Back Clinic Foot orthotics These are shoe inserts that are custom-made to medical specifications. Custom-made orthotics are considered more effective and made of higher quality than pre-made orthotics.
Custom-made orthotics can:
Correct abnormal walk or gait
Reduce pain
Prevent and protect foot/feet deformity
Better alignment
Take away pressure on the foot/feet
Improve mechanics of the foot
Foot pain can come from an injury, disease, or condition, but the cause of the foot pain is what the doctor wants to know to know what type of orthotic to design. The inserts are made by taking an impression of the foot/feet with a 3-D scan.
Suffering from foot pain, that can lead to leg, hip, and spine problems, then orthotics could hold the key to optimal health. By starting from the bottom up foot orthotics can prevent any problems/issues and relieve any pain. It is an option to be considered and should be discussed with your physician.
Individuals with plantar fasciitis may experience consistent flare-ups. Can knowing the causes help to find pain relief?
Plantar Fasciitis Flare-Up
Plantar fasciitis is a common cause of heel and foot pain. The plantar fascia is a band of tissue that runs along the bottom of the foot and becomes inflamed. Certain factors can cause plantar fasciitis flare-ups, including:
Increased levels of physical activity.
Not stretching regularly.
Wearing shoes without proper support.
Weight gain.
Causes
A plantar fasciitis flare-up is often triggered by physical activity. (MedlinePlus. U.S. National Library of Medicine. 2022) It can also be brought on by underlying conditions, like increased body weight, arthritis, or the shape of the foot. (Johns Hopkins Medicine. 2023) Despite the root cause, there are activities and experiences that can contribute to and/or worsen the condition.
New Exercise Routine
Being highly physically active can exacerbate plantar fasciitis symptoms.
High heels, boots, or shoes that raise the heel above the toes.
Worn-out shoes like exercise workout shoes.
Not Stretching Properly or At All
Tight calves can increase pressure on the plantar fascia.
Stretching the calves, Achilles tendon/heel, and the bottom of the feet is highly recommended to help treat and prevent the condition. (Johns Hopkins Medicine. 2023)
Not stretching thoroughly or skipping stretches can worsen symptoms.
Individuals with plantar fasciitis are recommended to stretch before and after physical activities, exercise, before going to bed, and after waking up.
Working Through the Pain
Individuals may try to continue physical activities during a flare-up.
This is not recommended as doing so can cause more pain and worsen the condition.
When pain presents, it’s recommended to:
Stop all activities that strain the feet
Stay off the feet for at least a week.
Tearing the Plantar Fascia
The plantar fascia rarely tear completely from repeated stress known as a plantar fascia rupture.
Pascoe, S. C., & Mazzola, T. J. (2016). Acute Medial Plantar Fascia Tear. The Journal of orthopaedic and sports physical therapy, 46(6), 495. doi.org/10.2519/jospt.2016.0409
Individuals that experience nerve pain in the foot could be caused by a number of different conditions, can recognizing the most common causes help in developing an effective treatment plan?
Nerve Pain In The Foot
These sensations can feel like a burning, shooting, electrical, or stabbing pain and can happen while in motion or at rest. It can occur on the top of the foot or through the arch. The area closest to the nerve may be sensitive to the touch. A number of different conditions can cause nerve pain in the foot, including:
Morton’s neuroma
Pinched nerve
Tarsal tunnel syndrome
Diabetic peripheral neuropathy
Herniated disc
Morton’s Neuroma
Morton’s neuroma involves the nerve that runs between the third and fourth toes, but can sometimes occur between the second and third toes becoming thicker. Typical symptoms include a burning or shooting pain in the area, usually while walking. (Nikolaos Gougoulias, et al., 2019) Another common symptom is the sensation of pressure beneath the toes like the sock is bunched up underneath. Treatments can include:
Arch supports
Cortisone injections to decrease swelling
Footwear modifications – can include lifts, orthotics combined with metatarsal pads, and rocker soles, to provide cushion where needed.
Things that increase the risk of developing the condition include:
Regularly wearing high-heels – the condition occurs more frequently in women.
Shoes that are too tight.
Participating in high-impact sports like running.
Having flat feet, high arches, bunions, or hammertoes.
Pinched Nerve
A pinched nerve can feel like shooting or burning pain. Nerve entrapment can occur in various regions of the foot or the area on top of the foot may feel sensitive. Causes can be caused by: (Basavaraj Chari, Eugene McNally. 2018)
Trauma that causes swelling.
Blunt impact.
Tight shoes.
Treatment can include:
Massage
Physical therapy
Rest
Footwear modifications
Anti-inflammatories.
Things that increase the risk of developing a pinched nerve in the foot include:
Poor-fitting footwear.
Repetitive stress injury.
Trauma to the foot.
Obesity.
Rheumatoid arthritis.
Tarsal Tunnel Syndrome
Another type of nerve entrapment is tarsal tunnel syndrome. Tarsal tunnel syndrome is “anything that produces compression on the posterior tibial nerve.” (American College of Foot and Ankle Surgeons. 2019) The tibial nerve is located near the heel. Symptoms include numbness and foot cramps, burning, tingling, or shooting sensations that often radiate from the instep/arch. Both can worsen while the foot is at rest, like when sitting or sleeping. Treatment can consist of:
Placing padding in the shoe where the foot is being compressed to relieve the pain.
Custom foot orthotics.
Cortisone shots or other anti-inflammatory treatments.
Surgery may be necessary to release the nerve.
Conditions that compress the tibial nerve and can lead to tarsal tunnel syndrome include:
Flat feet
Fallen arches
Ankle sprain
Diabetes
Arthritis
Varicose veins
Bone spurs
Diabetic Peripheral Neuropathy
Long-term high blood sugar/glucose associated with diabetes can lead to a form of nerve damage known as peripheral neuropathy. (Centers for Disease Control and Prevention. 2022) Neuropathy pain feels like burning or shooting pain, or the sensation of walking on bubble wrap that usually shows up overnight. The pain can come and go as well as a gradual loss of feeling in the feet that begins in the toes and moves up the foot. It’s estimated that around half of individuals with diabetes will eventually develop neuropathy. (Eva L. Feldman, et al., 2019) Treatments can include:
Physical therapy massage to increase circulation.
Topical treatments with capsaicin.
Vitamin B.
Blood sugar management.
Alpha lipoic acid.
Medication.
Individuals with diabetes have an increased risk of developing peripheral neuropathy if:
Blood sugar is not well-controlled.
Diabetes has been present for many years.
Kidney disease.
Smoke.
Overweight or obese.
Herniated Disc
Nerve pain in the foot can be caused by spinal issues. A herniated disc in the lower back can irritate and compress the nerves, causing pain that radiates down the leg and foot. Additional symptoms usually include muscle weakness in the legs and/or numbness and tingling. Most herniated discs don’t require surgery and get better with conservative treatment. (Wai Weng Yoon, Jonathan Koch. 2021) If symptoms don’t improve or worsen, a healthcare provider may recommend surgery. Herniated discs are most common in young and middle-aged adults. Increased chances of developing a herniated disc can come from:
Degenerative changes in the spine from normal age wear and tear.
Physically demanding job.
Lifting incorrectly.
Overweight or obese.
Genetic predisposition – family history of herniated discs.
Spinal Stenosis
Spinal stenosis occurs when the spaces in the spine begin to narrow, creating pressure on the spinal cord and nerve roots. It is usually caused by wear and tear on the spine as the body ages. Stenosis in the lower back can cause burning pain in the buttocks and leg. As it progresses pain can radiate into the feet along with numbness and tingling. Conservative treatment consists of physical therapy exercises and non-steroidal anti-inflammatory medications/NSAIDs. (Jon Lurie, Christy Tomkins-Lane. 2016) Cortisone injections can be beneficial and if the condition worsens, surgery may be an option. Risk factors include:
Physical trauma – after surgery or an automobile or sports accident.
Certain cancer, antiviral medications, or antibiotics.
Complex regional pain syndrome.
Tumors that irritate and/or compress a nerve.
Liver or kidney disease.
Infectious diseases – Lyme disease complications or viral infections.
Nerve pain in the foot is definitely a reason to see a healthcare provider. Early diagnosis can help prevent symptom progression and future problems. Once the cause of the pain has been identified, the healthcare team can work together to develop a personalized treatment plan to release compressed nerves and restore mobility and function. See a healthcare provider right away if the pain and symptoms worsen, or if there are difficulties standing or walking.
Chiropractic After Accidents and Injuries
References
Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: instructional review. EFORT open reviews, 4(1), 14–24. doi.org/10.1302/2058-5241.4.180025
Chari, B., & McNally, E. (2018). Nerve Entrapment in Ankle and Foot: Ultrasound Imaging. Seminars in musculoskeletal radiology, 22(3), 354–363. doi.org/10.1055/s-0038-1648252
Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature reviews. Disease primers, 5(1), 42. doi.org/10.1038/s41572-019-0097-9
Yoon, W. W., & Koch, J. (2021). Herniated discs: when is surgery necessary?. EFORT open reviews, 6(6), 526–530. doi.org/10.1302/2058-5241.6.210020
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234
Staff, N. P., & Windebank, A. J. (2014). Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneapolis, Minn.), 20(5 Peripheral Nervous System Disorders), 1293–1306. doi.org/10.1212/01.CON.0000455880.06675.5a
Individuals on their feet all day regularly experience back problems and discomfort symptoms. Wearing unstable shoes that are flat with no arch support with little or no shock absorption or the wrong type of shoe for gait can cause biomechanical issues that can cause back discomfort and lead to chronic back pain. Athletic running shoes are recommended for lower back pain because they are well-cushioned and designed to help absorb the impact of walking or running. They also have proper arch and ankle support to maintain foot position for correct posture. What to look for in running shoes to help relieve back pain and keep the back injury free?
Athletic Running Shoes
Shoes that don’t have enough cushioning can cause inflammation in the back muscles from the lack of impact absorption. The best athletic running shoes for back pain relief are stiff, supportive, and well-cushioned. When selecting shoes for back pain, the most important factors to consider are:
Stiffness of the sole.
Quality support and cushioning.
Proper and comfortable fit.
Shoe Type
Athletic running shoes are available in various types of support for all foot types.
Consider foot structure and gait when selecting shoes.
Flat and high-arched feet can cause muscle imbalances, which increase pressure on the back, hips, legs, knees, ankles, and feet.
The grooves and patterns increase friction and provide grip to the person while walking or running.
Durability
Wearing worn-out shoes with inadequate cushioning and shock absorption can increase the risk of back problems.
Depending on the uses, shoes can wear out in three months or less.
It is important to replace shoes when the cushioning wears out.
Look for high-quality material that doesn’t wear down quickly.
Improve Whole-Body Wellness
References
Anderson, Jennifer, et al. “A narrative review of musculoskeletal problems of the lower extremity and back associated with the interface between occupational tasks, feet, footwear, and flooring.” Musculoskeletal care vol. 15,4 (2017): 304-315. doi:10.1002/msc.1174
American Podiatric Medical Association. Which Running Shoe is Right for You?
Hong, Wei-Hsien, et al. “Effect of shoe heel height and total-contact insert on muscle loading and foot stability while walking.” Foot & ankle international vol. 34,2 (2013): 273-81. doi:10.1177/1071100712465817
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back Pain: Diagnosis, Treatment, and Steps to Take.
National Institute of Neurological Disorders and Stroke. Low Back Pain Fact Sheet.
Everyone worldwide knows that feet are important. The feet allow many individuals to run, walk, or jog for long periods without feeling pain for a moderate amount of time. To that point, the various muscles and tendons surrounding the foot provide full body flexion, extension, and stability. Even though it is very easy to get in the recommended amount of steps into being healthy, around 75% of individuals will have foot pain that can impact their ability to walk. One of the most common foot pains is plantar fasciitis, which can become a painful foot condition if it is not treated as soon as possible. Today’s article looks at plantar fasciitis, its symptoms, how trigger points correlate, and treatments for it. We refer patients to certified providers incorporating techniques and therapies for individuals dealing with plantar fasciitis. By locating where the trigger points are coming from, many pain specialists can develop a treatment plan to reduce the effects that plantar fasciitis is causing on the feet. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is a terrific way when asking our providers intricated questions at the patient’s request and understanding. Dr. Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
What Is Plantar Fasciitis?
Have you been dealing with constant heel pain? Do you feel pain shooting up your leg when you step or walk? Or do you feel a stabbing ache in your heel? Many of these pain issue people are dealing with correlate with plantar fasciitis. Studies reveal that plantar fasciitis results from degenerative irritation on the plantar fascia and its ligaments. This causes the muscle ligaments to become inflamed, swollen, and weak, which then causes the bottom of the foot or heel to hurt when a person is walking or standing. To that point, when there is a repetitive strain on the feet, it causes microtears in the plantar fascia. The plantar fascia in the foot plays an important role as it comprises three segments that support the medial arch and shock absorption when stepping down. As one of the most common causes of heel pain, the residual pain from plantar fasciitis tends to be a sharp, stabbing sensation. Plantar fasciitis is more prominent in middle-aged people. Still, anyone at any age can develop plantar fasciitis, especially if they have labor jobs requiring them to be constantly on their feet.
Symptoms Of Plantar Fasciitis
Since around 2 million Americans could potentially develop plantar fasciitis, it is important to know that when a person has been on their feet constantly, there will be inflammation along the tissues in the feet. Many individuals with a busy lifestyle that requires them to be on their feet frequently would often ignore the pain or discomfort. Some of the symptoms that plantar fasciitis causes include the following:
Pain on the bottom of the heel
Pain in the arch
Pain that is usually worse when waking up
Pain that increases over months
Swelling on the bottom of the heel
However, when the pain becomes overbearing, many people would often think they have sore feet or low back pain from being overly tired from work, under constant stress, or over-exerting their bodies. When this happens, many would think the pain would go away in a few days after resting for a short period.
Trigger Points Associated With Plantar Fasciitis
Now many individuals would often think that plantar fasciitis just only affects the heels, however, it can affect any part of the structure of the foot since all the surrounding muscle tissues are at risk of inflammation. When people start to ignore the pain and discomfort that plantar fasciitis is causing on the feet, it can overlap and develop trigger points in other areas of the body:
Ankles
Knees
Hips
Lower back
Studies reveal that trigger points or myofascial pain syndrome are hard, discrete, small nodules that are along the taut musculoskeletal band that causes numerous issues like inflammation, hypersensitivity, and pain to the affected muscle groups in the body. According to “Myofascial Pain and Dysfunction” written by Dr. Travell, M.D., it mentions that when the deep intrinsic muscles that work with the plantar fascia are affected by trigger points, would cause symptoms of numbness and the feeling of swelling in the foot. This causes many people to have limited mobility and have intense pain when walking, which can negatively impact their lifestyle.
An Overview Of Plantar Fasciitis- Video
Have you been dealing with aching feet? Do you feel a sharp, radiating pain in your feet? Or do you have difficulty walking? Many often think they are dealing with sore feet or other issues causing them pain. Around 75% of Americans often have foot pain affecting their ability to walk, and one of them is plantar fasciitis. The video above explains plantar fasciitis and how it can affect the feet. When the plantar fascia tendons become overused, it causes micro-tears in the muscle ligaments. When added compressive force starts to push against the heel boner, it can lead to a pathological state whereby the plantar fascia degenerates and creates dysfunction and pain. When this happens, it can lead to other conditions like trigger point pain along the muscle fibers in the foot. The pain and tenderness caused by trigger points in the plantar muscles may mask as plantar fasciitis. To that point, when plantar fasciitis becomes an issue and causes the individual to be in immense pain, it can become problematic. As luck would have it, treatments are available to reduce the pain from plantar fasciitis.
Treatments For Plantar Fasciitis
When treating plantar fasciitis, many available treatments can reduce the inflammatory effects in the heel and prevent trigger points from coming back. One of the available treatments is chiropractic care. Chiropractic care is an alternative treatment option to prevent, diagnose, and treat numerous injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems through spinal manipulation and adjustments. A chiropractor can carefully re-align the spine, improving a patient’s strength, mobility, and flexibility. Regarding plantar fasciitis, chiropractic care can work with other treatments, including physical therapy, massage, and even injections, to manage the pain and treat the condition. Even though plantar fasciitis takes several months to heal, chiropractic care can involve a precise technique that involves adjustments to the feet, ankles, and spinal alignment. This provides several benefits, which include the following:
Reduces Stress in the Plantar Fascia
Promotes Healing
Provides Effective Pain Management
Reduces the Risk of Further Injury
Conclusion
As many individuals worldwide are on their feet constantly, foot pain can hinder one’s ability to move. One of the most common foot pain is plantar fasciitis which can correlate with trigger points along the various muscles of the foot. Plantar fasciitis results from degenerative irritation on the plantar fascia and its ligaments, which causes sharp, stabbing pain on the heel. When this happens, it can cause the heel to be inflamed, swollen, and weak. To that point, it causes instability and pain when walking. However, plantar fasciitis can be treated when it is caught early through various treatments like chiropractic care. Chiropractic care can reduce the stress in the plantar fascia and help reduce the risk of further injuries. Combined with other therapies, many people can function normally and regain their walking ability without pain.
References
Buchanan, Benjamin K, and Donald Kushner. “Plantar Fasciitis – StatPearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 30 May 2022, www.ncbi.nlm.nih.gov/books/NBK431073/.
Petrofsky, Jerrold, et al. “Local Heating of Trigger Points Reduces Neck and Plantar Fascia Pain.” Journal of Back and Musculoskeletal Rehabilitation, U.S. National Library of Medicine, 2020, pubmed.ncbi.nlm.nih.gov/31594202/.
Shah, Jay P, et al. “Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective.” PM & R : the Journal of Injury, Function, and Rehabilitation, U.S. National Library of Medicine, July 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4508225/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
It didn’t happen at work, school, or exercise, and there haven’t been any trips and/or falls, but you can’t pinpoint what is causing foot and ankle discomfort and sensations. However, the cause could be originating in the lumbar spinal region. Sciatica is a set of symptoms that refer to pain, numbness, and tingling radiating down the leg from the lower back, affecting the legs, hips, buttocks, and feet. Injury Medical Chiropractic and Functional Medicine Clinic can release the compressed nerve, massage circulation back into the nerve, and restore mobility and function.
Sciatica Foot and Ankle
Sciatic nerve sensations can run down the back of the leg down into the foot.
Compression or irritation to any nerve roots can present with symptoms in the hip, thigh, calf, and foot.
Sciatica foot and ankle symptoms can accompany numbness and muscle weakness.
Sciatic nerve irritation mostly causes symptoms on the outside of the foot but can spread to other areas.
Nerve Roots
One or more of the lower spine’s sciatic nerve roots are being compressed or pinched. The foot symptoms location depends on which nerve root is affected.
If the S1 root is affected, symptoms will radiate to the sole and side of the foot.
If L5 is affected, symptoms will radiate to the top of the foot and the big toe.
If the L4 root is affected, symptoms can radiate to the medial or inside the ankle area.
Chiropractic Care and Relief
Foot Massage
A foot massage can be helpful.
A massage therapist finds points around the ankles that are tender.
Tenderness indicates a lymphatic blockage or muscle tension that needs to be worked out.
They will apply varying pressures to massage the muscles and get the circulation flowing.
The therapist will loosen the tarsal and metatarsal bones to loosen the muscles and nerves.
Moving the bones resupplies the joints, forces out inflammatory metabolic waste, opens the space for the nerves, and allows improved lymphatic drainage and blood flow to expedite healing.
A chiropractor will perform and train the individual on targeted stretches to the Achilles tendon and plantar fascia.
They will stretch, release, and open the ankle and sciatic nerve.
Injections
A cortisone injection where the nerve is affected can help in certain cases.
Injections of a corticosteroid, an anti-inflammatory medicine, can offer relief for up to three months and are given under local anesthesia.
The medicine reduces the inflammation and swelling around the nerve roots.
Foot Orthotics
Custom foot orthotics can help support a postural foot or ankle problem.
Overpronation is when the ankles collapse inward, which creates an imbalance of leg lengths that affects the hips, pelvis, and spine.
Orthotics can help provide symptom relief.
Nutrition
Part of a treatment plan will include an anti-inflammatory and antioxidant nutritional plan.
A professional nutritionist will make recommendations based on the individual’s case.
Magnesium-rich foods are generally recommended for sciatica as this nutrient aids the body in releasing muscle contractions.
99 percent of the body’s magnesium is stored in the bones, muscles, and soft tissues, with only 1 percent concentrated in the blood.
Foods rich in magnesium include:
Avocado
Bananas
Apricots
Dried pumpkin seeds
Dairy
Dark chocolate
Dried figs
Black beans
Brown rice
Fish
Spinach
Swiss chard
Yogurt
Benefits of Custom Foot Orthotics
References
Davis, David, et al. “Sciatica.” StatPearls, StatPearls Publishing, 6 May 2022.
Ge, Phillip S et al. “Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of the literature.” Vascular and endovascular surgery vol. 44,1 (2010): 64-8. doi:10.1177/1538574409351990
Hughes, Michael S et al. “Post-traumatic catamenial sciatica.” Orthopedics vol. 31,4 (2008): 400. doi:10.3928/01477447-20080401-15
The ankles provide an essential role in total body function. They work as a complex system within the feet to carry the body’s weight and support movement. Any imbalance can cause ankle instability that can cause other areas of the body to go out of balance. This is most often caused by an injury, like an ankle sprain. If not properly addressed, it can lead to chronic instability and long-term health issues throughout the musculoskeletal system. Chiropractic treatment can rehabilitate ankle injuries, strengthen the muscles to prevent instability.
Ankle Instability
The entire body is an extensive, complicated, and interconnected system. Every part influences the next as individuals go about their everyday routines. Imbalances can occur in the spine, hips, legs, and knees, leading to limping, ankle pain, or injury. The most common causes of ankle instability include:
Poor foot or ankle mechanics
Knee or hip imbalances
Ankle sprains
Muscle strain
Tendonitis
Arthritis
Fractures
Chronic inflammation from illness or injury.
Finding The Imbalances
Understanding where the imbalances are and systematically addressing them is the recommended course of action. If an ankle injury is present, local symptoms and dysfunction need to be addressed. However, it is important to assess other body areas to ensure any other dysfunctions are also addressed. This prevents unnecessary re-injury, aggravation, and other problems.
Chiropractic
One or more treatment options will be utilized for proper recovery when dealing with ankle instability.
Joint adjustments of the lower body and spine to support nerve and blood circulation.
Chiropractic is recommended for determining any body imbalances that need to be addressed with high-quality research-based care and can expedite the recovery process.
Body Composition
Compression Garments and Socks
These were only used to treat individuals with circulatory problems but are now available to the public. Recovery is about giving the body a chance to relax, recuperate, and recover from swelling, with the objective to resume physical activity. Compression garments come in shirts, pants, sleeves, and socks. The garments and socks are used for quicker recovery time, improved circulation and oxygen delivery to the muscles, and to reduce lactic acid build-up.
References
Anguish, Ben, and Michelle A Sandrey. “Two 4-Week Balance-Training Programs for Chronic Ankle Instability.” Journal of athletic training vol. 53,7 (2018): 662-671. doi:10.4085/1062-6050-555-16
Czajka, Cory M et al. “Ankle sprains and instability.” The Medical clinics of North America vol. 98,2 (2014): 313-29. doi:10.1016/j.mcna.2013.11.003
Gribble, Phillip A. “Evaluating and Differentiating Ankle Instability.” Journal of athletic training vol. 54,6 (2019): 617-627. doi:10.4085/1062-6050-484-17
Lubbe, Danella et al. “Manipulative therapy and rehabilitation for recurrent ankle sprain with functional instability: a short-term, assessor-blind, parallel-group randomized trial.” Journal of manipulative and physiological therapeutics vol. 38,1 (2015): 22-34. doi:10.1016/j.jmpt.2014.10.001
A Trendelenburg gait is an abnormal walking gait resulting from a defective or weakened hip abductor.The gluteal musculature is the primary musculature that includes the gluteus medius and gluteus minimus muscles. Weakness in these muscles causes sagging/dropping of the pelvis on the opposite side while walking. There will be a noticeable side-to-side motion if the glutes are too weak to support the body’s weight when walking. It can look as though the individual is limping or missing a step. Individuals can minimize the effects with foot orthotics, core strengthening, chiropractic, and physical therapy.
Trendelenburg Gait Causes
This gait often results from straining the hip abductor muscles during physical activity. Exercises specifically for the glutes done improperly are a common cause. When improper exercise form is the cause, the abnormal gait usually goes away as muscle inflammation fades. The gait can also present after total hip replacement surgery, as the procedure requires incisions in the gluteus medius muscle. This can weaken the muscle causing an abnormal gait. Weakness in these muscles can also be caused by:
Nerve damage or dysfunction in the nerves that run through the gluteal minimus and medius muscles.
Osteoarthritis is a type of arthritis that occurs when joint cartilage starts to wear down.
Muscular dystrophy is a condition that causes the muscles and bones to become weak over time.
Poliomyelitisis a condition associated with polio that weakens the muscles.
Cleidocranial dysostosis is a condition present from birth that can cause your bones to develop improperly.
Symptoms
The walking gait is made up of two phases:
Swing – When one leg moves forward.
Stance – The other leg stays still and maintains balance.
The main symptom of Trendelenburg gait can be seen when one leg swings forward and the hip drops down and move outward. This is because the hip abductor of the other leg is too weak to support the weight. Individuals may lean back or to the side slightly when walking to maintain balance, or they may lift the foot higher off the ground with each step to avoid losing balance or tripping as the pelvis shifts unevenly.
Diagnosis
Abnormal hip movement during a swing of one or both legs can give a doctor enough evidence to diagnose a Trendelenburg gait. A doctor will observe the individual’s walk in front and behind to get a detailed view. A doctor will also use the Trendelenburg test to diagnose the condition. The doctor will instruct the individual to lift one leg for 30 seconds. If the individual cannot keep the hips parallel with the ground while lifting, it could indicate Trendelenburg gait. X-rays of the hip will be used to identify any causes of weakness in the gluteus minimus or medius.
Treatment Options
Treatment options will depend on the severity and cause of the gait.
Medication
If the gait is causing pain, over-the-counter nonsteroidal anti-inflammatory NSAIDs, like ibuprofen or acetaminophen, will help ease symptoms.
In severe cases, a doctor may prescribe cortisone injections to help reduce pain.
Foot Orthotics
A doctor could also recommend using a foot orthotic in one or both shoes to compensate the hip abductor muscle weakness.
Chiropractic, Physical Therapy, and Exercise
Chiropractic and physical therapy can help adjust, realign, and strengthen the muscles to regain control of the Trendelenburg gait. The chiropractor or physical therapist will move the legs in various directions to help the joints become more accustomed to moving in certain directions and increase muscle strength and resistance. Exercises that can strengthen the hip abductor muscles include:
Lie on the side and extend the leg straight out.
Lie on the floor and move one leg up, over the other, and back in the opposite direction.
Step sideways and onto an elevated surface, then back down again.
Talk with a doctor or chiropractor before beginning any new exercise routine so they can recommend specific exercises and educate on proper form.
Complications
If left untreated, moderate-to-severe cases of Trendelenburg gait can become debilitating, leading to severe complications. These include:
Pinched nerves.
Sciatica.
Pain, stiffness, or grinding in the hips.
Loss of range of motion in the hips and gait.
Losing the ability to walk, which could require the use of a walker or wheelchair.
Trendelenburg gait is treatable with special shoes, orthotics, and exercises designed to strengthen the hip abductor muscles. Chiropractic and physical therapy can help limit the condition’s impact on the body’s health, the ability to walk, and reduce the risk of complications.
Body Composition
Heart-Healthy Foods
Citrus
The bright and tangy fruits are packed with vitamins and unique plant compounds known as polyphenols that can help lower blood pressure naturally.
However, it’s important to note that grapefruit and grapefruit juice could interact with certain prescription medications.
Beans and Lentils
Foods high in magnesium, potassium, and fiber can help maintain healthy blood pressure.
This is where beans and legumes come in, as they are high in fiber, potassium, and magnesium.
Individuals that swapped beans and lentils noticed a lower blood pressure, whether or not they had been diagnosed with hypertension.
Pumpkin Seeds
These seeds are packed with potassium, magnesium, and arginine.
Arginine is an amino acid used to make nitric oxide, which helps the blood vessels relax and dilate, allowing lower blood pressure.
A study found that postmenopausal women who took 3 grams of pumpkin seed oil daily for six weeks saw a significant decrease in their systolic blood pressure.
Garlic
Garlic contains nitric oxide, which has been shown to relax blood vessels.
Kyolic garlic, in particular, has been shown to help with arterial stiffness and can improve cholesterol levels.
References
Feyh, Andrew et al. “Role of Dietary Components in Modulating Hypertension.” Journal of Clinical & experimental cardiology vol. 7,4 (2016): 433. doi:10.4172/2155-9880.1000433
Gandbhir, Viraj N., et al. “Trendelenburg Gait.” StatPearls, StatPearls Publishing, 19 August 2021.
Giangarra CE, et al. (2018). Clinical orthopedic rehabilitation: A team approach.sciencedirect.com/science/book/9780323393706
Gilliss AC, et al. (2010). Use of osteopathic manipulative treatment to manage compensated Trendelenburg gait caused by sacroiliac somatic dysfunction.
jaoa.org/article.aspx?articleid=2093879
Maricelli JW, et al. (2016). Trendelenburg-like gait, instability and altered step patterns in a mouse model for limb-girdle muscular dystrophy 2i. DOI:
10.1371/journal.pone.0161984
Mayo Clinic Staff. (2017). Osteoarthritis.mayoclinic.org/diseases-conditions/osteoarthritis/home/ovc-20198248
Michalopolous N, et al. (2016). A personalized monitoring and recommendation framework for kinetic dysfunctions: The Trendelenburg gait. DOI: 10.1145/3003733.3003786
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
Athletic Running Shoes
