WHAT SHOES TO WEAR FOR FOREFOOT PAIN

Do you have forefoot pain or pathology and you’re not really sure what shoe you should be wearing? There are numerous foot pathologies that you could have, however we are going just zero in on a few today, such as bunions, first metatarsal joint arthritis, neuromas, and plantar plate tears.

Before we get into details about each, let’s just go over some quick anatomy.  The forefoot includes the phalanges (toes), the five metatarsals, and the connective tissue.

Now, let’s jump right into our foot pathologies and what feature in the shoe you should be looking for to accommodate for your pain.

  1. 1st MPJ arthritis:

This 1st metatarsal phalangeal joint is also referred to as the great toe. This is caused by the joint jamming too early in the gait cycle or an inflammatory reaction.  If you have arthritis in this toe and it is either painful and or limited in mobility, then the most important feature for your shoe will be a more rigid midsole. Secondly, you’ll want a wide toe box so that you have room for your toes to splay properly.

midsole

2. Bunion:

A bunion occurs when we lose stability in the metatarsal cuneiform joint (first ray). The first metatarsal will swing out and create a valgus position on the great toe. With a bunion, you definitely want a wide toe box. Because a bunion is caused by a lack of stability in the 1st ray, this often indicates that the foot is likely an unstable, everted foot type. In this case, a stiff heel counter in the back of the shoe will help control the foot so that it does not overpronate.

heel counter

3. Neuroma:

A neuroma is a scarred or fibrotic nerve often between the third and the fourth metatarsal. The nerve rubs on the fascial tissue and then becomes fibrotic.  This typically occurs from a loss of stability in the foot and/or compression in footwear, among other things such as injury. What will be most important with acute symptoms of a neuroma will be a stiff midsole. If the midsole is flexible, and you have an active, painful neuroma, you will continually compress the nerves at toe-off in your gait. So when your foot is more irritated, a stiffer midsole with a wide toe box will be most beneficial. 

toe box

4. Plantar plate tear:

The plantar plate is an extension of the plantar fascia that runs horizontally across the joints. A plantar plate tear can be very painful, and you’ll want to immobilize the tissue for a period of time. In this case, once again, you’ll want something more rigid in the midsole. During an acute injury, you will want to immobilize the tissue for a period of time, therefore utilizing the rigid midsole.

In certain circumstances depending on the level of forefoot pain and pathology and how it’s affecting your quality of life, a forefoot rocker is frequently recommended. If someone has advanced great toe arthritis, whether it’s fused itself or a fusion surgery has been performed, a rocker bottom shoe can be very helpful.  It can be added to the shoe or there are actually shoes that you can purchase with this specific feature.

Now for your bonus! The more cushion you have in your shoe, the more impact force you will have through your body. Picture yourself walking outside barefoot. Imagine how you would walk–your pace, your intention, your impact.  Now picture yourself doing the same walk in high cushioned shoes. Think about the difference in how you would interact with the ground. You will strike the ground much harder because you do not have the same sensory input that you would have if you were walking barefoot. 

When you have pain that is affecting your quality of life, shoes can be part of the solution, rather than part of the problem.

If you’d like to schedule a free 15-minute virtual discovery session, please email drarianne@themovementparadigm.com or text 302-373-2394 to schedule. We’d love to help you get healthy again!

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4 REASONS YOU SHOULD RECONSIDER NSAIDS

Do you have arthritis and you’ve been told by your physician that you should be taking some kind of anti-inflammatory and/or pain medications? You’ve maybe settled on Ibuprofen, or perhaps you have tried some prescription medications. Well, let’s talk about why we may want to reconsider.

Let’s start by saying that osteoarthritis is an inflammatory condition. It is important to recognize all the potentially inflammatory triggers that could be impacting your pain and function: food, bugs, toxins, trauma (both physical and emotional), and hormone dysfunction. Let’s not forget the movement compensations over many years that are also contributing to your painful patterns. It is not simply that you have poor genetics, or you played football when you’re younger, or you hurt your knee many years ago. Those may play into it but they are definitely not the only driver and you do not need to be debilitated by your pain and function. There are many negative side effects of NSAIDs.

1. Impacts the GI System

It can significantly impact your GI system. It can affect the lining of the GI system, even in the stomach, and can contribute to GI bleeds. Now let’s remember that 70 percent of your immune system is in your gut. If you are negatively impacting your gut lining by taking NSAIDs regularly, then you are impacting your ability to regulate inflammation. Remember, osteoarthritis is inflammatory.

2. Linked to Heart Issues

NSAIDs have been linked to more heart attacks, strokes, and other heart-related conditions.

3. Affects Kidneys

It can impact your kidneys and the blood flow to the kidneys.

4. Decreases Pain Threshold

Your pain threshold is lower. So, what may have just been a little bit of pain, such as a one or two out of 10 is now a five or six. This is because you cannot manage or process pain as you could before with chronic NSAID use.

This goes without saying but physical therapists are the best way to improve your overall function, decrease pain, and help you to do exactly what you want to do. Please reach out to us we would love to help you. Also focusing on things like breathing, yoga, meditation, all of the things have been shown to help with being able to manage pain more effectively.

I know that you think I might suggest ice or heat, but we’re going to ditch those. Neither one of them is going to have a positive or therapeutic impact on your arthritis. It may feel good, but it is not doing anything to help. When you’re using ice it’s decreasing blood flow to the area creating vasoconstriction, so it does not decrease inflammation despite what people think. Also, heat can potentially bring a little bit of blood flow to the area, but it’s such superficial heat that it’s very minimal. Although it might feel good once again it is not necessarily doing anything to improve your function. You want to try to move as much as possible because that has been shown over and over again through research that is the most effective treatment for arthritis.

If you need help on your journey to better health, contact drarianne@themovementparadigm.com to schedule a FREE 15 minute virtual consultation.

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Arthritis: An Inflammatory Condition

Have you or someone you’ve known experienced some kind of arthritis? Perhaps it has been debilitating and or it has affected your quality of life? Let’s define arthritis and discuss the drivers of osteoarthritis, as well as rheumatoid arthritis, and what you can do to prevent it.

Many people experience aches and pains as they age. Is this normal? Not really. Is this common? Yes. Is there something that we can do about it? Yes. You do not have to embrace the deterioration of your body as you get older. There are things that you can do to prevent osteoarthritis, as well as rheumatoid arthritis.

Let’s talk about some misconceptions about osteoarthritis. First, “everyone gets it”, which is not true. Second, is that it is genetic, and that is also not true. It is in fact, a matter of diet, lifestyle, and the environment.

Osteoarthritis is pain and inflammation in the joint or multiple joints. Research shows, however, that osteoarthritis is due to inflammation in other parts of the body. Specifically, it can be related to high insulin levels.  With diets, specifically the Western diet that is high in sugar and processed foods, can lead us to high insulin levels and poor blood sugar regulation. This is one of the key drivers in osteoarthritis. We want to remember this key thing, osteoarthritis is an inflammatory condition. Seventy percent of our immune system is in our gut. If we are having any type of systemic inflammation or excessive inflammation in our body, this can drive osteoarthritis. Often, you will see that a person that is experiencing severe osteoarthritis all over their body. They are in a very inflammatory state.

Rheumatoid arthritis, on the other hand, is an autoimmune condition. It affects 1.5 million Americans, but the interesting fact is that it has been happening at younger and younger ages. This is when the synovial fluid becomes thick and murky and creates degeneration in the cartilage of the joints. The joints can become very stiff and painful. One of the biggest drivers of autoimmune conditions, once again, is going to be a predisposition genetically, the environment, and activities of daily living. One of the biggest contributors to autoimmune disease specifically rheumatoid arthritis is a leaky gut, otherwise known as intestinal permeability. Our immune system begins to attack healthy tissues, too.

Before we get into what would be most helpful, let’s talk about what you should not do; take chronic nonsteroidal anti-inflammatories (NSAIDs). These will ultimately turn off your immune system, contributing to poor regulation. Although it may mask symptoms temporarily, it is not optimizing your immune system for the long-term.

In both cases of arthritis, a major goal is to reduce inflammation. Also, reducing your insulin, eating less sugar, eating to balancing your blood sugar, and keeping them stabilized throughout the day is critical. Improving your gut health and determining what foods are inflammatory for you is necessary. Doing so will help you to optimize your overall immune health and be able to prevent these types of inflammatory conditions.

As it relates to movement, please consider seeking out a qualified movement professional to help you on your journey to make sure you are moving well and without compensation.  Even though it’s inflammatory, you want to optimize the joint positioning, referred to as joint centration. Think about the shoulder joint, a ball and socket joint. When the ball isn’t in that center position of the joint, it will shift forward and often start to cause pain and irritation in the joint. So you’ll want to make sure that you’re stabilizing the joint and strengthening around it. Essentially, you’ll want to load the joint in its pain-free non-restricted range of motion.

There you have it; powerful ways to prevent and improve arthritis as you go into your older years.

If you need help on your journey to better health, contact drarianne@themovementparadigm.com to schedule.

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