Hey this is Dr. Gangemi and today's Sock Doc video is going to be about the
foot. I'm going to basically describe and talk about some few easy
treatment options that you can use for some common foot aliments that I
haven't discussed in other videos. And we're going to talk about top of
foot pain, Morton's toe, Morton's neuroma type issues and peroneal problems
as well as your big toe. And a little more about pronation and supination.
So let's get right to it. Pronation will kind of pick up a little bit more
where I left off on a plantar fasciitis video. If you want to know about
plantar fasciitis, check out that video. We're not going to talk about that
here, even though obviously it's a foot-heel problem. But your plantar
fascia, that sheath on the bottom of your foot is made up by, or supported
by I'll say, the tibialis posterior muscle. And that attaches to your
medial arch. This muscle has an important role in natural pronation, shock
absorption, natural rolling inward of your foot. And we're going to relate
that today to supination which is the rigidity of your foot as you push off
when you walk and run.
And that has to do with the peroneal muscles which I described a little bit
in the knee videos and we're going to talk about more now as they relate to
the foot. So you have three peroneal muscles and they start up here, your
peroneus longus comes down the outside of your leg and then wraps around
the bottom of your foot and attaches to your first metatarsal and your
first cuneiform. Pretty much right underneath the arch of your foot.
So if you're having a problem with anywhere on the outside of your lower
leg and especially if you do this with your foot. If you push it, if you
plantar flex it, push down and kind of turn out like that. That would be
more of peroneus longus or maybe peroneus brevis type of problem.
Very similar motion, the longus kind of scoops a little bit more where the
brevis just kind of pushes out. But, the longus again comes down, wraps
around the bottom of your foot, goes to that area. So look for trigger
points in the bottom of your foot, right around here, right around
underneath your arch just to the inside of your big toe, where the
metatarsal is, okay?
And then your brevis muscle starts a little bit lower, here. So, you want
to start looking in here and that attaches to the bottom of your fifth ray.
Your fifth toe, right about here, okay? So, feel around there for any
trigger points. The third one there is your peroneus tertius which is a
little muscle that has to do with bringing your foot out and kind of
dorsiflexing it like this, which is up and out.
It's not very often found, I don't see, I don't have to treat it that
often. But it starts way down here. It's mostly tendon and then attaches to
the top of your fifth metatarsal there, okay? So it's pretty much that
motion like that. So if you feel any pain when you bring your foot out like
that, think peroneus muscles, they have a lot to do with supination as I
said earlier. And the balance between supination and pronation with your
tibialis posterior that I talk a lot about in the plantar fasciitis video.
Because it has so much to do with your arch and plantar fasciitis problems.
Now, your big toe is the next muscle we're going to talk about. Your big
toe muscles, your flexor hallucis longus is this type of motion. If you
have problems curling your big toe or even plantar flexing your foot. That
muscle believe it or not, that helps to curl your big toe like that, starts
all the way out behind your fibula. Way up here. So, look for trigger
points behind here now, not on the side where you were looking for the
peroneus muscles. But in back, again all the way up here for the big toe.
And then, on the bottom of the big toe, right around here.
And the next one would be your peroneus brevis which is more of this
motion. If I'm pushing down, like that. Rather than this. So this is longus
and this is more brevis. And this muscle splays out and attaches to your
cuneiform muscle, bones. Which are underneath the arch here, like this. So
any big toe issues start digging around in there.
I'll tell you, even though I find these muscles to be weak and I have to
help people with their big toe muscles functioning more and more
efficiently. A lot of times it's because of improper pronation and they are
not naturally rolling in on their foot. Because of a tibialis posterior
dysfunction. Again, real quick, that would be on the inside where the
tendon sheath is of the tibialis posterior. But if you feel like you're
having that sort of problem, check out the shin splints video, because
that's where I really talk about your tibialis posterior.
Let's go right into Morton's toe and Morton's neuroma. Morton's toe is
actually when the first metatarsal is shorter than the second. A lot of
people think that you have to have a second toe longer than your first to
have a Morton's toe, but that's not necessarily the case.
They could actually be, very similar in length but it's about where this
one ends, your big toe. If it ends before the one on the second, your
second toe, then you would actually be known to have a Morton's toe. It
really doesn't mean you're going to have pain like a lot of people think
they do. They say, I have Morton's toe, even if their toe is obviously much
longer, could be a good centimeter or so longer than their big toe.
It means that you're going to be more susceptible to a problem if you have
Morton's toe. Because you're not going to pronate as efficiently as you
would if you didn't have that. Where your big toe is the biggest and you
can naturally roll in and not hit the longer of the bones before you hit
the shorter one. So, if you have a Morton's toe, it just means if your
pronation-supination balance is out of harmony with one another, you're
going to be more susceptible to a problem than if you didn't have a
Morton's toe.
But again, it doesn't mean you're going to have a problem. A lot of foot
problems and I talk about this on the Sock Doc site, are from too much
stress in your life. That can be poor diet, emotional issues; over training
is a big deal, improper footwear, any of these problems that relate to, too
much stress in your life, will result in foot problems and cause pronation,
tibialis posterior and supination problems, peroneus muscle problems and
result in other foot issues too. Such as, arch pain, such as a big toe
problem and that sort of thing.
And likewise someone can get what's called a Morton's neuroma. Which is
when one of the plantar nerves, typically the one between your third and
your fourth toe becomes inflamed. Painful, tender red hot, type of pain
right in the joint. That some people call a fibroma, abnormal growth or if
it's around the nerve, then a neuroma. An inflammation of that nerve. And
that again is from muscle imbalances of the foot that have been there for a
long time. Although many conventional methods like to treat these things
locally with corticosteroid shots and orthotics and that sort of stuff.
But they're really not addressing the problem if they do that. It's about
the balance of your foot and correcting these natural pronation-supination
imbalances that you may have resulting in any other problem. Which also
includes top of foot pain. A lot of people have pain on the top of their
foot. They think it's because their shoes are too tight, they tie them too
tight.
But it's really because their arch is being pulled up. Its too, the arch is
not naturally flexing and extending when they are walking and running. And
the bones are starting to become irritated at the top of the foot. And
again, often this is from the bottom of the foot. It's from the plantar
fascia, it's from the tibialis posterior attaching to the arch here and the
bones in the bottom of your foot. It's from tibialis posterior problems way
up here on the inside of the tibia.
It's from pronation problems, sorry, peroneus problems, supination problems
on the outside of the leg. So, it's about the balance there. I think the
best way to rehab your foot once you find the trigger points and are
hopefully starting to feel better or you address the reason for those
trigger points, also on the Sock Doc site, is to go barefoot as much as
possible or wear as you know, firm, flat, flexible shoes. Shoes with not
much of a drop.
This is a zero drop type shoe, meaning there's no drop from your heel to
your forefoot. Just as if you were barefoot. They're very flexible, just
as your foot should be, no support. And they're letting your foot feel the
ground. And feel where you are; develop proper proprioception. Develop
proper, what is known as kinesthetic sense, feeling the ground, so your
foot knows how to walk, run, jump and play naturally to help rehab these
muscles. Rather than isolate them one at a time through perhaps some
therapy and exercises or that sort of thing.
The more you are in over supportive shoes, the more you wear orthotics,
again, all this is on the Sock Doc site, the more you're going to cause
dysfunction of these lower leg and foot muscles. And the longer you'll end
up with pain and with discomfort. Maybe not while you're in them, but as
soon as you get out of them. You end up basically being devoted to them
forever.
So, that should about cover it. If you have any questions feel free to make
a comment, thanks.