Normal gait requires at least 10 degrees of ankle dorsiflexion, with maximum dorsiflexion occurring closed chain during late midstance. Limited ankle dorsiflexion can result in a myriad of compensations both proximally and distally.

From knee hyperextension to midfoot over-pronation, the deforming forces caused by tight calves is enough to make any Movement Specialist cringe. I refer to this lack of ankle joint dorsiflexion as a "Podiatric Epidemic" as a majority of people assessed lack adequate ankle joint range of motion.

For clients or athletes who have adequate pelvic flexibility but demonstrate decreased gastrocnemius range of motion, we want to integrate posterior group stretches.

When recommending posterior group stretches some classic stretches include the wall stretch, downward facing dog and dropping a heel off of the step. When performing theses stretches have you ever considered the role rearfoot position may have on the effectiveness of each stretch?

Impact of Rearfoot Position on Stretching

A 2009 study by Jung et al. evaluated the impact of rearfoot position on the effectiveness of gastroc stretching. Due to the prevalence of tight gastrocs in an over-pronated foot type, Jung et al. wanted to determine if the everted calcaneal position altered the effectiveness of the stretch.

Jung et al. evaluated 30 patients with both a neutral foot type and an over-pronated foot type with increased calcaneal eversion (average 4 degrees). Subjects performed a gastrocnemius wall stretch both in their relaxed calcaneal stance position and while wearing orthotics which placed the calcaneus in a neutral position.

Ultrasound technology was used to evaluate the degree of stretch as determined by the change in myotendinous length. It was observed that rearfoot position had a significant impact on the effectiveness of posterior group stretching. A 3mm difference in gastroc lengthening was achieved while stretching with the everted rearfoot shifted into a neutral position.

Considerations for the Movement Specialist

When considering articles to review and share on the EBFA Blog, I like the above study for several reasons:

1. It emphasizes the impact subtle adjustments in body positioning can have on stretching effectiveness. As evidence-based fitness professionals, if we can apply research studies such as this into our client's programming we may begin to see better results.

2. It re-emphasizes the concept of foot-specific programming which I integrate into my Barefoot Training Specialist workshops. In an over-pronated foot type with increased calcaneal eversion you want to consider the impact ankle stretching may have on the weakened posterior tibilais tendon.

3. When the calcaneus is brought out of the excessive eversion the stretch becomes more isolated to the Achilles tendon and gastrocnemius/soleus - with little stress to the posterior tibialis.

Want to integrate this evidence into your client's programming?

1. For any clients with an over-pronated foot type, isolated gastroc stretching should be performed preferably non-weight bearing to minimize the impact of rearfoot position during the stretch.

2. If a client uses orthotics that control rearfoot motion, perform closed chain gastroc stretches while wearing the orthotics and then remove the shoes for the barefoot training exercises.

3. For any clients with an over-pronated foot type and wear Vibrams or minimal footwear for daily use and training, frequent evaluation of the posterior tibialis tendon should be performed.

To learn more about this, make an appointment online or visit a podiatrist at one of our convenient locations.

By: Dr Emily Splichal, DPM

With school sports seasons in full swing, it’s important to remember athletes should never “play through the pain” in their feet. Left untreated, heel pain can lead to difficulty in walking that may require complicated therapy or treatment.

Our Podiatrists at Midtown Podiatry have been seeing an increase in pediatric patients reporting heel pain with sports such as football, soccer and basketball. Obesity is also emerging as another prominent cause of heel pain even with students in physical education class activities. The good news is that kids generally heal very quickly and treatment may be simple if it is taken care of promptly.

Kids undergoing growth spurts are especially susceptible to heel pain starting at age 8 until around age 13 for girls and 15 for boys. The source of the pain is usually the growth plate of the heel bone, a strip of soft tissue where new bone is forming to accommodate adolescents’ lengthening feet. Overuse, repeated pounding or excessive force on the Achilles tendon can cause inflammation and pain.

For many teenagers, the growth plate has completely closed, and heel pain is caused by other conditions such as plantar fasciitis, tendonitis, bursitis, bone bruises or fractures. The only way to know for sure what your child is suffering from is to have them examined.

People have a tendency to give it time and see if the pain goes away on its own, and sometimes that can happen. But if symptoms persist, it’s best to make an appointment at Midtown Podiatry with locations in Midtown, Gramercy Park, Union Square, Wall Street  and Glen Cove to make an accurate diagnosis and to avoid complications.

By: Paul J. Betschart, DPM

          Zumba has quickly become the new craze not only in NYC but throughout Hollywood as well; celebrities such as Kirstie Alley, Madonna, and Jennifer Lopez have all expressed their love for the new workout routine. Zumba is an intense fitness program that gets you into shape while you dance away to sensational Latin and International inspired beats.  It combines upbeat, irresistible music, created by Grammy-Award winning producers, with dynamic movements and cardio training to get visible results.  But can this contagious, body-firming, calorie-burning phenomenon take a toll on your feet??  Not if you allow the podiatrists at Midtown Podiatry to help keep you prepared and take the right precautions!!

            I’ve had several Zumba-fanatic patients present in the office with severe foot pain.  Some of the common complaints have been toe cramps, numbness, burning sensation during class, pain on bottom of feet (plantar fasciitis), ankle sprains, blisters, and knee pain.  Of all of these, the most common complaint in my experience has been a burning, numbness feeling in the toes.  The reason this pain occurs is because of to too much pressure on the toes, since most of the movements in Zumba require staying on the balls of your feet.  Several criteria can cause excess pressure, among these are:

• Ill-fitted shoes
• Internal tendon imbalances and joint mal-alignments
• Too much or too little room in the toe box of your sneaker. 

These can all be avoided if you just follow some simple rules and take some precautions:

            The type of sneaker that you choose is crucial.  Many beginners will think that any good quality sneaker is sufficient.  However, due to the types of movements required in Zumba coupled with the aerobic type of activity, improper shoe gear can put you at risk for various foot and ankle injuries.  You need a sneaker with a low tread, something that is light weight, has good shock absorption, and enough support for medial/lateral (side to side) movements.  The low tread will allow you to do the dance-like moves without causing excessive torque to your ankles and knees. 

            A running shoe is a definite no.  This has too much tread and is made particularly to control front to back motion (not side to side).  Contrary to popular belief, a dance shoe is also not the best choice (although better than a running shoe).  A “typical” dance shoe does have low treads and is light weight; however, its thin soles lack shock absorption and support.  Therefore the best sneaker is an aerobic sneaker made for dance.  This shoe will have a thinner sole, few treads, good shock absorption, and support for medial/ lateral movements.

            Also important is to make sure you take at least 5 minutes extra to stretch before and after your workout.  Stretching before exercises will warm up your muscles and will reduce the strain on them during your exercise routine.  Stretching after exercise will allow your heated up and tight muscles to gently cool down to prevent soreness a few hours later.  Doing both of these will drastically reduce your chance of foot injury.

            Lastly, custom molded orthotics can address any structural or functional mal-alignment of the joints, tendons, and muscles of your feet and ankles.  These custom foot inserts made specifically for your feet can easily replace the inserts that come with your sneaker.  At Midtown Podiatry, with locations in Midtown, Wall Street, Union Square, Gramercy Park and Glen Cove we have the proper equipment to make custom orthotics in all of our offices.

            So, there it is folks.  Continue with your irresistible, contagious Zumba programs! Have fun and rewarding workouts, but don’t forget to make an appointment with the podiatrists at Midtown Podiatry to keep those feet Zumba ready!

By: Lisa Shah, DPM