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Barefooted Activity

Discussion in 'General Issues and Discussion Forum' started by Mark Egan, Aug 28, 2006.

  1. Mark Egan

    Mark Egan Active Member


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    Dear All,

    Have a patient who has suffered from bilateral peroneal issues which I have successfully treated with orthotics, footwear, stretches and massage.

    She is keen to begin doing more barfooted activity i.e. kick boxing but her symptoms return when she is barefooted. Obviously she should not do the barefooted activity but she is keen.
    Low Dye taping works well but the problem is the cost of strapping, and the issues with prolonged strapping. She is not able to wear a support/stabilising ankle support due to the laces and bracing within the devices. I have advised her to increase the massages and stretches and have advised her on posterior tibialis exercises in an effort to counter-act the peroneal issues.

    Any other ideas?

    Thanks
    Mark
     
  2. bearfootpod

    bearfootpod Member

    Hey mark

    What are the peroneal issues they suffer ie tendonitis, subluxation, muscle belly pain ???? What symptoms return????

    As you know it is really common for athletes to strap ankles, wrists, fingers etc to allow them to play sport or train pain free or to reduce the risk of injury. Most of my patients realise that if their sport requires them to be barefoot ie gymnastics, then strapping is something they will need to do.

    You can train their parent / coach etc to be able to strap and they can order bulk strapping tape to reduce cost.

    cheers

    claire
     
  3. davidh

    davidh Podiatry Arena Veteran

    Hi Mark,
    I would suggest you find out why your pt is so keen to do barefoot sport.

    Our feet have not evolved for hard. flat surfaces, although we do adapt pretty well. However some feet are less able to adapt than others (your pt?).
    Barefoot sport on a soft or undulating surface, like sand, is fine. I suggest barefoot kick-boxing for this pt is probably not going to work.

    Regards,
    david
     
  4. Mark Egan

    Mark Egan Active Member

    Hi Bearfoot and david,

    thanks for the replys.

    Barefoot - symptoms are belly and lower 1/3 of tendon of peron longus no subluxtion just overuse issues. Strapping is not a good idea in the long term due to residue of taping and the cost of taping both feet, I have also offered to show someone at home how to do the taping to reduce the costs more.

    David - yes the obvious thing is for this patient to stop doing the exercise but she loves it, as such I am trying to see if there is anything else that could be done. If not she has 2 choices, but at least we tried.

    cheers
     
  5. elaine.dean

    elaine.dean Welcome New Poster

    It might be possible for your patient to wear Kung Fu/Martial Arts shoes for her training as these are very soft but would accomodate some types of orthoses (not rigid casteds like carbon fibres, but some preforms and eva types, etc). This might give her enough support in training to be symptom free, or symptom reduced at least. She would have to take these shoes off for combat and competition, but would allow her to have support when she trains, which is a large bulk of her activity.
    As for why does she want to do barefoot activity, the question is really, why shouldn't she want to do martial arts activities, many of which arebarefoot activities. I agree that we should be helping her to find a way of maintaining her activity, rather than simply repeating the outdated attitudes that suggest that she should simply stop them. In these days of obesity epidemics we should be encouraging activity of any kind, and in these violent days we should be encouraging women to develop skills that help to keep them safe on the streets.

    If the above strategies do not help your patient, maybe an option is to change to another martial art that will allow her to wear footwear, such as Kung Fu, Chi Quong, etc.
     
  6. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi Mark, What about Prolotherapy? Dry Needling? hj
     
  7. Mark Egan

    Mark Egan Active Member

    Elaine.dean thanks for the suggestions - I have already suggested these things, she is not willing to wear any form of footwear and the opportunity to do another form of martial arts is not available in the town she lives in.

    hj--ray she has had acupuncture without any improvement prior to getting the orthotics, with regards to prolotherapy I have only read a small amount on this - unless I am mistaken because it uses 2% lig I being a Qld podiatrist am unable ot administer this form of therapy, also some of the statements on the site for this form of Rx make me a little sus of the claims.

    Regards
     
  8. davidh

    davidh Podiatry Arena Veteran

    Elaine,
    You said:
    "As for why does she want to do barefoot activity, the question is really, why shouldn't she want to do martial arts activities, many of which arebarefoot activities. I agree that we should be helping her to find a way of maintaining her activity, rather than simply repeating the outdated attitudes that suggest that she should simply stop them. In these days of obesity epidemics we should be encouraging activity of any kind, and in these violent days we should be encouraging women to develop skills that help to keep them safe on the streets."

    Whilst I agree with you, the fact remains that there are some feet which do not cope well with hard, flat surfaces.
    Regards,
    david
     
  9. David Smith

    David Smith Well-Known Member

    Dear Mark

    As a practicing martial arts player for almost 40yrs I have found this a difficult problem to solve. I'm 49 and for the last couple of years have suffered severe metatarsalgia when walking barefoot on hard floors. I now only go to Dojos that have a matted areas like my Dojo. Most striking disciplines, eg karate kick boxing etc, do not have this facillity however. A wooden floor is better for fast movements that involve a sliding motion. Keeping the feet on the floor decreases the chances of a foot sweep and tends to increase striking power due to GRF influences. The best interface material for this purpose is skin. It grips just enough for stability but not too much to stop you from sliding.This is the problem with shoes and tape. Tape reduces friction and you end up on your arse just when you are demonstrating how clever you are at a reverse spinning back kick (ushiro Mawashi Geri) to the class. Shoes grip too much and sliding is inhibited. Tape is fine on a matted or canvased area. Wrestlers boots might be the answer for your patient. They are soft leather all round and can be strapped up the calf for support of the ankle.
    Orthoses in soft shoes dont work in this scenario as they end up anywhere but the bottom of your foot. I hav'nt tried them with wrestlers boots though, might be ok if they were also taped over the top to keep them in place.
    They would have to be EVA or similar since a kick in the face with a hard plastic wedge strapped to your heel might not go down to well with your opponent or the referee. Laces and straps can have similar limitations as they can cause cuts.
    Overall I have found taping the most convenient solution for sprained ankles and such like. Tape the foot but allow the fore foot and most of the heel not to be covered with tape. Many Judo players tape up before practice and especially before a competition. It only takes a minute or two. A lace up ankle brace with a neoprene cover added for safety can be a good solution.

    I have used an ankle brace with shin and foot gaurd taped over the top when entering an important compettition and having a sprained ankle caused at a training session. Kills two birds with one stone, protects from impact trauma and supports the ankle.

    A good instructor should be able to guide your patient as to the best way to protect themselves from further injury.

    Cheers Dave
     
  10. Mark Egan

    Mark Egan Active Member

    Thanks David i will see the patient at the end of the month and will put forward your suggestions

    Regards
     
  11. METaylor

    METaylor Active Member

    prolotherapy

    Dear Mark
    Prolotherapy does have some pretty amazing results for young healthy fit people like your patient, and even some of the older patients can get dramatic improvements in function and pain relief. There are doctors and now podiatrists in Queensland doing prolotherapy and I will be running a workshop in Queensland sometime in the next 6 months or so. See my website Prolotherapy for Doctors www.drmtaylor.com.au for more details and links to the basic research. There are now 6 double blind trials in prolotherapy - see PubMed for yourself. You can use whichever strength lignocaine you wish - its the strength of the glucose which matters and which should be about 20% in the final mixture. Just do about 0.5cc to the tender insertions of the peroneal tendons. The tenderness is the guide to the correct place to inject. Email me for more details and names of Queensland practitioners including podiatrists: taylorme@internode.on.net but I won't be back in Australia until 31st of October.
     
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