How can one effectively manage the early signs of bunions?
Bunions
A bunion, also known as hallux valgus, is a bony, often painful protrusion on the side of the big toe. The most common cause of bunions is a misalignment of the big toe. Early symptoms of a bunion include redness, thicker skin, edema, and discomfort around the big toe joint. While you can’t stop a bunion from growing, you can manage the symptoms along the way. Early indicators of bunions include pain management measures and treatment choices. (MedlinePlus, 2024)
Early Visual Signs
Bunions are initially minor and don’t result in many noticeable issues. The following symptoms may be present in the early stages of a bunion around the metatarsophalangeal (MTP) joint, which joins the base of your big toe to the rest of your foot. (American Academy of Orthopaedic Surgeons, 2022)
Redness
Skin that is darker and swollen
Skin that has gotten thicker and harder
There is a bony bump
A bump where the big toe goes toward the second toe or even under it
Corns and calluses
Early Physical Signs
While bunions may not be visible immediately, they can cause discomfort even in the early stages. Here are some early physical indicators of a developing bunion. (MedlinePlus, 2024)
Pain in the foot and big toe
This pain is especially noticeable when walking or wearing tight, narrow-toed shoes.
Decreased movement of the big toe
Tenderness
Inflammation
Swelling
Stiffness
Heat
Stages
Bunions often worsen over time, a condition known as progressive. You could have problems if you don’t do anything to stop your bunions from getting bigger. Bunions in later stages might cause the following symptoms: (American Academy of Orthopaedic Surgeons, 2022)
Long-lasting, intense pain in and around the MTP joint and the sides and bottom of your foot
Bursitis causes a sac full of fluid to form at the bottom of your big toe.
The big toe bends toward and even crosses over the second toe.
Too much bone development on the side of your big toe
Not being able to wear your regular shoes
Hard to walk
Abnormalities known as “hammer toe” occur when your second, third, or fourth toes bend upward in the middle, resembling a hammer or claw.
Hallux rigidus is a form of arthritis affecting the big toe.
Manage the Progression
Bunions tend to remain in place once they start to develop. However, there are several steps you can take to prevent them from worsening or causing additional problems. These are some of them: (American Academy of Orthopaedic Surgeons, 2022)
Place spacers between your toes to prevent friction and chafing.
Use over-the-counter (OTC) pads made of felt, silicone, or foam to cover the bunion.
You should also stretch your calf muscles to improve joint alignment.
Managing Pain
Advil and Motrin (ibuprofen) are two examples of non-steroidal anti-inflammatory medicines (NSAIDs) that can aid with bunion pain. Studies also show that injecting Botox into the muscles in the forefoot can help with pain. (Hurn, S. E., et al., 2022)
Nonsurgical Early Stage Treatment
If your bunions continue to worsen despite using the self-care procedures listed above, you may need to consult a podiatrist (a foot expert) or another healthcare provider. A healthcare provider may recommend.
Orthotics, or foot orthoses
Foot orthoses, also known as orthotics, are customized inserts that help alleviate bunion pain and prevent chafing.
Splints
Bunion splints are orthotic devices that can help straighten out your toes. People typically use them at night. (Aebischer, A. S., & Duff, S. 2020)
Physical Therapy
A physical therapist can help you by giving you exercises that will help your feet and joints line up better. They might also do manual therapy to help with pain. (Hurn, S. E., et al., 2022)
Podiatrist
A podiatrist is a medical doctor (M.D.) who specializes in treating health problems that affect the feet, ankles, and lower legs. If you want help with your bunion issues, ask your doctor for a referral to a podiatrist. (American Podiatric Medical Association, 2025)
Chiropractic Treatment
Chiropractors and nurse practitioners (NPs) have distinct roles in managing bunions, which are bony bumps at the base of the big toe caused by joint misalignment, often resulting in pain, swelling, and restricted movement. Here’s how each can help:
Chiropractors:
Focus: Chiropractors primarily address musculoskeletal issues through manual adjustments and manipulations.
Bunion Support:
Foot Adjustments: They may perform adjustments to improve foot alignment and joint mobility, which can potentially reduce bunion-related discomfort.
Soft Tissue Therapy: Techniques such as massage or myofascial release can help alleviate tension in surrounding muscles and tissues.
Orthotics or Taping: Some chiropractors recommend custom orthotics or use taping to support proper foot mechanics.
Exercise Guidance: They may suggest stretches or exercises to strengthen foot muscles and improve alignment.
Limitations: Chiropractors don’t prescribe medications or perform surgeries, so severe cases requiring these interventions would need referral to a podiatrist or orthopedic specialist.
Evidence: While some patients report relief from chiropractic care for foot issues, evidence specifically for bunions is limited, and results vary.
Nurse Practitioners:
Focus: NPs are advanced practice registered nurses with broad medical training, able to diagnose, treat, and prescribe medications within their scope of practice.
Bunion Support:
Diagnosis and Assessment: NPs can evaluate bunion severity, often using physical examinations or ordering imaging, such as X-rays, to assess joint damage.
Pain Management: They may prescribe anti-inflammatory medications (e.g., ibuprofen) or corticosteroid injections for pain and swelling.
Conservative Treatments: NPs can recommend padding, splints, or orthotic devices to reduce pressure and improve alignment.
Lifestyle Advice: They provide guidance on footwear (such as wide-toed shoes) and weight management to reduce stress on the bunion.
Referrals: For severe cases, NPs can refer patients to podiatrists or orthopedic surgeons for surgical options, such as bunionectomies.
Scope: NPs offer a medical approach, bridging conservative care and coordination with specialists.
Key Differences:
Chiropractors focus on non-invasive, manual techniques and alignment, while NPs can incorporate medications and broader medical management.
NPs are more likely to coordinate with other healthcare providers for comprehensive care, whereas chiropractors tend to work more independently.
General Notes:
Both can assist in managing mild to moderate bunion symptoms, but neither can “cure” bunions, particularly if the structural deformity has progressed.
Consult a podiatrist or an orthopedic specialist for persistent or worsening symptoms, as severe cases may require surgical intervention.
Always verify the provider’s credentials and experience in treating bunions.
Injury Medical Chiropractic and Functional Medicine Clinic
Dr. Jimenez, a nurse practitioner, treats a wide range of conditions using a combination of medical knowledge and chiropractic care. The clinic offers personalized care plans that incorporate functional medicine, acupuncture, electroacupuncture, and sports medicine. The clinic treats chronic pain syndromes and injuries, focusing on strength, agility, and flexibility. Comprehensive care plans, when paired with in-person and virtual health coaching, offer personalized treatment and wellness outcomes for patients of all ages and abilities.
Enhance Your Performance with Functional Foot Orthotics
References
MedlinePlus (2024). Bunions. U.S. Department of Health and Human Services.
American Academy of Orthopaedic Surgeons. (2022). “Bunions.” OrthoInfo. from https://orthoinfo.aaos.org/en/diseases–conditions/bunions/.
Hurn, S. E., Matthews, B. G., Munteanu, S. E., & Menz, H. B. (2022). Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta-Analysis. Arthritis care & research, 74(10), 1676–1688. https://doi.org/10.1002/acr.24603
Aebischer, A. S., & Duff, S. (2020). Bunions: A review of management. Australian Journal of General Practice, 49(11), 720–723. https://doi.org/10.31128/AJGP-07-20-5541
American Podiatric Medical Association. (2025). “What is a podiatrist?” Advancing foot and ankle medicine and surgery. from https://www.apma.org/patients-and-the-public/what-is-a-podiatrist/.
Children walking with their toes pointed in may be pigeon-toed. What are the causes, conditions associated with it, and treatments?
Pigeon-toed Walking
If a child walks with their feet turned inward at the toes, it is usually described as being pigeon-toed. This pointing inward of the feet occasionally occurs as a child learns to walk and may continue through toddlerhood. It is noticed more often in children than adults, but older individuals can experience it. Pigeon-toed walking is rarely a major orthopedic problem and usually disappears without treatment. However, there are times when it may impact a child’s lower extremities and hips. Bracing or surgery may be necessary in these cases to correct the problem. (Paramanandam V. et al., 2019) This condition is common and typically is caused by abnormal birth positions in utero. Sometimes, slight issues may lead to noticeable functional characteristics. Mild changes in bone shape and positioning usually cause pigeon toes. Often, it subsides in a few years as the child continues to develop.
What Does It Mean?
There is usually no need to worry, as this condition is likely not permanent and will go away in a few years. (Paramanandam V. et al., 2019) However, it is recommended that you check in with your healthcare provider to ensure the child is developing normally. Some adults walk with their toes turned in. This may be due to a birth defect, a weakness, or a rare case of pigeon-toed walking as a youth that was left untreated or did not go away.
Causes
There are various reasons for pigeon-toed walking. To determine the cause, a healthcare provider can assess the child’s condition and make a diagnosis, including:
Metatarsus Adductus
A condition where the front part of the foot is turned inward.
The metatarsals are the long bones of the forefoot.
This is when the bones of the foot point inward, leading to pigeon-toed walking.
A clinical examination and X-ray can confirm the metatarsus adducts as a cause of pigeon-toed walking.
Tibial Torsion
A twisted shinbone (tibia) can cause the feet to turn inward in younger children.
The shinbone/tibia in some children may be slightly twisted.
The tibia can either turn outward or inward.
When it twists inward, it may manifest as a pigeon-toed gait.
Tibial torsion may accompany femoral anteversion.
It is diagnosed with an X-ray.
Children with tibial torsion typically grow out of the problem, and the pigeon-toed disappears by age 4. (Uden H., & Kumar S. 2012)
Femoral Anteversion
A common cause, especially in older children, is when the thighbone/femur is twisted inward.
If the femur turns inward and forward unnaturally, where the femoral neck meets the body of the femur, it is called femoral anteversion.
An outward and backward rotation of the femur is called femoral retroversion.
Many children with femoral anteversion appear knock-kneed with a large gap between their feet when standing with knees together, and when they walk, they appear pigeon-toed.
A clinical examination and X-ray diagnose it.
Symptoms
In most cases, the child does not complain of any pain. However, if pain is felt, it can include:
Tightness in the calf muscles
Aching on the outer edges of the feet
Knee pain
Usually, parents will notice pigeon-toes when their child is first learning to walk. Rest assured, the child most likely is not experiencing pain. They have feet and knees that turn inward when they walk and run. (Uden H., & Kumar S., 2012)
A pediatrician or primary care provider can assess the situation and make recommendations. Most pigeon-toed children begin walking and running normally after age 3 or 4, so a watch-and-wait approach is used. Parents may have to take their child to a specialist, like an orthopedic surgeon, if they complain of pain while walking. A specialist may be referred if the child cannot walk due to the inward turn of their feet.
Risk Factors
Pigeon-toed walking is not a preventable condition but rather one that develops during pregnancy. Causes may include: (Scorcelletti M. et al., 2020)
A pregnancy with twins or multiple births
Large fetus
Breech position in utero when the baby is positioned feet first.
Typically, a normal gait will appear by age 3 or 4. Other treatments may include:
Physical Therapy Exercises and Gait Training
Exercises to stretch tight lower extremity muscles and strengthen hip and leg muscles can help improve walking gait.
See a pediatric specialist before starting, as research shows that parental stretching of a newborn with metatarsus adductus offers little benefit. (Eamsobhana P. et al., 2017)
Bracing or Casting
Braces
Serial casting is a procedure that helps children improve their range of movement and may be done to place their lower extremities in an optimum position as they develop. (Uden H., & Kumar S., 2012)
Surgery
For cases in which tibial torsion is the cause, osteotomy surgery, which involves cutting and/or removing bone, may be recommended to correct the structural deformity of the shinbone.
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Foot Pronation
References
Paramanandam, V., Lizarraga, K. J., Soh, D., Algarni, M., Rohani, M., & Fasano, A. (2019). Unusual gait disorders: a phenomenological approach and classification. Expert review of neurotherapeutics, 19(2), 119–132. https://doi.org/10.1080/14737175.2019.1562337
Uden, H., & Kumar, S. (2012). Non-surgical management of a pediatric “intoed” gait pattern – a systematic review of the current best evidence. Journal of Multidisciplinary Healthcare, 5, 27–35. https://doi.org/10.2147/JMDH.S28669
Scorcelletti, M., Reeves, N. D., Rittweger, J., & Ireland, A. (2020). Femoral anteversion: significance and measurement. Journal of Anatomy, 237(5), 811–826. https://doi.org/10.1111/joa.13249
Eamsobhana, P., Rojjananukulpong, K., Ariyawatkul, T., Chotigavanichaya, C., & Kaewpornsawan, K. (2017). Does the parental stretching programs improve metatarsus adductus in newborns?. Journal of Orthopaedic Surgery (Hong Kong), 25(1), 2309499017690320. https://doi.org/10.1177/2309499017690320
Individuals dealing with pain in the buttocks and in the back of the thigh, along with numbness and tingling down to the bottom of the foot, may be experiencing hamstring syndrome, a condition caused by pressure on the sciatic nerve. What is the recommended treatment?
Hamstring-Syndrome Relief
The hamstrings are three muscles in the back of the thigh, extending from the pelvis or upper thigh across the back of the knee to the leg. This muscle group is important for bending the knee, straightening the hip, and stabilizing the knee. The sciatic nerve is a large nerve that runs from the lower back down the legs. It usually passes near or through these muscles, and the pelvis then runs under these muscles in the thigh. Hamstring syndrome refers to pain in the buttock and back of the thigh, often radiating down the leg, caused by compression or irritation of the sciatic nerve at the hamstring-insertion point on the ischial tuberosity, typically due to tight or scarred tissue. (Sakari Orava, 1997)
Pain Location
The pain is primarily felt in the buttock and back of the thigh, sometimes extending down the leg. It’s characterized by pressure on the sciatic nerve, which runs through the buttock and into the back of the thigh, where it supplies the hamstring muscles. (Kaiser Permanente, 2024)
In some cases, injections with cortisone and numbing medicine may be used to reduce nerve inflammation and pain. (Lower Limb Surgery, 2024)
Surgery
In severe cases, surgery may be necessary to release the compressing bands and free the sciatic nerve. (Lower Limb Surgery, 2024)
Injury Medical Chiropractic & Functional Medicine Clinic
Talk to a healthcare provider about what interventions would help the most. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Kaiser Permanente. (2024). Hamstring Syndrome: Care Instructions. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.hamstring-syndrome-care-instructions.abr3618
Puranen, J., & Orava, S. (1988). The hamstring syndrome. A new diagnosis of gluteal sciatic pain. The American Journal of Sports Medicine, 16(5), 517–521. https://doi.org/10.1177/036354658801600515
Zion Physical Therapy. (2023). Hamstring Tendinitis Vs. Hamstring Syndrome. https://www.zionpt.com/post/hamstring-tendinitis-vs-hamstring-syndrome
What are the treatment options for individuals dealing with foot overpronation when the foot and ankle move too much downward and inward?
Overpronation
Pronation is the normal foot and ankle movement when taking a step and is usually associated with flat feet. Overpronation is a movement pattern in which the ankle rolls inward and downward, causing the foot’s arch to collapse with each stride. Overpronation can strain the muscles and ligaments in the feet and legs, leading to heel pain, ankle pain, shin splints, and low-back pain. (Pedorthic Association of Canada, 2023) Orthotic inserts for shoes, prescribed stretches, ankle braces, physical therapy, and surgery can all help alleviate the impact of overpronation. (Sánchez-Rodríguez, R. et al., 2020)
Signs and Symptoms
Some individuals with overpronation can have no symptoms at all. (Pedorthic Association of Canada, 2023) while others experience pain or other symptoms in their legs and feet. Overpronation is not a medical condition but a movement pattern that, if left untreated, can increase the risk for certain medical conditions because it strains the feet and leg muscles, joints, and ligaments. (Sánchez-Rodríguez, R. et al., 2020) Certain medical conditions can be a sign of overpronation and include: (Pedorthic Association of Canada, 2023)
Bunions
Heel pain
Plantar fasciitis
Achilles tendon pain
Posterior tibial tendonitis
Shin splints
Knee pain, including patellofemoral pain syndrome
Pain in the iliotibial or IT band
Lower back pain
Arthritis in foot and ankle joints
Stress fractures
Individuals may also experience pain in the midfoot or hips, which can be a symptom of flat feet.
Underpronation
Pronation refers to the normal movement of the foot and ankle while walking. Overpronation and underpronation are both abnormal movement patterns.
Overpronation – when the ankle rolls too much inward and downward.
Underpronation – occurs when an individual’s foot lacks flexibility and moves too little. This condition is called supination and is often associated with a high-arch foot type.
Overpronation can be caused or worsened by flatfeet. However, some individuals have overpronation because their feet and ankles are very flexible, so they tend to move more. Risk factors for flatfeet can also increase the chances of developing overpronation and include:
Age, especially individuals over 40.
Wearing shoes like high heels and shoes with a narrow-toe box.
Women are more prone to overpronate because of the various shoes and high heels worn.
Being overweight
Doing repetitive, impactful movements like running.
Correction and Treatment
Treating overpronation focuses on alleviating strain on muscles in the foot, ankle, and leg to relieve symptoms in the heel, ankle, knees, hips, or back. Common treatments are wearing supportive shoes and/or using foot orthotics. Exercises and stretches are also recommended to maintain flexibility and strength. Surgery is rare, but correcting flat feet that can cause overpronation may be recommended. (Sánchez-Rodríguez, R. et al., 2020) Individuals with overpronation are advised to see a podiatrist who can explain the best treatment options.
Supportive Shoes
The first course of treatment is to wear added supportive footwear. This can include specialized shoes or inserts that support the foot and reduce ankle movement. Individuals are advised to use shoes with firm heel and midfoot support to help prevent disproportionate movement. (Pedorthic Association of Canada, 2023)
Orthotics
A healthcare provider can recommend orthotics for individuals with moderate overpronation. These are meant to support the foot, especially the arch, and reduce overpronation. (Naderi A. Degens H. and Sakinepoor A. 2019) Individuals can purchase orthotics from shoe stores and elsewhere, but those with severe overpronation may need custom orthotics molded to the foot to provide individualized support.
Exercises and Stretches
Exercises and stretches can also help. A study found that exercises targeting the feet, core, and hips helped correct pronation over nine weeks. The exercises included: (Sánchez-Rodríguez, R. et al., 2020)
Toe pickups in which the individuals grab small objects with their toes and move them from one position to another.
Flexing and pointing the toes using a resistance band placed around the toes.
Hip abduction exercises to target the hip and glutes.
Abdominal and oblique muscle exercises to stabilize the torso.
Short-foot exercise raises the foot arch off the ground, drawing the toes toward the heel. (Sulowska I. et al., 2016)
Surgery
Rarely will surgery be needed to treat flat feet and severe overpronation. But if necessary, reconstruction realigns the bones to support the arch better and reduce overpronation. A metal implant is used for flatfeet to stabilize the area. Surgery can also repair torn tendons or other damage contributing to overpronation. (Healthline, 2020)
Injury Medical Chiropractic and Functional Medicine Clinic
Individuals with overpronation but no symptoms don’t necessarily have to see a healthcare provider since this may be the body’s natural movement pattern. But if the feet, legs, hips, or back begin to present with pain and other symptoms, see a healthcare provider who can evaluate gait and recommend treatment options. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Enhance Performance with Functional Foot Orthotics
References
Pedorthic Association of Canada. (2023). Overpronation and Underpronation Correction. https://pedorthic.ca/services/foot-health/pronation/
Sánchez-Rodríguez, R., Valle-Estévez, S., Fraile-García, P. A., Martínez-Nova, A., Gómez-Martín, B., & Escamilla-Martínez, E. (2020). Modification of Pronated Foot Posture after a Program of Therapeutic Exercises. International journal of environmental research and public health, 17(22), 8406. https://doi.org/10.3390/ijerph17228406
Naderi, A., Degens, H., & Sakinepoor, A. (2019). Arch-support foot orthoses normalize dynamic in-shoe foot pressure distribution in medial tibial stress syndrome. European journal of sport science, 19(2), 247–257. https://doi.org/10.1080/17461391.2018.1503337
Sulowska, I., Oleksy, Ł., Mika, A., Bylina, D., & Sołtan, J. (2016). The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial. PloS one, 11(6), e0157917. https://doi.org/10.1371/journal.pone.0157917
Healthline. (2020). All About Surgery for Flat Feet: Pros and Cons. https://www.healthline.com/health/flat-feet-surgery
Can various stretches can help relieve individuals with plantar fasciitis to reduce foot pain and restore gait function?
Introduction
As human beings, we are constantly on the move, and our feet are the ones that take a toll after a long day. The feet have various muscles, ligaments, tendons, and soft tissues that help protect the joints and provide stability. The feet are part of the lower body extremities that aid in mobility and strength of the upper body. When many individuals are constantly on their feet, the muscles and ligaments become overworked and can develop into pain-like issues. Most of the time, it is just muscle aches and pain; however, when repetitive motions start to cause more problems on the feet, it can lead to micro tears in the foot’s fascia. This, in turn, can lead to the development of plantar fasciitis, affecting a person’s gait ability. Today’s article looks at how plantar fasciitis affects gait function and how various stretches can help alleviate plantar fasciitis. We discuss with certified associated medical providers who consolidate our patients’ information to assess plantar fasciitis and its associated comorbidities. We also inform and guide patients on various stretches for plantar fasciitis and ask their associated medical providers intricate questions to integrate a customized treatment plan to incorporate multiple stretches to reduce the pain-like symptoms correlated with it. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
How Plantar Fasciitis Affects Gait Function
Do you feel like you are walking crooked from one location to another? Do you feel a stabbing pain when you take your first steps? Or do you feel constant pain in your feet while you are resting? As stated earlier, many individuals are constantly on their feet and have dealt with some pain that can affect their quality of life. Since the feet are part of the lower body extremities, a person experiencing a lot of pain in their heels can lead to a chronic musculoskeletal condition known as plantar fasciitis. The plantar fascia plays a huge part in the human body as it helps with the normal biomechanics of the foot, supports the arch, and provides shock absorption when a person is stepping. (Buchanan et al., 2024) When a person has been doing repetitive motions on their feet, it can lead to the development of plantar fasciitis. Plantar fasciitis is a common musculoskeletal disease that causes chronic degenerative changes in the plantar fascia. This musculoskeletal disease is also associated with mechanical factors such as repetitive stress and weight bearing that can lead to microtears in the muscle fibers. (Tseng et al., 2023) That point causes many individuals to have gait issues and other comorbidities.
Some risk factors correlated with plantar fasciitis are decreased ROM in plantarflexion and increased tensile load, which can cause many individuals to have gait issues while walking. (Hamstra-Wright et al., 2021) Since many individuals rely on walking and are experiencing pain from plantar fasciitis, not only their gait function is being affected, butthe surrounding muscles in the legs are also affected. Pain symptoms like intrinsic muscle weakness, reduced muscle strength on the legs and dorsiflexion, leg length discrepancy, and arch deformity can increase the chances of plantar fasciitis developing. (Khammas et al., 2023) This can cause many individuals to have gait dysfunction since the pain can be unbearable. Additionally, when people deal with plantar fasciitis, they shift their weight to one side of their bodies to reduce the pain and allow their secondary muscles to take on the unnecessary weight load. Luckily, there are ways to minimize the pain-like effects of plantar fasciitis and help restore a person’s gait function.
What is Plantar Fasciitis?-Video
Effective Stretches To Alleviate Plantar Fasciitis
When it comes to reducing plantar fasciitis, many individuals seek various treatments to reduce the pain-like symptoms causing their gait dysfunction. Many individuals seek non-surgical and surgical treatments to find the right solution for their plantar fasciitis. Depending on the severity of the pain affecting their feet, the main objective is to reduce tissue compressive load and provide a personalized treatment plan to educate and treat plantar fasciitis. (Morrissey et al., 2021) One of the best ways to reduce the pain from plantar fasciitis is by incorporating various stretches. Various stretches for plantar fasciitis can be effective as they can help relieve pain and enhance muscle strength in the extrinsic and intrinsic foot muscles. (Boonchum et al., 2020) Below are some stretches that many people dealing with plantar fasciitis can do at home to relieve the pain.
Towel Stretch
This simple stretch is perfect for the morning, especially before taking your first steps.
How to do it:
Sit alongside the bed with your legs straight in front of you.
Loop a towel around the ball of the feet and hold each end with your hands.
Pull the towel towards you while trying to keep the knees straight until you feel a stretch along the bottom of your foot and calf.
Hold the position for 15 to 30 seconds.
Repeat 2-3 times for each foot.
Calf Stretches
Tight calf muscles can exacerbate plantar fasciitis. Stretching your calves can relieve the pressure on your plantar fascia.
How to do it:
Stand near a wall with one foot back and one foot in front of you.
Keep your back heel on the ground and bend your front knee until you feel a stretch in the back leg’s calf muscle.
Hold for about 30 seconds and switch.
Repeat 2-3 times for each leg.
Plantar Fascia Stretch
Directly stretching the plantar fascia can help alleviate pain and improve foot function.
How to do it:
Sit with your affected foot and place it over the opposite side.
Use your hand to pull your toes back towards the shin until you feel a stretch along the arch of your foot.
Hold the stretch for at least 15 seconds and repeat the stretch three times.
Achilles Tendon Stretch
This stretch helps both the calf muscles and the plantar fascia.
How to do it:
Stand with your affected foot behind you.
Keep your heel down and bend your knee slightly.
Hold the position for 15-20 seconds, then relax.
Repeat 2-3 times for each leg.
Marble Pickup
Strengthening the muscles around your foot can also support the healing process.
How to do it:
Sit in a chair
Then, place 20 marbles and a bowl on the floor before your feet.
Use your toes to pick up one marble and place it into a bowl one at a time.
Repeat until you have all the marbles in the bowl.
References
Boonchum, H., Bovonsunthonchai, S., Sinsurin, K., & Kunanusornchai, W. (2020). Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis. J Musculoskelet Neuronal Interact, 20(3), 411-420. https://www.ncbi.nlm.nih.gov/pubmed/32877978
Hamstra-Wright, K. L., Huxel Bliven, K. C., Bay, R. C., & Aydemir, B. (2021). Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis. Sports Health, 13(3), 296-303. https://doi.org/10.1177/1941738120970976
Khammas, A. S. A., Mahmud, R., Hassan, H. A., Ibrahim, I., & Mohammed, S. S. (2023). An assessment of plantar fascia with ultrasound findings in patients with plantar fasciitis: a systematic review. J Ultrasound, 26(1), 13-38. https://doi.org/10.1007/s40477-022-00712-0
Morrissey, D., Cotchett, M., Said J’Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med, 55(19), 1106-1118. https://doi.org/10.1136/bjsports-2019-101970
Tseng, W. C., Chen, Y. C., Lee, T. M., & Chen, W. S. (2023). Plantar Fasciitis: An Updated Review. J Med Ultrasound, 31(4), 268-274. https://doi.org/10.4103/jmu.jmu_2_23
Can physical therapies help treat a high steppage gait from injury or medical conditions and restore normal gait patterns for individuals who have or are developing one?
Walking or gait anthropometric analysis on a treadmill
Neuropathic Gait
Neuropathic gait, aka equine or high steppage gait, is a type of walking abnormality that causes individuals to raise their hips to lift their legs higher than normal. It occurs when individuals have a foot drop or ankle equinus due to loss of dorsiflexion. As a result, the foot hangs with the toes pointing down, causing the toes to drag while walking. The foot may appear floppy when it drops. Foot drop is caused by weakness or paralysis of the anterior tibialis muscle in front of the shin bone. The anterior tibialis muscle contracts to help flex the foot and ankle while walking, ensuring the foot clears the floor and doesn’t drag. Individuals with anterior tibialis weakness or paralysis may have a neuropathic gait and excessively bend the hip and knee while stepping forward, lifting their leg high off the floor to clear the foot to avoid tripping. A physical therapy team can help with a high steppage gait pattern after illness or injury.
Causes
Conditions that can cause anterior tibialis weakness or paralysis and a high steppage gait pattern include:
Sciatica
Pain caused by compression or irritation of the sciatic nerve starts in the lower back and travels down the back of the leg. (McCabe, F. J., McCabe, J. P. 2016)
Peroneal Nerve Injury
Damage to the peroneal nerve branches from the sciatic nerve that help move the lower leg and foot. (Johns Hopkins Medicine. 2024)
Multiple Sclerosis
An autoimmune disease that damages nerve cells in the brain and spinal cord. (Taylor, P. N. et al., 2016)
Balance exercises will help improve overall proprioception, or the sense of the body’s position and movement.
Neuromuscular electrical stimulation, or NMES, can help improve the function of the muscle. (Hollis, S., McClure, P. 2017)
The electrical stimulation artificially contracts the muscle to restore proper function.
For anterior tibialis weakness caused by sciatica, back decompression exercises may be prescribed to relieve pressure off the sciatic nerve.
The exercises release the nerve to restore normal signal transmission up and down the nerve in the lower back.
Neuromuscular electrical stimulation may also be used to help improve muscle function.
Assistive Walking Devices
A therapist may suggest using an assistive device to help the patient walk properly. This could include a wheeled walker or a quad cane. A temporary solution to anterior tibialis weakness is to elevate the foot while walking with an elastic band. Tie a band around the leg below the knee and secure it around the ball of the foot. When swinging the leg forward, the band pulls the foot up. Using it as a temporary solution may help maintain safe mobility. Sometimes, paralysis of the anterior tibialis muscle can become permanent. In this case, individuals may benefit from a special brace called an ankle-foot orthosis. The brace helps to lift the foot and toes off the ground.
For individuals concerned about losing their balance and falling, there are ways to improve walking patterns to stay safe. A healthcare provider may recommend physical therapy to correct gait, strengthen the anterior tibialis muscle, improve balance, and educate on injury prevention. Individuals should discuss symptoms and conditions with a primary physician, healthcare provider, or specialist to guide them in the right direction and determine the best treatment.
Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach personalized to the individual that focuses on what works for them and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Control Foot Motion and Posture
References
McCabe, F. J., & McCabe, J. P. (2016). An Unusual Presentation of Right-Sided Sciatica with Foot Drop. Case reports in orthopedics, 2016, 9024368. https://doi.org/10.1155/2016/9024368
Kaykisiz, E. K., & Unluer, E. E. (2017). An Unexpected Reason for Isolated Foot Drop: Acute Stroke. Pakistan journal of medical sciences, 33(5), 1288–1290. https://doi.org/10.12669/pjms.335.13593
Taylor, P. N., Wilkinson Hart, I. A., Khan, M. S., & Slade-Sharman, D. E. (2016). Correction of Footdrop Due to Multiple Sclerosis Using the STIMuSTEP Implanted Dropped Foot Stimulator. International journal of MS care, 18(5), 239–247. https://doi.org/10.7224/1537-2073.2015-038
Hollis, S., & McClure, P. (2017). Intramuscular Electrical Stimulation for Muscle Activation of the Tibialis Anterior After Surgical Repair: A Case Report. The Journal of orthopaedic and sports physical therapy, 47(12), 965–969. https://doi.org/10.2519/jospt.2017.7368
For individuals dealing with plantar fasciitis, every step can be painful. Can taking an integrative approach and utilizing acupuncture help treat this condition and accelerate symptom relief?
Acupuncture Plantar Fasciitis
Plantar fasciitis is when the supportive tissue running under the foot, from the heel to the base of the toes, becomes irritated and painful. The disorder can be difficult to manage, but there are alternative treatment options. Acupuncture plantar fasciitis therapy is one potential method of relief, alleviating pain, and returning the individual to regular activities. Acupuncture involves inserting extremely thin needles into points in the body to restore and balance the normal flow of energy and improve overall health. (Johns Hopkins University. 2024) In traditional Chinese medicine or TCM, the body comprises a series of meridians/channels that supply energy flow or qi/chi.
Facts
Plantar fasciitis is a common disorder affecting the foot. The condition occurs when the plantar fascia, designed to absorb the forces that travel through the arch of the foot, becomes overloaded. When the bottom of the foot is constantly subjected to high amounts of strain, it leads to ligament degeneration, pain, and inflammation. The most common symptom is heel pain, the first thing an individual experiences in the morning or after a long day of work and activities. Anyone can get plantar fasciitis, but those who are more prone to the condition include individuals with:
Acupuncture and its effectiveness are still being studied, but there is evidence suggesting that it is beneficial in plantar fasciitis treatment.
One review found significant pain improvements in individuals who had acupuncture for the condition compared to individuals who received standard treatments like stretching, orthotics, and strengthening. (Anandan Gerard Thiagarajah 2017) The same review also found benefits when comparing acupuncture to a placebo version of the treatment, further reinforcing the findings.
Another medical review found that acupuncture helped alleviate heel pain and improve daily function when combined with nonsteroidal anti-inflammatory medications/NSAIDs such as ibuprofen or naproxen. (Richard James Clark, Maria Tighe 2012)
Side Effects
While acupuncture plantar fasciitis therapy is beneficial, it is important to remember there can be potential side effects that can include:
Pain in the area where the needles were placed.
Bleeding in the area where the needles were placed.
Bruising or skin discoloration.
Allergic reaction or contact dermatitis/itchy rash.
The chances of a serious adverse side effect are relatively low when undergoing acupuncture on the foot.
Acupuncture Points and Sensations
The ways acupuncture works are not yet fully understood, but like other neuromusculoskeletal therapies, the process activates the body’s healing properties.
Inserting a needle into the body’s points stimulates the central nervous system.
This leads to the release of chemicals in the brain, spinal cord, and muscles that promote healing.
These same chemicals and reactions also reduce the body’s sensation of pain. (Teng Chen et al., 2020)
Number of Sessions
The amount of sessions that acupuncture takes to provide pain relief varies from person to person and case to case.
One review found that treating plantar fasciitis weekly with acupuncture produced significant pain relief after four to eight weeks. (Anandan Gerard Thiagarajah 2017)
This corresponds to another medical review that included a study showing significantly improved pain levels in individuals undergoing weekly acupuncture sessions for four weeks. (Richard James Clark, Maria Tighe 2012)
Individuals are recommended to consult a healthcare provider about personalized treatment plans and if they have a bleeding disorder, are on blood thinner medications, or are pregnant.
American Academy of Orthopaedic Surgeons. (2022). Plantar fasciitis and bone spurs. (Diseases and Conditions, Issue. https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs
Thiagarajah A. G. (2017). How effective is acupuncture for reducing pain due to plantar fasciitis?. Singapore medical journal, 58(2), 92–97. https://doi.org/10.11622/smedj.2016143
Clark, R. J., & Tighe, M. (2012). The effectiveness of acupuncture for plantar heel pain: a systematic review. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 30(4), 298–306. https://doi.org/10.1136/acupmed-2012-010183
Chan, M. W. C., Wu, X. Y., Wu, J. C. Y., Wong, S. Y. S., & Chung, V. C. H. (2017). Safety of Acupuncture: Overview of Systematic Reviews. Scientific reports, 7(1), 3369. https://doi.org/10.1038/s41598-017-03272-0
Chen, T., Zhang, W. W., Chu, Y. X., & Wang, Y. Q. (2020). Acupuncture for Pain Management: Molecular Mechanisms of Action. The American journal of Chinese medicine, 48(4), 793–811. https://doi.org/10.1142/S0192415X20500408
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