Foot pain is one of the more commonly mismanaged areas of the body. A trip to your family doctor, podiatrist or even to the Internet and you will be labeled with plantar fasciitis. Then, you start icing, stretching, taking anti-inflammatories, rolling your foot with a ball, or may have been convinced that getting a cortisone injection was a good idea. You can continue this routine for months or years with minimal results. Your symptoms may reduce or resolve with time, but only because your body compensated putting extra stress on another area of your body to reduce pressure on your foot. This can lead to pain in your other foot, knee, hip, low-back, and/or reoccurring pain in your injured foot over time.

So, where did you go wrong?

It all starts with an inaccurate diagnosis (plantar fasciitis) that can lead to wrong and ineffective treatment methods. It’s crucial to receive a correct diagnosis and receive the right treatment to stay pain free and continue doing everything you love.

To get an accurate diagnosis regarding your foot, it is best to start with a soft tissue specialist. Click here to contact Phipps Soft Tissue and Spine so you can receive the correct diagnosis and treatment and begin your road to recovery.

Below you will find additional information on foot pain, anatomy, and why plantar fasciitis treatments such as injections, stretching, rolling and ice can be a waste of time.

What exactly is plantar fasciitis?

The plantar fascia is a thickened area of connective tissue and is often blamed for pain on the bottom of your foot. The diagnosis of plantar fasciitis implies that the attachment point of the plantar fascia and heel (circled in red below) is inflamed and causing pain.

The plantar fascia, just like all the structures in the foot, is capable of generating pain. However, plantar fasciitis is rarely the main diagnosis as the foot is much more complicated than just the plantar fascia. There are multiple layers of muscles and tendons in your feet that are deep in the plantar fascia. See the pictures below.

In addition, muscles originating in your calf will travel behind your ankle and attach onto your foot as well. The picture below (highlighted in blue, green, and yellow) shows the muscles that originate deep in your calf that travel and attach onto the bottom of your foot (depicted as the red shaded areas)

It is clear that there are many structures in your foot and calf that can contribute to pain. All structures in your foot and calf play a role in stabilizing and keeping your foot pain free. Additionally, they are all capable of developing pathology and generating pain.

The most common pathologies that develop in the foot are:

• Adhesion
• Tendon degeneration

Adhesion

Adhesion can form in any muscle in your foot and calf and form from overuse (standing, walking, running). It acts like glue in your muscles causing them to become weak and less flexible. This will generate pain and cause the tendons in your heel to become overloaded and degenerated (more on this below). A soft tissue specialist will break down adhesion with Manual Adhesion Release™ or Instrument Adhesion Release™. Which treatment they will use will depend on the muscles involved. Below are 2 brief video clips of Dr. Phipps utilizing both techniques on muscles that will contribute to your foot pain.

Treatments such as. injections, rolling your foot on a ball, stretching, ice, and anti-inflammatories will not break down adhesion. With expert treatment, this will improve the function of your foot immediately.

Degenerated Tendons.

A tendon is a soft tissue structure that attaches a muscle to a bone.  Below shaded in orange, green, and blue are 3 muscles that have their tendons attach onto the heel. These tendons are capable of degenerating and causing heel pain commonly misdiagnosed as plantar fasciitis.

If you have heel pain that occurs when you take the first few steps out of bed or a chair, this is likely one of your diagnoses. The tendons in your feet can degenerate for months or even years without your knowledge, causing it to one day cross a threshold, resulting in pain that doesn’t go away. This degeneration can occur when the load placed on the tendons is too high and the tendon can’t recover properly, causing it to break down and degenerate.  Muscle Adhesion and prolonged standing/walking/running are a few sources that create high loads on your tendons.

Firstly, for treatment of degenerated tendons you should have the adhesion treated to decrease the load on the tendon immediately. Load management advice, orthotics and rehab exercise will depend on your personal case. Then properly managing your case and receiving the correct treatment will allow the tendon to regenerate and become healthy again- meaning your foot will be pain free and stay that way.

Contact Phipps Soft Tissue and Spine today to receive the correct diagnosis for your foot pain. Ignoring your foot pain or relying on ineffective treatment methods will only make your condition worse and harder to resolve.

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To schedule an appointment, please call us at (716) 629-3100 or take advantage of our convenient online form

*Please note that every patient is different. The content and tips displayed on this page are for educational purposes only, and do not substitute for medical advice. Please consult with a medical or healthcare provider, such as Dr. Phipps, for specific diagnosis and treatment advice. Williamsville, NY 14221 Chiropractor

The first step when you have pain, numbness, or tingling in your fingers is to visit a doctor to receive a proper diagnosis so you can receive the proper treatment. It is important that you start with the most conservative approach and then progress to more invasive procedures if needed. This approach obviously doesn’t apply in emergency situations where it is important to get to a hospital right away and is outside the scope of this article.

The only conservative care system in the world that trains doctors in the assessment, diagnosis and treatment of adhesion and nerve entrapment is the Integrative Diagnosis system. Dr. Phipps of Phipps Soft Tissue and Spine is a full body Integrative Diagnosis provider in the Western NY/Buffalo area that has the skills and knowledge to assess and treat this for you (contact us).

If you live outside of Western NY then go to the Integrative Diagnosis find a provider page to find a provider near you. Most cases will be managed fully with this type of care so you can move on with your life and live symptom free.

In more sever cases, imaging like MRI or nerve conduction studies may be required to grade the severity and exact location of your problem. If your primary diagnosis is carpal tunnel syndrome then you may need to consult with a surgeon, especially if you are not responding to conservative care. Dr. Phipps or your Integrative Diagnosis provider will be able to determine when you need to consult with a surgeon or a neurologist.

Surgery is always the last option and only considered in chronic cases that do not respond to conservative care. The surgeon will be able to answer all your questions about the risks associated with carpal tunnel syndrome and the success rates. When you have been evaluated and conservatively treated by an Integrative Diagnosis provider, you can be confident that the other potential causes of your symptoms have been treated and ruled out, making surgery a good option if it comes to that. Pictured below is what the incision site will look like after carpal tunnel surgery.

Don’t go under the knife until you have been fully managed by Dr. Phipps or an Integrative Diagnosis provider.

GET RELIEF NOW

To schedule an appointment, please call us at (716) 629-3100 or take advantage of our convenient online form.

*Please note that every patient is different. The content and tips displayed on this page are for educational purposes only, and do not substitute for medical advice. Please consult with a medical or healthcare provider, such as Dr. Phipps, for specific diagnosis and treatment advice. Williamsville, NY 14221 Chiropractor

In part 2, we mentioned how adhesion can cause median nerve entrapment. This section will explain this concept in more detail.

Adhesion is the most common cause of pain and stiffness in the body and generally forms from overuse during typing, gripping, and repetitive use of your hands. Adhesion will act like glue in the muscle making the muscle weaker, less flexible and can also glue a muscle and nerve together preventing the nerve from moving properly, causing irritation to the nerve and tingling into your fingers.

Below is a video of Dr. Brady, the founder of Integrative Diagnosis (Again more on this in part 4) explaining nerve entrapment. He is demonstrating how the median nerve cannot glide freely when it is adhered to the muscle in your forearm.

The entrapment that he is demonstrating will cause tingling into the same fingers as carpal tunnel syndrome. (Note from Dr. Phipps: Many patients will come in to my office with the diagnosis of “carpal tunnel syndrome” and have complete resolution of their symptoms when this nerve entrapment is fixed in the forearm.) Nerve entrapments can occur at multiple spots and each one needs to be ruled out.

Adhesion will also play a role if your pain is being generated from your neck. Adhesion will result in more compression to your spine causing more irritation of the spinal nerves that travel down your arm, resulting in more symptoms in your fingers. Breaking down adhesion and restoring the strength and flexibility to your neck will decompress your spine and provide a healing environment for your nerves so you have less symptoms into your fingers.

In the final part of this series we will go over where to start with treatment so you can be sure that you receive the correct treatment in the correct area.

*Please note that every patient is different. The content and tips displayed on this page are for educational purposes only, and do not substitute for medical advice. Please consult with a medical or healthcare provider, such as Dr. Phipps, for specific diagnosis and treatment advice. Williamsville, NY 14221 Chiropractor

In part 1 we discussed the signs and symptom of median nerve irritation and how the carpal tunnel is one area where the nerve is vulnerable to compression. The most important thing for you to understand is that tingling or symptoms into your fingers doesn’t mean you have carpal tunnel syndrome. There are two major causes of tingling into your hand and they include median nerve irritation and spinal nerve irritation.

Median Nerve

The median nerve (or nerves that make up the median nerve) can be irritated anywhere along its path down the arm, not just at the carpal tunnel. The median nerve is formed by the nerves that come from your neck and travels down your entire arm to the hand. This is pictured below.

Marked with blue circles are the 4 common areas where the median nerve can be irritated and mimic the symptoms of carpal tunnel syndrome. The irritation comes from adhesion causing a nerve entrapment; we will go into more detail about this in part 3. As a patient you need to be aware that these areas need be properly evaluated before you consider more invasive therapies like injections or surgery.

Cervical Spine (neck)

Another source of your finger symptoms originates from your cervical spine (neck). As your spine wears out either from age, poor genetics, overuse, poor posture, or trauma, the spinal nerves that travel out of your neck and down arm become irritated and compressed causing symptoms into your fingers. The spinal nerves can become irritated from degenerative changes in your cervical spine, disc bulging, disc herniation or anything that takes up space in the canal and irritates the nerve. The location of your symptoms will be determined by which spinal nerve is being irritated. Below is a picture of a cross section of your spine.

This picture depicts how easy is for the nerve to be irritated from a disc herniation taking up space in the canal. The lower levels in your neck (which are the most common segments that degenerate) supply the skin of your fingers and will create tingling, numbing, burning, or pin and needle sensations into your fingers (similar to carpal tunnel symptoms). Nerve irritation at the spinal level needs to be ruled in or out by Dr. Phipps or an Integrative Diagnosis provider (more on this in part 4). Treatment for this is completely different than treatment for the median nerve and carpal tunnel; highlighting the importance of a proper diagnosis.

Median nerve entrapment and spinal nerve irritation at the cervical spine are two of the most common causes of symptoms into the hand and will mimic the symptoms of carpal tunnel syndrome. Disease processes like rheumatoid arthritis, diabetes, lupus, and hypothyroidism can also cause carpal tunnel syndrome. There are many other causes of symptoms into your fingers and any neurological sensation like numbness, tingling, burning, and pins and needles needs to be thoroughly investigated immediately. Ignoring this could lead to permanent damage and loss of nerve function.

In part 3 we will discuss the role adhesion plays in nerve irritation and creating symptoms into your hand and fingers and how this has likely been missed in your case.

*Please note that every patient is different. The content and tips displayed on this page are for educational purposes only, and do not substitute for medical advice. Please consult with a medical or healthcare provider, such as Dr. Phipps, for specific diagnosis and treatment advice. Williamsville, NY 14221 Chiropractor

Carpal tunnel syndrome occurs when the nerve that travels through the carpal tunnel in your wrist gets compressed and irritated. The picture below is a cross section of your wrist and carpal tunnel.

The nerve that passes through the carpal tunnel is called the median nerve. The signs and symptoms of carpal tunnel syndrome all revolve around the median nerve being compressed and irritated. Therefore, this section should really be called the signs and symptoms of median nerve irritation.

Symptoms

• Tingling, numbness, pin and needles, or altered sensation in your thumb, index and middle fingers along with 1/2 of the ring finger. The median nerve distribution is depicted as the green shaded area in the picture below. Your symptoms can be in all of the distribution (green area) or part of it and the symptoms can be constant or occur only with use.
• Weakness and/or pain with gripping.
• Pain at night, may wake you up.
• Wrist and forearm pain.

Signs

• It is rare to see any visual changes with your hand, except in the advanced stage when the muscles controlling your thumb will get smaller (pictured below). The median nerve supplies these muscles and when it has been compressed for too long they will waste away, get weaker and smaller. You should be properly treated long before this happens.

Unfortunately, the term carpal tunnel is commonly used anytime someone has tingling or symptoms in their fingers. The reality is there are many causes of tingling or symptoms into your fingers making it crucial that you seek medical attention for a proper diagnosis (we will cover who to see in part 3). In part 2, we will cover two of the more common causes of pain that mimic carpal tunnel.

*Please note that every patient is different. The content and tips displayed on this page are for educational purposes only, and do not substitute for medical advice. Please consult with a medical or healthcare provider, such as Dr. Phipps, for specific diagnosis and treatment advice. Williamsville, NY 14221 Chiropractor

Carpal tunnel symptoms can come out of nowhere and become a huge intrusion into your life. Researching a symptom you’re experiencing can be helpful to determine where to start. Then, the next step is receiving a proper diagnosis and treatment. However, this can be difficult with the conflicting information available on the internet. In addition, misdiagnosis of carpal tunnel happens often. So getting a correct diagnosis is key before receiving treatment.

This 4 part series will give you the basics regarding tingling, numbness, and pain traveling into the fingers so that you can receive the proper treatment from the correct doctor.

Set up a consultation with Dr. Phipps to get help today!

*Please note that every patient is different. The content and tips displayed on this page are for educational purposes only, and do not substitute for medical advice. Please consult with a medical or healthcare provider, such as Dr. Phipps, for specific diagnosis and treatment advice. Williamsville, NY 14221 Chiropractor