♪Bob and Brad, ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet ♪
- Hi folks I'm Mike Kenitz,
physical therapist assistant,
- Brad Heineck physical therapist,
- and together we're the most famous
physical therapists on the internet, right?
- Well, not quite.
I noticed something different.
You're, you're about six inches shorter than Bob.
- What?
- Yeah, Bob couldn't make it today,
so, so Mike is filling in
- Hi!
- and he does an excellent job.
We're happy to have him.
Today's video:
"What's causing your foot pain?"
Question mark.
And we've got four most common causes with
some science research to help back this up.
- Yes, but before we get into that,
- Oh!
- Check out our giveaway section
for this week's giveaway of
a SleepOvation mattress.
- That's right.
- [Mike] And some pillows as well.
- Yeah, so here we got the mattress.
700 tiny mattresses.
We've got air flow in it,
Both Mike and I found out
we can sleep on our backs comfortably now,
after the mattress.
- Yes.
- Also, a pillow comes,
is it going to be part of the giveaway?
They actually have little springs in this pillow
- Yep.
- And you you'd never know it.
They're lovely pillow,
but let's get on with the foot pain, Mike.
- Enough about that.
You could ch- whoa!
- Oh!
- You could check us Instagram, TikTok and Twitter
for short versions of our videos,
or pinned to the top of our Facebook is our giveaway
and bobandbrad.com.
- Yeah.
- All right, now we're done with all that.
- Mattress giveaway is incredible.
So here we go.
I did a little research on this, Mike.
I wanted to find out: foot pain.
Where is;
what are the most common diagnoses?
What are the causes?
The most common one?
So I found in the Physician and Sports Medicine Journal,
2004, Dr. Steven Stovitz,
I think it's pronounced,
and Dr. Chris Cozzi,
hopefully got the pronunciation right,
they came up with four diagnoses.
- Mm hmm.
- And what they found out was,
and this is not surprising,
is generally,
can you come down here and look at my foot,
Liz, thank you?
All four of these diagnoses,
they feel the commonality,
the common cause is a mechanical problem,
and that the foot pronates,
or it goes into a flat footed position
with weight bearing or the activity.
- [Mike] Mm hmm.
- [Brad] So it's associated with flat foot,
but don't worry if you have flat feet
doesn't mean you're going to have; get these.
That's our explanation.
The four are,
we're going to go through them one through four,
and I'm just going go through each one
so you'll just have to,
if you think this first one is not your foot pain,
go to the next one.
So number one,
this is a big one.
I think every therapist or doctor will agree.
- Yeah.
- Plantar fasciitis.
- This is the one we most commonly probably see
in the practice field.
- [Brad} Yep.
- Typically diagnosed with this.
Honestly, of these four,
this is the one I know for sure.
And the other three are like,
I'm not super common with.
- Right, well, I've seen them
and I pretty much agree.
And I talked to Bob about this last week
and he concurred.
- Yeah.
- So anyways, let's go to plantar fasciitis.
Typically the painful plane,
the whole foot can be painful
depending on how severe it is,
but the primary source is this red dot
right here on my foot.
Liz said it looked like a little bit of blood,
but don't worry, it's not,
it's just a red marker.
So right there,
when I see a patient,
I will palpate and I'll go around here
and I'll say,
"Tell me when I hit the really tender spot."
And almost always right there they go,
"Oh! That's it!"
So that's a common symptom that you can
find on yourself
Also, a common symptom is getting out of the bed
in the morning and when you first put weight on it,
it's very uncomfortable and you limp around for a bit.
But then it starts to feel a little bit better
after a few minutes of weightbearing or walking.
Two common symptoms.
We're not going to go through all of these in detail
as far as treatment,
because it would be a 20 minute video or a 30 minute.
We don't have that kind of time.
So, common treatments, Mike.
- Cold bottle is a very common one.
Take a pop bottle, water bottle, whatever.
Put it in the freezer,
freeze it up,
put it under your foot.
And then...
- Yeah.
- [Mike] Oh, you're barefoot.
Roll on it.
- [Brad] Yeah. Make sure when you freeze it,
there's a little air at the top,
otherwise it'll expand
and break your, your bottle
and possibly get water in your freezer.
- [Mike] Yep. And another common thing is a night splint.
That's kind of a splint you would put on your foot
to keep it in more of a stretch position.
Oh, you actually have one.
- Yes, I do it.
We just did a video on the effectiveness of night splints
for plantar fasciitis.
So you can look that up.
We just got it up maybe a couple of weeks ago.
Do you remember Liz?
Do you remember that one?
Yup. See.
- So very common things to do at home
are just icing and doing some stretching.
If you're seeing a therapist,
they might either do,
I've seen iontophoresis or ultrasound,
or different things as well
- Right, right.
- But just on your own,
these are common things.
- If you Google bobandbrad.com plantar fasciitis,
you will get a number of videos will come up
and explain a lot of different treatments.
- You did a whole program series on it.
- That's right.
- So watch those.
- Exactly. Number two,
posterior tibialis tendonitis.
That's a mouthful.
- That is.
- Yeah.
So if we break it down,
what it boils up to be is
the posterior tib muscle.
Well, let's get Sam out here.
- Posterior means back.
- Yep.
- [Mike] Tibilais refers to your tibia.
- [Brad] There you go.
So the back of the tibia,
so it's in here.
So in this area of the tibia
and then the tendon actually
wraps around the backside of your malleolus.
I got a purple line here representing the tendon.
And it connects up to the navicular bone.
That's that bone that sticks out on the side there.
And what that muscle does is when it contracts,
it helps support your arch.
- [Mike] Yeah.
- [Brad] So this all is kind of coming together here.
So if your arch collapses too much,
it can cause that muscle to overwork
and then that tendon can become inflamed
and that's the tendonitis part.
So down in here, symptoms are,
if it hurts on the medial side
or the inside of your ankle,
and if you push on the backside,
here's my malleolus,
or that ankle bone,
and I push on the backside of it here
with this finger,
You may find that to be quite tender there.
Good sign that that's part of your problem
or it is your problem.
So Mike, you got any, any clues
for what you would do with that?
- Well, you would probably put in a type of foot support.
- Yes.
- Or a brace.
- Yep. You can add in some kind of arch support,
you don't have to get a custom one,
you can just try getting something off the counter
at, you know, online or at the local foot store.
And you're going to put it like,
this is the insert from here,
you will probably put it underneath the insert.
Sometimes you take this one out and put the whole one in.
Depends on, on what you're buying.
But that supports that,
allowing that tendon to have less stress on it,
therefore getting it better.
If it's real tender,
you can put a cold pack on it,
do that couple times a day
and just be off of it.
Activities that irritate it,
back off on them, you know, if you can.
- Take some rest,
strengthen the muscle a little bit too.
Tibialis posterior typically inverts,
so meaning it brings your foot in.
You can do some just gentle range of motion.
if it's really painful.
- [Brad] Yep.
- You can always add some TheraBand for resistance
if you really want to strengthen that.
- [Brad] Sure.
- But those are just some common options.
- I believe we have a video specifically for this.
I know we do for...
if you go Google bobandbrad flat-footed
or tibi-
(Brad laughs)
- posterior tibialis tendinitis,
that should come up with much more details
on the exercises.
Number three,
hallux valgus.
- You take this one.
(Brad laughs)
- These are all the medical terms.
You'll know this more as people end up getting
what's right here, Mike, they call that?
- [Mike] Bunion?
- Bunion! Exactly, what happens is
if you look at the line on my toe,
I know my sister had this,
is the toe ends up going,
valgus means out,
hallux just refers to the great toe,
and it goes out this direction.
So, and a lot of force gets put
on this part of the foot.
That causes the bunion
and it can get bigger
and the toe can actually go valgus more over time.
It creates a real pain problem with walking.
- [Mike] My dad had that.
His dislocated actually.
- {Brad] Oh wow.
- [Mike] Yeah. He had to have surgery
to get his bunion cut down.
- [Brad] Oh wow.
- [Mike] Yeah.
- [Brad] And, and you know, your dad to have it,
and I find through the research,
they find it 10 times more women get this then men,
but there's a good reason.
(Mike laughs)
- I don't think this is the reason my dad had it either.
(Brad laughs)
- These types of shoes right here.
This is my wife's shoe.
She was fortunate.
She said, go ahead and use it.
You know, I can't do anything.
It's one of her older pairs.
I call them high heels.
But I guess in the back in the day they called them pumps.
But Liz, she's younger.
She says that's kind of outdated.
But anyways, if you imagine...
What are you laughing at?
(Mike laughs)
If your foot is in here
and we got your heel elevated
your weight bearing compresses the forefoot
and it, you can see this actually forces it.
It's like putting a brace on your foot
or your big toe to move it in the wrong direction.
It puts it out of neutral.
And over time, if you wear these for years on end,
you can develop the same problem that we just talked about.
That hallux, big toe, pointing inwards,
then going to a bunion.
So the best way to treat this,
we really don't have a physical therapy regimen for this
- No.
- is get change your shoes.
- Yeah. - You're going to have to
sorry, but the pumps are going to have to go.
- Yeah.
- Make sure you have wide forefoot
or the toe box in the shoe
so things have room in there.
We take that stress off of there.
If the bunion is too bad,
you'll have to go to your podiatrist.
They have ways to take care of that as well.
- I think mine actually goes in a little more.
- Well, good, so you got room.
You could wear some pumps and you could,
you'd be all right.
- [Mike] I don't think that size will fit me though.
- [Brad] Well, I hope you're not considering it.
(Mike laughs)
- All right. And last but not least,
another medical term,
metatarsalgia.
- So your metatarsal heads are
this part of your foot basically.
You have five of them.
- Right, so it's on the bottom, too.
This refers to pain on the bottom.
Now, Mike, you just mentioned
you had a little episode of this,
but the location of your pain?
- Mine was on the fifth metatarsal head.
It was the opposite foot,
but I had recently gotten some different shoes
and I was trying them out for the first time
on a six mile hike and an eight mile hike in the mountains.
So not the best way to break in some new shoes.
But I had some really annoying pain afterwards
for a few days.
Now I don't wear those shoes and I'm fine, so...
- Which oftentimes is the case with this diagnosis.
And in my case, I have pain right here,
I put another red dot here.
And if you have it right there below your fifth digit
or the second to smallest toe,
right about this location,
and it hurts with walking,
with weight bearing,
it very likely could be Morton's neuroma.
There's a nerve bundle in there.
And it's a mechanical issue.
If your toe box is too tight,
that can irritate it.
I have some other shoes that
if the, the base of the foot where the insert
is not shaped properly,
puts pressure on there.
It gets very painful.
- Yeah.
- The nice thing about it is
if you take your shoe off,
pain goes away or quit walking on it
and take the weight off it,
pain goes away very rapidly.
What I've done with my shoes,
and we've got a video on this too,
is I take my insert,
pull it out of my shoe
and where this orange is,
I put in a cushion there.
And that takes pressure,
instead of going on the Morton's neuroma,
that nerve bundle,
it puts pressure in the arch.
So you're just changing where the pressure location is,
and it works quite well.
And I just keep them in there.
I put some tape over it
so it doesn't move.
And I have great success.
We do have a video specifically on that,
actually two videos on Morton's neuroma,
details on how to fix that.
You can also,
if it's really sore and I've done this
after I've irritated it and it feels better,
but it's still tender,
I'll put a cold pack on it,
put my foot on a cold pack while I'm, you know,
reading something or watching the, watching the tube.
It's not a tube anymore.
It's a flat screen. (Mike laughs)
You can't say tube.
- It's not really a tube anymore.
- Back in my day it was a tube. Right.
So anyways, those are the things that are gonna help.
Sometimes just a cushiony base, you know,
insert without the, the custom made cushion
can be adequate.
So, that's it Mike.
Four diagnoses for foot pain.
If you went through all of them,
there's a good chance that your foot pain
is from one of these.
- One of these.
- Yep. Yep. So anything else?
Did we miss anything, Sam?
- I don't think so.
- All right. Very good.
- We still can't fix a broken heart, but...
- Right.
- We're working on that.
- You got to say that.
We could fix just about anything except for-
- a broken heart.
- There you go.
But we're working on it and good old Sam.
Yeah, he's not going to help.
(Mike laughs)
- No, he doesn't have a heart.
- Yeah. Take care.