Flat Feet

Posted on February 9, 2024

Flat Foot, medically known as Pes planus, is a condition in which the medial longitudinal arch (MLA) which runs the length of the foot is flattened out or lowered. Flatfoot may affect one or both feet, and it can not only increase the load acting on the foot structure, but also interferes with the normal foot function. Therefore, individuals with flat feet experience discomfort while standing for long periods of time and exhibit a distinctive flat-footed gait. Typical flatfoot symptoms include a tenderness of the plantar fascia, a laxity of the ligaments, a rapid tiring of the foot, pain under stress, and instability of the medial side foot structure. Over time, the mechanical overloading resulting from the flattened MLA is transferred to proximal areas such as the knees, hips, and lower back. Flatfoot is recognized as a contributory factor in a wide variety of medical conditions, including lower limb musculoskeletal pathologies such as plantar fasciitis Achilles tendonitis, and patella-femoral joint pain.

Flatfoot deformities are commonly treated using some form of orthotic device. Such devices are designed to provide stability and to realign the foot arch, and have a demonstrable success in alleviating patients’ symptoms

Anatomy

Flatfeet are an anatomical alteration which can occur in one foot or in both feet. The most common structural difference in flatfeet is found to be rear-foot varus which in turn causes excessive pronation of the foot. In addition, deepened navicular cup, widened talus articular surface, proximally faced talus, and higher positioned navicular articular surface can be seen. These alterations cause the MLA to collapse resulting in a loss of arch height. When this loss of arch height is observable in both non-weight bearing and weight bearing positions, it is termed as rigid flatfeet. Contrarily, when a normal MLA height is present in non-weight bearing condition and collapses with weight bearing is identified as flexible flatfeet.

Symptoms

The most identifiable symptoms and characteristics of flat feet are the decrease or lack of arches in the feet (especially when weight bearing) and pain / fatigue along the inner side of the feet and arches.

Some issues caused by flat feet include:
• Inflammation of soft tissue
• Foot, arch, and leg fatigue
• Heel, foot, and ankle pain
• Knee, hip, and lower back pain
• Rolled-in ankles
• Abnormal walking patterns
• Shin splints
• Bunions
• Hammertoe
• Arthritis
• Plantar fasciitis
• Posterior tibial tendon dysfunction (PTTD)

Causes

Flatfeet is not unusual in infants and toddlers, because the foot’s arch hasn’t yet developed. Most people’s arches develop throughout childhood, but some people never develop arches. People without arches may or may not have problems.
Some children have flexible flatfeet, often called flexible flatfoot, in which the arch is visible when the child is sitting or standing on tiptoes but disappears when the child stands. Most children outgrow flexible flatfeet without problems.
People without flatfeet can also develop the condition. Arches can collapse abruptly after an injury. Or the collapse can happen over years of wear and tear. Over time, the tendon that runs along the inside of the ankle and helps support the arch can get weakened or tear. As the severity increases, arthritis may develop in the foot.

Diagnosis

The observation of the feet mechanics from the front and back and also toes stand. The strength test in the ankles and locate the main area of pain. The wear pattern on the shoes also may reveal information about the feet.

Tests

Imaging tests that can be helpful in diagnosing the cause of foot pain may include:
• X-rays. A simple X-ray uses a small amount of radiation to produce images of the bones and joints in the feet. It’s particularly useful in evaluating alignment and detecting arthritis.
• CT scan. This test takes X-rays of the foot from different angles and provides much more detail than a standard X-ray.
• Ultrasound. Ultrasound may be used when a tendon injury is suspected. Ultrasound uses sound waves to produce detailed images of soft tissues within the body.
• MRI. Using radio waves and a strong magnet, MRIs provide excellent detail of both bone and soft tissues.

Treatment

Many people with flat feet don’t have significant problems or need treatment. However, if foot pain, stiffness or other issues occur health provider might recommend nonsurgical treatments. Rarely, people need surgery to fix rigid flat feet or problems with bones or tendons.
Treatments include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs), rest and ice to ease inflammation and pain.
• Physical therapies to stretch and strengthen tight tendons and muscles, improving flexibility and mobility.
• Supportive devices like foot orthotics, foot or leg braces and custom-made shoes.

Exercises

Toes elevations: Start by standing with your feet shoulder-width apart and flat on the ground. Slowly raise your toes off the ground as high as you can, while keeping your heels on the ground. Hold this position for a few seconds, then lower your toes back down to the ground. Repeat for several repetitions.

Toes scrunches: Begin by sitting in a chair with your feet flat on the ground. Scrunch your toes together as tightly as you can, then relax them. Repeat for several repetitions.

Double/Single leg raises: Start by lying on your back with your legs straight out in front of you. For double leg raises, raise both legs off the ground at the same time, keeping them straight. For single leg raises, raise one leg off the ground while keeping the other leg straight and on the ground. Hold the raised leg in the air for a few seconds, then lower it back down to the ground. Repeat for several repetitions on each leg.

Standing single leg balance: Stand on one foot with your knee slightly bent. Hold this position for as long as you can, up to 30 seconds, then switch to the other foot. For a greater challenge, close your eyes or stand on a pillow or unstable surface.

Toes walks: Start by standing with your feet flat on the ground. Slowly walk forward on your toes, keeping your heels off the ground. Walk for a few steps, then lower your heels back down to the ground. Repeat for several repetitions.

Heel walks: Begin by standing with your feet flat on the ground. Slowly walk forward on your heels, keeping your toes off the ground. Walk for a few steps, then lower your toes back down to the ground. Repeat for several repetitions.

Calf muscle stretch: Start by standing facing a wall with your hands on the wall at shoulder height. Take one step back with one foot, keeping your heel on the ground. Bend your front knee, keeping your back leg straight, until you feel a stretch in your calf muscle. Hold this position for 15-30 seconds, then switch legs and repeat.

Prevention

Although flat feet are often hereditary and cannot be completely prevented, there are strategies that can be put in place to help reduce the risk of developing flat feet symptoms. Here are some preventative measures:
Footwear:
Choose supportive footwear with good arch support and cushioning and try to avoid shoes with flat soles.
Consider using orthotic insoles or arch supports that are designed to provide additional support and alignment for the feet.

Foot Exercises:
Perform exercises to strengthen the muscles of the feet and lower legs. This may include toe curls, heel raises, and toe taps. Consult with a healthcare professional or a physical therapist for guidance on appropriate exercises.

Maintain a Healthy Weight:
Excess body weight can contribute to the flattening of the arches. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce stress on the feet.

Avoid Prolonged Standing:
If your job or activities involve prolonged periods of standing, take breaks to rest and stretch your feet. Consider using supportive mats or insoles in areas where you stand for long durations.

Stretching Exercises:
Perform stretching exercises to maintain flexibility in the Achilles tendon and calf muscles. This can help prevent excessive pronation and contribute to better foot alignment.

Avoid High Heels:
Limit the use of high-heeled shoes, as they can contribute to foot misalignment and increase stress on the arches. Opt for shoes with a moderate heel height.

Gradual Changes in Physical Activity:
If you are starting a new physical activity or exercise routine, make changes gradually. Sudden increases in intensity or duration can place additional stress on the feet.

Proper Body Mechanics:
Pay attention to your body mechanics and posture. Maintain good posture while standing and walking and be mindful of how you distribute your weight on your feet.

Consult with a Specialist:
If you have concerns about your foot structure or experience symptoms of flat feet, consult with a podiatrist or orthopaedic specialist. They can provide a thorough evaluation and recommend appropriate interventions, such as orthotics or physical therapy.

Consider Arch-Supporting Activities:
Engage in activities that naturally support the arches, such as swimming or biking. These activities can be less stressful on the feet compared to high-impact sports.
It’s important to note that preventive measures may vary based on individual factors, and what works for one person may not be suitable for another. If you have specific concerns about flat feet or foot health, seeking advice from a healthcare professional is recommended. They can provide personalized recommendations based on your unique circumstances.

Stroke and Its Effects on Motor Functions

Posted on February 6, 2024

Stroke and Its Effects on Motor Functions (arms and legs)

A stroke can occur when the blood supply to part of the brain is interrupted or reduced (Ischemic stroke) that is caused by the obstruction of a blood clot (most common), or by blood vessels bursting (ruptures) and preventing the blood flow to the brain (Haemorrhagic stroke). Strokes prevent brain tissue from getting the required oxygen and nutrients, that can affect muscles in the arms and legs. Most strokes are ischemic, accounting for 85% of most strokes, and transient ischemic attacks are similar, except that no brain damage occurs, and symptoms typically resolve within an hour. After a stroke, the muscles may become limp and feel heavy (flaccid or low tone). In the weeks or months after a stroke, the muscles may shorten and tighten, making movement very difficult (spasticity). A stroke can be severe, so immediate treatment is crucial, and early action can reduce brain damage and other complications. Strokes can occur in any age group or sex; however, the risk increases with age. At younger ages, males are most likely to have a stroke, although hormonal changes during pregnancy, childbirth, and menopause, increases the risk of stroke for females.

Anatomy

At the base of the brain, the carotid and vertebrobasilar arteries form a circle of communicating arteries (namely the Circle of Willis). Other arteries such as the anterior cerebral artery (ACA), the middle cerebral artery (MCA) and posterior cerebral artery (PCA), develop and travel around the brain.
Ischemic stroke is caused by deficient blood and oxygen supply to the brain, as a build-up of plaque that causes the vascular chamber to constrict, and form clots (thrombotic stroke). A blood clot or the plaque can also break off and travel to the brain, reducing blood flow (embolic stroke), which causes severe stress and possible cell death (necrosis) that can be accompanied by a loss of neuronal function.
Haemorrhagic stroke is caused by sudden bleeding of blood vessels (accounts for about 10-15% of strokes). Stress in the brain tissue and internal injury causes an artery in or on top of the brain to open (rupture), causing pressure and swelling of the brain, that produces toxic effects in the vascular system, and causes abnormal accumulation of blood within the brain.

Symptoms

• Difficulty with speech and confusion on others speech
• Paralysis or numbness the body, including the face, an arm, or leg- restricting movement due to weakness and numbness
• Abnormally high blood pressure
• Problems with balance and coordination
• Vision loss in one or both eyes
• Severe headache (may be accompanied with vomiting and dizziness)
• Trouble walking

Risk Factors

• High blood pressure (hypertension) and high LDL cholesterol levels
• Diabetes or Obesity
• Family history and genetics
• Smoking and excessive alcohol drinking
• Heart disorders and atrial fibrillation
• Inflammation of blood vessels (vasculitis)

Diagnosis

Most stokes can be diagnoses through a neurological examination, that involves an observation evaluation of the nervous system (assessment of signs and symptoms, and the timing of symptoms). This often examined through completing the ‘standardised NIH Stroke Scale’, that measures neurological function and deficits through a list of questions and physical and mental tests (assessing alertness, communication, and simple movements).
Other assessments for stroke, sometimes includes brain imaging techniques such as CT scans, which are often used to rule out any bleeding in the brain before giving any medication. An MRI is often used to detect any stagnation of water movement through the cells in injured brain tissue. Both imaging techniques are equally as accurate in determining bleeding, however an MRI can provide an earlier diagnosis of ischemic stroke, performed on those without any types of metallic or electronic implants, such as a pacemaker.

Rehabilitation

The process of rehabilitation depends on the symptoms and severity, that could include different specialists such as speech therapy, physiotherapists, psychologists, and occupational therapists. The weakness or paralysis of the body, or limbs, can result in problems with coordination and balance, where the severity of the physical disability will be assessed before creating a treatment plan. The aim is often to relearn simple motor activities such as walking, sitting, standing, and lying down, and will focus on improving muscular strength to overcome any movement disabilities. Rehabilitation could involve:
• Constraint-induced therapy- an unaffected limb is immobilized, causing the person to use the affected limb to regain movement and function
• Electrical stimulation therapy- stimulates the nerves that make the muscles contract, to help regain control over the limb, and reduce pain and spasticity
• Stretching exercises- promotes blood flow and range of motion
• Strength exercises- improving grip and ability to use the affected limb
Early-stage example: holding the weak arm with the string arm and rocking it back and forth.
After gaining strength and mobility: squeezing a ball, using wrist weights, or hand weights to build muscle.
• Practice fine motor skills- (examples: picking up objects, writing and drawing with a pen)
• Injections- targeted therapy acts as nerve blocks in affected muscles, helping with spasticity (Phenol injections) or block the release of nerve chemicals involved in muscles contraction (Botulinum treatments)

If you are suffering from any of the symptoms or have suffered from having a stroke, our health and exercise professionals are happy to support you. Contact us on 0330 043 2501 or email us at info@livewellhealth.co.uk.

Exercises for Knee Pain

Posted on January 25, 2024

Exercises for Knee Pain

Early stage of rehab

Swimming is often recommended for knee pain as it is a low-impact form of exercise that can help improve joint range of motion, flexibility, and strengthen the muscles around the knee without putting excessive stress on the joint. The buoyancy of the water reduces weight bearing on the knee, allowing for a comfortable and pain-free workout.

Strengthening

Glute Bridge: Laying flat on your back with your knees bent and feet flat on the ground, tighten your glutes and lift your hips towards the ceiling. Hold for a few seconds, then lower back down. Repeat for several repetitions.
Sitting Knee Extension: Sitting in a chair with your legs extended, lift one leg up while keeping the other foot flat on the ground. Hold for a few seconds, then lower back down. Repeat for several repetitions on each leg.
Unweighted Flexion: Stand behind a chair, using the back of the chair for balance. Flex one leg up to about a ninety-degree angle, hold for ten seconds, then go back to starting position. Switch legs and do ten repetitions with each leg.
Heel and Calf Raises: Stand with your feet hip-width apart. Raise up on the balls of your feet, then lower back down. Repeat for several repetitions. To make the exercise more challenging, try doing calf raises on just one foot at a time.

Stretching/ Mobility

Ankle Stretch: Stand facing a wall and place one foot behind the other. Keep your front knee slightly bent and press your heel into the ground. Hold this position for 15 to 30 seconds, then switch to the other foot.
Single Hamstring Stretch: Sit on the ground with one leg straight in front of you and the other leg bent with the foot flat on the ground. Reach forward and hold onto your straight leg, keeping your back straight. Hold this position for 15 to 30 seconds, then switch to the other leg.
IT Band Stretch: Lie on your side with the affected leg on top. Bend the knee of the top leg and use your hand to gently pull it toward your chest. Hold this position for 15 to 30 seconds, then switch sides.
Quadriceps Stretch: Stand facing a wall and place your hand on it for balance. Bend your knee and bring your heel towards your buttock. Hold onto your ankle and hold this position for 15 to 30 seconds, then switch to the other leg.

Progression

Warming up before doing exercises for the knee is important to prevent injury and to improve performance. Warming up increases blood flow to the knee, which can help to reduce stiffness, improve range of motion, and reduce the risk of injury. This can also help to prepare the muscles, tendons, and ligaments for the workout ahead, reducing the risk of strains or tears. Warming up can include simple exercises like walking or light jogging, or dynamic stretching to help increase flexibility and range of motion in the knee.

Strengthening

Squats/Single Leg Squat: Start by standing with your feet shoulder-width apart. Lower your body down as if you are sitting back into a chair, keeping your weight in your heels. Push back up to the starting position. For a single leg squat, lift one foot off the ground and perform the squat on just one leg.
Lunges: Start by standing with your feet hip-width apart. Take a big step forward with your right foot, bending both knees to 90 degrees. Your back knee should come close to the ground, and your front knee should be directly over your ankle. Push back up to the starting position and repeat with the other leg.
Side Leg Raises: Start by lying on your side with your legs extended. Keeping your legs straight, lift your top leg up as high as you can, then lower it back down. Repeat for the desired number of repetitions, then switch sides.
Single Leg Deadlifts: Start by standing on one leg with a slight bend in the knee. Reach forward with your other leg while keeping your back straight. Keep reaching forward until your other leg is parallel to the ground. Push back up to the starting position.
Step Up: Stand in front of a step or bench and place your right foot on the step. Push down through your right foot to lift yourself up onto the step, keeping your left foot off the ground. Step down with your left foot and repeat with the other leg.
Crab Walk with Elastic Band: Start by sitting on the floor with your legs bent and your feet flat on the ground. Loop an elastic band around your legs, just above your knees. Keeping your feet on the ground,

Obvioucly knee pain can come in many forms for many reasons and one size doesn’t fit all. At livewell we like to understand you the person and how this knee pain has happened before designing rehabilitation programes. If you would like to have a consultation with one of our sports therapists or physiotherapists to understand the reasons for your pain and ways in which you can treat your pain, whether through exercise, stretching, massage or any one of the services we offer then please contact us via email or tel on 07939 212 739

Exercises for Sciatica

Posted on January 24, 2024

Stretching

Back flexion stretch – knees to chest

Lie down on your back with your knees bent and feet flat on the floor.
Slowly bring one knee towards your chest and hold it with your hands.
Keep your other leg flat on the floor.
Hold the stretch for 10-30 seconds and then release.
Repeat the same with the other leg.

Supine Twist – Knee to chest with rotation

Lie down on your back with your knees bent and feet flat on the floor.
Bring one knee towards your chest and hold it with your hands.
Keeping your shoulders on the ground, gently rotate the knee towards the opposite side of your body.
Hold the stretch for 10-30 seconds and then release.
Repeat the same with the other leg.

Cat/ Cow Stretch

Start on your hands and knees, with your wrists under your shoulders and your knees under your hips.
As you inhale, arch your back and lift your tailbone and head towards the ceiling, creating a “cow” shape.
As you exhale, round your spine, tucking your chin to your chest, creating a “cat” shape.
Repeat this stretch several times, flowing smoothly from one movement to the next.

The Pelvic Tilt

Lie on your back with your knees bent and feet flat on the floor.
Tighten your abdominal muscles and tilt your pelvis upward so your lower back presses into the floor.
Hold this position for 5-10 seconds and then relax.
Repeat this exercise 10 times.

Sitting pigeon pose

Start in a seated position with your legs extended straight out in front of you.
Bend your right knee, bringing your right foot to the outside of your left knee.
Slowly lower your right knee to the ground on the outside of your left leg, keeping your left leg extended straight behind you.
Hold this stretch for 10-30 seconds and then release.
Repeat the same with the other leg.

Figure 4 stretch

Lie on your back with your knees bent and feet flat on the floor.
Cross your right ankle over your left knee.
Gently pull your left knee towards your chest, keeping your right ankle on top of your left knee.
Hold this stretch for 10-30 seconds and then release.
Repeat the same with the other leg.

Standing hamstring stretch

Stand with your feet hip-width apart.
Bend forward at the waist and reach towards your toes, keeping your knees straight.
Hold this stretch for 10-30 seconds and then release.
Repeat this stretch several times.

Strengthening

Forearm Plank

Start by positioning yourself on your forearms and knees, with your elbows under your shoulders.
Straighten your legs behind you and balance on your toes, keeping your body in a straight line from head to heels.
Hold this position for 10-30 seconds, keeping your abdominal muscles tight and your hips level.
Repeat this exercise several times.

Bird Dog

Start on your hands and knees, with your wrists under your shoulders and your knees under your hips.
Reach forward with your right arm and back with your left leg, keeping your spine in a neutral position.
Hold this position for a few seconds, then return to the starting position and repeat with the other arm and leg.
Repeat this exercise several times.

Dead Bug

Lie on your back with your arms extended towards the ceiling and your legs raised towards the sky.
Lower your right arm and left leg towards the floor, keeping your lower back pressed into the ground.
Return to the starting position and repeat with the other arm and leg.
Repeat this exercise several times.

Knees Side to Side

Start in a seated position with your knees bent and feet flat on the floor.
Slowly move your knees from side to side, keeping your feet together.
Repeat this exercise 10-15 times.

It’s important to consult with a doctor or physical therapist to determine if these exercises are appropriate for your specific condition, and to ensure proper technique to avoid further injury.

If you want to know more about correct technique or would like professional advice from one of our personal trainers then please get in touch then we can help too with our specialist sports massage service. For more information on how these types of massage could help you, contact us on 07939 212 739 or drop us an email at info@livewellhealth.co.uk

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