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Someone posted a question about foot pain last week and a few of our staff, alumni and CE providers responded.

The question, now deleted by the original person that asked the question, was “What is the best modality for foot pain?  Foot pain can exist in many areas, plantar surface, dorsal surface, deep, superficial, and can be caused by multiple factors.  Which modality would you use to alleviate conditions of the feet?”

Here are a few responses...

This is from Wendy Hines, as ASIS alumni that works with olympic athletes;

To alleviate general conditions of the feet I would first asses the condition through postural & movement assessment to see the stress and strains through out the foot and accompanying structures. Then I would utilize myofascial techniques to lengthen tissues, and general rehabilitation massage techniques including range of motion to free up the many joints of the foot, deep tissue to the thigh, calf and foot for increased circulation and general mobility of the surrounding tissues, and isolate and stretch.  When applying many of these techniques I would enhance the efficiency of the tissue manipulation by having the client become an active participant in their session with specific range of motion to help open the tissues.  I would then educate the client through my alignment awareness exercises, yoga therapy and other strengthening and stretching techniques which areas of their leg, foot, and other areas need strengthening and which need specific stretching to maintain a more efficient alignment and provide a long term change. I would then suggest other self care that would include cryo therapy, and self massage with tools such as tennis balls depending on the main area of pain. Other modalities that would be useful may include shiatsu, neuromuscular techniques and craniosacral therapy.

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This is from ASIS CE provider and Reflexology master, Thomas Bennan;

Reflexology has been my preferred modality for foot pain because reflexology technique is
profoundly effective and versatile. (1) Reflexology techniques target and are effective in resolving
the tension and congestion that can often be associated with both active and passive foot pain. I
define active foot pain as pain that a person is aware of during daily activities and passive pain
as pain that a person would experience only in response to touch or pressure. I target and
regularly achieve a palpable softening of those areas of “tension” in my clients feet. After a
session my clients often report that they feel like they have “new feet” or like they are “walking on
clouds”. (2) During reflexology sessions my clients almost always report profound relaxation.
Persons receiving reflexology session from me will in most cases go very quickly from an active
conversational mode to an “altered” state which they after report as being similar to sleep with an
active dream component. This change or shift regularly happens within the first two to ten minutes
of a session. It is important because in reflexology we would see this relaxation as indicative of
an awakening of the natural healing processes of an integrated being, which will benefit every
aspect. Clients often report that they have experienced resolution of personal concerns either
while in this dream like state or in the days following the session. (3) In reflexology we would see
the foot pain as giving us information about the well-being of the whole person and specific
information about the health of the areas and systems of the body which in reflexology would be
seen as directly related to the painful areas. (4) As a safety point, reflexolgists will almost
always have training in recognizing contraindications which might preclude working directly on the
feet or suggest a modified technique. Hand reflexology can also be used with a very effective
result in combination with foot reflexology or when there is a reason for not working directly on the
feet. (5) It is important to note that although reflexology is not massage and only about ten
percent of reflexologists are also massage therapists, reflexology can be easily learned by
massage therapists and applied well as an integrated part of a massage session. The
advantages of this are in enhanced benefit to specific concerns, like foot pain, which a client might
have and in profoundly enhancing a reduction of over-all stress, which many clients are seeking.
For more on this and other topics please visit my website at www.sedona-reflexolgy.com and my
blog at http://blog.sedona-reflexology.com/.
Thank you Thomas Brennan
This is from ASIS staff member, Sara Zender;

I often describe Chinese medicine as a metaphorical medicine which uses observation as its most invaluable diagnostic tool. In this system nature is the macrocosm to which our bodies are the microcosm. Health is seen as a return to nature, surrendering the struggle against nature. My practice focuses on body awareness, client education and the mind-body connection. When a client presents with foot pain I don't just want to know where the pain is at, I want to know what it feels like, what makes it feel better or worse, what times of day the pain is worst and if the weather affects the pain, among other things. Then I ask the question, if your foot were trying to tell you something through this pain what do you think it is?

In the book, You Can Heal your Body by Louise Hay she would say the feet represent our understanding of ourselves, of life and of others. Pain represents guilt. Louise argues that guilt always seeks punishment. In the instance of foot pain perhaps there is a miscommunication happening in the client’s life that is causing the pain to manifest in the feet. This usually facilitates an a-ha moment for the client and bridges the gap between pain and self. The first step in removing the pain is awareness. Louise is a proponent of positive affirmations, in this case using “My understanding is clear, and I am willing to change with the times. I am safe.” for the feet and “I lovingly release the past. They are free and I am free. All is well in my heart now.” for the pain. Ultimately through the client's habits, lifestyle, etc he or she is responsible for the creation of this imbalance. However, in Chinese Medical terms the same energy that caused imbalance will also be the driving force in the return to balance, and the release of pain. In this way there is no need for the blame and shame game just an opportunity for learning.

Morgan Marlo's Mutant Message from Down Under describes a passage where Morgan's feet are aching after her first day on a “walk-about” barefoot in the bush with an aboriginal tribe. The Medicine Woman comes to ease her pain. The Medicine Woman holds her feet in her hands and says a blessing, thanking Morgan's feet for all they have provided not only in the functional activities of walking and standing but the part her feet play in the community, letting her feet know through touch and words that the entire community appreciates their effort so that Morgan could walk with them. She then massages her feet with an herbal salve and "ta-da" her feet feel soothed. Our feet are our foundation, how often are they taken for granted?

In my office I use many Chinese herbal liniments and decoctions both externally and internally to achieve balance and relieve pain as a tool to my massage practices. I am a big proponent of Aromatherapy to further connect mind with body as our sense of smell is directly connected to our limbic system, or emotional center of the brain. Therapeutic grade essential oils have medicinal value for the physical and emotional bodies. Cypress, lemongrass and wintergreen is the equivalent to a natural "icy-hot" helping to increase circulation and relieve tension and pain. To further assist in body awareness and prevention the client would leave with homework or in this case "foot work."

Self Foot Massage

Beginning with your right foot, gently rub oil in small circular motions from your ankle to the toes; then from the ankle to the heel.

Gently rub oil in small circular motions on the sole of the foot.

Next press the thumb on the place where the shin meets the top of your foot. Gently, slowly drag your thumb across the top of your foot to the big toe. Return to the ankle and in the same manner drag the thumb toward the second toe to the fifth toe.

This initial treatment improves circulation and activates important energy points on the feet.

Cross your right ankle over your left knee and cup the side of your right heel in your left and push the foot inward, outward and then in a circular motion first counter clockwise and then clockwise.
With your right thumb, apply pressure from the big toe to the heel, along the inner border of the foot. Then drag your thumb from the root of your fifth toe to the heel. Make a fist with your right hand and press it against the foot, working it along the sole in a circular motion to activate a variety of energy points.

Next, slowly pull each toe away from the foot, as though you are “popping” the joint, to remove stress.

Repeat with your left foot. When you’re finished, soak your feet for 5-10 minutes in a bucket filled halfway with warm water and one teaspoon of salt to draw the stress and toxins out of your feet.
This is from ASIS CE provider, Lolita Knight;

The most boring massage I ever gave was using just my elbow with calcium deposits in my clients heel. He had been in pain for 20 years and with one session was 80% pain free, and totally pain free after the second session. He then attended my class on deep tissue massage so he could lean it himself to help others. For fallen arches I use my knuckles and while it does not fix it, it definitely reduces the discomfort. And lastly, my favourite therapy I use the lateral edge of my foot with the barefoot Fijian Massage for plantar problems with favorable results. Any questions you may look at my web page www.fijianmassage.com. Cheers Lolita Knight
This is from ASIS CE provider, Judy Taylor;

As a Lymphatic Specialist, I recommend Gua Sha, a Chinese lymphatic modality, promoting Qi and blood circulation and removes toxic heat, blood and lymph fluid from the body. The use of lymphatic drainage encourages the inner river of life to alleviate conditions of the feet and body. Gua Sha is an almost miracle method of improving health, ridding the body of pain, fever and fatigue. The method of applying Gua Sha involves applying a thin layer of oil on the skin and then scraping with a Gua Sha tool (a thin, flat board of Water Buffalo Horn or Jade about the size of a credit card). For the feet one would scrape the legs below the knees downward, scrape the front of the ankle and foot toward the toes; scrape the back of the knee downward, scrape the back of the ankle and foot downward, and lastly scrape the whole bottom of the feet toward the toes. The pain and inflammation are being released. Combining foot reflexology and lymphatic drainage is beneficial for conditions of the feet.

Judy Taylor
Author, Lymphatic Specialist, Educator
This is an interesting article regarding his father's cause of foot pain from a visit to the hospital, from ASIS instructor, Ernest Love;

Dear Patient Relations Specialist:

I waited to send this email because it expresses a concern of mine that relates to medical care in general. A particular assessment of my father's foot while he was at the hospital is the specific issue that brings to mind a general concern. (You may recall that my father complained of foot pain as a reason for not wanting and/or not being able to walk following gall bladder surgery. I spoke about this with you when my father was still at the hospital. I decided to write something following your comment: "Coming from you, it means far more than my relay of our conversations alone.”)
MY COMMENTS
It appears that the medical community, in general, is myopic with respect to seeing clearly the potential benefit of non-medical school trained health care professionals; specifically, therapeutic massage. (I include nursing and physical therapy as under the banner of "medical school" in this application because calling upon nurses and physical therapists as part of the medical team is accepted as standard practice.)
Case Example:
90 year/7 month-old patient recuperating from ball bladder surgery that required a second hospitalization to remove additional abscess and monitor infection. Infection appears to be under control with treatment of intravenous antibiotic. Lab analysis of abdominal drainage indicates no infection, however visual inspection indicates that pus is still draining. Patient is receiving nourishment intravenously. Tests of stomach action indicate that "things are moving slowly" through the stomach. Diet should be non-fat, liquids and soft foods only. Patient should eat small quantities throughout the day rather than "meals" with a goal for the present time of 1500 calories. Patient is not yet eating soft solids and is drinking minimally. Although getting out of bed and walking is highly recommended, patient remains in bed and complains of right-foot pain on dorsal-lateral aspect of foot in approximate area of cuboid and extensor digitorum brevis. X-ray of right foot indicates "normal" and diagnosis is verbalized as "don't see anything wrong; don't know why it hurts." A physical therapist made an assessment that indicated he could support himself standing and was able to get up and sit in a chair independently. Patient remains in bed. Other than the complaint of foot pain when standing or walking, the patient has been pain free and is not on any pain medication.
That's it... "don't see anything wrong; don't know why it hurts," and the patient remains in bed and complains of foot pain when he puts weight on it; yet the goal was to get the patient up and walking.
Had an experienced massage therapist been called in (or perhaps a podiatrist), the following might have transpired; and in fact the following DID transpire when a massage therapist got involved... in this case the massage therapist was the patient's son who arrived two days following the situation described above.

ASSESSMENT of RIGHT LEG, ANKLE and FOOT (approx. 3-5 minutes)
Testing of range of motion (to include passive, active and resisted movement) and palpation of the right leg, ankle and foot indicated the following:
Overall: Hypertonicity and pain (following palpation) is present in the leg-foot system in several locations.
1. Range of motion for dorsiflexion was limited; no pain but patient expressed "feels tight"
2. Passive movement (flexion/extension) of toes indicated general stiffness; passive flexion of toes induced pain in interphalangeal joints
3. Patient expressed extreme sensitivity to moderate-to-deep thumb palpation pressure on the antero-inferior surface of the calcaneus. While maintaining light-to-medium thumb palpation pressure at the antero-inferior surface of the calcaneus, passive dorsiflexion brought about increased sharp pain. (Note that this is the location that one would expect pain symptoms for plantar fasciitis when standing and walking; yet the patient did not have pain on the antero-inferior surface of the calcaneus unless it was palpated firmly.)
4. Palpation of plantar aponeurosis of right foot indicated hypertonicity as well as the patient indicating pain when palpated with light-to-medium-to-deep pressure.
5. Palpation of flexor digiti minimi induced moderate soreness.
6. Palpation of medial and lateral gastrocnemius and soleus indicated general hypertonicity as well as trigger points; calcaneal tendon was inflexible.
7. Tibialis anterior, peroneus longus, and extensor digitorum were all hypertonic, and the patient indicated pain at various locations when palpated.
8. Pain at approximate area of cuboid and extensor digitorum brevis (the location of pain that the patient felt when he stood or walked) was induced only when directly palpated (medium-to-firm pressure) or when patient was standing.
TREATMENT (approx 15-25 minutes) and RATIONALE
Attend to the areas of muscular and aponeurosis hypertonicity seeking to reduce it as well as gain ROM for dorsiflexion, gain freedom of movement for the tarsals and metatarsals, and reduce ischemia.
It appears that the patient, when standing or walking, presents with an atypical pain symptom for what might be developing into plantar fasciitis. This is indicated by palpation and manipulation of the antero-inferior surface of the calcaneus and plantar aponeurosis. However, the presence of extreme hypertonicity of tibialis anterior, peroneus longus, and extensor digitorum longus could possibly cause compression of the tarsals leading to pain on the dorsal aspect of the foot. Note that if this patient has a peroneus tertius which is an extension of the extensor digitorum longus and is not uncommon, it's pathway to attachment at the tuberosity of the 5th metatarsal is along the area of pain that is felt by the patient when applying weight. Also, given the general lack of body movement/walking due to the patient's previous weeks of surgical/recovery needs, a general state of hypertonicity in his lower extremities has developed. Given the state of hypertonicity that is present in the muscles and tissues of the right leg and foot, it is likely that there is ischemia which could be one source of the cause of pain. In this case, "following the symptom" of the patient's pain (at the approximate area of cuboid and extensor digitorum brevis) by focusing and attending to this location alone is a distraction from the source of the problem.
RESULTS
Immediately following the treatment plan as generally described above, the patient was out of bed and walking for a period of 45 minutes. His gait had a slight limp as he continued to protect himself from any discomfort that he felt on the dorsal aspect of his foot. The patient indicated that the feeling he had in his foot had changed. His words: "I wouldn't call it pain, but it feels like a bruise of some sort." He also indicated that the sensations he was feeling were no longer in "exactly the same location." Following this walk, the patient rested by sitting in a chair for about 45 minutes. Then he walked again for a period of 45 minutes with similar observations as the first walk.
It is now (Wednesday, July 29) two weeks since that treatment (Thursday, July 16). Since that day, the patient has been up and walking regularly. The discomfort in his foot diminished continually without the need for further intervention; just movement of his own.

CLOSING COMMENT
I have not been to medical school. I am not a doctor. However, I am a well-trained, certified/licensed massage therapist with many hours of continued education to include subjects that are part of medical school such as cadaver work. My scope of practice as a massage therapist does not even allow me to refer to those I work on as "patients." So, please forgive my use of the term "patient" in the above.
Again, I am not a doctor. However, when I spoke with the physician in charge of my father's care at the hospital, it was clear that I knew more than he did about my father's foot. Specifically, I first questioned the doctor about any restrictions or contraindications for my father's movement, being mindful of his surgery recovery process; he indicated, "none." I then mentioned that I was a massage therapist, and that I observed that he might have foot pain due to some early indications that are more typical of plantar faciitis. I am guessing that he probably only heard the words "plantar faciitis" because he responded by indicating where the pain in my father's foot presented (lateral-dorsal aspect) and implied through gesture, context and word that “it wouldn't be that.” He also stated openly and dismissively, "I don't remember the name of the muscle" as he demonstrated where the pain on my father's foot was." He then returned to filling in the records at the doorway to my father's room.
Well, if he would have asked, I could have told him exactly the musculoskeletal anatomical names that applied to the location of the pain. I could have also shared with him my thought process (see assessment and treatment plan above).
Again, I am not a doctor. And I realize fully that I was at the hospital in the role of "son" and not "health care professional."
However, this incident highlights the following: The medical assessment, diagnosis and treatment ended with "don't see anything wrong; don't know why it hurts." There was no focus given to, "Well, then who might we ask? Who might know something about this situation that we do not?" A physical therapist is certainly a good next step. However, massage therapy is not a focus of a physical therapist's schooling/training. While there is much overlap in the treatment provided by physical therapy and therapeutic massage, these two approaches "see with different eyes" so to speak. And it is certainly possible that a doctor or a physical therapist might "see" what a massage therapist observes. But, in this case they didn't, and in many cases they don’t ... and not because they aren't good at what they do. But, if achieving the goals of the treatment plan is germane, then some changes are needed in order for doctors to turn to massage therapists as those who have something of value to offer in a medical setting.

Respectfully yours,
Ernie Love B.A., B. Mus., M.A. CMT, LMT

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