No worries at all, glad it was help and best of luck for the future

To pronate the forefoot to help engage the windlass mechanism and take the load off the plantar fascia. Then lateral to compress the fat pad

Glad it was helpful!

Hi @noivctheaf many thanks for the message, yes the insertional will not like stretching. Of course we can offer an online consultation you can book in with the link below. nk-active.cliniko.com/bookings?practitioner_id=53034&appointment_type_id=1260834468004889714 Thanks Nick

Great stuff

Glad it helped!

Glad it was helpful

Yes of course we can, we can schedule it for next couple of months time

Sorry I have just seen this, if you have not already please message Julie ATnkactive.co.uk your CV and covering letter thank you

Sorry this is a very vague answer as it depends our clinical evidence. Say it is anything from 12 weeks up to 7-8 months from when you start a treatment plan. There are many factors that count towards the difference in time length the main factor is if there is problems or dysfunction around the big toe as this will increase the load going through the leaser plantar plate those toes

If you’re getting symptoms after swimming, this can be irritated if you are using the Foot to push you off the wall, however if this is not the case and you’re not pushing off the wall and you’re still getting irritation on swimming that is a sign you’re not offloading it enough

You can use somethings like hypafix or mefix on the top or leave the top bit off. It in only there to stop it catching on socks

Soak your foot in water

Sorry to hear about the Injury. Having a look at north face vectiv would be helpful or hoka trail shoe. Happy to help with an appointment face to face or over video if you are not local to us nk-active.cliniko.com/bookings#location

It was a pleasure, glad it was helpful. If you like a stiffer feeling shoe look at the hoka carbon x also

Thanks for the message, I think it depends, and to check if you feet are a 4e width, just because most people are in the incorrect size shoes and it could be wider or narrrower Wider shoes Hoka Wide fitting shoes Altra FwD experince Brooks ghost max wide Thanks Nick

Yes, absolutely, rocker shoes should be helpful for sesamoiditis nkactive.co.uk/wp-content/uploads/2024/04/Footwear-.pdf

Many thanks for the question, the use of insoles and footwear are tools to help live with OA, they dont have to worn everyday, you decide when you need to wear them to help you the most

My pleasure

Thank you for the comment. The north face vectiv and hoka comes in a walking boot version as well which are waterproof. Unfortunately the majority of the options with a rocker are running or trail shoes very limited options when especially looking at a leather shoe, this is why we often will put orthoses or a stiff rocker in normal shoes to help

Thanks!

Thanks roger. Hope you are well

No problem

Thanks for the question. with CECS pain will not continue, with Biomechanical over load syndrome (BOS), pain will not continue after, however as with BOS it is often related to reduced strength in the legs and calf you can get muscle pain after. The other option to consider is popliteal artery entrapment syndrome. Happy to have an appointment face to face or video if you are not local

Thank you for your quick response. My doctor suggested we look into that too. Will reach out if I need an appointment. Thanks a lot🙏🙏

Thanks for the message. Yes CECS could be a possibilty or Biomechanical over load syndrome, however I would expect the pain to be more intense, did the MRI scan show any boney bruising?

It was a pleasure Colin, we do plan to get Jill back on the podcast again

Glad it was helpful! Also I need to add a shoe to this Altra FWD experience, which are nice and wide, I ordered a pair to test a few weeks ago and very happy with them so far

@@NKActiveClinics Hello again! I use altra and especially the altra paradigm and of course i like the wide toe box but it doesn't have a rocker sole. So if you have tested the new altra FWD, could you please tell me about it, in comparison to saucony endorphin or the other roccker shoes that you mention in the video!

@@stratos1974athe FWd experience has a rocker, comfortable shoe. The Altra doesn’t have a plate in it so not a stiff so you don’t feel the rocking motion as much, but if you are looking for really wide then the Altra fwd experience is the shoe or the books ghost max which is wide with a rocker but again no plate inside

@@NKActiveClinics It seems that it's one-way to try saucony endorphin and hoka clifton which are the wider with rocker and plate. Of course i will try brooks and altra you mentioned just to compare the feeling, because i have been wearing altra shoes for 3 years now and i am afraid that my feet are used to the wide feeling in the toes. Thank you!!

@@NKActiveClinics Hello again! I tried saucony endorphin 4, hoka bondi 8 and clifton 9. The endorphin feeled narrow in toes and also the bondi. The feeling was better in clifton. But my problem is that here in Greece i can't find the wider version of bondi and clifton to try to see the difference. It seems that if i can test bondi wide, this could be my choice. I keep checking.. About asics metaspeed the choices are sky, edge, sky+ and edge+. If it is possible could you tell me what the proposel is? which one? Starting from your fully informative video, i started having hope to find something that it fits me best to help me with Subhallucial interphalangeal sesamoiditis.

Many thanks and good luck on the venture. Where are you based?

This can help as part of a treatment process, however it is rare that one treatment on it's own will help solve plantar fasciitis

I always explain that once we have an tendinopathy we can settle the sympotms however need to keep nice and strong going forward to help reduce the risk of it coming back, so you think of it as it is a constent managment, hope your symptoms not causing you too many issues

Thanks for the message, there are few things it can be signs of neuropathy or nerve entrapment or it can be related to things like diabetes. My recommendation is to see a health care professional to have an assessement

Sorry to hear you are suffering from this. Yes, military recruits are one of the most common groups we see this in, especially new recruits, I think part of it is with basic training and tabbing, a lot of people don't do a lot of the physical prep work prior to joining. The biomechanical overload syndrome was actually developed in the military as they found if they made the soldiers stronger, in some work on the way they walked, things got better. This is partly also where the rough guidelines of squatting body weight and dead lifting 1.5 X body weight came from. In the clinic during the rehab process, we get the military patients to do rehab with their kit (or equivalent weight) on. Hope your symptoms get better and hope you are getting the required support. If not we can help. Thanks, Nick

This ended my army career. Even though I was a pt stud I couldn’t pass a pt test to save my life. Listen up. When you get out make sure you get 30% for chin splints. Don’t forget this. Make them pay.

@@theavalanchmanI have this and am in now I can run like 2 days a week any more and my feet go numb what’s ur advice?

Thanks for the message Graham, I agree, I am not a fan of safety shoes, I have had 3 patients this week where safety shoes played a huge role in their problem, the issue with the design of safety shoes, is they are designed around safety and not foot function, I believe they could make a couple of changes to the boots to help out, whilst steel maintaining the safety. Currently, you cant change on the shoes, so you need to off load with orthoses (insoles) and making the foot much stronger than average to cope with the loading. We have patients, who manage to get treatment and orthoses paid from by their employer as it is part of PPE to do their role as the cost of treatment is less than then the cost of going on sick. Hopefully that helps, we can offer virtual or face to face appointments if required. Thanks

The bondi 8 will be ok, the bondi x maybe better as a stiffer than the bondi 8, however you may feel the bondi 8 off loads the symptoms enough

@@NKActiveClinics Thank you so much for your comments! By the way, may I have your opinion about the role of Shockwave Therapy in the treatment of plantar plate tear? I saw some doctors advocate the Shockwave Therapy as the important tool for treating PPT. Thank you!

No worries at all. The aim of shockwave therapy is to promate healing. Ligaments have a poor blood supply so do not tend to heal that well (that doesnt mean you can get back running and reduce the pain etc) but for me I am not convincned in the use of shockwave for plantar plate injuries. We have a shockwave machine in clinic, however I never use it for plantar plate inujuries. Thanks Nick

@@NKActiveClinics Appreciated your time & professional advice! Thanks again!

@@frankh8821 it is a pleasure

It will not change how much the foot supinates (rolls out words) or pronates (roll in) the aim is to reduce the tensile load through the plantar fascia and help compress and off load the fat pad. It makes the foot feel very supported

It is so much more interesting than road running

Yes, we try and work on if pain 4/10 or lower then ok to keep running, if above 5/10 then maybe back off, work on treatment and then get back to running

The tape is called zinc oxide tape nkactive.co.uk/product/zinc-oxide-tape-1-25cm-width-3-pack/

Hi sorry I missed this. If you are in the UK we sell the bands nkactive.co.uk/product/tone-loops-complete-set/ Thanks Nick

Hi it is not an exercise that is specific for plantar plate tears, however having tight calf muscles can increase the load through the plantar plate, so if you have tight calf muscles it can be helpful

Many thanks for the message. In general orthoses with a metatarsal dome are the best, the key part is the placement, however even then not everyone can toleate a dome. You can off load with a carbon lining rokcer or rocker shoe. Then also helping to get the foot stronger is key as well. We do have a plantar plate play list kzbin.info/aero/PLbkYmQL0j2thoQUaYnTuC3zcS6v369qwQ Then we have some blogs as well www.running-physio.com/plantar-plate/ www.running-physio.com/plantar-plate3/ Or we can help with a video or face to face appointment Thanks, Nick

@@NKActiveClinics God bless you! I've having pain for a long time! I'll try to follow your advice💯☺️

Once strength is built up look at building calf and single leg strength then adding in plyometrics which is the posh word for jumping around, this helps to improve the elasticity back within the tendon, so it can’t get ready for repetitive continuous loading activities like running, if you just build basic strength, and then look at incorporating exercises into the rehab process that the tendon is going to do during your sporting activities things tend flareup

The question is how are you the afternoon / morning after burpees etc. try the seated calf raises. Also don’t worry about the pain that is 2/10, you can keep on running and that can settle on it’s own. If things don’t settle, maybe worth seeing if there is a retrocalcaneal bursa present

there's no increase in pain or stiffness after these exercises so I figure it's ok, it's really just the running that doesnt feel right and i can feel the mild pain during. Thanks, i will give the strengthening a go and see a specialist if it doesnt resolve.@@NKActiveClinics

Looking forward to meeting you

Plantar plate injuries needs a episode on their own!!

Thank you for the questions. I will try to answer them one by one. The scholl metatarsal pads are wider, and effectively are just cushioning, rather than trying to offload, the reason it has a ring for the toe is that you physically attach the pad to your foot. In general, they tend to be very cumbersome and I’m not overly effective in offloading the ball of the foot applying a dome to and insole or trainer lining tends to be more effective. I am not sure where you can purchase them in Australia as a member of the public. However, most podiatrists will have access to them. With regards to how long it can take to go away, this purely depends on the diagnosis. There are well over 50 different reasons as to why the front of the foot can hurt using a metatarsal dome can be in offloading strategy and part of a treatment plan however, you need a diagnosis first, and then you can work out how long it will take to recover. Gel inserts, very much like the scholl, will help cushion, however, will not offload as effectively as a dome, slightly depends on what the treatment objective is. My advice is, if you are suffering with pain symptoms is to see a podiatrist in Australia to help formulate a diagnosis and treatment plan .

Hmm not really, if fluid seen will most likely be a intermetarsal bursitis. Injection can help. Key point is to look at why the started in the first place

@@NKActiveClinics I started walking on a treadmill at incline of 4-8 in bad sneakers for months. The tread on my sneakers was worn flat on ball of foot location. Was also overweight and I powered through the pain. If the fluid did not leak but we can see a small mass below the fluid locations, maybe it’s inflammation. Orthopedic Surgeon seems to believe the bursa tore and fluid leaked and that is the mass and body is yet to absorb.

@@jasonstone5022 it is possible for the bursa to burst but would expect the body to absorb it quickly. I have personally not seen a case of a popped bursa, even it is has It maybe to the cause of the symptoms. If the tread on the trainers have worn in that area that would indicate increased loading in the area and that maybe more of the cause of the symptoms. So it it is mays to off load that ie metatarsal domes and rocker shoes. Then strengthen the foot back up

@@NKActiveClinics I’m amazed that the fluid is still there if it is fluid. First MRI is from 12/22 and the other is from 6/29. No change in size of the mass beneath the met head. Could this be capsulitis inflammation instead? Symptoms and MRI don’t seem to be consistent the neuroma.

@@jasonstone5022 yea could be, US would be a better scan on choice. However also remember it is based on your symptoms. What we see on imaging doesn’t also correlate to pain

If suffering with since 2017 that would Suggest the treatment hasn’t been the right one for you so far Or not pushed hard enough during the rehab process. Unfortunately rest doesn’t do you any favours long time. Insertional Achilles tendinopathy takes around 4-6 months to settle ( providing there is no other medical reasons why it may not settle )

Thanks the message Eric. In general stretching will aggravate symptoms. Best way is strength work. Making sure when doing heel drops the heel doesn’t down. With massage help in short term but effects very short lived. I did a more detailed video a couple of years ago kzbin.info/www/bejne/ZqGnZoqNg5h0ack