900
finding with lot of these things
is this often got irritate a 

245
00:11:37,900 --> 00:11:40,100
long time ago, you may have felt
something may have not. 

246
00:11:40,100 --> 00:11:42,900
So when it actually starts 
showing up and you're noticing 

247
00:11:42,900 --> 00:11:47,100
it, it may be a fashio apathy 
which the APA Theory or osis 

248
00:11:47,100 --> 00:11:48,800
it's the tendons, are called, 
like, tendinosis or 

249
00:11:48,800 --> 00:11:51,300
tendinopathy. 
These, those are the long-term 

250
00:11:51,300 --> 00:11:56,300
chronic irritations, where how 
it's getting inflamed is no 

251
00:11:56,300 --> 00:11:59,300
longer like, when it just got 
irritated, you know, if you have

252
00:11:59,300 --> 00:12:03,300
an acute or very short-term 
irritation you, try to calm some

253
00:12:03,300 --> 00:12:05,200
that inflammation down. 
Maybe reduce some of the 

254
00:12:05,200 --> 00:12:07,800
swelling, right? 
And anti-inflammatory, although 

255
00:12:07,800 --> 00:12:10,600
there's some argument that may 
be helpful to calm things down a

256
00:12:10,600 --> 00:12:13,000
little bit. 
That's not how these response 

257
00:12:13,000 --> 00:12:15,600
because the inflammation there 
isn't just happening. 

258
00:12:15,600 --> 00:12:18,700
It's been sticking around. 
It's well acquainted with this 

259
00:12:18,700 --> 00:12:20,300
era. 
It's it knows this neighborhood.

260
00:12:20,300 --> 00:12:22,700
Super well and anti-inflammatory
and soft. 

261
00:12:22,700 --> 00:12:26,200
Typically, typically do not work
for these because it's just 

262
00:12:26,200 --> 00:12:27,900
different. 
The pathology is different. 

263
00:12:27,900 --> 00:12:30,300
So that's just we've learned. 
So a lot of people I go. 

264
00:12:30,300 --> 00:12:32,200
I'm taking these 
anti-inflammatories or not 

265
00:12:32,200 --> 00:12:33,200
icing. 
I'm not do anything. 

266
00:12:33,200 --> 00:12:35,600
It's like, Yeah, that's an 
apathy. 

267
00:12:35,600 --> 00:12:38,100
This has been going on for a 
little bit when it started. 

268
00:12:38,800 --> 00:12:41,900
Don't know, we just know that 
you notice it now and hopefully 

269
00:12:41,900 --> 00:12:43,200
that means you're going to do 
something about it. 

270
00:12:44,000 --> 00:12:47,100
So you're kind of talking about 
like, how this Progressive 

271
00:12:47,100 --> 00:12:50,400
loading over time. 
This kind of repetitive 

272
00:12:50,400 --> 00:12:52,500
irritation that you may or may 
not feel. 

273
00:12:53,400 --> 00:12:56,000
Can you talk then about? 
What are these mechanisms that 

274
00:12:56,000 --> 00:12:57,300
do? 
Irritate it, what is it? 

275
00:12:57,300 --> 00:12:59,200
That puts stress through this 
structure? 

276
00:12:59,400 --> 00:13:02,400
David mentioned weight-bearing, 
but kind of just talk about 

277
00:13:02,400 --> 00:13:05,400
what? 
What stress and Rain our way as 

278
00:13:05,400 --> 00:13:07,200
it relates to the plantar 
fascial a little bit more. 

279
00:13:07,200 --> 00:13:09,400
Yeah, that's a great question. 
I'm going to say a couple 

280
00:13:09,400 --> 00:13:14,800
comments but know that as we 
learn more this concept might 

281
00:13:14,800 --> 00:13:17,500
change. 
So the previous evidence has 

282
00:13:17,500 --> 00:13:19,600
been that. 
This is a passive structure. 

283
00:13:19,600 --> 00:13:23,300
Meaning you know, there's no 
muscle attached to it supposedly

284
00:13:23,300 --> 00:13:28,700
and it really is just there as a
kind of ligament kind of not to 

285
00:13:28,700 --> 00:13:32,200
provide some passive stability 
to the arch and the under the 

286
00:13:32,208 --> 00:13:34,600
planter underside of the foot. 
Foot. 

287
00:13:34,600 --> 00:13:36,900
Right? 
It kind of supports sewage, a 

288
00:13:36,908 --> 00:13:39,700
couple different components, the
different bones that are there. 

289
00:13:39,700 --> 00:13:42,700
And you know, for some people 
keeps up a high arch for some 

290
00:13:42,700 --> 00:13:45,000
people that got a little moral 
laxity, keeps a little bit 

291
00:13:45,000 --> 00:13:47,200
lower. 
Don't worry too much about that.

292
00:13:49,300 --> 00:13:52,700
Go at the question again. 
Well I'm sorry just mechanisms 

293
00:13:52,700 --> 00:13:54,400
distress of mechanisms letter 
finish. 

294
00:13:54,400 --> 00:13:58,300
This is great so they're sorry 
it's been a lot of break. 

295
00:13:58,300 --> 00:14:00,200
He noticed another, I got it, I 
got it. 

296
00:14:04,400 --> 00:14:06,900
Technically, right? 
Because original one and then 

297
00:14:06,900 --> 00:14:09,900
three more it again, so many. 
It's too many. 

298
00:14:10,100 --> 00:14:13,400
So mechanisms of irritation, 
very common ones. 

299
00:14:13,400 --> 00:14:16,700
Since they take the ligaments, 
tend to be and keep your arch up

300
00:14:16,700 --> 00:14:20,500
a little bit excessive motion, 
going the other direction as 

301
00:14:20,500 --> 00:14:22,600
people would call it pronation 
which I don't want to say that's

302
00:14:22,600 --> 00:14:26,400
a bad thing but just motion that
continues to go that direction 

303
00:14:26,400 --> 00:14:29,800
excessively and stretch that 
tissue can certainly be a 

304
00:14:29,800 --> 00:14:32,200
mechanism that can irritate it. 
We know from some of the 

305
00:14:32,200 --> 00:14:36,300
systematic reviews that have a 
having a little bit more like 

306
00:14:36,300 --> 00:14:38,900
kind of collapse, excessive 
pronation there that may be 

307
00:14:38,900 --> 00:14:42,000
loading that we actually know 
that the opposite is true that 

308
00:14:42,000 --> 00:14:45,300
having a very high arch has also
been found to be a risk factor 

309
00:14:45,300 --> 00:14:48,100
for plantar fasciitis. 
So and you will see this theme 

310
00:14:48,300 --> 00:14:53,000
is that a lack of motion or too 
much motion, seems to be a risk 

311
00:14:53,000 --> 00:14:54,800
factor for the for the plantar 
fascia. 

312
00:14:54,800 --> 00:14:58,100
So to hire an arch or too much 
motion through, the art seems to

313
00:14:58,108 --> 00:15:01,500
be ways that can stress that 
tissue going up to the knee. 

314
00:15:01,500 --> 00:15:04,200
They've actually seen that a 
varus knee alignment. 

315
00:15:04,400 --> 00:15:07,100
Going out that direction. 
You're going out this way can 

316
00:15:07,100 --> 00:15:10,000
actually be a mechanism for 
stressing it. 

317
00:15:10,400 --> 00:15:14,000
We've seen excessive load 
through their long term so 

318
00:15:14,000 --> 00:15:16,800
excessive amounts of standing 
especially if you have a little 

319
00:15:16,800 --> 00:15:19,600
bit higher weight, that tip the 
higher weight typically Works 

320
00:15:19,600 --> 00:15:21,700
more for the non-athletic of 
visuals. 

321
00:15:21,900 --> 00:15:24,200
The ones that are athletic that 
doesn't seem to matter as much 

322
00:15:24,200 --> 00:15:26,800
but anybody that has got a stand
on their feet all day and 

323
00:15:26,800 --> 00:15:29,600
they're continually loading, 
that tissue, certainly can be a 

324
00:15:29,608 --> 00:15:31,400
risk factor for that. 
We've seen some interesting 

325
00:15:31,400 --> 00:15:34,200
studies where forefoot pronation
actually. 

326
00:15:34,300 --> 00:15:36,500
Stressed out a little bit more 
based on where the ligaments, 

327
00:15:36,500 --> 00:15:40,200
attach I already mentioned 
excessive amounts of motion. 

328
00:15:40,300 --> 00:15:44,100
What's weird is from some of the
reviews that we've seen actual 

329
00:15:44,100 --> 00:15:49,100
impact, not as much of a risk 
factor like loading and stuff 

330
00:15:49,100 --> 00:15:52,900
like that, but prolonged 
excessive pressure can be a 

331
00:15:52,900 --> 00:15:56,000
little bit more of a risk 
factor. 

332
00:15:56,000 --> 00:15:58,900
And the other thing that's very 
unique is there is not one shoe 

333
00:15:58,900 --> 00:16:02,400
that's been found to reduce this
risk. 

334
00:16:02,400 --> 00:16:04,200
The only thing that we found is 
that a shoe? 

335
00:16:04,300 --> 00:16:06,600
Rotation is the only thing 
associated with decreased 

336
00:16:06,600 --> 00:16:08,700
plantar fascial risk. 
You asked me for a risk factors,

337
00:16:08,700 --> 00:16:11,600
but I'm going the other way too.
Well, yeah. 

338
00:16:11,600 --> 00:16:15,400
And we'll talk more about shoes 
at the, at the end to because I 

339
00:16:15,408 --> 00:16:17,900
think, you know, that's 
obviously a question that people

340
00:16:17,900 --> 00:16:20,500
come to us about to kind of, 
think about the Practical side 

341
00:16:20,500 --> 00:16:22,500
of usual, utilizing shoes. 
But go ahead. 

342
00:16:22,500 --> 00:16:23,700
Matt. 
And of course, how could I 

343
00:16:23,708 --> 00:16:25,500
forget those? 
The other thing that's excessive

344
00:16:25,500 --> 00:16:28,900
or too much, is that we found 
that the lot of people think, 

345
00:16:28,900 --> 00:16:32,300
oh, I got to stretch this. 
So we found that too, much, 

346
00:16:32,400 --> 00:16:34,200
ankle, Mobility, so your tail. 
Oh cruel. 

347
00:16:34,300 --> 00:16:38,900
You're bending too much mobility
and to little are both risk 

348
00:16:38,900 --> 00:16:41,600
factors for plantar, fasciotomy 
theor, fasciitis as well. 

349
00:16:42,100 --> 00:16:45,700
Yeah, well and David maybe this 
is a question for you to kind of

350
00:16:45,708 --> 00:16:48,800
start talking about and when we 
talk about too much or too 

351
00:16:48,800 --> 00:16:52,000
little of something, I think 
something that's often tied to 

352
00:16:52,300 --> 00:16:57,100
the conversation around plantar 
fasciitis, as it's talked about 

353
00:16:57,100 --> 00:17:00,200
or plantar fascial pain is what 
impact do low. 

354
00:17:00,200 --> 00:17:04,200
Arches are flat feet, have on 
that and maybe on the other. 

355
00:17:04,300 --> 00:17:07,099
I'd those high arches. 
This has been kind of we've 

356
00:17:07,099 --> 00:17:09,099
dabbled with this a little bit, 
but what kind of thoughts do you

357
00:17:09,108 --> 00:17:12,400
have on terms of what do we know
about the relationship between 

358
00:17:13,200 --> 00:17:17,200
flat feet and plantar fascia 
pain or high arches and plantar 

359
00:17:17,200 --> 00:17:19,599
fascia pain? 
Yeah, I think the question is 

360
00:17:19,599 --> 00:17:24,099
bigger than the two categories 
as well, client, kind of alluded

361
00:17:24,099 --> 00:17:28,200
to this, but let's say we have 
too much ankle Mobility. 

362
00:17:28,800 --> 00:17:30,900
Probably have some laxity, 
things are moving around a 

363
00:17:30,908 --> 00:17:33,500
little bit. 
Just what I tell people is 

364
00:17:33,500 --> 00:17:36,200
having a lot of Range of motion 
in and of itself is not a bad 

365
00:17:36,200 --> 00:17:38,000
thing. 
As long as you can control it, 

366
00:17:38,300 --> 00:17:41,000
and if you can't control it, 
now, we have issues because 

367
00:17:41,000 --> 00:17:43,400
you're going to start doing 
things with other joints in 

368
00:17:43,400 --> 00:17:46,500
order to make the motion happen 
in a smooth way. 

369
00:17:47,000 --> 00:17:52,400
So usually and this is more 
generally speaking but if you 

370
00:17:52,400 --> 00:17:55,900
have more Mobility let's say you
are a little bit more flat 

371
00:17:55,900 --> 00:17:57,800
footed the ligaments their 
little more lacks. 

372
00:17:57,800 --> 00:18:00,400
There's a little bit more going 
on, you're going to have kind of

373
00:18:00,400 --> 00:18:02,700
a greater Arc of motion there 
just in general. 

374
00:18:04,600 --> 00:18:07,300
That may be through the ankle, 
that maybe through more knee, 

375
00:18:07,300 --> 00:18:11,300
flexion that maybe through more 
hip rotation, it could be a lot 

376
00:18:11,300 --> 00:18:15,100
of different things going on. 
But normally you're going to 

377
00:18:15,108 --> 00:18:18,400
have a little bit more of a 
moment there, if it's a more of 

378
00:18:18,400 --> 00:18:21,000
a flat foot pronation type 
presentation. 

379
00:18:21,000 --> 00:18:23,500
Now if it's the other way you 
have a high arch again. 

380
00:18:23,500 --> 00:18:26,300
Generally speaking, you're going
to be a little more taut 

381
00:18:26,300 --> 00:18:28,800
underneath, you're going to be a
little bit more of a supinated 

382
00:18:28,800 --> 00:18:30,800
position. 
And at rest, that's where that 

383
00:18:30,800 --> 00:18:32,800
mid-foot, subtalar joint, 
everything's a little bit more 

384
00:18:32,800 --> 00:18:35,100
locked out. 
And that's a great. 

385
00:18:35,100 --> 00:18:37,400
If you're pushing off, you want 
to have tension, you want to be 

386
00:18:37,400 --> 00:18:41,300
able to lever from that for foot
and really get off and and push 

387
00:18:41,300 --> 00:18:44,300
off. 
However, if you're in that 

388
00:18:44,300 --> 00:18:47,900
position a lot, you don't 
attenuate Force very well and so

389
00:18:47,900 --> 00:18:51,400
it goes both ways and that's 
strictly speaking at the foot, 

390
00:18:51,400 --> 00:18:54,000
but that can also happen like 
client side with a various new 

391
00:18:54,000 --> 00:18:56,100
position. 
It's going to set you up for a 

392
00:18:56,100 --> 00:18:58,600
little bit of a predisposition 
to be kind of on the outside of 

393
00:18:58,600 --> 00:18:59,500
that foot. 
Anyways. 

394
00:19:00,800 --> 00:19:05,100
So I think the question so much 
bigger than just Just pronation 

395
00:19:05,100 --> 00:19:08,000
like flat foot high arch. 
There's a lot of things that can

396
00:19:08,000 --> 00:19:11,300
go into that passive and or 
dynamic position. 

397
00:19:12,200 --> 00:19:15,300
But generally speaking, usually 
when it's a little bit more 

398
00:19:15,300 --> 00:19:17,400
locks, you're going to have a 
greater range, you're going to 

399
00:19:17,400 --> 00:19:19,700
move through a larger range, you
just got to be able control it 

400
00:19:20,100 --> 00:19:22,200
with having it a little bit 
stiffer. 

401
00:19:22,300 --> 00:19:25,200
Not moving through a full range,
you may have to work on Mobility

402
00:19:25,200 --> 00:19:27,500
a little bit more and or control
elsewhere. 

403
00:19:28,000 --> 00:19:29,600
Yeah, I think that's big and 
something. 

404
00:19:29,600 --> 00:19:32,600
I think that you hit on and so 
that's important is it's not so 

405
00:19:32,600 --> 00:19:36,700
much the presence of Flat foot. 
In fact, when you, when you look

406
00:19:36,700 --> 00:19:40,400
at the systematic reviews about 
risk, factors for plantar fascia

407
00:19:40,400 --> 00:19:42,100
pain. 
It's not just the presence of a 

408
00:19:42,100 --> 00:19:44,500
flat foot, that's not even on 
the list, didn't even make the 

409
00:19:44,500 --> 00:19:46,100
list. 
But what did make it as your 

410
00:19:46,100 --> 00:19:48,700
ability to control those motions
and how much time you're 

411
00:19:48,700 --> 00:19:51,600
spending there during a 
movement, like running and the 

412
00:19:51,600 --> 00:19:54,400
Ville, how much velocity it? 
You're driving into that 

413
00:19:54,400 --> 00:19:55,700
position. 
So it's a lot more about 

414
00:19:55,700 --> 00:19:58,600
control, which means it's not 
about your foot, it's about your

415
00:19:58,600 --> 00:20:03,600
foot, your calf, your knee, your
thigh muscles, your hamstrings, 

416
00:20:03,600 --> 00:20:06,200
like Everything is involved 
because it's about the whole 

417
00:20:06,200 --> 00:20:09,700
movement pattern and not about 
the presence of a flat foot. 

418
00:20:09,700 --> 00:20:12,900
But what is what does make the 
list is what's called a canvas 

419
00:20:13,100 --> 00:20:16,800
or cavus foot arch profile and 
posture. 

420
00:20:16,800 --> 00:20:19,100
And so that's more of the high 
arch people. 

421
00:20:19,800 --> 00:20:24,100
And so that's when you know if 
if your foot never goes through 

422
00:20:24,100 --> 00:20:27,300
motion to attenuate those forces
like you said, that means that 

423
00:20:27,300 --> 00:20:30,400
the only thing that's going to 
take the stress is going to be 

424
00:20:30,400 --> 00:20:33,800
the plantar fascia because the 
bones and joints can't. 

425
00:20:34,000 --> 00:20:35,600
You see, you only get the one 
thing. 

426
00:20:35,600 --> 00:20:39,300
So sometimes those flat flat 
foot might even help some people

427
00:20:39,300 --> 00:20:42,700
because look at the risk factors
based on systematic reviews say 

428
00:20:42,700 --> 00:20:46,400
that it's high arches, not low, 
arches that play a role in then 

429
00:20:46,400 --> 00:20:49,500
it's everything coming together 
to control whatever movement 

430
00:20:49,500 --> 00:20:51,900
that you have going on. 
Matt, did you have something? 

431
00:20:52,100 --> 00:20:55,000
Yeah, and I want to add again. 
A lot of the evidence has been a

432
00:20:55,000 --> 00:20:58,100
little iffy on, hey, a static 
foot posture. 

433
00:20:58,100 --> 00:21:00,400
Although ironically as you 
mentioned, and as we mentioned, 

434
00:21:00,600 --> 00:21:02,900
it's that high some of the 
higher Arch positions are 

435
00:21:02,900 --> 00:21:05,500
actually increased and I think 
you hit it on the head when you 

436
00:21:05,500 --> 00:21:08,900
said you know that tissues never
gotten a chance to stretch or 

437
00:21:08,900 --> 00:21:12,100
move very much and so if you ask
it to do that all of a sudden 

438
00:21:12,100 --> 00:21:13,500
then all of a sudden yeah that 
makes sense. 

439
00:21:13,700 --> 00:21:15,900
Where somebody has a flatter 
foot posture. 

440
00:21:16,100 --> 00:21:18,500
They might have a little bit 
more laxity in that tissue 

441
00:21:18,500 --> 00:21:20,800
already so it's already going to
be able to handle that stretch. 

442
00:21:20,800 --> 00:21:23,300
That doesn't mean you still 
can't overwork it and you 

443
00:21:23,300 --> 00:21:26,400
certainly can. 
It just means just because you 

444
00:21:26,400 --> 00:21:29,700
have flat feet don't freak out 
the same thing. 

445
00:21:29,700 --> 00:21:32,700
If you have a higher Arch also 
don't freak out, you got to know

446
00:21:32,700 --> 00:21:35,500
hey there it's Ever one thing. 
That's that's the key. 

447
00:21:35,500 --> 00:21:37,900
That was one of the big factors 
from these systematic reviews is

448
00:21:37,900 --> 00:21:41,500
it's never one thing it's always
a culmination of factors. 

449
00:21:41,700 --> 00:21:44,200
So trying to pinpoint. 
One thing is not a great use of 

450
00:21:44,200 --> 00:21:47,700
your time but going, hey I got a
couple these things. 

451
00:21:47,700 --> 00:21:50,100
I might, you know, might want to
start addressing some of those. 

452
00:21:50,500 --> 00:21:52,200
That's probably a better way to 
handle that. 

453
00:21:52,200 --> 00:21:52,600
Go ahead. 
David. 

454
00:21:52,600 --> 00:21:56,100
Yeah, and I know our Niche is 
primarily running but when you 

455
00:21:56,100 --> 00:21:59,500
take a look at plantar fascial, 
Bethy, whatever you want to call

456
00:21:59,500 --> 00:22:02,900
it, you know, fasciitis, I think
it's important to take a look at

457
00:22:02,900 --> 00:22:06,200
the direction of load. 
O2 and anecdotally people that 

458
00:22:06,200 --> 00:22:08,800
have had a little bit higher, 
you know, cavus positions. 

459
00:22:08,800 --> 00:22:11,000
In that mid-foot, I've noticed 
that a lot too and soccer 

460
00:22:11,000 --> 00:22:13,600
players and a lot of people that
have to do these forceful 

461
00:22:14,900 --> 00:22:16,700
horizontal plane motions, you 
know, where they have to go in 

462
00:22:16,700 --> 00:22:20,600
the front of planning, sorry 
where they have to go into a 

463
00:22:20,600 --> 00:22:24,100
very forceful adduction and or 
abduction moment and they have 

464
00:22:24,100 --> 00:22:27,100
to be able to control their limb
as they move into that space. 

465
00:22:27,100 --> 00:22:29,400
And if they can't control it and
they're planting just really 

466
00:22:29,400 --> 00:22:34,000
hard on those passive structures
that might lead to some other In

467
00:22:34,000 --> 00:22:36,500
that area as well. 
And that might actually lead 

468
00:22:36,500 --> 00:22:40,000
more to some of that fasciitis 
in some cases, you know, if it's

469
00:22:40,000 --> 00:22:43,200
an acute ramp up and they're 
just slamming it into the ground

470
00:22:44,300 --> 00:22:47,600
coming, from an angle, you know.
That's what's challenging about.

471
00:22:47,600 --> 00:22:51,400
The plantar fascia is it's this 
wonderful tissue that actually 

472
00:22:51,400 --> 00:22:53,900
helps you transfer forces. 
So people like, oh, I should cut

473
00:22:53,900 --> 00:22:56,700
this out and they've done that. 
It's not the best idea, because 

474
00:22:56,700 --> 00:22:59,600
then you lose a method of 
transfer about force transfer. 

475
00:22:59,900 --> 00:23:03,700
So when you're Landing right, 
this is what helps as you start 

476
00:23:03,800 --> 00:23:07,100
Transitioning through that that 
gait cycle as your foot goes 

477
00:23:07,100 --> 00:23:08,800
flat. 
Especially as you get on to the 

478
00:23:08,800 --> 00:23:11,600
forefoot when you get on the 
floor foot, the plantar fascia 

479
00:23:11,600 --> 00:23:13,700
actually helps lock everything 
up. 

480
00:23:13,700 --> 00:23:17,300
So as David mentioned you can 
now push off from a rigid 

481
00:23:17,300 --> 00:23:20,900
platform rather than a platform 
is not the right word but like a

482
00:23:20,900 --> 00:23:25,300
rigid base Foundation looking 
for a rigid base a rigid 

483
00:23:25,300 --> 00:23:27,500
Foundation rather than kind of a
more loose one. 

484
00:23:27,500 --> 00:23:29,600
So you can actually transfer 
your Force better. 

485
00:23:29,600 --> 00:23:32,700
The challenge is when you're 
trying to do that in ways that 

486
00:23:32,700 --> 00:23:35,300
maybe it's not set up. 
With like excessive frontal 

487
00:23:35,300 --> 00:23:37,700
plane side to side motion, you 
really loading that you don't 

488
00:23:37,700 --> 00:23:41,100
have as good a movement control 
that might be a little bit more 

489
00:23:41,100 --> 00:23:42,600
challenging. 
Right? 

490
00:23:42,600 --> 00:23:45,600
So you know, it's just asking, 
are you using this tissue 

491
00:23:45,600 --> 00:23:48,300
correctly? 
I think is the big big thing and

492
00:23:48,300 --> 00:23:51,800
if you're not which again that 
what you good and not good will 

493
00:23:51,800 --> 00:23:53,400
be very different for each 
person. 

494
00:23:53,800 --> 00:23:55,500
That's probably where it's going
to get pissed off. 

495
00:23:55,500 --> 00:23:57,800
And again, the difference going,
you don't know when that 

496
00:23:57,800 --> 00:23:59,300
happened and that's the really 
hard part. 

497
00:23:59,300 --> 00:24:00,900
That's why a history is so 
important going. 

498
00:24:01,300 --> 00:24:03,700
What do you do? 
What kind of activities are you?

499
00:24:03,800 --> 00:24:06,800
Going through what as there? 
Any changes things like that. 

500
00:24:06,800 --> 00:24:08,600
That's why when you're working 
with a medical profession or 

501
00:24:08,600 --> 00:24:09,900
kind of look at yourself to 
going. 

502
00:24:10,300 --> 00:24:11,800
Was there a change that happen 
or is this pain? 

503
00:24:11,800 --> 00:24:15,300
This long-standing thing that 
keeps getting annoyed? 

504
00:24:15,600 --> 00:24:16,900
That's where it can be 
challenging? 

505
00:24:16,900 --> 00:24:18,900
Yeah. 
Yeah. 

506
00:24:19,400 --> 00:24:21,700
Also when map when did you lose 
the bucket? 

507
00:24:21,700 --> 00:24:24,400
I just took it off because you 
just hats getting too hot. 

508
00:24:24,400 --> 00:24:28,800
My head is sweating fair enough.
She's very nice fine. 

509
00:24:29,300 --> 00:24:35,600
All right, so let's see what. 
All right. 

510
00:24:35,600 --> 00:24:40,100
So one of the things that I like
to do when I'm looking through, 

511
00:24:40,500 --> 00:24:43,500
you know, systematic reviews, or
any sort of study, that's trying

512
00:24:43,500 --> 00:24:47,100
to identify risk factors for 
something, I kind of do two 

513
00:24:47,100 --> 00:24:49,400
things, one of them. 
Is I try to understand the. 

514
00:24:49,400 --> 00:24:53,300
Why behind each of those risk 
factors that's really helpful 

515
00:24:53,300 --> 00:24:55,800
from a treatment perspective. 
If you're a physical therapist, 

516
00:24:56,100 --> 00:24:59,000
does a really nice exercise to 
do is to understand the, why 

517
00:24:59,000 --> 00:25:01,400
behind each of those because 
that can help you determine 

518
00:25:01,400 --> 00:25:04,200
treatment plans. 
And then in the same vein, what 

519
00:25:04,200 --> 00:25:07,800
I like to do is look through the
list and try to find the modify 

520
00:25:07,900 --> 00:25:11,700
easily, modifiable risk factors,
because some of them are fixed 

521
00:25:11,700 --> 00:25:15,100
things, they're part of who you 
are as a human that you can't 

522
00:25:15,100 --> 00:25:17,600
necessarily change. 
But there are ones that are very

523
00:25:17,600 --> 00:25:19,400
easily. 
Modified, especially through 

524
00:25:19,400 --> 00:25:21,000
exercise. 
So, in the case of plantar, 

525
00:25:21,000 --> 00:25:23,400
fascia pain, when you go through
the list of all the risk 

526
00:25:23,400 --> 00:25:27,400
factors, some of them are low 
toe flexors strength, less 

527
00:25:27,400 --> 00:25:33,000
hamstring flexibility excessive 
or limited ankle mobility and 

528
00:25:33,000 --> 00:25:36,400
then overall a total lack of 
regular exercise. 

529
00:25:36,400 --> 00:25:40,400
So if you're kind of a weekend 
warrior, so when you look at 

530
00:25:40,400 --> 00:25:43,700
those things, there's easy 
exercises to add in, whether you

531
00:25:43,700 --> 00:25:46,600
have this or you know, 
prevention's tricky. 

532
00:25:46,600 --> 00:25:48,500
We can't measure prevention very
Lie. 

533
00:25:48,500 --> 00:25:50,800
But if you do want to, you know,
stay healthy. 

534
00:25:50,800 --> 00:25:53,800
You can look at risk factors and
then minimize your risk factors 

535
00:25:53,800 --> 00:25:56,300
for that thing in theory that 
may help you. 

536
00:25:56,300 --> 00:26:00,300
So, can we talk a little bit 
about some tips when it comes to

537
00:26:00,300 --> 00:26:02,700
reducing your risk factors for 
plantar, fascial pain. 

538
00:26:02,700 --> 00:26:06,300
So again, things like toe, 
flexors strength, limitations, 

539
00:26:06,300 --> 00:26:09,600
or hamstring flexibility, 
excessive or limited ankle 

540
00:26:09,600 --> 00:26:11,700
Mobility. 
Like are there things in those 

541
00:26:11,700 --> 00:26:15,000
Realms that you like in terms of
maybe some of your own routine 

542
00:26:15,000 --> 00:26:17,800
that you do or things you 
prescribed to patients to help 

543
00:26:17,800 --> 00:26:20,600
with those? 
Those sorts of limitations, I 

544
00:26:20,600 --> 00:26:22,800
think one of the key things just
because there has been some 

545
00:26:22,800 --> 00:26:25,900
increasing evidence on some of 
the intrinsic muscle strength of

546
00:26:25,900 --> 00:26:28,200
the foot, meaning the muscles 
that are specific to that area 

547
00:26:28,200 --> 00:26:30,700
and ironically there's been less
a little bit less of the 

548
00:26:30,700 --> 00:26:34,100
extrinsic ones up higher. 
But you know some of the smaller

549
00:26:34,100 --> 00:26:37,500
muscles like your toe flexors or
your medial Arch, muscles are 

550
00:26:37,500 --> 00:26:40,300
all muscles. 
That sit either around or top of

551
00:26:40,300 --> 00:26:43,900
just that basically support the 
this tissue. 

552
00:26:43,900 --> 00:26:46,900
And while the the planar patch 
itself, is not contractile, all 

553
00:26:46,900 --> 00:26:50,400
this other stuff is, if you Keep
that stuff really strong, which 

554
00:26:50,400 --> 00:26:53,000
a lot of people don't use that. 
You don't go around, you know, 

555
00:26:53,000 --> 00:26:56,000
when you're an adult playing in 
the grass and wiggling your toes

556
00:26:56,000 --> 00:26:59,100
around and people don't do that,
it'd be great if they did but 

557
00:26:59,100 --> 00:27:02,500
people don't do that. 
So keeping the muscles strong 

558
00:27:02,500 --> 00:27:05,700
that support, that tissue is 
really important because David 

559
00:27:05,700 --> 00:27:09,900
and Nathan both said this. 
It Mobility, you know, you want 

560
00:27:09,900 --> 00:27:12,200
to have some Mobility. 
There's a balance of it, but you

561
00:27:12,200 --> 00:27:14,500
really want to make sure you 
have control of it and that 

562
00:27:14,500 --> 00:27:17,500
controls going to come from 
muscles, especially muscles 

563
00:27:17,500 --> 00:27:19,100
locally. 
You know, there's some other 

564
00:27:19,100 --> 00:27:21,500
ones farther away that you might
want to pay attention to. 

565
00:27:21,500 --> 00:27:25,300
But definitely keeping that foot
strength up is really important 

566
00:27:25,300 --> 00:27:28,700
and there's platoons ways you 
can do that till flexor stuff 

567
00:27:28,700 --> 00:27:30,700
that Yoga Toes. 
Are you have the the not the 

568
00:27:30,700 --> 00:27:33,700
thumb, the big toe, come up and 
everyone stay down and go on 

569
00:27:33,700 --> 00:27:36,400
back and forth it to be honest. 
Does it really matter? 

570
00:27:36,400 --> 00:27:40,800
No it's just get that stuff 
moving I think but yeah just 

571
00:27:40,800 --> 00:27:42,600
keeping some intrinsic foot 
muscle strength. 

572
00:27:42,800 --> 00:27:45,800
The other thing is being aware 
of your a really stiff or really

573
00:27:45,800 --> 00:27:47,900
loose person if you're really 
stiff. 

574
00:27:48,000 --> 00:27:49,600
You Might want to work on your 
Mobility. 

575
00:27:49,700 --> 00:27:52,000
If you really loose person you 
might want to work on some 

576
00:27:52,000 --> 00:27:55,300
movement control, right? 
So it's working on the things 

577
00:27:55,300 --> 00:27:58,900
that you don't have kind of does
that guy? 

578
00:27:58,900 --> 00:28:01,100
Did you don't have to go 
overboard, but just make sure 

579
00:28:01,100 --> 00:28:02,400
things are a little bit 
balanced. 

580
00:28:02,400 --> 00:28:04,100
You don't have to be perfectly 
lined up. 

581
00:28:04,500 --> 00:28:06,600
That'll perfect. 
Alignment is a lie. 

582
00:28:06,700 --> 00:28:09,400
That's not a thing. 
But going, how do I try to keep 

583
00:28:09,400 --> 00:28:12,400
myself in the middle as much as 
I can? 

584
00:28:12,400 --> 00:28:15,800
And then control it when I go 
out of that is probably the best

585
00:28:15,800 --> 00:28:18,100
wisdom I can give without 
getting into. 

586
00:28:18,200 --> 00:28:21,200
To specifics. 
I think that there's a couple 

587
00:28:21,200 --> 00:28:24,400
that I really like both when it 
comes, I'll start with kind of 

588
00:28:24,400 --> 00:28:28,900
intrinsic foot stuff so and 
extrinsic just total toe flexors

589
00:28:28,900 --> 00:28:31,500
strength. 
So, if you again, like you said,

590
00:28:31,500 --> 00:28:34,600
Matt, if you go on YouTube and 
you just Google or if you're 

591
00:28:34,600 --> 00:28:36,200
home, Josh go on YouTube and 
Google it. 

592
00:28:36,200 --> 00:28:38,400
I guess they're the same 
company, but if you go on 

593
00:28:38,400 --> 00:28:43,100
YouTube and you and you look up 
toe yoga, but there's gonna be a

594
00:28:43,100 --> 00:28:45,300
lot of options, check them out 
and try them. 

595
00:28:45,300 --> 00:28:47,900
What I will tell you is that 
they're going to say do this 

596
00:28:47,900 --> 00:28:49,500
motion. 
In with your feet and you're 

597
00:28:49,500 --> 00:28:51,600
going to look down at your feet 
and be like my feet aren't 

598
00:28:51,600 --> 00:28:52,600
moving. 
Oh yeah. 

599
00:28:52,600 --> 00:28:54,600
It's going to feel like you 
can't do it and it's going to 

600
00:28:54,608 --> 00:28:57,200
feel like you're not able to and
that's kind of the point if 

601
00:28:57,200 --> 00:28:59,400
that's happening for you. 
That's a sign that this is a 

602
00:28:59,400 --> 00:29:00,900
really good thing for you to 
work on. 

603
00:29:00,900 --> 00:29:03,100
They're going to say, lift your 
big toe and keep your other ones

604
00:29:03,100 --> 00:29:05,400
on the ground or keep your big 
toe on the ground and lift your 

605
00:29:05,400 --> 00:29:07,400
other ones up. 
You like I can't do that, or 

606
00:29:07,400 --> 00:29:10,400
they'll say, splay your toes 
apart or created just like an 

607
00:29:10,400 --> 00:29:12,500
arch increase the Dome, and your
foot. 

608
00:29:12,500 --> 00:29:15,200
If you like in the world, am I 
supposed to do this? 

609
00:29:15,400 --> 00:29:19,000
Just keep practicing on a skill 
and it Takes time, it's 

610
00:29:19,000 --> 00:29:22,200
neuromuscular control. 
So that's, that's, I would just 

611
00:29:22,200 --> 00:29:25,000
look those up and just give it 
the diligent time. 

612
00:29:25,000 --> 00:29:27,600
And they're things that you can 
do sitting at your desk 

613
00:29:27,700 --> 00:29:30,700
wherever, or if hopefully you 
can work an active job too. 

614
00:29:30,700 --> 00:29:34,000
But it's easy to do the best 
time and people will do this. 

615
00:29:34,000 --> 00:29:37,200
Now is those boring, Zoom 
meeting through, like, why am I 

616
00:29:37,208 --> 00:29:39,400
here? 
This is, that's the best time. 

617
00:29:39,400 --> 00:29:42,900
So the Parent-Teacher 
conferences, the work meetings, 

618
00:29:42,900 --> 00:29:45,600
all those are the best time to 
do those because then you'll 

619
00:29:45,600 --> 00:29:48,700
actually get something done. 
Well, my boss is I just want to 

620
00:29:48,700 --> 00:29:50,800
put it out there. 
I've been doing foot exercises 

621
00:29:50,800 --> 00:29:53,100
through this entire segment. 
That's great. 

622
00:29:53,900 --> 00:29:57,800
No idea so it's perfect things 
that you know even do it while 

623
00:29:57,800 --> 00:30:00,600
I'm talking with patients, 
sometimes like and I'm like you 

624
00:30:00,600 --> 00:30:03,300
guys can't tell unless you look 
at my foot and I look down and 

625
00:30:03,300 --> 00:30:06,700
I'm they could see my toes like 
in my shoes kind of right now. 

626
00:30:06,700 --> 00:30:09,400
It's now let's try it. 
This is really inappropriate but

627
00:30:09,400 --> 00:30:13,500
I'm going to get my cut it out. 
It's like pelvic floor exercises

628
00:30:13,500 --> 00:30:15,500
if you do it, right? 
No one else should know. 

629
00:30:17,000 --> 00:30:18,600
It's true. 
There's nothing wrong with that.

630
00:30:19,000 --> 00:30:22,400
No, yeah, I didn't know she was 
gonna get cut out if the resets 

631
00:30:22,400 --> 00:30:26,400
inappropriate. 
But you know, I think the other 

632
00:30:26,400 --> 00:30:30,800
thing when we talk about limited
ankle Mobility, there's two 

633
00:30:30,800 --> 00:30:33,000
different. 
Now, there's more than two but 

634
00:30:33,000 --> 00:30:35,400
there's at least two things that
can limit your ankle Mobility. 

635
00:30:35,500 --> 00:30:37,500
One can be the muscles, like 
your calf muscles. 

636
00:30:38,000 --> 00:30:40,600
Think about easy calf, 
stretches, hanging your heel off

637
00:30:40,600 --> 00:30:43,100
a step or a lunge, kind of a 
stretch where you're stretching,

638
00:30:43,100 --> 00:30:44,900
the calf in the back. 
You could stretch, both your 

639
00:30:44,900 --> 00:30:48,000
gastroc, your Soleus figured 
keep your knee straight, it's 

640
00:30:48,000 --> 00:30:50,400
more gastroc. 
If you bend it solely as long 

641
00:30:50,400 --> 00:30:53,700
holds of the key for muscular 
stretching, like a minute plus 

642
00:30:53,700 --> 00:30:56,400
to hold those things. 
Maybe, I think the evidence 

643
00:30:56,400 --> 00:30:58,700
right now in stretching is kind 
of like four to five minutes. 

644
00:30:58,700 --> 00:31:02,900
A day of stretching is what's 
needed to create actual changes 

645
00:31:02,900 --> 00:31:06,700
in muscle length. 
So that's a long time, the other

646
00:31:06,900 --> 00:31:09,800
the exam saves all at once or 
can that be spread out 

647
00:31:09,800 --> 00:31:13,500
throughout the dressing, some 
about like, two sets of two 

648
00:31:13,500 --> 00:31:16,000
minutes or something like that. 
Could be spread about three to 

649
00:31:16,000 --> 00:31:18,500
five times. 
Yes prescription yeah. 

650
00:31:18,500 --> 00:31:20,800
It's not. 
I think that the, the segment's 

651
00:31:20,800 --> 00:31:23,900
need to be at least like 45 
seconds to a minute, but then 

652
00:31:23,900 --> 00:31:27,100
you need a total of five minutes
of that throughout a day. 

653
00:31:27,700 --> 00:31:30,400
But that evidence is is 
squirrely. 

654
00:31:30,400 --> 00:31:32,300
So just take for what it's 
worth. 

655
00:31:32,300 --> 00:31:34,100
The point is you have to hold 
for a long time. 

656
00:31:34,100 --> 00:31:36,400
It's not a 10-second hold. 
That's going to get you changes 

657
00:31:36,400 --> 00:31:37,800
that. 
I think that's that's the big 

658
00:31:37,800 --> 00:31:40,100
picture point. 
The other thing that can limit 

659
00:31:40,100 --> 00:31:43,200
it is you the actual mobility of
your ankle joint? 

660
00:31:43,900 --> 00:31:47,400
And so, a stretch. 
I like to do is to take Take you

661
00:31:47,400 --> 00:31:48,900
kind of have the two ankle 
bones. 

662
00:31:48,900 --> 00:31:52,500
Matt TV, wrinkle model on you. 
He has always got it. 

663
00:31:52,500 --> 00:31:54,600
So if you're watching, you can 
see this on YouTube. 

664
00:31:54,600 --> 00:31:56,100
If you're listening, I'll try to
explain it. 

665
00:31:56,100 --> 00:31:59,600
Well, if you're too, like bony 
ankle bones at the bottom of the

666
00:31:59,600 --> 00:32:03,300
ankle, what you want to do, is 
take a like a band and you'll 

667
00:32:03,300 --> 00:32:05,900
put it just below. 
So in the front of your ankle 

668
00:32:05,900 --> 00:32:10,400
and then put the sides of the 
band below those bones and then 

669
00:32:10,400 --> 00:32:12,500
you'll somehow secure it behind 
you. 

670
00:32:12,500 --> 00:32:15,200
Sometimes, you can do this half 
kneeling, you can put it behind 

671
00:32:15,200 --> 00:32:18,500
your back knee, or you can be 
Standing and you can step on it 

672
00:32:18,500 --> 00:32:21,400
behind you and then you just 
lunge forward and the goal of 

673
00:32:21,400 --> 00:32:24,500
that is to create a glide, 
through the talus or the bottom 

674
00:32:24,500 --> 00:32:26,800
part of the ankle joint. 
So that you can practice, 

675
00:32:26,800 --> 00:32:29,400
bending forward and creating 
Mobility through your joints. 

676
00:32:29,400 --> 00:32:32,600
So those are a couple that I 
like for gaining mobility in the

677
00:32:32,600 --> 00:32:35,900
ankle. 
I also like the ones for like we

678
00:32:35,900 --> 00:32:37,500
talked about for intrinsic foot 
strength. 

679
00:32:37,500 --> 00:32:39,200
David, you have something 
client. 

680
00:32:39,200 --> 00:32:41,700
How do you say that bone the 
tail of that? 

681
00:32:41,700 --> 00:32:43,400
What which what the tail? 
Okay, joint okay. 

682
00:32:43,400 --> 00:32:55,100
Yeah yeah yeah, I see it. 
Yeah, but the bone does not, it 

683
00:32:55,100 --> 00:32:57,000
doesn't matter. 
Doesn't matter if it's are 

684
00:32:57,000 --> 00:33:00,300
correct. 
Yes? 

685
00:33:00,300 --> 00:33:06,100
Yeah, yeah, and I say talisay. 
Sometimes, I'm following you. 

686
00:33:06,100 --> 00:33:14,100
It's like, I'm not sure what's 
the name of the carpal? 

687
00:33:14,100 --> 00:33:16,600
Bone that is most commonly 
fractured with pork. 

688
00:33:16,700 --> 00:33:21,200
This body has definite scaphoid 
escape with it, like a void, I 

689
00:33:21,200 --> 00:33:23,900
say scaphoid. 
Oh, I see scaffold to. 

690
00:33:23,900 --> 00:33:27,100
I hope you can call is gave 
students a work with this. 

691
00:33:27,100 --> 00:33:29,200
The students I work with made 
fun of me for scenes, where 

692
00:33:29,400 --> 00:33:31,600
they're like, what may I could 
skate for? 

693
00:33:31,600 --> 00:33:33,800
Yeah, I perform as concentrate. 
Yeah. 

694
00:33:34,000 --> 00:33:38,500
So for the listeners going back 
with this golf, would that what 

695
00:33:38,900 --> 00:33:42,100
is describing is an ankle joint 
mobilization, that is specific 

696
00:33:42,100 --> 00:33:45,600
for the Taillow, cruel joint, or
the point, where the tibia and 

697
00:33:45,600 --> 00:33:47,400
fibula actually me. 
Meet the foot. 

698
00:33:48,200 --> 00:33:52,600
If that is stiff, traditional 
stretching, may not make an 

699
00:33:52,600 --> 00:33:56,000
impact, because got whatever 
intervention use has to be 

700
00:33:56,000 --> 00:33:57,700
directed at the actual 
impairments. 

701
00:33:57,700 --> 00:34:00,600
Whatever thing is stiff, right? 
If it's the cap that stiff, it's

702
00:34:00,600 --> 00:34:03,500
the joint that stiff. 
If it's both great, you can use 

703
00:34:03,500 --> 00:34:06,400
whatever but if it's one of 
those you're going to need to 

704
00:34:06,400 --> 00:34:09,100
have the appropriate thing to 
get that thing moving better. 

705
00:34:09,100 --> 00:34:10,800
Because if you don't, it may not
may it. 

706
00:34:10,800 --> 00:34:13,100
Make an impact for those people.
That tell me. 

707
00:34:13,199 --> 00:34:15,300
Yeah, I've got this stiff joint 
are this. 

708
00:34:15,300 --> 00:34:17,800
This stick that I don't have 
very Made range of motion. 

709
00:34:17,800 --> 00:34:20,300
I was told to stretch and 
actually makes things hurt more.

710
00:34:20,500 --> 00:34:23,100
That's a cue, I have to test 
this but that's a cue that goes,

711
00:34:23,500 --> 00:34:25,400
that's probably not the calf. 
That might actually be the joint

712
00:34:25,400 --> 00:34:27,600
that stiff because if the judge 
if you're trying to stretch 

713
00:34:27,600 --> 00:34:30,600
something that doesn't normally 
stretch, it's going to load the 

714
00:34:30,600 --> 00:34:32,500
tissue more and it may not like 
that. 

715
00:34:32,500 --> 00:34:34,900
So it's not actually a bad 
thing, it's just good 

716
00:34:34,900 --> 00:34:38,199
information, just make sure 
you're treating the right thing.

717
00:34:38,500 --> 00:34:42,100
Yep and that kind of brings us 
towards the next couple things 

718
00:34:42,100 --> 00:34:46,500
so I'm going to add just a 
couple of more tidbits about 

719
00:34:46,600 --> 00:34:49,199
About like how it sometimes 
feels or presents. 

720
00:34:49,199 --> 00:34:52,199
When you do have this kind of 
pain a couple Hallmark signs for

721
00:34:52,199 --> 00:34:54,600
plantar, fasciitis, or plantar, 
fascial, pain, or plantar, 

722
00:34:54,600 --> 00:34:57,000
fasciitis? 
I prefer whatever. 

723
00:34:57,100 --> 00:34:58,500
No, it doesn't matter what I 
prefer right now. 

724
00:34:59,100 --> 00:35:02,100
But what one of the Hallmark 
signs is? 

725
00:35:02,100 --> 00:35:04,200
If you're not on your feet for a
while, if you're sitting in a 

726
00:35:04,208 --> 00:35:07,600
chair you're getting up from 
bed, those first couple steps 

727
00:35:07,600 --> 00:35:11,800
have a have the most pain to 
them and that pain like David 

728
00:35:11,800 --> 00:35:15,600
said is usually on the bottom of
the foot close to the heel bone.

729
00:35:16,200 --> 00:35:19,800
That's the Was typical place to 
have the pain come in and 

730
00:35:19,800 --> 00:35:23,600
usually it's pretty pointed and 
sharp in that region for those 

731
00:35:23,600 --> 00:35:26,200
first steps and then it kind of 
dissipates as you walk for a 

732
00:35:26,208 --> 00:35:29,700
while and then if you do too 
much activity, can come back but

733
00:35:29,700 --> 00:35:32,100
I think the most common pattern 
is a lot of pain. 

734
00:35:32,100 --> 00:35:34,400
Right? 
After you get up goes away might

735
00:35:34,400 --> 00:35:37,300
come back if you're on your feet
for a long period of time and 

736
00:35:37,300 --> 00:35:39,700
then you can restart the cycle 
if you sit and wait. 

737
00:35:39,800 --> 00:35:43,200
Ironically very similar to how 
irritated tendons presents. 

738
00:35:43,600 --> 00:35:46,200
They don't do super well, if 
they're not moving. 

739
00:35:46,600 --> 00:35:49,100
As soon as you get the moving 
you can it can warm up through 

740
00:35:49,100 --> 00:35:51,200
it and then as soon as you too 
much, they get pissed off. 

741
00:35:51,600 --> 00:35:54,900
So very common for those that 
have things that present 

742
00:35:54,900 --> 00:35:57,400
differently. 
That might not be plantar, 

743
00:35:57,400 --> 00:36:00,800
fasciitis, fasciitis? 
That was my next question was 

744
00:36:00,800 --> 00:36:03,600
going to be any time that you 
think you have something? 

745
00:36:03,800 --> 00:36:06,600
I mean, you can find the answer 
to anything on. 

746
00:36:06,600 --> 00:36:10,400
Google doesn't mean that it's 
the right answer and most times,

747
00:36:10,400 --> 00:36:14,200
if you say I have pain in the 
bottom of my foot, Google doc is

748
00:36:14,200 --> 00:36:16,800
going to tell you, dr. 
Google is going to tell you And 

749
00:36:16,800 --> 00:36:20,400
it's plantar fasciitis. 
What other things though, could 

750
00:36:20,400 --> 00:36:22,000
it? 
Because differential diagnosis 

751
00:36:22,000 --> 00:36:24,300
is always important because if 
you're treating something that 

752
00:36:24,300 --> 00:36:27,000
it isn't, you might not actually
get better. 

753
00:36:27,000 --> 00:36:28,900
So, what else? 
Matt, what are some, 

754
00:36:28,900 --> 00:36:31,100
differentials? 
Some other things that can cause

755
00:36:31,100 --> 00:36:34,000
discomfort or pain down there? 
That might look similar. 

756
00:36:34,000 --> 00:36:37,100
So there's a couple of some of 
these you're going to have a 

757
00:36:37,100 --> 00:36:39,800
hard time figuring out if you're
not a medical professional, but 

758
00:36:39,800 --> 00:36:41,800
I'll still go into this stuff 
and it's not too freaky, I just 

759
00:36:41,800 --> 00:36:43,000
going, hey, just be aware of 
this. 

760
00:36:43,900 --> 00:36:46,000
One of the more common things 
you gotta realize that's not the

761
00:36:46,000 --> 00:36:47,600
only thing that That's their 
right. 

762
00:36:47,600 --> 00:36:51,200
So one of the classic signs is 
hey you got pain right in front 

763
00:36:51,200 --> 00:36:54,500
of that heel bone right there. 
But you also have a ton of 

764
00:36:54,500 --> 00:36:56,300
muscles that attach there as 
well. 

765
00:36:56,600 --> 00:36:59,500
If you have more symptoms up 
further in the Arts that usually

766
00:36:59,500 --> 00:37:01,800
starts to make me think, is this
one of those Arch muscles, 

767
00:37:01,800 --> 00:37:02,700
right? 
If it's a little bit more 

768
00:37:02,700 --> 00:37:07,900
forward to same thing. 
So a muscular strain or a tendon

769
00:37:07,900 --> 00:37:11,700
issue of those muscles is a very
very common thing, especially 

770
00:37:11,700 --> 00:37:14,300
for people, that aren't 
responding to traditional things

771
00:37:14,300 --> 00:37:16,500
that typically tend to work for 
plan. 

772
00:37:16,700 --> 00:37:20,300
Fasciitis feschi, apathy, 
fasciitis, muscle, stuff is 

773
00:37:20,300 --> 00:37:25,100
super, super common. 
I would say in that realm, not 

774
00:37:25,100 --> 00:37:29,500
muscle, but tendon, I would say,
I've had a lot of people come in

775
00:37:29,500 --> 00:37:32,400
saying, I have plantar 
fasciitis, and then they end up 

776
00:37:32,400 --> 00:37:35,000
having post tube insertion 
irritation. 

777
00:37:35,000 --> 00:37:37,900
So the tibialis posterior wraps 
around the inside of the ankle 

778
00:37:37,900 --> 00:37:40,800
and attaches, right on the 
inside of the arch on the 

779
00:37:40,800 --> 00:37:44,000
navicular bone and it kind of 
spits, always out for ya. 

780
00:37:44,000 --> 00:37:47,800
But yeah, yes, but but that's 
that's a, that's a common area 

781
00:37:47,800 --> 00:37:50,500
of pain that people just 
described to plan our fish fast 

782
00:37:50,500 --> 00:37:53,400
refresh apathy, when really, 
it's the tempo? 

783
00:37:53,400 --> 00:37:56,200
So, I'd say that's for me. 
That's one that I often like 

784
00:37:56,200 --> 00:37:59,300
find clinically. 
That's different than if it was 

785
00:38:00,300 --> 00:38:03,500
plantar fasciitis, any other? 
And then I have some fun ones. 

786
00:38:04,300 --> 00:38:05,800
Yeah. 
Like why not the fibularis 

787
00:38:05,800 --> 00:38:08,400
longus that high? 
See that all the time? 

788
00:38:08,400 --> 00:38:10,800
Yes, you know. 
And if you take a look at that 

789
00:38:10,800 --> 00:38:13,700
muscle and I'll just point out. 
Yeah, it's one of your planner 

790
00:38:13,700 --> 00:38:16,500
flexor, so it's on the backside 
but it also it either. 

791
00:38:16,600 --> 00:38:19,100
The foot in isolation it's it 
acts like a little Stirrup 

792
00:38:19,100 --> 00:38:21,900
functionally when your weight 
bearing and it comes down the 

793
00:38:21,900 --> 00:38:24,900
outside of your leg wraps, right
around that heel bone at the 

794
00:38:24,908 --> 00:38:28,200
Obama with the ankle bone on the
outside and it goes right on 

795
00:38:28,200 --> 00:38:31,400
that lateral malleolus and it 
kind of Cups underneath the foot

796
00:38:31,400 --> 00:38:34,600
and actually goes down to the 
base of the first toe. 

797
00:38:35,100 --> 00:38:37,500
And it's one of the things that 
can help depress that toe, 

798
00:38:37,500 --> 00:38:39,900
create that rigid lever. 
We were talking about earlier 

799
00:38:40,200 --> 00:38:43,300
and sometimes people will have 
irritation there and it feels 

800
00:38:43,300 --> 00:38:46,400
like foot pain and it can be 
anywhere from the outside. 

801
00:38:46,600 --> 00:38:48,200
The foot down through the base 
of the foot. 

802
00:38:48,200 --> 00:38:51,200
It can be that I've had some 
great toe flexors strains 

803
00:38:51,200 --> 00:38:53,200
believe it or not. 
I mean, we got sand here so 

804
00:38:53,200 --> 00:38:57,200
like, um, a lot of things that 
require a lot of range of motion

805
00:38:57,200 --> 00:39:01,300
and things like that. 
So there's just a lot of things 

806
00:39:01,300 --> 00:39:04,100
that can be going on down there.
And I mean, client said that, 

807
00:39:04,100 --> 00:39:08,700
you know, and yeah, I'm going to
add some of the, the extra fun 

808
00:39:08,700 --> 00:39:12,200
ones or even a stress fracture. 
Y-yeah calcaneal stress fracture

809
00:39:12,200 --> 00:39:15,200
has fractured or something or 
like yeah, those that still 

810
00:39:15,200 --> 00:39:16,200
possible. 
Yeah. 

811
00:39:16,600 --> 00:39:19,300
Check out the other stuff that I
find really common for the 

812
00:39:19,300 --> 00:39:22,200
people that have that chronic 
plantar fasciitis, that never 

813
00:39:22,200 --> 00:39:24,200
seems to get better and they 
jump around from person to 

814
00:39:24,208 --> 00:39:27,800
person is oftentimes nerve. 
You have several nerves that 

815
00:39:27,800 --> 00:39:30,500
passed right through that area. 
So a nerve tension test is a 

816
00:39:30,500 --> 00:39:32,500
really good guy. 
Be careful with those is a 

817
00:39:32,500 --> 00:39:34,700
really good way to go. 
Hey, is this something different

818
00:39:34,700 --> 00:39:36,200
and nerves? 
You got to treat very 

819
00:39:36,200 --> 00:39:39,600
differently than a lot of stuff.
So nerve is definitely option. 

820
00:39:39,600 --> 00:39:42,400
The other thing that I commonly 
see is referred spine pain. 

821
00:39:42,400 --> 00:39:44,000
So, this is all my residents 
fellows. 

822
00:39:44,000 --> 00:39:47,600
And my students always say, hey,
Any any inkling? 

823
00:39:47,700 --> 00:39:52,500
Check, the spine, L4 L5. 
S1 a lot of the those vertebrae 

824
00:39:52,700 --> 00:39:55,200
were fur and sensation down to 
that spot. 

825
00:39:55,400 --> 00:39:59,000
So check that and if you've got 
anything there, that's an easy 

826
00:39:59,000 --> 00:40:01,600
place that we refer, that won't 
change with anything that you do

827
00:40:01,600 --> 00:40:03,100
the foot. 
You got to maybe look up a 

828
00:40:03,100 --> 00:40:06,200
little bit higher. 
And just to just to say this for

829
00:40:06,200 --> 00:40:09,900
the sake of anecdote, in the 
last two weeks, I've had two 

830
00:40:09,900 --> 00:40:11,500
patients come in now for foot 
pain. 

831
00:40:11,500 --> 00:40:15,900
But for isolated knee pain, 
where all of their knee testing 

832
00:40:15,900 --> 00:40:18,600
was negative. 
But when I tested their spine 

833
00:40:18,600 --> 00:40:20,100
that's what recreated, their 
knee pain. 

834
00:40:20,100 --> 00:40:22,900
Exactly. 
So this isn't a thing that never

835
00:40:22,900 --> 00:40:25,700
happens, so all the screen in 
your screening you back, if 

836
00:40:25,700 --> 00:40:30,800
you're alone that can that can 
mean doing you know and range 

837
00:40:30,800 --> 00:40:33,700
motions of your spine and just 
kind of bending backwards 

838
00:40:33,700 --> 00:40:36,100
forwards as long as you can't as
far as you can and those 

839
00:40:36,100 --> 00:40:39,500
positions and just seeing does 
this change my pain in my foot 

840
00:40:39,500 --> 00:40:41,300
or my knee that could be a first
step. 

841
00:40:41,400 --> 00:40:45,100
Obviously working with a PT 
would be a great way to actually

842
00:40:45,100 --> 00:40:48,400
get that screened out but But 
yeah that stuff it's not like it

843
00:40:48,400 --> 00:40:50,500
never happens. 
Pretty fun actually, it's more 

844
00:40:50,500 --> 00:40:53,700
of a zebra but but it can happen
here is doing something 

845
00:40:53,700 --> 00:40:58,100
happened. 
It's a exist zebras are real 

846
00:40:58,100 --> 00:40:59,500
too. 
Yeah. 

847
00:40:59,500 --> 00:41:01,600
But you got Davis to put a 
little cap and kind of weave it 

848
00:41:01,600 --> 00:41:03,300
all together. 
Another thing we talked about 

849
00:41:03,300 --> 00:41:06,700
earlier was hamstring length and
sometimes it's not genuine 

850
00:41:06,700 --> 00:41:08,400
hamstring length. 
They could be neurological 

851
00:41:08,400 --> 00:41:12,700
tension as well, impacting that 
and so doing things like nerve 

852
00:41:12,700 --> 00:41:14,300
Glides. 
I mean obviously doing in smart 

853
00:41:14,300 --> 00:41:17,000
but testing for those things, 
you know, is there a Drop meant,

854
00:41:17,000 --> 00:41:19,000
what is going on? 
Is it a length issue? 

855
00:41:19,100 --> 00:41:21,200
How can we work on? 
Getting that neuromuscular 

856
00:41:21,200 --> 00:41:23,600
connection to actually work in 
the way you want it to? 

857
00:41:25,200 --> 00:41:28,000
Because that could be something 
that's higher up, it and feeling

858
00:41:28,000 --> 00:41:30,100
it in the foot. 
And if you stretch your 

859
00:41:30,100 --> 00:41:33,200
hamstrings and you feel your 
foot getting warm like that, 

860
00:41:33,200 --> 00:41:36,700
could be up some, some 
neurological tension there. 

861
00:41:36,700 --> 00:41:40,000
So totally. 
So let's start kind of 

862
00:41:40,000 --> 00:41:44,100
transitioning from talking about
causes and all this kind of 

863
00:41:44,100 --> 00:41:47,700
stuff too. 
What can we do to help it? 

864
00:41:47,700 --> 00:41:49,700
You know what are the things 
that are assuming that it 

865
00:41:49,700 --> 00:41:52,700
actually is plantar fasciitis 
a'ti or plantar? 

866
00:41:52,700 --> 00:41:55,100
Fasciitis is what actually 
helps. 

867
00:41:55,100 --> 00:41:58,700
I think when we hear about 
plantar fasciotomy, 'they we 

868
00:41:58,700 --> 00:42:02,400
hear roll it with a nice bottle.
So like freeze, a nice bottle 

869
00:42:02,400 --> 00:42:08,000
and roll it. 
We hear get arch support and 

870
00:42:08,200 --> 00:42:12,300
rest that probably are the three
things that I hear most commonly

871
00:42:12,300 --> 00:42:14,100
or if somebody comes in, what 
have you been doing for it? 

872
00:42:14,100 --> 00:42:16,400
Well, I got one of those spike 
balls that I can. 

873
00:42:16,600 --> 00:42:19,800
Isn't that I can roll on it? 
Like there's a lot of remedies 

874
00:42:19,800 --> 00:42:23,400
for this that people commonly 
use, what kind of Merit is there

875
00:42:23,400 --> 00:42:26,200
for those? 
And it Orthotics would be 

876
00:42:26,208 --> 00:42:28,100
another one that I think is 
very, very common. 

877
00:42:29,400 --> 00:42:32,500
What sort of I don't know what's
the Merit of those things and 

878
00:42:32,500 --> 00:42:34,400
what do we actually what can we 
hang our hats us. 

879
00:42:34,500 --> 00:42:38,300
So I'll jump on in this and the 
it's not to say that nothing 

880
00:42:38,300 --> 00:42:39,900
works. 
I really want to put that out 

881
00:42:39,900 --> 00:42:41,200
there. 
It's that most those 

882
00:42:41,200 --> 00:42:45,100
interventions there's been, 
there's short-term there's been 

883
00:42:45,100 --> 00:42:49,500
some good evidence for Or acute 
use of things like orthosis or 

884
00:42:49,500 --> 00:42:52,000
arch support insoles. 
There's been some good stuff for

885
00:42:52,000 --> 00:42:53,400
something called a night, 
splint, right? 

886
00:42:53,400 --> 00:42:55,600
You know when you tend to sleep,
some people will have their feet

887
00:42:55,600 --> 00:42:57,900
plantar flex and you wake up 
that stuff's really stiff so 

888
00:42:57,900 --> 00:42:59,800
it's trying to make that stuff 
little easier. 

889
00:43:00,200 --> 00:43:03,800
Taping has also been found to 
have some short-term relief of 

890
00:43:03,800 --> 00:43:07,400
symptoms, manual therapy or 
ourself mobilization. 

891
00:43:07,400 --> 00:43:11,000
We're using the ice cup or 
you're using you know the spiky 

892
00:43:11,000 --> 00:43:13,400
ball that you paid way too much 
money for and you could just use

893
00:43:13,400 --> 00:43:19,400
a golf ball or tennis ball those
Things have had some good short 

894
00:43:19,400 --> 00:43:21,300
term efficacy for this kind of 
stuff. 

895
00:43:21,300 --> 00:43:24,000
It's not, it probably won't 
solve your issue. 

896
00:43:24,000 --> 00:43:26,400
So don't get super pissed off 
when you're like, hey, I did 

897
00:43:26,400 --> 00:43:29,300
exactly what you said and it 
hasn't gone away because 

898
00:43:29,300 --> 00:43:35,500
unfortunately one of the best 
things that we found is time and

899
00:43:35,500 --> 00:43:38,100
trying to, you know, trying to 
figure out why this thing is get

900
00:43:38,100 --> 00:43:39,900
it loaded getting loaded in the 
first place. 

901
00:43:40,100 --> 00:43:42,800
There's not very good evidence 
for a lot of the modalities. 

902
00:43:42,800 --> 00:43:46,400
So stuff like laser, I've seen 
the Shockwave stuff is getting 

903
00:43:46,500 --> 00:43:49,200
Dang, really popular. 
I've seen very, very, very mixed

904
00:43:49,200 --> 00:43:51,500
evidence on that kind of stuff 
just because this is a unique 

905
00:43:51,500 --> 00:43:53,100
tissue, you to make sure you 
have the right stuff. 

906
00:43:53,500 --> 00:43:56,800
Surprising, if found kind of 
mixed results for needling, I 

907
00:43:56,800 --> 00:43:58,900
think, has needling, in my 
opinion, needling tends to work 

908
00:43:58,900 --> 00:44:00,500
better for muscle than some of 
these tissues. 

909
00:44:00,500 --> 00:44:03,200
But, you know, I don't do it as 
much as I would like in 

910
00:44:03,200 --> 00:44:07,100
California, but time seems to be
one of the biggest factors, 

911
00:44:07,100 --> 00:44:09,300
we've even seed, some kind of 
back and forth on some of the 

912
00:44:09,300 --> 00:44:11,400
strengthening stuff whether it 
is, some people have had these 

913
00:44:11,400 --> 00:44:15,500
protocols where you do really 
intense loading of the tissue 

914
00:44:15,500 --> 00:44:18,700
just like you would For tendon. 
And for some people that works 

915
00:44:18,700 --> 00:44:22,100
really well in some people, it 
doesn't, I think one of the big 

916
00:44:22,100 --> 00:44:25,200
things is trying to modify 
whatever stress might be 

917
00:44:25,200 --> 00:44:27,500
irritating this and then trying 
to make sure. 

918
00:44:27,500 --> 00:44:30,900
Hey let's slowly reload this, 
keep you moving, how I would 

919
00:44:30,900 --> 00:44:34,300
whatever method you can and just
give this tissue a little time 

920
00:44:34,300 --> 00:44:36,200
to heal. 
That doesn't mean stop running. 

921
00:44:36,200 --> 00:44:38,800
By the way, for the runners. 
It means if you can still handle

922
00:44:38,800 --> 00:44:41,800
the running without pissing us 
off too much, you're good. 

923
00:44:41,800 --> 00:44:44,700
Just make sure you modify some 
stuff so this thing can heal. 

924
00:44:44,900 --> 00:44:48,500
Yeah, I think. 
What I want to do is drive home.

925
00:44:49,300 --> 00:44:53,500
One point that you just made 
about Orthotics or even just 

926
00:44:53,500 --> 00:44:55,100
just kind of reinforce that 
idea. 

927
00:44:57,100 --> 00:45:01,000
I think often times regardless 
of the medical professional, 

928
00:45:01,200 --> 00:45:03,500
there's a chance that they 
recommend that you go get custom

929
00:45:03,500 --> 00:45:06,400
orthotics. 
If you have plantar fascia pain 

930
00:45:07,300 --> 00:45:11,500
and there might be somebody that
that's the right move but from 

931
00:45:11,500 --> 00:45:17,000
what we know it's not usually 
the option you need to take When

932
00:45:17,000 --> 00:45:19,600
there's the talk about 
short-term benefit, that's 

933
00:45:19,600 --> 00:45:24,800
usually two to four weeks of 
benefit for that acute more and 

934
00:45:24,800 --> 00:45:28,100
it keeps not even the necessary.
The right, the highly erodible 

935
00:45:28,100 --> 00:45:31,300
phase of this to help with 
symptoms and those can be bought

936
00:45:31,300 --> 00:45:35,200
over the counter, they can be 
cheap ones, they can be whatever

937
00:45:35,200 --> 00:45:37,600
is just feeling the most 
comfortable under your foot, 

938
00:45:37,600 --> 00:45:40,100
whatever is permanent 
filter.you, no pressure or 

939
00:45:40,100 --> 00:45:42,500
support. 
Like find the thing, that feels 

940
00:45:42,500 --> 00:45:46,100
the most comfortable in that 
moment for that short term time.

941
00:45:46,400 --> 00:45:49,800
Period to allow some of the 
irritability to calm down, but 

942
00:45:49,800 --> 00:45:52,500
most people are not going to 
need to go and buy 200 pair of 

943
00:45:52,500 --> 00:45:54,800
custom orthotics. 
Excuse dose, really common. 

944
00:45:55,500 --> 00:45:57,900
That's that's kind of what I 
wanted to hit home because I 

945
00:45:57,908 --> 00:46:01,500
think it's so common for that to
be recommended for a pretty much

946
00:46:01,500 --> 00:46:04,600
any foot condition, and the 
evidence of our thought excision

947
00:46:04,600 --> 00:46:08,700
that they have benefit for the 
short term short term time. 

948
00:46:08,800 --> 00:46:12,000
Obviously like I said, there are
cases in which yes you might 

949
00:46:12,000 --> 00:46:14,600
need an orthotic but that would 
be if your work you've worked 

950
00:46:14,600 --> 00:46:17,300
with someone for a long time and
you've tried All of the things 

951
00:46:17,300 --> 00:46:19,800
first. 
If you've tried all the things 

952
00:46:19,900 --> 00:46:23,600
and all of the things, like Matt
said, there isn't a cookie 

953
00:46:23,600 --> 00:46:25,900
cutter recipe to, you know, 
solve all these problems. 

954
00:46:26,200 --> 00:46:28,700
But you go with an impaired 
based approach, you figure out 

955
00:46:28,700 --> 00:46:31,400
where your limitations, you work
on those. 

956
00:46:31,400 --> 00:46:34,200
You give it enough time to work 
on those and for the tissue to 

957
00:46:34,200 --> 00:46:36,500
calm down because if you're 
working on strength and 

958
00:46:36,500 --> 00:46:40,700
neuromuscular control, give 
yourself 20 weeks, I hate to say

959
00:46:40,700 --> 00:46:43,200
that, but like true strength 
gains aren't going to happen for

960
00:46:43,200 --> 00:46:47,200
8 to 12 and then you have to 
relearn, how to I move and how 

961
00:46:47,200 --> 00:46:50,100
to keep things relaxed. 
So, give yourself long periods 

962
00:46:50,100 --> 00:46:52,200
of time. 
This is pretty common now for a 

963
00:46:52,208 --> 00:46:55,800
lot of different conditions, 
even a lot of shoulder 

964
00:46:55,800 --> 00:46:58,000
conditions now even like slap 
tears. 

965
00:46:58,500 --> 00:47:01,700
They're saying conservative 
management for six months before

966
00:47:01,700 --> 00:47:05,400
you even consider surgery. 
So you really, and obviously 

967
00:47:05,400 --> 00:47:07,200
this is in surgery, this would 
be getting. 

968
00:47:07,200 --> 00:47:10,500
Well, there are surgeries 
robotic surgeries for different 

969
00:47:10,500 --> 00:47:12,400
things for plantar fascia pain. 
We're not going to dive into 

970
00:47:12,400 --> 00:47:15,900
those, but yeah, I just wanted 
to reinforce that one David 

971
00:47:15,900 --> 00:47:16,900
anything. 
You want to add? 

972
00:47:16,900 --> 00:47:19,300
Yeah, I think we've missed 
something pretty big. 

973
00:47:19,300 --> 00:47:23,700
Actually, I've been hearing a 
lot about stress irritation, 

974
00:47:23,700 --> 00:47:26,300
avoiding those factors those 
types of things. 

975
00:47:26,300 --> 00:47:30,600
One thing in the short term you 
can do as well, is take care of 

976
00:47:30,600 --> 00:47:33,200
yourself, get sleep. 
There's a lot of good healing 

977
00:47:33,200 --> 00:47:34,600
things that happen when you're 
asleep. 

978
00:47:34,600 --> 00:47:37,600
And there's a lot of people that
are running themselves into the 

979
00:47:37,600 --> 00:47:39,300
ground expecting nothing to 
happen. 

980
00:47:39,300 --> 00:47:42,300
And they wonder why they keep 
getting worse and we're not 

981
00:47:42,300 --> 00:47:46,500
getting better. 
And so, like sleep, and This 

982
00:47:46,500 --> 00:47:49,800
isn't the case with everybody 
but it it's not I've only heard 

983
00:47:49,800 --> 00:47:52,400
this a few times where someone's
like, oh I stopped drinking beer

984
00:47:52,400 --> 00:47:54,700
and my pain went away. 
You know, like some people who 

985
00:47:54,700 --> 00:47:57,900
drink regularly or do things 
that abuser body or they have 

986
00:47:57,900 --> 00:48:01,200
different inflammatory, things 
from a chronic healing 

987
00:48:01,200 --> 00:48:04,800
standpoint, they're impairing 
their own healing and sews, just

988
00:48:04,800 --> 00:48:07,300
some small lifestyle 
modifications, not to say, don't

989
00:48:07,300 --> 00:48:12,200
ever do that, you know, but to 
just try and keep tabs on 

990
00:48:12,200 --> 00:48:14,000
yourself and just take care of 
yourself. 

991
00:48:14,000 --> 00:48:15,200
Make sure you're getting enough 
sleep. 

992
00:48:15,200 --> 00:48:19,300
Make sure you're eating. 
Well, because your tissue will 

993
00:48:19,300 --> 00:48:21,400
notice it. 
I would say, that's probably one

994
00:48:21,400 --> 00:48:23,000
of the biggest. 
That's probably one of the most 

995
00:48:23,000 --> 00:48:25,300
important things. 
And I'm glad you brought that up

996
00:48:25,300 --> 00:48:27,700
to address first because often 
times those can be some of the 

997
00:48:27,700 --> 00:48:29,500
easiest changes. 
Can you get an extra hours? 

998
00:48:29,500 --> 00:48:32,400
Sleep can maybe you cut down on 
some activities that cause more 

999
00:48:32,400 --> 00:48:35,300
of those inflammatory process, 
inflammation isn't bad. 

1000
00:48:35,400 --> 00:48:38,200
But if you body is, if it's, if 
it's happening in a way that 

1001
00:48:38,200 --> 00:48:41,300
slows your body's ability 
recover, like alcohol does like 

1002
00:48:41,300 --> 00:48:44,500
others, things might do like a 
lack of sleep, like stress, like

1003
00:48:44,500 --> 00:48:46,300
all those kind of things you 
might want. 

1004
00:48:46,400 --> 00:48:47,900
To see if you could knock those 
out because you might be 

1005
00:48:47,908 --> 00:48:49,700
surprised how quick the start 
screwing up. 

1006
00:48:49,700 --> 00:48:52,200
Or at least you could facilitate
the healing a little bit better,

1007
00:48:52,200 --> 00:48:54,300
but I think that's a phenomenal 
thing to bring up. 

1008
00:48:54,300 --> 00:48:57,600
Yeah, totally. 
Thanks David and also just get 

1009
00:48:57,600 --> 00:48:59,300
strong calves. 
Strengthen them. 

1010
00:48:59,900 --> 00:49:02,100
Probably good for pretty much 
everything if you want to run 

1011
00:49:02,100 --> 00:49:03,100
his restaurant. 
That's true. 

1012
00:49:03,100 --> 00:49:06,100
Ironically there's some very 
interesting evidence that those 

1013
00:49:06,100 --> 00:49:07,600
people. 
I'm not saying don't have strong

1014
00:49:07,600 --> 00:49:08,700
calves, it's really important 
running. 

1015
00:49:09,000 --> 00:49:11,300
One of the systematic reviews 
are going over said that, people

1016
00:49:11,300 --> 00:49:14,600
with plantar fasciitis actually 
had stronger caps. 

1017
00:49:16,600 --> 00:49:20,200
Sure, but that's not that, 
doesn't say that's not cause now

1018
00:49:20,200 --> 00:49:23,400
it's not, it was just a 
correlation, which I would bet. 

1019
00:49:23,400 --> 00:49:26,100
But yes, grading, right? 
Because the calf muscle starts 

1020
00:49:26,100 --> 00:49:28,800
working really hard to stop that
tibia from going forward and 

1021
00:49:28,808 --> 00:49:30,700
causing me stress. 
So it's not saying don't have 

1022
00:49:30,700 --> 00:49:33,400
strong calves. 
I'm just just trying to cause 

1023
00:49:33,400 --> 00:49:35,600
chaos, that's it. 
Yes, you should be as strong as 

1024
00:49:35,600 --> 00:49:37,500
possible. 
Yeah. 

1025
00:49:37,500 --> 00:49:40,100
Intrinsic muscle strength 
half-strength glute. 

1026
00:49:40,100 --> 00:49:41,100
Strength. 
Quad string camps. 

1027
00:49:41,100 --> 00:49:45,900
Everything Cool. 
So now I want to ask kind of two

1028
00:49:45,900 --> 00:49:48,000
more questions and then we'll 
wrap things up. 

1029
00:49:48,000 --> 00:49:52,000
So here's to the two last 
questions are one. 

1030
00:49:52,000 --> 00:49:57,100
If I have plantar fascia pain 
can I still run or what kind of 

1031
00:49:57,100 --> 00:49:59,600
guidelines should I use to know 
if I should run or not? 

1032
00:50:00,000 --> 00:50:02,700
Because that's always on the 
Forefront of our minds is 

1033
00:50:02,700 --> 00:50:05,200
Runners. 
The second is the shoe question 

1034
00:50:05,200 --> 00:50:07,400
are there shoes? 
What should I consider? 

1035
00:50:07,400 --> 00:50:09,000
I guess. 
Maybe that's, that's the better 

1036
00:50:09,000 --> 00:50:10,200
question. 
What should I consider When 

1037
00:50:10,200 --> 00:50:13,800
selecting a shoe? 
If I have Plantar fascia pain 

1038
00:50:14,900 --> 00:50:18,300
take either one, I would say 
when it comes to running in, 

1039
00:50:18,300 --> 00:50:21,000
this is something that I tell 
people, especially with this, is

1040
00:50:21,000 --> 00:50:22,800
it. 
If, if it is, if you can 

1041
00:50:22,800 --> 00:50:25,500
tolerate this as right with 
running and you're not having to

1042
00:50:25,500 --> 00:50:28,900
dramatically adjust your 
mechanics, that's a good place 

1043
00:50:28,900 --> 00:50:31,200
to start but the other things 
you really have to pay attention

1044
00:50:31,200 --> 00:50:34,400
to is how you feel right after 
your run, how you feel late. 

1045
00:50:34,400 --> 00:50:38,100
It's a 23, how you feel right 
afterwards, how you feel later 

1046
00:50:38,100 --> 00:50:40,400
in the day and then how you feel
the next morning? 

1047
00:50:40,600 --> 00:50:42,800
Because if your symptoms are 
way, Worse. 

1048
00:50:42,800 --> 00:50:45,600
The next morning. 
That might have been a little 

1049
00:50:45,600 --> 00:50:48,700
bit too much but if you wake up 
and you're like, hey, you know, 

1050
00:50:48,800 --> 00:50:50,400
it's actually the same or it's 
better. 

1051
00:50:50,800 --> 00:50:53,500
You're probably okay to do that.
What I would I would highly 

1052
00:50:53,500 --> 00:50:57,100
suggest is don't keep doing the 
same thing. 

1053
00:50:57,100 --> 00:50:59,200
If you're running like a hundred
miles a week, it might be better

1054
00:50:59,200 --> 00:51:01,700
for you to modify the little 
bit, you know, maybe drop that 

1055
00:51:01,700 --> 00:51:04,200
down a little bit more 
manageable level, but you're 

1056
00:51:04,200 --> 00:51:07,600
going to have to test and see if
things are super flared up and 

1057
00:51:07,600 --> 00:51:09,500
you start running and then it 
gets to the point where you 

1058
00:51:09,500 --> 00:51:12,100
can't even walk. 
You shouldn't be doing that if 

1059
00:51:12,100 --> 00:51:14,600
it It gets if you're able to get
through it and later on, you're 

1060
00:51:14,600 --> 00:51:16,700
like, oh my gosh, this is 
getting worse. 

1061
00:51:17,400 --> 00:51:20,300
You might want to pull back, you
got to see what your body can 

1062
00:51:20,300 --> 00:51:22,600
handle and what it can recover 
from. 

1063
00:51:23,300 --> 00:51:27,300
So there's no cookie cutter 
approach, there's there's this 

1064
00:51:27,300 --> 00:51:30,600
is not validated for plantar 
fascia pain, it was created and 

1065
00:51:30,600 --> 00:51:36,700
validated for Achilles, 
tendinopathy by cyber Nagle and 

1066
00:51:36,800 --> 00:51:40,000
what she created with something 
called the pain monitoring 

1067
00:51:40,000 --> 00:51:42,600
model. 
And when you use it for, I think

1068
00:51:42,600 --> 00:51:45,300
we've talked about it a long 
time ago on the podcast, maybe, 

1069
00:51:45,300 --> 00:51:48,700
but the way it works for 
Achilles tendinopathy is they, 

1070
00:51:48,700 --> 00:51:52,900
they took two groups, all who 
had Achilles tendon pain, half 

1071
00:51:52,900 --> 00:51:55,700
of them got to continue running 
using the pain monitoring model,

1072
00:51:55,700 --> 00:51:57,500
half of them had to stop 
running. 

1073
00:51:57,500 --> 00:52:00,700
They both did the same rehab and
they both ended up doing the 

1074
00:52:00,700 --> 00:52:02,200
same. 
So when it comes to the 

1075
00:52:02,208 --> 00:52:05,100
Achilles, this is something that
if we do an Achilles one again 

1076
00:52:05,100 --> 00:52:08,000
will probably bring back up, but
basically the rules in that, is 

1077
00:52:08,000 --> 00:52:11,300
that your paint in the reason 
that the rules existed in the 

1078
00:52:11,300 --> 00:52:14,600
Achilles world is, Cuz they took
ultrasound imaging of the 

1079
00:52:14,600 --> 00:52:17,700
tendon. 
And with following these rules, 

1080
00:52:17,700 --> 00:52:20,200
there was not degradation. 
In fact, there was continued 

1081
00:52:20,200 --> 00:52:24,100
healing of the Achilles tendon 
from an Imaging perspective. 

1082
00:52:24,300 --> 00:52:29,900
So what those rules stated was 
that if you could run with pain 

1083
00:52:30,000 --> 00:52:34,500
less than a 5 out of a 5 out of 
10 or less during the activity, 

1084
00:52:35,300 --> 00:52:39,500
after the activity, the date the
morning, after the activity and 

1085
00:52:39,500 --> 00:52:43,100
it doesn't worsen week-to-week, 
you can keep doing That amount 

1086
00:52:43,100 --> 00:52:46,100
of activity. 
So again, if your pain or the 

1087
00:52:46,100 --> 00:52:50,400
stiffness pain or stiffness, 
worsens more than a 5 out of 10 

1088
00:52:50,400 --> 00:52:54,900
during after the next morning or
if your symptoms are worse, need

1089
00:52:54,900 --> 00:52:57,200
week-to-week. 
That amount of activity is too 

1090
00:52:57,200 --> 00:53:00,500
much if it follows those rules 
and you can keep the pain under 

1091
00:53:00,500 --> 00:53:03,200
that 5 and I usually tell people
five is kind of the Tipping 

1092
00:53:03,200 --> 00:53:05,900
Point between soreness and like 
sharper pain. 

1093
00:53:06,300 --> 00:53:09,400
Then you're fine to continue 
that amount of activity. 

1094
00:53:09,800 --> 00:53:13,400
So again this is not validated 
For plantar fascial pain. 

1095
00:53:13,500 --> 00:53:16,800
But if you're looking for 
something to guide you I think 

1096
00:53:16,800 --> 00:53:20,200
that's a kind of a nice 
framework to use to have the 

1097
00:53:20,200 --> 00:53:23,500
idea of how does it feel during 
after in the next day and week 

1098
00:53:23,500 --> 00:53:26,200
to week in my getting better or 
worse. 

1099
00:53:26,200 --> 00:53:29,200
That can tell you is the amount 
of activity I'm doing too much 

1100
00:53:29,200 --> 00:53:32,600
or not. 
So that's in the again not for 

1101
00:53:32,600 --> 00:53:35,500
plantar fascia pain but I think 
it's a helpful kind of 

1102
00:53:35,500 --> 00:53:37,900
framework. 
David. 

1103
00:53:37,900 --> 00:53:39,300
You have any other thoughts on 
that question? 

1104
00:53:39,300 --> 00:53:42,100
Or do you want to start talking 
about shoe considerations? 

1105
00:53:42,100 --> 00:53:43,300
Yeah. 
And we're gonna give the most 

1106
00:53:43,300 --> 00:53:46,200
important question to David that
people been waiting the whole 

1107
00:53:46,200 --> 00:53:49,400
time for this everyone's been 
waiting, you know, three years 

1108
00:53:49,400 --> 00:53:52,100
of podcasting, whatever it is. 
Does this is the moment? 

1109
00:53:52,100 --> 00:53:56,800
No, this is episode. 
But that probably says, yes, the

1110
00:53:56,800 --> 00:53:59,300
end-all-be-all bowl of 
questions, this is terrible now.

1111
00:54:01,600 --> 00:54:03,900
I mean, you kind of hit on the 
head I think, with looking at 

1112
00:54:03,900 --> 00:54:06,100
all of the other things that 
there's not really a cookie 

1113
00:54:06,100 --> 00:54:07,300
cutter. 
Roach. 

1114
00:54:07,300 --> 00:54:12,200
I think if someone just tells 
you put a Hoka on, like I don't 

1115
00:54:12,200 --> 00:54:15,600
know if I would jump right on 
that and listen without much 

1116
00:54:15,600 --> 00:54:18,000
other reasoning, you know, 
attached to that. 

1117
00:54:18,000 --> 00:54:20,000
Not to say that it doesn't work 
for some people. 

1118
00:54:20,000 --> 00:54:24,400
It certainly does. 
But I think looking at why it's 

1119
00:54:24,400 --> 00:54:27,800
happening, looking at the 
impairments, let's say you are 

1120
00:54:27,800 --> 00:54:30,700
going through a wild range of 
motion and you need to decrease 

1121
00:54:30,700 --> 00:54:32,900
that range of motion, may be 
having something with a higher 

1122
00:54:32,900 --> 00:54:36,200
drop might actually be good, you
know, like decrease the length 

1123
00:54:36,200 --> 00:54:38,600
that your It has to actually 
move through that might actually

1124
00:54:38,600 --> 00:54:40,700
make your foot better and that 
has nothing to do with the 

1125
00:54:40,700 --> 00:54:44,100
rocker profile or a high stack 
and that's just a simple static 

1126
00:54:44,100 --> 00:54:45,500
measurement. 
That's nothing. 

1127
00:54:45,700 --> 00:54:49,300
You know. 
I get hesitant to just say like 

1128
00:54:49,300 --> 00:54:53,900
go by that shoe, you know. 
And I think Comforts a huge part

1129
00:54:53,900 --> 00:54:55,800
of it to, right? 
And you talked about it like 

1130
00:54:55,800 --> 00:54:58,600
some discomfort is going to be 
normal like if you're at a 5 out

1131
00:54:58,600 --> 00:55:01,300
of 10, you know like to me 
that's pretty high. 

1132
00:55:01,300 --> 00:55:04,700
I don't know if I'd be rolling 
the dice on that but still like 

1133
00:55:04,700 --> 00:55:06,700
knowing that some discomfort is 
okay. 

1134
00:55:06,900 --> 00:55:08,800
To some degree, right? 
Like it's manageable, it's not 

1135
00:55:08,800 --> 00:55:11,500
getting worse. 
You going day today, if you like

1136
00:55:11,500 --> 00:55:13,200
the shoes, you're in, you can 
stay in the shoes. 

1137
00:55:13,200 --> 00:55:14,800
You're in and work on the other 
things. 

1138
00:55:15,200 --> 00:55:18,000
You know, I wouldn't just jump 
ship just because your foot 

1139
00:55:18,000 --> 00:55:20,700
hurts, you know, it'd be like 
doing the same thing for a 

1140
00:55:20,708 --> 00:55:23,400
hamstring or a hip, or a knee, 
or your back. 

1141
00:55:23,400 --> 00:55:25,800
You know, there's so many things
that could be going on. 

1142
00:55:26,000 --> 00:55:28,600
And I know that's not the answer
that our listeners probably want

1143
00:55:28,600 --> 00:55:33,900
to hear, you know, but, but for 
some people, maybe they want a 

1144
00:55:33,908 --> 00:55:36,000
little bit more cushioning, they
want something a little bit 

1145
00:55:36,000 --> 00:55:37,900
higher up in. 
For them if they like that 

1146
00:55:37,900 --> 00:55:40,100
sensation and they like that 
feeling by all means do it. 

1147
00:55:40,100 --> 00:55:43,300
You know like that's if that's 
working for you then do it like 

1148
00:55:43,700 --> 00:55:46,400
and there are some days where 
that's what I want you know like

1149
00:55:46,400 --> 00:55:49,300
my body just kind of tells me 
and I'm like for I don't know 

1150
00:55:49,300 --> 00:55:52,100
why but this shoe is calling to 
me and I want to wear that shoe 

1151
00:55:52,100 --> 00:55:55,800
and I will wear that shoe and 
that's regardless of whatever 

1152
00:55:55,800 --> 00:55:58,800
we're testing, you know, like I 
will break testing schedule for 

1153
00:55:58,800 --> 00:56:04,100
my own health, you know, none. 
But yeah, there's no specific 

1154
00:56:04,100 --> 00:56:05,900
magic shoe for plantar 
fasciitis. 

1155
00:56:05,900 --> 00:56:07,700
I think that's probably just the
point. 

1156
00:56:07,700 --> 00:56:09,900
We got to drive home here. 
Can I add on that? 

1157
00:56:09,900 --> 00:56:12,800
Is that the lot of the 
suggestions that you'll hear, 

1158
00:56:12,800 --> 00:56:15,200
right? 
So David mentioned the classic 

1159
00:56:15,200 --> 00:56:18,700
ones people will suggest High 
drop they'll suggest a rocker 

1160
00:56:18,700 --> 00:56:21,500
shoe that's really common and 
that might work. 

1161
00:56:21,700 --> 00:56:25,800
It also might be problematic 
some people by having a higher 

1162
00:56:25,800 --> 00:56:28,800
heel drop this is adrenaline 23.
So if you have that and lift it 

1163
00:56:28,800 --> 00:56:35,700
up the embargoes not we're good.
I The I think the I lost my 

1164
00:56:35,700 --> 00:56:38,500
thought process, a higher heel 
might be better for some people 

1165
00:56:38,500 --> 00:56:40,600
because it shorts that tissue 
for other people. 

1166
00:56:40,600 --> 00:56:43,100
It might increase the stress 
right in this area. 

1167
00:56:43,200 --> 00:56:45,100
So it may or may not work for 
you. 

1168
00:56:45,500 --> 00:56:48,700
The more maximalist this is, the
only one I have right now. 

1169
00:56:48,700 --> 00:56:51,600
I know it's super dirty, you 
know, a maximalist shoe that 

1170
00:56:51,600 --> 00:56:56,000
more competitive, more the 
increase cushioning or the, the,

1171
00:56:56,100 --> 00:56:58,500
The forefoot Rocker right here, 
might unload it. 

1172
00:56:58,500 --> 00:57:00,900
But if that thing is to 
rockered, and it's holding your 

1173
00:57:00,900 --> 00:57:03,200
foot in It toes an extension. 
That's actually going to 

1174
00:57:03,200 --> 00:57:04,900
increase the stress on the 
plantar fascia. 

1175
00:57:04,900 --> 00:57:08,300
That's actually a test called 
the win last test Where You Yank

1176
00:57:08,300 --> 00:57:10,900
the person's toe and extension 
and poke that area for hurts. 

1177
00:57:10,900 --> 00:57:12,600
It's positive. 
That's how you stress it. 

1178
00:57:13,000 --> 00:57:16,300
So, I totally and then it's the 
same thing with you'll, you 

1179
00:57:16,300 --> 00:57:20,200
know, a lot of people go, I need
to go buy a support shoe, that 

1180
00:57:20,200 --> 00:57:22,900
might be helpful, that also 
might increase stress in that 

1181
00:57:22,900 --> 00:57:24,700
area. 
So I think going. 

1182
00:57:24,700 --> 00:57:27,800
Hey, do I need a new shoe is 
probably the first question. 

1183
00:57:27,800 --> 00:57:30,300
You really think about do? 
I need to go like, spend a bunch

1184
00:57:30,300 --> 00:57:33,000
of extra stuff. 
Or do I need to address what's 

1185
00:57:33,000 --> 00:57:34,400
going on? 
Do I need to address the fact 

1186
00:57:34,400 --> 00:57:36,600
that I'm not sleeping not eating
very well? 

1187
00:57:36,800 --> 00:57:39,800
And I've got a condition where a
body is not doing super hot and 

1188
00:57:39,800 --> 00:57:43,000
I haven't given it the 
environment to heal is it 

1189
00:57:43,000 --> 00:57:46,100
because my shoes are super old 
and worn down and maybe it's 

1190
00:57:46,100 --> 00:57:48,900
time for a new pair 2 root 2 R 
to reduce. 

1191
00:57:48,900 --> 00:57:51,600
Some of the stress there. 
Is it cuz your overtraining is 

1192
00:57:51,600 --> 00:57:53,600
it because you're loading the 
thing in a way that there's 

1193
00:57:53,600 --> 00:57:55,600
something maintenance wise you 
have been addressing. 

1194
00:57:56,100 --> 00:57:58,800
Those are probably the bigger 
questions as David mentioned 

1195
00:57:59,000 --> 00:58:01,200
that you need to address before 
you start needs certainty. 

1196
00:58:01,300 --> 00:58:03,600
Think about what exact shoe do I
need? 

1197
00:58:03,600 --> 00:58:06,300
And then after that, it's going,
why am I having this problem? 

1198
00:58:06,300 --> 00:58:09,400
And what, shoot my health kind 
of facilitate that but again, 

1199
00:58:09,400 --> 00:58:11,700
it's going to be a short-term 
solution. 

1200
00:58:11,700 --> 00:58:14,300
Probably like the orthotic. 
You're probably going to need to

1201
00:58:14,300 --> 00:58:15,800
address. 
What's driving this? 

1202
00:58:16,300 --> 00:58:18,500
Yeah, and I totally agree with 
y'all. 

1203
00:58:18,500 --> 00:58:23,000
And there isn't a shoe profile 
that's going to say. 

1204
00:58:23,000 --> 00:58:26,000
This is the right shoe profile 
for plantar fascia pain. 

1205
00:58:26,000 --> 00:58:29,300
It's more like what is your 
Runner profile right now? 

1206
00:58:29,300 --> 00:58:31,900
What are your aggravating 
factors that We'll drive your 

1207
00:58:31,900 --> 00:58:34,300
shoe. 
So let's say you have pain at 

1208
00:58:34,300 --> 00:58:39,000
the toe off part of running or 
of walking, maybe a more rigid 

1209
00:58:39,000 --> 00:58:41,300
four foot with a rocker could 
help because then you don't have

1210
00:58:41,300 --> 00:58:42,800
to go through that windlass 
mechanism. 

1211
00:58:42,800 --> 00:58:46,200
Maybe. 
So just depending on, what is 

1212
00:58:46,200 --> 00:58:50,500
your mechanism of pain 
generation match a shoe to limit

1213
00:58:50,500 --> 00:58:52,200
that? 
Like if you're having a lot of 

1214
00:58:52,200 --> 00:58:56,200
pain Barefoot maybe having a 
shoe that allows a lot of 

1215
00:58:56,200 --> 00:58:58,000
motion, maybe that's not what 
you want. 

1216
00:58:58,000 --> 00:59:00,300
Maybe you want something that's 
more structured because then it 

1217
00:59:00,300 --> 00:59:02,800
can provide more stability. 
Ability for your foot, right? 

1218
00:59:02,800 --> 00:59:05,600
So like, think about what's 
caught, when what situations are

1219
00:59:05,600 --> 00:59:09,100
causing your issues, maybe try 
shoe that creates a new 

1220
00:59:09,100 --> 00:59:12,900
environment for your foot kind 
of, in the same way that there's

1221
00:59:12,900 --> 00:59:16,800
a short-term benefit of like 
over-the-counter orthotics in 

1222
00:59:16,800 --> 00:59:20,000
the same way you could find the 
right shoe that you know does 

1223
00:59:20,000 --> 00:59:23,300
the does the deal changes the 
environment in a way that 

1224
00:59:23,300 --> 00:59:26,700
decreases some of that soreness 
oh no Silver Bullet when it 

1225
00:59:26,700 --> 00:59:30,600
comes to shoes. 
Well thank you all for joining 

1226
00:59:30,600 --> 00:59:35,100
us for Episode really fun to 
talk about plantar fascia pain 

1227
00:59:35,100 --> 00:59:36,600
because it's a really 
interesting topic. 

1228
00:59:36,600 --> 00:59:40,000
A lot of Runners end up dealing 
with it at some point in their 

1229
00:59:40,000 --> 00:59:41,200
life. 
Remember, there's differential 

1230
00:59:41,200 --> 00:59:44,300
diagnosis that are important to 
rule in or out. 

1231
00:59:44,500 --> 00:59:47,800
So find a great PT that you can 
work with. 

1232
00:59:48,300 --> 00:59:50,900
I think they can just be an 
amazing resource for you. 

1233
00:59:52,200 --> 00:59:56,400
And if you have an idea for that
segment where we talk about 

1234
00:59:56,500 --> 00:59:59,200
quickly, talk about the shoe 
that we are currently testing. 

1235
00:59:59,300 --> 01:00:01,200
We would love to hear your ideas
for that segment. 

1236
01:00:01,300 --> 01:00:04,200
Or if you think it's a terrible 
segment, we don't have to 

1237
01:00:04,200 --> 01:00:06,400
continue doing it but we thought
it might be fun to give a little

1238
01:00:06,400 --> 01:00:08,000
flavor of the things we're 
testing. 

1239
01:00:08,400 --> 01:00:11,800
So, feel free to follow us as 
always on Instagram, Facebook, 

1240
01:00:11,800 --> 01:00:14,900
Twitter, but I think the 
besting, the besting, oh my 

1241
01:00:14,900 --> 01:00:17,100
gosh. 
The the best thing y'all can do 

1242
01:00:17,100 --> 01:00:19,200
to help us. 
We've just appreciated the 

1243
01:00:19,200 --> 01:00:21,600
growth. 
We've seen in the podcast. 

1244
01:00:22,100 --> 01:00:24,300
It's still weird to us that a 
lot of people listen to this 

1245
01:00:24,300 --> 01:00:26,600
podcast in the first place. 
So we thank you all for 

1246
01:00:26,600 --> 01:00:28,400
following us. 
Something that really helps us 

1247
01:00:28,400 --> 01:00:31,200
continue to grow is if you just 
subscribe to the podcast, 

1248
01:00:31,300 --> 01:00:33,400
Podcast. 
And if you leave a review on 

1249
01:00:33,400 --> 01:00:35,800
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1250
01:00:35,800 --> 01:00:38,700
more reviews, we have the more 
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1251
01:00:38,700 --> 01:00:40,800
more time to dedicate to stuff 
like this. 

1252
01:00:40,800 --> 01:00:44,400
So appreciate you all following 
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1253
01:00:44,400 --> 01:00:45,400
you all next time.