AAPSM

AAPSM1

 

 

 

 

 

 

 

 

 

West Point, NY. September 2015.

Sports medicine specialists from around the world convened at West Point Military Academy to discuss best practices and what is new in the field of sports medicine.

While some things stayed the same, such as attempting to help our athletes recover without surgery, other things changed substantially when compared to our previous approach to athletic injuries.

A significant example of one such recent change is that we will no longer suggest that pronation is a primary cause of athletic injuries. Rather, pronation is a normal physiological movement that varies from athlete to athlete and should not be treated as a dysfunctional movement. Further, the idea that athletic shoes favorably alter pronation, and thus reduce injury, has been abandoned. This is a huge paradigm shift in the world of sports medicine, and fortunately this shift is supported by the available medical literature that was reviewed.

Another powerful step forward (this pun is intended) is the realization that teaching an athlete how to run better can alter their body mechanics in such a way as to reduce certain types of injuries. Heel striking as the favored method of running has been replaced with the need to get the athlete’s foot under their body, by teaching and focusing on a midfoot strike. Again, thankfully, the medical literature supports this as an injury reducer.

Dr. Mark Cucuzzella gave a great talk on how we all need to play, and that movement is medicine for all of us, for our entire lives.  Unfortunately, he had to condense what he ordinarily teaches in a 2-day course into a 30-minute talk. Nevertheless, his wisdom was appreciated.

Golden Harper, designer of Altra footwear, was present and tirelessly taught many sports medicine doctors the merits of natural foot positioning, and the importance of allowing the athlete’s feet to function as nature intended with the least amount of interference coming from the footwear.

Jonathon Beverly, editor of Running Times and Runner’s World magazines, was there to capture it all.

Many relationships were formed, and a renewed passion for helping our athletes was deeply palpable.

Perhaps the highlight, of many high points for me personally, was the invitation to speak to the group next year regarding the natural foot health program we offer at NWFA/Correct Toes. Could it get any better? Yes! Next year’s meeting will be held in Portland, Oregon, and I have been asked to help organize and lead the meeting.

If you are a sport medicine provider, we hope to see you in Portland next year.

Until then, have fun, be well, and don’t forget to play each day, no matter your age!

– Dr. Ray McClanahan, DPM
AAPSM

In Top Photo: Dr. Ana, Dr. Ray McClanahan, Dr. Mark Cucuzzella

In Bottom Photo: Golden Harper (Altra Running Shoes), Dr. Ray McClanahan, Dr. Mark Cucuzzella

#AskCorrectToes: Heat or Ice for Plantar Fasciosis (Fasciitis)?

This month’s featured #AskCorrectToes question comes from @RyanHisner, who asks the following:

Can applying heat to the plantar fascia (in conjunction with proper footwear and Correct Toes) facilitate healing?

Ryan’s follow-up question is:

Since plantar fasciosis is due to insufficient bloodflow, does this mean that you should avoid icing your feet?

Great questions, Ryan! Dr. Ray McClanahan answers these questions in this video:

Correct Toes Play an Important Role in Physical Therapy

TAI LogoTherapeutic Associates Inc (TAI) is physical therapist-owned and operated partnership of unique clinics that aim to be an integral part of an individual’s journey toward positive health and wellness. TAI phsycial therapy clinics are located throughout Oregon, Washington, California, and Idaho. Many TAI practitioners have incorporated Correct Toes into their practices, and we were curious about their, and their patients’, experiences. We recently interviewed Belen Vala-Haynes, PT, DPT, OCS of Northeast Portland PT and Julie Dresch, MS, PT, OCS of Ballard PT. What follows is our discussion:

CT: Please tell us a bit about yourself and your PT clinic.

BVH: I work at a manual therapy focused clinic – meaning that we do hands-on work in combination with a very specialized home exercise program aimed at improving musculoskeletal problems. When we see our patients, we aim to give them a hands-on approach as needed with soft tissue work and mobilizations or stretches that the patient can’t do or that are aimed to progress their body area impairments and carried over with their home exercise program.

BVH: I myself am a physical therapist (PT), and I have my board certification in orthopedics (OCS), and I have been through some specialized training through Kaiser’s residency program in manual therapy. My personal philosophy is: talk to patients, listen what they want to get out of PT and try to give that to them. I think it is really important to explain what I can do and what their role is in their own improvement. I let them know that they need to take responsibility for their injury in order to get better, because they aren’t going to be in PT forever.

JD: Julie Dresch MS, PT, OCS. My clinic is in the Ballard neighborhood of Seattle. We are a busy outpatient practice with 3 full-time physical therapists, and we specialize in general orthopedics. We have an active group of employees from our front office to professional staff who pride themselves on creating great experience for our customers.

CT: What are the most common foot complaints you hear from your patients?

BVH: The most common foot complaints I treat are plantar fasciitis, post tibial dysfunction and generalized foot complaints from equinus posture in the foot (tight calf syndrome).

JD: We see a great deal of foot and ankle patients at TAI Ballard PT. The injuries are quite varied including plantar fasciitis, a variety of tendon pathologies, great toe arthritis, ankle sprains, and post-operative management.

CT: What are patients’ initial reactions when they see or experience Correct Toes?

BVH: Most of the time they really love them. I have them try them on to see what they do for their foot alignment. Then I make them walk around in them and usually that is where they are sold. The only problem I encounter is the price point – it’s sometimes a hard sell, but usually if they really want to get better, they buy them.

[CT: To address any concern about the Correct Toes price-point, please visit our Correct Toes Advantages page.]

JD: On observation, they look a little silly (thank my 3 year old, for me describing everything as silly!). With a good explanation on neutral foot positions and the effect returning to a nice wide forefoot can have on mechanics, pain relief, and muscle recruitment, they are usually willing to try. I almost always have foot/ankle patients try on our clinic pair (we keep all sizes on hand in our gym for trials), then have them perform balance and gait activities with and without so they can feel immediate changes..

CT: What results have you seen in your patients using a natural foot health approach?

BVH: I have had good results in the patients that work really hard at home to strengthen their feet. The ones that want me to do all the work, never feel satisfied. They may see some quick improvement with wearing the Correct Toes, but if they don’t do anything else they tend to plateau and get frustrated. They have to do the work.

JD: We live in a very educated world, and I think people are doing more proactively to find out about conservative and natural treatments. I have had nothing but praise for our approach to trying to find solutions that our own bodies can be trained to manage.

CT: Will you share your favorite foot rehabilitation tip or exercise?

BVH: I like tibialis anterior strengthening without toe extensor use – so you curl your toes, keep them curled and them tap your foot. I also give a lot of calcaneal eversion self mobilizations and a “Foot Rainbow” – which is a pronation/supination active foot exercise.

JD: Strengthen your hips along with your feet! Never ignore the top of the chain, because we are only as strong as what the foot is attached to.

CT: Please feel free to share a patient or personal testimonial about recovery from a foot problem, using Correct Toes and natural foot care.

BVH: I wear the Correct Toes everyday, and it has done wonders for my bunionette on my right foot!

Thanks, Belen and Julie, for sharing your experience and for all your work in helping alleviate foot pain in the Pacific Northwest!

Natural Feet Unite!

Prepared by Sanatan Golden, DPT of Optimal Results Physical Therapy, about his professional partnership with Ray McClanahan, DPM of Northwest Foot & Ankle.

When I moved back to my hometown of Portland in 2010 with my wife and infant daughter, I did so to be closer to family. I did not expect to get any more traction in the medical community with my natural-foot treatment concepts than I did in Seattle, which was basically none. Yet again and again, I heard other practitioners saying: “you’ve got to meet this ‘barefoot-podiatrist-guy’, Dr. Ray McClanahan. You guys are speaking the same language.”

Soon after meeting, we realized that despite coming from two distinct disciplines [podiatry and physical therapy], we had reached many similar conclusions about the foot’s ability to support itself and the problems with most modern footwear. With a blueprint hashed out on the back of beer coasters, Dr. Ray and I decided to try to create Minimalist Mondays, a weekly community-education program designed to share some of these concepts with the public, and help those interested to become happier and healthier runners. 2+ years, 90 clinics, and thousands of miles run and walked barefoot by participants later, and the message continues to grow.

We have filmed the entire 12-week Minimalist Monday series in its entirety, from special guest speaker Michael Sandler in Week 1, to the cross-Portland relay Tabor2Crest in the Week 12 finale.  So even if you can’t make it down to the live sessions in Portland’s waterfront park, you can follow the program at home with weekly episodes released on Northwest Foot & Ankle’s YouTube channel.

Overall, I feel blessed to have connected to Dr. Ray and my patients have benefited greatly. From his ingenious Correct Toes, to introducing me to Dr. Rossi’s influential articles, Dr. Ray has been nothing short of a great influence to my practice, and gracious colleague. We have worked together successfully on many patients and I look forward continuing to grow for years to come.

Dr. Sanatan Golden’s Professional Profile

Sanatan (pronounced sah-NAH-tahn) started his professional life as a mechanical engineer, but soon realized that the ‘machine’ he most loved was the human body. After years as a Strength and Conditioning Specialist and personal trainer he decided that there would be no better way to improve his ability to help others grow strong and healthy, than becoming a Doctor of Physical Therapy. He received his degree from The University of Washington Medical School, where he was honored with the McMillan Fellowship for being the top applicant in his class. He is currently pursuing advanced manual therapy training through the North American Institute of Orthopedic Manual Therapy.

Sanatan is recognized as a regional expert in running mechanics and efficiency, and specializes in lower extremity injury prevention and treatment. He instructs physical therapists, doctors, and other healthcare practitioners with his continuing-education course: Successfully Integrating a Natural-Foot Perspective Into Your Practice. While personally an avid barefoot runner (yes, skin to the ground) since 2008, he has found that his patients need not get rid of all their shoes in order to reap the strength, power, and healing benefits provided by the restoration of natural foot posture and function.  Sanatan partnered with podiatrist Dr. Ray McClanahan in the founding of Minimalist Mondays in 2010, a 12-week program for those interested in the many benefits of transitioning to more minimalist shoes (or none at all!) to restore natural running and walking gait. They have since hosted over 90 clinics in Portland and helped countless runners find a natural stride that is more efficient, injury resistant, and fun.

Spending years as high-flying competitive Ultimate Frisbee player at the collegiate, national, and international levels, Sanatan certainly knows the demands of sport on the body. A bit more grounded now with a 3 year-old daughter, Nalu, and 1 year-old son, Levi, he also understands the challenges of trying to stay active and healthy within our busy lives. If you feel too busy for exercise, be sure to ask him about ‘opportunistic therapy/training.’

Sanatan is psyched to be part of the interdisciplinary team at Optimal Results Physical Therapy Downtown Portland, and looks forward to helping you and your body move naturally down the path towards health and wellness.

Education & Professional Certifications

  • Doctor of Physical Therapy from University of Washington
  • Bachelor of Science in Mechanical Engineering from Bucknell University
  • Certified Strength and Conditioning Specialist (CSCS)
  • ASTYM Certified
  • BikeFit Certified
  • Certified Level 2 MovNat Trainer

Specialties / Interests

Ultimate Frisbee, Natural running and Barefoot running technique, Movnat training, Primal movement, Cycling, Kettlebell training, Olympic-style lifting, CrossFit.

Dr. Sanatan Golden’s New Practice

Dr Sanatan GoldenAfter three great years practicing physical therapy at Therapeutic Associates-Downtown Portland, Dr. Golden has decided to become an independent practitioner. An expert and instructor in the field of functional natural foot health, his innovative practice is now in the heart of Downtown Portland, at: Optimal Results Physical Therapy.

Sanatan (as most of his patients call him) is very excited about his new venture, which will allow him to not only give more time and attention to each of his patients, but also spend more time with his young family. Over a long working relationship with Dr. Ray McClanahan, Sanatan has developed many complementary treatments to help accelerate the process of healing lower extremity injuries, including:

  • Total body evaluation and assessment to find root-causes of pain and treatment.
  • Building you a personalized, and laser-targeted, home exercise program to address your specific needs
  • Targeted manual therapy:  A hands-on method of restoring proper motion and function.
  • The Astym System: A manual treatment the stimulates the body’s own healing response.
  • Real-time running technique video analysis and specific training drills to immediately improve technique.
  • RESTORE: The natural foot function restoration program.
  • Full access to the only AlterG Antigravity Treadmill in Portland, outside of OHSU. Click the link to see an amazing short video of one of the most revolutionary pieces of rehab equipment around. From the Olympic track stars, the Portland Timbers, to weekend warrior trying to run their first half-marathon, to a patient the day after a hip replacement, the AlterG can help folks get back on their feet sooner, and go for longer, than ever before.

Special Offer For Correct Toes Newsletter Recipients: As a token of appreciation for his ongoing partnership with Dr. McClanahan and Northwest Foot & Ankle, Dr. Golden would like to extend the offer for a complimentary injury examination and consultation or AlterG trial for all those looking accelerate their healing process. Between now and December 1st, contact Optimal Results and mention the Correct Toes Newsletter to get your complimentary appointment.

Optimal Results Physical Therapy
Portland, Oregon
Phone: 503-294-7463
Fax: 503-294-7405
Email: sanatan@optimalresultspt.com

If you would like to see Dr. Golden’s Specialties and Professional Profile, click here.
If you would like to read more about Dr. Golden’s practice and relationship with Dr. McClanahan, click here to read Natural Feet Unite!

It’s National Physical Therapy Month!

It's National Physical Therapy Month! Show your PT some love!Hey, y’all! October is National Physical Therapy Month (NPTM). NPTM is “designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives.” We just want to take the opportunity to thank all the incredible physical therapists out there, including the ones who have adopted Correct Toes into their practices.

If you are a physical therapist or PT assistant, please do consider submitting a Correct Toes testimonial in the comments section, below. We would greatly appreciate your positive feedback about our toe-spacing device and the impact it’s had on your patients.

Metatarsal Pads

Metatarsal pads are used to help spread your transverse arch (the arch behind the ball of your foot, that runs across the width of your foot), promote the return of your overextended toes to their normal anatomical position, and encourage the return of your forefoot fat pad to its rightful position supporting your metatarsal heads. Your metatarsals are the long, thin bones in your mid-foot. The heads of your metatarsals are at the ball of your foot, and they connect to the base of your toes. Metatarsal pads help properly realign your metatarsal heads and the fat pad that’s underneath them. This, in turn, can help straighten and realign your toes, especially when your metatarsal pads are used in conjunction with our toe-spacing product (Correct Toes).

The conventional footwear features of heel elevation, toe spring, and toe taper can
negatively affect your foot over time. After many years of weight-bearing activity in shoes possessing these design characteristics, your feet become shaped like the shoes you wear. Your toes become chronically overextended (pointed upward) and tapered toward your foot’s midline. The muscles under your foot, your flexors, become excessively stretched and weakened, while your extensors, on top of your foot, become too tight. In turn, your forefoot’s fat pad, which normally provides cushioning for your metatarsal heads and the nerves between them, becomes displaced too far forward. The bones and nerves in this area are then relatively unpadded and therefore vulnerable. This foot configuration can lead to a host of problems, including, but not limited to, Morton’s neuroma, sesamoiditis, and plantar fasciosis, or more simply: pain in the ball of your foot, heel, or both.

Metatarsal pads, when properly placed within a completely flat shoe with a sufficiently wide toe box, can help undo muscle imbalance in your foot. Metatarsal pads help reconfigure your foot to the position that nature intended; that is, with splayed metatarsal heads, splayed toes, and a fat pad located directly underneath the fragile bones and nerves in the ball of your foot. Numerous foot and lower extremity problems can be prevented or reversed by restoring your natural foot anatomy and function.

It’s important to place your metatarsal pads correctly in your shoes. Please see our document on the proper placement of metatarsal pads. Improper placement of pads is uncomfortable and could possibly worsen your foot condition. Also, as with Correct Toes, it’s important to use metatarsal pads in shoes that are completely flat (i.e have no heel elevation, no toe spring, and no padding under your arch) and widest at the ends of your toes (not just at the ball). Finding such shoes can be challenging. Please see our list of healthy footwear options.

Bottom of pad contains a sticky adhesive for easy placing. Click here for more detailed information on placing metatarsal pads.

To purchase metatarsal pads click here.

–Dr. Ray McClanahan, DPM, Northwest Foot and Ankle / Correct Toes

Capsulitis

 

Image: http://www.healingfeet.com/blog/foot-care/forefoot-pain-could-be-capsulitis
Image: http://www.healingfeet.com/blog/foot-care/forefoot-pain-could-be-capsulitis

Capsulitis is inflammation of a joint capsule. Ligaments surround your joints, including your toe joints, and help form a capsule. Joint capsules help your joints to function properly. Capsulitis is a common problem in certain parts of your body, especially your shoulders and toes. Capsulitis-related inflammation may cause significant discomfort. This health problem can, over time, lead to toe dislocation if it not treated appropriately. In fact, capsulitis is sometimes known as pre-dislocation syndrome. Capsulitis is a condition that can manifest in people of all ages.

Condition Information

Certain parts of your feet and toes may be more likely to develop capsulitis than others. One of the capsules that most commonly experiences this ligamentous inflammation are the capsules surrounding your metatarsophalangeal, or MTP, joints at the ball of your foot. Each foot possesses five MTP joints that connect your toe bones, or phalanges, with your metatarsal bones—long, thin bones located in your mid-foot.

The most common MTP joint capsule to develop capsulitis is the one that connects your second metatarsal bone with your second set of phalanges. Problems with this capsule, especially inflammation, are particularly common, due to excessive pressure placed on this joint during weight-bearing activities. Capsulitis may be difficult to diagnose because of the tendency for other structures in your forefoot to also become inflamed from biomechanical problems.

Causes and Symptoms

Most podiatrists and other healthcare providers believe that capsulitis is caused by aberrant, or unusual, foot mechanics that involve excessive weight-bearing on the ball of your foot beneath your affected toe joint. Certain factors may increase your likelihood of developing this problematic condition, including:

  • Extreme bunion deformity
  • A second toe that is longer than your first toe
  • An unstable foot arch
  • Tight calf muscles on your involved side
  • Imbalance between the muscles on top of and below your feet (extensors and flexors)
  • Regular use of footwear with an elevated heel and/or toe-spring

Conventional footwear may be the most common cause of capsulitis. Most shoes possesses elevated toe boxes, or toe-spring, as a built-in design feature. Toe box elevation increases pressure under the capsules of your MTP joints. Because your second metatarsal bone is usually the longest in your foot, it performs more than its normal share of weight bearing, and it can become inflamed and painful. Tapering toe boxes—another problematic design feature built into most conventional footwear—is another factor contributing to capsulitis. Tapering toe boxes force your big toe against your second toe, putting your big toe out of balance with its corresponding metatarsal bone.

Several distinct signs and symptoms commonly develop in people who have capsulitis, including:

  • Pain in your affected area
  • Swelling around your involved joint capsule
  • Redness of the skin overlying your affected joint
  • The sensation that you are walking on a stone

Painful calluses may form in some individuals if capsulitis becomes a chronic health problem. A person who develops calluses may feel as though the callus has a core or seed inside of them. These calluses are commonly misdiagnosed as plantar warts, and they can occur under any of your metatarsal heads. Capsulitis-induced calluses usually respond to metatarsal pads and cutouts. Cutouts are an orthotic technique that allows your more prominent metatarsal head—one of the structures most commonly affected by capsulitis—to drop lower than your other metatarsal bones. This action helps balance your weight-bearing load and decreases the pressure on your affected area.

Some people with this condition also experience nerve symptoms caused by capsulitis-related swelling. Bursitis—inflammation of fluid-filled sacs located in your forefoot—is another health problem that may be associated with capsulitis or confused with this condition.

Treatment

Capsulitis often responds to conservative, non-surgical treatments. This condition is best treated in its early stages to help improve your affected joint’s stability, reduce your pain and other symptoms, and resolve the root cause of your problem. Common treatment strategies for this health problem include:

  • Rest: Reducing weight-bearing activities can help control your symptoms
  • Ice: Icing your affected area can minimize your pain and swelling
  • Taping or splinting: Taping helps align your involved toe and prevents your toe from drifting
  • Stretching: Stretching may be particularly important for those who have tight calf muscles or foot extensor/flexor imbalance
  • Shoe therapy: Shoes with little or no toe-spring and with wide toe boxes may be most helpful. Also, metatarsal pads placed in your shoe can help return your foot’s fat pad to its rightful, protective location under your metatarsal heads.
  • Anti-inflammatory agents: Supplements or medications can help reduce your pain and swelling

-Dr. Ray McClanahan, DPM, Northwest Foot & Ankle/Correct Toes