♪ Bob and Brad the two most famous ♪
♪ Physical therapists on the internet ♪
- Hi, folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we're the most famous
physical therapists on the internet.
- In our opinion, of course.
- In our humble opinion.
Today, Brad, we're gonna talk about the big lie.
About heel spurs, heel pain, and plantar fasciitis.
And this is kind of a myth that's going on.
- Yeah.
- And is being perpetuated,
and it's actually being perpetuated
by a lot of websites, even.
- Sure.
You're right, and it gets people,
their anxiety too high and makes the diagnoses worse
than what they really are.
- Speaking of people, Brad,
we have a couple new ones here today.
How many?
- I see three right now.
- Three. Okay.
- One left, we're down to two.
- All right.
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- There you go.
- Lets get back to this heel spurs, Brad.
So what are we talking about?
- Now this is really the key right here. Isn't it, Bob?
- You wanna focus on it (indistinct).
- Zoom in on that, Lonnie.
- [Bob] No, we're kidding of course.
That'd be a boot spur, Brad. That's not a heel spur.
- [Brad] Yeah. But that is one.
- [Bob] Yeah, that would hurt, wouldn't it?
- [Brad] Yeah. That'll show up on the X-rays.
- [Bob] Let's take that right away.
Now a heel spur actually forms,
you got that pen yet, Brad?
That would actually word work good.
- [Brad] Yep, the red one?
- [Bob] Yeah.
So if you look at the bottom of the foot here
right on the heel, Lonnie, you got any of that or?
She says, yes.
You got the fascia right here.
Okay, that's a tough band
that runs from the heel to the toes.
Well, this is where this picture
is actually a little bit wrong.
Underneath the fascia are some small muscles, Brad,
that help flex the toes.
- [Brad] Right. They curl the toes.
- [Bob] Yeah.
And they put a force on the bone
and they're pulling on the bone.
If those muscles are tight,
they're gonna be pulling on the bone for years.
- [Brad] Sure.
- [Bob] And putting the stress on it.
And what does bone do when it reacts to (indistinct).
- [Brad] It calcifies it, tracks the-
- [Bob] It calcifies and pulls out.
So here we got again the muscles attached from here to here.
Yeah. Maybe a different color would be good.
- [Brad] By the way, this is Bob's rendition
of artistry of a foot.
- [Bob] It's terrible.
- [Brad] So those are toes
and this is supposed to be some big fat,
calcaneus, I guess.
- [Bob] Yeah. That's the bone that's supposed to be there.
But so yeah, here we got the muscles are in the green here,
and they're pulling on this bone,
and over after a while, it actually calcifies
and it actually through like Wolf's log
creates more bone and it creates a bone spur
that sticks out.
- [Brad] And they're are little pointy.
- [Bob] They're a little pointy.
- [Brad] Yeah. That's why they got the name bone spurs.
So are they causing a problem, Bob?
- [Bob] And that's the big dilemma here.
That's the big myth is that, that they cause you pain.
This is what happens, Brad,
you go in and you're having pain in your heel
and you've had it for quite a while
and you're going to the doctor
and finally he decides to take an x-ray.
And lo and behold, he sees a bone spur.
- Sure.
- So he goes to ask, what's causing your pain?
- Right there is-
- Well, it's not.
And generally very rare cases it might.
- Sure.
- If you can actually feel it, they said,
if you can feel it below the surface,
it might be giving you pain.
- Right.
- They said one out of 20 people who have heel spurs
that's the only amount that have pain.
- And they've done studies on us
where they take people with zero symptoms,
X-ray 'em and find a certain percentage of bone spurs,
but there's no symptoms.
They're living normal life.
- One study I saw, 15% of the population has bone spurs,
and they have no pain.
- Sure.
- So what's causing your pain in most instances
is the plantar fascia which is down below.
So you treat the plantar fascia and the pain goes away.
- So the plantar fascia is a wide ligamentous material that-
- Right.
Let's go ahead and show it on you, Brad.
- So right this red spot here,
are you zoomed in on this, Lonnie?
- [Bob] That's generally where you're gonna feel the pain
with planter fascia.
- [Brad] That's a common hotspot for plantar fascia.
- [Bob] And the fascia runs along like this.
- [Brad] (laughs) Wow. Yeah.
- [Bob] So.
- [Brad] Yeah, it's that's wide band
and it goes from the heel all the way up.
- [Bob] Up into the toes.
- [Brad] Right.
- [Bob] It does extend up,
you know when you stretch the toes,
you are stretching the fascia.
'Cause I wanna show that a little later on, Brad.
- [Brad] Right.
- [Bob] But let's say that's really not where your pain is.
Let's talk about some of the other things
that could be causing your heel pain.
- [Brad] Sure, you bet.
- First off, let me say, Brad,
if you are having heel pain in both heels,
I would probably have you go checked out by a doctor.
Especially if it's both heels and other joints,
it could be something more systemic.
- Sure.
- Like, I mean, I don't wanna throw out scary terms,
but it could be rheumatoid arthritis.
- Right.
- Or lupus or some of these other things.
- 'Cause you're saying typically
you don't have this problem in both feet.
- Right.
- It happens in one, it's kind of like sciatic,
it's usually one leg.
- Right.
Although it can,
I had it at the start of it in both feet
because I had both of my shoes were bad, so.
- I can just imagine.
I suppose that was in your college days.
- Well, no, it was just from running too much.
- Last year?
- Yeah, I was wearing it out, but.
- Sure.
- Which by the way is the thing is too,
they find more bone spurs
in people that are older of course,
because as you get older,
that's it's taking a long time to create that bone spur.
- Right. Takes a while for that calcification.
- So one of the first tests I want you to do, Brad,
is I want you to do the squeeze test.
- Yeah.
- Where you just go up there
and you can show on yours, I'll show on mine.
You just go like that, you squeeze,
the calcaneus bone there.
- [Brad] Okay.
- [Bob] You're gonna squeeze it.
And if there's any pain there,
then you should go and get x-rays,
'cause maybe you have a fracture there.
- [Brad] Okay.
- [Bob] You know if you're osteoporotic or if you run a lot
you could have a stress fracture there.
- [Brad] So you're squeezing the bone itself.
- [Bob] Yep. You're squeezing the bone itself.
- [Brad] Pretty aggressively.
- [Bob] Yep. Yep.
You wanna see it?
There shouldn't be, do you have any pain right now?
- [Brad] There shouldn't be any pain.
- [Bob] Do you have any pain right now?
- [Brad] Absolutely not.
- [Bob] No. No.
- [Brad] I'm not that strong.
- [Bob] So yeah, that might be part of it.
So. (chuckles)
All right.
Now let's palpate another spot, Brad.
You've already got it drawn in there, the red spot there.
- [Brad] Right.
- [Bob] You have the posterior tibial tendon
that comes around through here
and attaches to the navicular bone here.
So that actually goes a little further, Brad.
- [Brad] Yeah. Well I was just being general by it.
- [Bob] Right.
- [Brad] So if your heel pain
is actually coming from right around in here,
it happens here,
you more likely have posterior tibial tendonitis.
- [Brad] Sure.
- [Bob] And not plantar fascia.
It's not a heel spur.
- [Brad] Yeah.
So actually this bone right here
acts as a little pulley system
and it goes around and the muscle is up in area.
- [Bob] Yep, it pulls up and turns the foot and all that.
- [Brad] Yeah, it makes you invert.
- [Bob] The other one, the other spot, Brad,
thank you for moving.
- [Brad] Yeah. (indistinct)
- [Bob] If your tendon is back here,
and this might even go down a little further too.
- [Brad] Sure.
- [Bob] Could even go down into the heel.
- [Brad] Yep.
- [Bob] Then you maybe have more of Achilles tendonitis.
- [Brad] Right.
- [Bob] You know.
- [Brad] You got that big Achilles tendon there.
That's an amazing tendon.
It really does a lot of work so it can easily get injured.
- [Bob] And then the last one, Brad. Yes.
So you could have it on this side,
on the outside of your foot,
again, going around the ankle bone.
And that would be peroneal tendonitis.
- [Brad] Right.
And those peroneal muscles there
are like those are right up in here, so.
I dunno if it's peroneal or peroneals.
- [Bob] Yeah. Let's get in another question.
- [Brad] Potato, potato.
All right. Let's get back to the subject.
- All right.
So Brad, again, I'm gonna assume
most of you are gonna have the plantar fasciitis.
That's the one that's very, very common.
- [Brad] Right.
- Let's just show you three things you can do for it, Brad.
- [Brad] Sure.
- [Bob] You know, don't wanna have you leave here with us,
just giving you this big myth and then finding out
we didn't give you any answers for it, so.
One thing you wanna make sure, Brad is,
when you get up in the mornings
is that you're putting your shoes on before you get out.
- [Brad] Right.
- [Bob] And that usually is a symptom, isn't it, Brad?
Is that when you get up
after you've been sitting for a while,
(Brad groans)
or yeah.
- [Brad] You gotta take a while.
- [Bob] It really hurts in the mornings.
- [Brad] Right.
- [Bob] So.
- Should we tell 'em the reason
'cause if you sleep all night
your feet are typically relaxed position, plantar flexed,
and these tissues tighten up overnight,
and then, and they're already sore
because they were sore the day before,
and then you put a quick stretch on 'em
with all that weight and all those tender tissues
wake 'em up really quick and then-
- Then they break open again.
- Let's you know.
- That's a scar tissue and you break it open again.
- Well, it'd be like
if you had a cut on your knuckle right there
and you went like that, and you just split it.
- Yeah, exactly.
So before you even get outta bed
the thing I like to have people do, Brad,
is to actually stretch those toes like this.
- Sure.
- And you're stretching that plantar fascia.
Is just grab on the four foot here and pull.
And this is so easy to do in bed before you even get out.
- Right. You're gonna do it slow, you'll know.
Your body will tell you.
- Yep. Just go ahead and give it a stretch.
And I would like to see you doing this stretch
throughout the day, Brad, like if you're sitting in a chair
and you've been sitting for a while
and before you get up again and you get that sharp pain,
go ahead and give it a stretch.
- [Brad] Sure.
- [Bob] Before you even get up, take your shoe off
and have people talk about you in the office.
That's always fun.
- Maybe you can get someone come over and do it for you.
- Oh, I bet you that's gonna be easy to do. Yeah.
All right.
The next thing you wanna try, Brad,
is we had a lot of people
that have had luck with the splint.
- Right.
- The night splint.
- And there's quite a few different
makes and models of these,
but they have the same basic concept.
Oftentimes they're Velcro.
- This is the thing that,
my wife was doing all the other things
you're supposed to do, she was icing and stretching.
This is the one that healed it quickly.
- [Brad] Sure.
- I mean, were shocked. It was within two nights.
She was already back to walking
and then by a week she was back to running.
- So in her case, that was a key part of the healing.
- And I know I'm only giving her one example
but the studies have shown too,
that this combined with the other stuff
often really does help.
Not sure what it does there.
- Oftentimes they're adjustable.
So see, my foot can plantar or flexor go down,
but if you pull it up like this,
there, and then that pulls it into that neutral position.
- Yeah.
You really gotta watch it.
I mean, you can't stretch it too much.
She said there's a couple times
she woke up in the middle of the night had to release it
because it was too much.
- Right.
- So.
And the last thing I'm gonna show you, Brad,
is a taping one.
And this is the thing, you try it and if it works great,
if it doesn't work, don't do it.
- Right.
- [Bob] But you just get some tape, some, what is that?
Zinc oxide tape.
Some of that rigid tape. Is that what it's called, Brad?
Zinc oxide? - (indistinct) to know.
Well, I don't know.
You're talking about dog tape.
- [Bob] Athletic tape.
Athletic tape that doesn't stretch much.
So you're gonna do is,
this is the one if we're gonna do the left foot here,
you're gonna put it underneath the foot here,
underneath the heel,
and you're gonna bring it up and around.
This should be a little bit longer, Brad.
This should be a longer piece.
- [Brad] Yeah.
- [Bob] It should go all the way around,
I didn't measure this before.
But what this is doing,
this is called externally rotating the heel, Brad.
So you're gonna pull up on it like this
and then pull it across.
- [Brad] You tape up to there?
- [Bob] I would tape even beyond it.
- [Brad] Okay.
- [Bob] I would go all the way around even.
- [Brad] I've done it up to this area already.
- [Bob] Oh really?
- [Brad] Yeah.
- [Bob] I would do it too.
- [Brad] Yeah.
Either way it pulls it this way,
but then I always put some tape around here to hold the end.
- [Bob] Right, to hold.
I would, yeah.
If you let's say, if you even do it my way,
I would double tape it by every means,
this tape's long enough.
- [Brad] You could double tape,
go combiners and really have some support over there.
- [Bob] Yeah.
Either way you're really trying
to externally turn that heel.
- [Brad] Why don't you put your foot up,
so they can see that better.
- [Bob] We used kind of the wrong color tape,
didn't we here, Brad?
- And you know this will work because as soon as you walk
the pain will go from a eight over 10 down to half of that.
- [Bob] I think when you first step,
it's gonna feel awkward, Brad,
'cause you have to let the tape-
- [Brad] Stretch out a little bit.
- [Bob] Yeah, you'll feel the tape pulling.
- [Brad] Just pulling your skin.
- [Bob] And that's what I feel right now.
But right, if it's gonna help, it's gonna help right away,
it's gonna feel better.
- [Brad] Right.
- [Bob] And if it does, you can tape every day.
- And that is fun as a therapist when you put that tape on
and they get up and walk around
and they put a smile on their face and say,
"Oh, I can't remember walking like this."
- Right. Without pain.
So thanks everybody for watching.
- Oh yeah, it's time to go.
- Yeah. It is.
- See you, Bob.