Morton’s Neuroma

Morton's neuroma is a common condition that affects the nerves in the foot, typically between the third and fourth toes. It occurs when the tissue surrounding a nerve thickens, leading to compression and irritation of the nerve.

This condition often causes pain, tingling, or numbness in the affected area of the foot. Symptoms may worsen with activities that put pressure on the foot, such as walking or wearing tight shoes. Some people describe the sensation as feeling like there's a pebble or marble inside their shoe.

The exact cause of Morton's neuroma isn't always clear, but factors such as wearing high heels or tight shoes, participating in high-impact activities, or having certain foot deformities can increase the risk of developing it.

Diagnosis of Morton's neuroma typically involves a physical examination and may include imaging tests such as X-rays or MRI scans to rule out other possible causes of foot pain.

Treatment options for Morton's neuroma may include wearing supportive footwear with a wider toe box, using orthotic inserts or pads to relieve pressure on the affected area, corticosteroid injections to reduce inflammation and pain, or in severe cases, surgery to remove the affected nerve tissue.

It's essential to seek medical advice if you experience persistent foot pain or discomfort, as early diagnosis and treatment can help alleviate symptoms and prevent complications.

plantar fasciitis

Is this you?

This weekend you had a long run. The spring is here! With the sunshine back, you are motivated and inspired to get outside and cruise some longer distances. It feels great to run in the sun!

But…

This morning you woke up, like any other morning, stepped out of bed looking forward to your morning coffee but BAM!

Did you step on something??? Holy smokes! It feels like you are walking on GLASS! The first five steps are the worst. Then it backs off a bit.

Uh oh…

You’ve heard of this before. Your running mate had this last year and is just now getting back to running…

Is this the dreaded PLANTAR FASCIITIS?

Let’s talk about it.

Most runners have heard about Plantar Fasciitis. It is a dreaded injury that can sideline your running season.

Truly, a pain in the foot…

Specifically the heel.

WHAT IS PLANTAR FASCIITIS?

To understand plantar fasciitis, let’s talk about what FASCIA is and then specifically the PLANTAR FASCIA

FASCIA is connective tissue. It runs throughout the body and encases our muscles and joints. It is super important for the structure of our muscles and joints. One of its primary functions is transferring force along the kinetic chain. In this case, we are talking about the posterior chain, which runs from the bottom of your foot all the way up to the back of your hip and beyond.

Think of the fascia in your feet as a strong, stretchy band that runs along the bottom, kind of like a rubber band. When you run, this fascia helps support your arches and absorbs the shock from each step you take. But sometimes, especially if you've increased your running a lot, this fascia can get irritated and sensitized.

It's like if you keep pulling on that rubber band too much, it might start to get sore and swollen. When your plantar fascia gets inflamed, it can feel like a sharp pain in your heel or along the bottom of your foot, especially when you first step out of bed in the morning.

The PLANTAR FASCIA is an especially thick section of fascia that runs from your heel to the ball of your foot. It is SUPER STRONG and helps absorb and transfer force every step while running and walking. When we step and load the foot, the plantar fascia stretches while the arch of the foot lengthens. Along with the muscle of the foot, the plantar fascia keeps the arch from collapsing, while making us more efficient walkers/runners.

In PLANTAR FASCIITIS, the origin point of the plantar fascia becomes irritated and VERY painful. A common belief is that the fascia becomes inflamed, but this actually is not true! It’s more accurate to say that the plantar fascia and the nerves around it are irritated, but not necessarily inflamed.

WHAT CAUSES PLANTAR FASCIITIS (plantar heel pain)?

Like any running injury, plantar fasciitis can be caused by running too much too soon. When the amount of activity you do exceeds the amount of activity you can recover from, it can cause plantar fasciitis (or other running injuries!).

But… plantar foot pain is common in people who don’t run. This means that running alone isn’t the cause of plantar fasciitis. The plantar fascia is loaded in running, walking, and even standing. We see plantar fascia pain in people who stand or walk a lot for work, sedentary people, and people with higher BMI (body mass index).

It is possible to have plantar fascia pain without an increase in running volume, but in active people we usually see a pattern of increased activity leading to symptoms!

A big issue with plantar foot pain is that once we ring that bell, it can be really hard to settle. It is important to get on top of it early to keep it from becoming a larger, more debilitating issue!

HOW DO WE DIAGNOSE PLANTAR FASCIITIS?

If you work with a Sports Chiropractor or Physiotherapist in Vernon, we will do a thorough history and physical exam. The combination of these will tell us if this is plantar fasciitis or something else.

In the physical exam, we will test the foot and plantar fascia to see if it fits classic plantar fasciitis. If not? It may be coming from somewhere else entirely (more on this later!)

HOW DO WE TREAT PLANTAR FASCIITIS?

Treating running-related injuries is simple, but not always easy.

We need to take three steps to get you back running without plantar fasciitis coming right back.

1. RESET: managing pain, while removing or modifying the things that are causing the symptoms in the first place. This typically involves a period of RELATIVE rest (decreases running, but not always eliminated).

2. RESTORE: improve mobility, strength, and endurance to prepare you for returning to running at the volume and intensity that you want to be at. This means specific and progressive exercises to strengthen your feet!

3. RELOAD: get back to running at the volume and intensity you were before the injury!

Treatment options for PLANTAR FASCIITIS

Forget about icing and popping anti-inflammatories for long-term relief. We're not dealing with a classic inflammation scenario here. While rolling your foot on a frozen water bottle or lacrosse ball might offer some relief, it's not the main game plan for treating plantar fasciitis. We're not out to break up scar tissue or change your foot's structure either. If rolling feels good and fits into your rehab strategy, go for it, but it's not a must-do.

Manual Therapy

At Base Camp, we often use muscle work, scraping, taping, and joint adjusting to decrease pain. You can also use some self-myofascial manipulation using a ball to roll out the bottom of your foot or calf. It’s important here to know that this IS NOT a NO PAIN NO GAIN scenario. Less is more when it comes to rolling out your foot and calf.

Changing footwear and/or heel lift

Footwear can temporarily change your symptoms. Using a shoe with more cushion, and a heel lift, can decrease the tension on the plantar fascia.

Stretching

Stretching out the bottom of the foot and the plantar fascia as soon as you wake up, before and after activity, and as a pain control method can be helpful. Try this tried and true plantar fascia stretch

Foot Strengthening

Strengthening a few muscles in the foot, ankle and calf can support the plantar fascia. Here are a few I give a lot (videos at the bottom of this section):

• Toe Yoga

• Foot Doming

• Calf Raises

Then what?

Runners Injury Purgatory.

Where most people fall short is when trying to return to running. They return too soon, without a progressive plan. After a plantar fascia injury, you need to take your return to running slowly and progressively.

Just because the pain is gone, does not mean you are ready to run.

Returning to running too early or at an intensity you are not ready for can land you in the dreaded RUNNERS INJURY PURGATORY!

This is when you repeatedly get injured from running every time you try and start again.

In order to avoid that, a well-structured walk-run program is key!

This is equally important if you have an active goal that is not running.

Using progressive exercise is the best way to get you back to doing your activity without plantar fascia pain coming back.

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But… what if it isn’t even plantar fasciitis in the first place?

Plantar fasciitis is WAY over diagnosed.

Every season I see patients come in who have been suffering from plantar fasciitis for months, throwing every treatment they can think of at the foot and getting nowhere, just to find out… it was never plantar fasciitis to begin with.

If your pain is NOT:

• WORST in the MORNING with the first few steps

• Improving after sitting, only to come right back when you stand up

…and if your pain IS:

• WORSE at the end of the day

• WORSE with sitting

• INCREASING with walking

• INCREASING when your lower back pain gets worse

• DULL/ACHY/TINGLING/BURNING and never SHARP…

Then your pain might not be related to the plantar fascia in the first place! This is why it is important to get assessed by a clinician who works with foot and ankle injuries, so that you can have confidence you are on the right path!

If your clinician or doctor tells you to:

• Get orthotics

• Ice your foot

• Take ani-inflammatories

• or change your footwear…

..without assessing your ankle, knee, hip and lower back… then there is a chance you are being treated for plantar fasciitis, when that is not even the issue!

Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.

Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.

Request a free consult with him here: CONTACT

ankle sprains: the most under-rehabbed injury

Ankle sprains are like uninvited guests at a party – they show up unexpectedly and can be quite a nuisance. Whether you're an athlete or just someone who enjoys an occasional stroll, chances are you've experienced the discomfort of an ankle sprain at some point in your life. But what exactly is an ankle sprain, and why do they often linger longer than expected?

Anatomy of an Ankle Sprain

When we talk about ankle sprains, we're usually referring to injuries involving the ligaments on the outer side of the ankle. These ligaments, such as the anterior talofibular ligament (ATFL) and the fibulocalcaneal ligament, are crucial for stabilizing the ankle joint. Ankle sprains typically occur when the foot rolls inward, stretching or tearing these ligaments in the process.

Ankle sprains are graded based on severity, ranging from grade one (mild stretching) to grade three (complete ligament tear). Even in milder cases, the loss of proprioception – the body's ability to sense joint position – can significantly impact recovery and increase the risk of future sprains.

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Why Your Ankle Sprain Lingers

If you've found yourself still bothered by an ankle sprain long after the initial injury, you're not alone. Here are three common reasons why ankle sprains can be persistent:

1. Inadequate Rehabilitation

One of the biggest mistakes people make is discontinuing rehabilitation once the pain subsides. While pain relief is important, true recovery requires comprehensive rehabilitation that goes beyond symptom management. Building strength, improving balance, and restoring proprioception are essential for long-term ankle health.

2. Ineffective Rehab Strategies

Traditional rehabilitation methods often focus on unstable surfaces like wobble boards and foam pads. While these tools have their place, they may not adequately prepare the ankle for real-world challenges. Functional exercises that mimic daily activities or sports-specific movements are more beneficial for restoring stability and preventing re-injury.

3. Lack of Activity-Specific Training

If your goal is to return to running, hiking, or any other physical activity, it's crucial to incorporate that activity into your rehabilitation plan. Merely strengthening the ankle in isolation may not translate to improved performance or reduced injury risk in your chosen activity.

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Choosing the Right Footwear

Another aspect often overlooked in ankle sprain recovery is footwear selection. Contrary to popular belief, bulky, cushioned shoes may not be the best choice post-injury. Minimalist footwear with a low stack height (the distance between your foot and the ground) can promote better ankle stability by minimizing the lever arm during foot inversion.

While minimalist shoes are ideal for everyday use, exceptions exist for activities requiring additional support, such as backpacking or heavy lifting. In such cases, footwear with increased ankle support may be warranted to mitigate the risk of re-injury.

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The Road to Recovery

Rehabilitating an ankle sprain isn't just about reducing pain; it's about restoring function and preventing future injuries. A comprehensive approach that addresses strength, balance, proprioception, and activity-specific training is key to achieving optimal outcomes.

If you've recently sprained your ankle or are still grappling with lingering symptoms, don't hesitate to seek professional guidance. By investing time and effort into your rehabilitation, you can overcome the limitations of your ankle sprain and get back to doing what you love – pain-free and with confidence.

Rehab Exercises:

Week 1: GOAL is to improve range of motion, reduce swelling, and reduce pain. VIDEO

Week 1-2: Restore Range of Motion and load in pain-free range. VIDEO

Week 2+: Increased ankle loading and ligament loading. VIDEO

Week 4+: Improve strength, endurance, and tolerance to inversion stress

Week 6-8+: Increase power, speed, resilience, and stability, preparing for sport-specific demands

Do NOT STOP your rehab plan when your pain is gone. KEEP GOING until you have returned to FULL FUNCTION!

Your plan should be at least 8 weeks. Yes, even for a Grade 1 ankle sprain.

Healing takes time, especially when you want to get back to meaningful activities.

Need help? Book a free consult with us!

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Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.

Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.

Request a free consult with him here: CONTACT

How to exercise through pain

Exercise is an integral part of a healthy lifestyle but it's not uncommon to experience some degree of discomfort or pain during or after a workout. It's important to understand how much pain is too much and when it's time to take a step back. In this blog post, we at Base Camp Chiropractic and Sports Rehab (@base.camp.doc) will share with you a useful concept: The Rule of 10, a strategy that can help you manage pain while staying active.

The Rule of 10 Explained

The Rule of 10 is a simple guideline that can help you avoid flare-ups and keep you on track with your fitness goals. It involves adding together your effort intensity and pain level, aiming to keep the total at or below 10. This way, you can continue exercising while managing your pain levels.

The Rule of 10 in Action

To better understand how the Rule of 10 works, let's look at a few examples:

• Knee pain:

• If your knee pain level is 3/10 and your effort level is 7/10, the total is 10/10. This is within the limit.

• Hip pain:

• If your hip pain level is 6/10 and your effort level is 4/10, the total is 10/10. Again, this is within the limit.

• Shoulder pain:

• If your shoulder pain level is 2/10 and your effort level is 8/10, the total is 10/10. This is acceptable according to the Rule of 10.

• Back pain:

• If your back pain level is 4/10 and your effort level is 6/10, the total is 10/10. This is an acceptable level of discomfort and effort.

Staying Active While Managing Pain

The Rule of 10 is a strategy that can help you stay active and continue exercising even while dealing with pain. It's all about balancing your effort levels with your comfort levels, allowing you to push yourself within safe limits.

We want to give credit to Ben Cormack (@corkinetic) for putting this concept out. It's a practical way to measure and manage your pain levels during exercise, enabling you to maintain your fitness regimen without putting your health at risk.

Rehab Can Be Frustrating, But It Doesn't Have to Be

Rehabilitation from an injury or surgery can be a frustrating process, especially when pain seems to halt progress. However, with the right guidance and plan, it's possible to continue your journey towards recovery.

If you're ready to get help, reach out to us at Base Camp Chiropractic and Sports Rehab. Send us a message or visit our website at www.basecampclinic.com. We're here to support you every step of the way.

Remember to save this blog post for future reference and share it with anyone who might find it useful. Stay active, stay healthy, and manage your pain smartly!

3 ways to manage pain with running (without stopping!)

Embarking on a run is not just a physical activity; it's a journey into self-discovery and the great outdoors.

Yet, what do you do when the joy of each stride is overshadowed by the unwelcome companionship of pain? At Base Camp Chiropractic and Sports Rehab, we've witnessed countless runners grappling with this predicament. The prospect of giving up something you love is disheartening, but fear not! Let’s take a look at three alternatives that can keep you on track, pain-free and on track to hit your running goals.

Running is a fantastic way to stay in shape and explore the outdoors. But what happens when every stride sends a jolt of pain through your body? At Base Camp Chiropractic and Sports Rehab, we've seen many runners struggle with this issue. Rather than quitting this activity that you love, consider these three alternatives.

1. Manipulate the Volume

One of the most common mistakes runners make is trying to do too much, too soon. This approach often leads to overuse injuries and burnout. Instead of stopping completely or pushing through the pain, consider adjusting the volume of your runs.

For example, if you have a long run planned for Saturday with a target of 20 km, you could split this into two separate runs. You could run 10 km in the morning and then another 10 km in the evening. This approach reduces the strain on your body while still allowing you to reach your mileage goals.

2. Change Your Pace or Cadence

Another way to address running-related pain is by changing your pace or cadence. Your pace (your mph or km/h), and your cadence (the number of steps you take per minute), both play a significant role in how your body absorbs the impact of each stride.

Adjusting your pace can change the load on your joints and muscles. Increasing or decreasing your pace can sometimes alleviate pain by changing the way your foot strikes the ground.

Similarly, increasing your cadence by 10% can also change the joint loads. By taking more steps per minute, you reduce the impact of each individual step, spreading the load more evenly across your stride.

3. Warm Up!

Our final tip is to always warm up before running. A thorough warm-up can prepare your body for the demands of running and potentially reduce the risk of injury. Some of our favourite warm-up exercises include calf raises, lunges, squats, and toe lifts. These movements target the muscles used most during running, ensuring they are ready for action.

Running should be an enjoyable activity, not something that causes you pain. If you're experiencing pain while running and these tips don't help, don't hesitate to reach out to us at Base Camp Chiropractic and Sports Rehab. We're here to help you get back on track and enjoy your runs again.

Remember, running is an exhilarating pursuit, and pain shouldn't be a constant companion on your journey.

Instead of succumbing to the frustration of persistent discomfort, consider manipulating the volume, changing your pace or cadence, and incorporating a thorough warm-up into your routine.

Should these tips fall short, the experts at Base Camp Chiropractic and Sports Rehab stand ready to guide you back to pain-free runs, ensuring that every step is not just a stride but a leap towards your wellness. Embrace the joy of running – we're here to make sure it remains a source of delight in your life.