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Foot Ankle Toe Treatment Principle

1. Checking ankle joint strength and speed in 4 directions

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Ankle Inversion and Eversion have to be strong and fast symmetrically

Ankle dorsiflexion and Plantar flexion have to be strong and fast symmetrically

Fast and strong muscle contraction is indicating that the controlling nerve system is healthy.

If one side muscle gets weaker and slower, it can result in muscle imbalance and increase joint stress.

If muscles are moving slowly, swelling in the leg and foot increases since circulation in the leg is relying heavily on muscle pumping effect.

2. Checking the toe strength and balance

Toe strength in flexion (Down to the ground) is important in absorbing the stress when walking or running. Toes are pushing off the ground in the end phase of weight bearing in walking. If toe flexion is getting weak, the other parts of the foot have more stress in walking and it can cause pain around heel or ball of the foot.

Checking toe extension range is important. If plantar fascia (The bottom of the foot) is too tight, toe extension range and strength decrease. In the swing phase while walking, toes are extending upward which increases the arch height and elasticity. This is the preparatory movement of landing on the ground.

If the arch height and elasticity is not enough to absorb the stress while landing on the ground, the rebounding force will go up to the other joints and increase unstable movement. This is why improving Toes and arch/plantar fascia flexibility and checking the foot alignment are important in rehab treatment.

3. Checking Ankle Alignment in standing and walking

Foot is presenting with slight pronation while walking in weight bearing phase. In a healthy foot, the arch of the foot will be restored after a quick pronation movement such as a spring. ​This movement absorbs landing stress and also help pumping the blood circulation. A person having a high arch will present with supinated foot with minimal pronation movement while bearing weight in walking. Treatment for this population should focus on increasing pronation movement in the weight bearing phase by the stretching and flexibility program. Over pronation is the most common foot problem in walking or running. The arch of the foot is collapsing significantly in the landing phase and it restores slowly. It can lead to ligament and joint stress in the whole body ( knee valgus movement (moving medially) and hip internal rotation ).

​For this population, treatment should focus on activating the weak arch muscles with specific manual treatment techniques and exercise program (Arch, toe, ankle restoration exercise program).

The Conditions We Treat
  • Plantar Fasciitis
  • Bunion (Hallux Valgus)
  • Neuroma
  • Achilles Tendonitis
  • Metatarsalgia
  • Foot and Ankle Stress Fractures
  • Shin Splint
  • Ankle Sprains
  • Tarsal Tunnel Syndrome
  • Collapsed arch problem and pain
  • Arthritis

Important Points in The Treatment Program

1. Make weak and slow muscles strong and fast moving

Find out the muscle imbalance, weak/slow muscles and reactivate it using manual treatment techniques so that joint has no stress while walking

2. Improve foot and ankle balance

After restoring strength and speed, balance exercise program will improve muscle coordination ability. Once foot and ankle stability increase, the whole body alignment and posture will be improved. In addition, muscles in the body work more efficiently.

3. Find out trigger points and scar tissues 

Trigger point and scar tissue are the major reason of muscle weakness and pain. Use the palpation skills to find it out and release it (Trigger point therapy, myofascial release, Graston technique, cupping). After releasing it, always recheck if the strength and muscle length are restored.

4. If ankle/ foot treatment is not effective, check the other body parts (Piriformis, Gluteus medius, abdomen tightness)

Piriformis (Hip external rotators) tightness can cause ankle, foot, calf muscle pain, tingling sensation and weakness by compressing the biggest nerve in the legs, Sciatic Nerve.

Lower abdomen myofascial (Muscle and Fascia) tightness decreases strength and circulation in legs and feet in general.

If strength restores and pain diminishes after the treatment, we can confirm that the above body part is the source of the problem.