The TRUTH About Foot Pain

If you live an active lifestyle or spend a lot of time on your feet, chances are you have encountered some type of foot pain. We all spend an enormous amount of time on our feet, and most of us tend to neglect our feet, until we encounter a foot problem - which really means foot pain. Chronic foot pain can kill any athletic quest and can even make day-to-day activities difficult. What to do? There are lots of treatments available, and why is that? Why is Traditional Medicine all over the place when it comes to Foot Pain?  It’s because we treat SYMPTOMS and not Mechanical errors or flaws.  It’s because we treat pain and not the problem.  It’s because we’re willing to sacrifice long-term gains by settling for instant gratification. It’s because most medical professionals have turned foot treatment into a mystery. In short, the solution is simple, and we make it more complicated than it needs to be.

Maximum Velocity PT is a running specialist clinic.  Our clients are active, busy, and are willing to invest in their health.  Our clients prefer long term gains in short periods of time.  That requires a physical therapist with skill and experience.  Over 300 runners have come through the MVPT clinic in nearly 2 years of service to the community.  The rehabilitation of runners is overly complicated at times and very simple at other times. The most important aspect of rehabilitation is education.  The education of runners or any patient with foot pain begins with a thorough evaluation.  Lumbar spine, hip, knee, and foot/ankle must be considered.  From there, the anatomical impairments mean nothing until you correlate them with movement.  Movement includes gait evaluation.  Simple solutions for complicated movement patterns like running are where the skill of gait evaluation comes in.  Running gait assessment is not taught in PT school.  It is not taught in medical school. It is also not taught in chiropractor school.  It’s a continuous education endeavor that is highly skilled and professional and requires years of commitment to master.  At MVPT, we have hundreds of hours of gait evaluation training and also hundreds of hours educating runners of efficiency of gait.  Why do many people suffer from foot pain?  They suffer mostly because often times it not even a foot PROBLEM. 

At MVPT, we have 2 obligations to our clients.  Get them out of pain (resolve the current symptoms), and give them tools to be successful in the long term.  Short cuts add time onto the life of the problem.  Occasionally, people are not interested in long term fixes if those fixes do not make them feel amazing today.  Unfortunately, that isn’t how our body heals.  “Do not confuse motion with progress.”  The healing process demands adaptation and time.  If the right adaptation is applied, then the time may be short, but time is still a requirement!  There isn’t anything that can be done from the outside in, which is better than what happens from the inside out.  Traditional medicine still has not latched onto this concept.  Let’s briefly review common misuses of interventions in medical treatment.  It must be said that the purpose of this review is not to smear other professions or practitioners. We are simply on a quest to discover what works and what doesn’t. Current research and literature coupled with varied experiences bring on change and progression. Some of the following interventions have been a part of the treatment I have applied to patients in the past, and several of these interventions are being taught in PT school. 


Why most traditional treatments fail:

-Ultrasound-Ultrasound is a chemical fix for a mechanical problem.  There is very little evidence that says it even does anything.  The take home message is that the foot has about 80% mechanoreceptors.  That means there’s a very high likelihood a mechanical problem occurs.  Something is stiff or something is weak.  Even a “tendonitis” problem is a mechanical issue.  Using chemical means to treat a mechanical problem will lengthen the life of the problem with short term “gains.”  It feels good now but isn’t any better long term.

-Massage-Who doesn’t love a massage? Massage is a tremendously “beneficial” modality.  By beneficial we mean it feels very good.  However, if the mechanical issue is not addressed then the pain comes right back.  Short term cycles of feeling better and not making up any ground is technically chasing your tail.  Or put another way, this is an endless cycle with no real improvement. Massage can be very effective at removing pain or removing abnormal moving tissue, but it won’t improve the mechanical problem.  Mechanical problems need mechanical fixes - Period. If you choose to treat your foot problem with massage, then you will always need a massage.

-Orthotics/Heel Cups/ETC-While adding something to the shoe sometimes offers immediate relief, after some time, another compensation is likely to occur.  Adaptation to the plastic requires time and effort to change.  If you do not address the biomechanical issue before the plastic comes than the biomechanical situation is bound to take another turn in compensation.  The foot should be (can be) retrained.  Do not let anyone tell you the foot cannot be retrained.  Once the client is aware of the biomechanical flaws they are making and the corrective adaptations to the spine, hip, knee or foot take place, there is no need for orthotics or plastic.  We have been walking and running with no help forever.  Run training is the piece that most medical people are missing.  Managing the mileage, the efficiency via cuing, and the running piece, on top of the biomechanical piece, makes for efficient running, with no pain, and no plastic!  If there is no change in biomechanics then the client will become dependent on the plastic.  What happens when the plastic fails?  You have to go buy more.  $250-500 investment every 2 years?  No thanks! Retrain the foot. Let good running correct the foot pain.

-Dry Needling-PT’s around the country are rallying together over the fight to add dry needling to our practice act.  It does have some promising literature behind it.  However, like ultrasound, it’s a chemical fix.  If the tissue is mad, can the dry needling make it feel good?  Yes.  Our response is, “is that what you want?”  Do you want a short-term chemical fix that does not address the mechanical problem?  Of course you don’t.  Can specific area treatments influence the big biomechanical picture?  Afraid not.  Go to the source of the problem. Correct THAT, and the current symptoms are eliminated.  The symptoms are relieved far faster than the relief that the needles provide.  While dry needling is a strong adjunct, it is not the final solution.  Never will be.  The problem is movement.  If the movement is still poor after the treatment the symptoms will return very quickly.  At MVPT, the average treatment time is 2-4 visits.  We are treating most runners from start to finish in 2-4 visits.  Move better, run better, no gimmicks.

-Footwear-This is a hot topic in many realms.  MD’s try to prescribe footwear, shoe store people try to do gait evaluation, and many others offer something in between.  The funny thing about this issue is the footwear companies drive the research.  A lot of the research is biased towards the footwear industry making money.  The truth is that footwear is just equipment.  Footwear changes your foots interaction with the ground. That’s it. Minimum, maximum, five fingers, etc….they all are the same.  Your movement matters. Your running or walking mechanics is what need to change.  Your brain, your muscles, and your movement strategy should be the target.  The medical community doesn’t understand the running side and the running side doesn’t understand the medical side.  They are detached.  Except at MVPT.  We put the two together.  We offer running rehabilitation, strength programs, and running programs that help you apply biomechanics to the skill of running. You run with the shoe, the shoe doesn’t run you.

-Over Specialized Medicine-American healthcare is riddled with overspecialized areas of medicine.  Hurt your foot?  Podiatrist.  Hurt your hip?  Orthopod.  What if you have a problem with both?  PT.  A foot issue can cause a hip problem and vice versa.  We can treat you as a team.  We like knowing that the X-ray is negative to move forward with the treatment, but should we take an anti-inflammatory for a mechanical problem?  Recent literature suggests the more exposures to anti-inflammatory chemicals the more the person will struggle with inflammation.  Ice, heat, US, and anti-inflammatories do not get to the source of the problem.  Runners with pain are people. A person is not broken down into independent compartments.  A holistic approach, scientific and research based, with a running coach mentality is the fastest way to eliminate pain. Return to running immediately (rest is not the answer), and get onto fast running soon. 

The truth about foot pain is that the pain is normally the result of some biomechanical or movement error that can be corrected.  Temporarily removing pain with a chemical or an applied force or patch is not a permanent solution no more than learning how to tolerate pain would be a solution or cure.  The truth about curing foot pain is that with the assistance of a trained and experienced physical therapist, you can learn to fix the problem yourself instead of relying on gadgets, gimmicks or solvents to solve the problem for you.  When you understand movement, you move correctly.  When you strengthen muscles and move correctly, you avoid pain and injury.  Strong muscles, correct movement, no pain, and an iron will leads to greatness.  That’s the truth.

At MVPT, serving a community of active, healthy, and information hungry people is an absolute joy.  We do not treat people as a number; we build relationships.  We have no wait times for an appointment.  Each person is treated on a case-by-case basis.  The treatment is holistic, one on one, research based, fun, and repeatable.  We would rather see 10 runners for 3-4 visits than 5 patients for 12 visits.  With the summer heat in full force, now is a great time to get your gait evaluated.  You don’t have to be injured.  You just have to want to learn and grow as a runner.  Strength training is an effective way to supplement your running.  Stop by for a strength evaluation or a strength class to move you to the next level in your running.  Not reaching your running goals?  You have either a biomechanical problem, a strength issue, or a training problem.  All in all, we are so proud and happy to serve such a wonderful group of people in this community.  Please like, comment, and share.  Oh and don’t be afraid to like this page if you liked the information!  Please call the clinic for an appointment 702-998-2900 or request an appointment at