How to Avoid Foot Surgery

October 11, 2016August 18, 2017 Bare Physical Therapy foot pain, knee pain, Manual Physical Therapy, metatarsalgia, Orthotics, plantar fasciitis, Podiatrist arch support, arch supports colorado springs, custom orthotics colorado springs, foot pain, laramie foot pain, laramie myofascial therapy, laramie physical therapist, laramie physical therapy, laramie podiatrist, matatarsalgia, orthotics, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs, plantar faciitis, stress fractures, stress fractures colorado springs

Elective foot surgery is expensive, debilitating, time consuming, frequently unnecessary, and patients are often worse pain following surgery. Matter of fact, if you find anyone happy with an elective foot surgery you might also want to go ahead and buy yourself a lottery ticket…the odds are about the same. I always say, “there is NOTHING surgery can’t make worse”. That is especially true in elective foot procedures.

Has your surgeon told you that you need surgery for the following?

Neuroma
Bunion
Hammertoe
Plantar fasciitis
or maybe because you had advanced degenerative Osteoarthritis?

Trust me, the surgery will not address the cause of any of the above pathology. If you fuse, remove, dissect, or realign something in the foot without addressing the cause, you are just kicking the can down the road until you need surgery #2, #3, etc.

A brief bio on me to provide credibility on this subject: I became the Army’s expert in lower extremity biomechanics and foot/ankle treatment specialist in 2000 and was honored to hold that position until my retirement in 2013. I’ve attended 120 hours of continuing education in biomechanics and have taught courses all over the country. I have also successfully treated thousands of patients in my career, relieving their pain and in countless circumstances, avoided the above mentioned surgeries.

The BARE NECESSITIES Do’s and Don’ts of foot pain…

The Don’ts

Don’t see a podiatrist. Podiatrists are foot surgeons and they have little knowledge or inclination toward conservative treatment options.
Don’t let anyone inject your foot. Cortisone injections are somewhat effective in treating foot pain, BUT they do NOTHING to address the cause of foot pain. As a result, when the steroid wears off the foot pain often returns worse than before.
Don’t let anyone sell you a hard plastic arch support. Your foot was designed to bend and flex during the stance phase of gait, and it can’t perform correctly with a hard piece of plastic wedged under the arch. These “custom” arch supports are also expensive and rarely covered by health insurance.
Don’t let anyone convince you that you just need to “stretch” more. Typically the most common cause of foot pain is an underlying instability… instabilities get WORSE with stretching even though it can feel a bit better short term.

The Do’s

Do try a change of shoe. Many times replacing a worn out, or poorly fit shoe will be enough to start the healing process. If possible get advice on footware from a reputable shoe dealership (none of the chains) or medical professional with significant foot/shoe experience or training. If you are on your feet a lot (work, home, sports), don’t skimp on your shoes. You don’t need to spend a fortune, but the shoe market is competitive and you do get what you pay for.
Do try a full length off-the-shelf shoe insert that you can usually get in a running shoe store for $40-$70. This is a semi-rigid arch support and will still allow your foot to flex and bend as it’s intended to, but will still provide some support.
Do find a good manual therapist (Massage or Physical Therapist) to break up the adhesions that are likely contributing to the pain in your foot. If your therapist tries pushing “exercise” as the cornerstone of treatment and does no or very little manual therapy, go find a different provider. This condition cannot be fixed with exercise, though exercise can be a component of recovery…the main emphasis should be on manual therapy (not dry needling) to both lower extremities.
If all else fails…Do find a biomechanical specialist to construct a custom biomechanical corrective orthotic (shoe insert) to address the underlying cause of your foot pain. These professionals are few and far between. I noted above how I became a specialist in this field, and here is a link to my website. You will find information on the difference between arch supports and biomechanical orthotics as well as examples of what I would need to conduct an assessment on you (video and other) if you happen to not live close to Colorado Springs.

Lastly, if you happen to find this blog AFTER you already had a surgery (or 4)…there is still hope. Follow these same do’s and don’ts and you will be amazed at your recovery!!

By LTC Tony Bare (ret), DPT, OCS, ATC

Custom Orthotics By Providing Video Gait Analysis

June 1, 2015August 31, 2017 Bare Physical Therapy achilles tendonitis, Arch Support, bunion, foot pain, knee pain, metatarsalgia, Orthotics achillis tendonitis, arch support, arch supports colorado springs, custom orthotics colorado springs, foot pain, hip pain, hip pain colorado springs, iliotibial band syndrome, knee pain, knee pain colorado springs, laramie arch supports, laramie cranial therapy, laramie foot pain, laramie knee pain, laramie manual physical therapy, laramie myofascial release, laramie myofascial therapy, laramie orthotics, laramie physical therapist, laramie physical therapy, laramie podiatrist, matatarsalgia, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs, shin splints

I’ve had a lot of interest in my Bare Necessities Custom Orthotics (arch supports or shoe inserts) from people across the country and I’ve had good success making them based off the information below. If you’ve read my post on the Fallacy of Arch Supports, you know that one of the components of my exam that makes the orthotic successful is the dynamic gait analysis, so if I’m provided the video footage I’ll have great insight into your biomechanics and if they need any help or correction.

The good news is that I’ll assess your videos FREE!! All I need is 10 second clips of you walking barefoot on the treadmill from behind and from each side. Just do your best to walk on the treadmill at your comfortable walking pace. Take video footage of the following angle/level (including both sides/foot):

I’ll need a tracing of your foot next to a ruler. See picture below (it doesn’t have a ruler but you’ll need a ruler next to your tracing). The tracing will let me know what size of orthotic to make and I’ll have an idea what adaptations your biomechanics have forced your foot to make and that will be even more information helping to guide my orthotic prescription.

The orthotics themselves are only an average cost of $85 plus $10 shipping and handling, so send me your videos and get on the road to pain free walking or running.

Now that we are relocating to Laramie, WY please refer your Colorado Springs friends to this post.

Please email me your video and foot tracing to tony@barept.com

LTC Tony Bare (ret), DPT, ATC, OCS
Physical Therapist
Laramie, WY

The Fallacy of Arch Supports

May 9, 2015October 16, 2017 Bare Physical Therapy achilles tendonitis, Arch Support, bunion, Cortizone Injections, foot pain, knee pain, metatarsalgia, Orthotics, plantar fasciitis, Podiatrist, shin splints achillis tendonitis, arch support, arch supports colorado springs, cortizone injections, custom orthotics colorado springs, foot pain, hip pain, hip pain colorado springs, knee pain, matatarsalgia, physical therapist tony bare, physical therapy colorado springs, plantar faciitis, shin splints, stress fractures, stress fractures colorado springs

Have you been told you need foot surgery? Have you been failed by physical therapy? Orthotics (shoe inserts)? Podiatry (cortisone injections)? Have you been told surgery is your last option?

Please let me share three things I’ve learned as a 15 year military expert on foot mechanics, pain and dysfunction:

There is nothing a foot surgery can’t make worse
You can’t “unsurgery”
Foot surgery is like a potato chip….hard to stop at one

Step 1
Why did conventional physical therapy fail you?
You were treated with modalities (ultrasound, heat, electrical therapy), stretching, strengthening and balancing exercises…you may have received massage or myofascial release. You probably did get some relief but never complete and always temporary….why?
NONE of the above treatments addressed the cause of your pain….just the symptoms. Once your cause is addressed all of these treatments become amazingly effective!

Step 2
Next, you receive a cortisone injection. You may have felt great for hours, days or maybe months but gradually your symptoms returned and you were ready for your next injection and the next and the next. There are consequences to a single cortisone injection let alone multiple injections. Please do your research!

Lastly, this injection also fails to address the cause of your foot pain, the reason why your symptoms return eventually.

Step 3
Orthotics (shoe inserts)
these may be included as a part of physical therapy or podiatry treatments. Why have they failed you?

Failure 1: Your assessment

How detailed was your orthotic evaluation? Were your feet glanced at?
Maybe your health care provider watched you walk back and forth across a clinic floor. Maybe you just stepped in a foam box or had your foot casted.

My evaluation includes detailed assessment of your:

Current shoes and any inserts that either came in your shoes or were purchased separately
Static standing posture of your leg/ankle/foot. Static prone posture of your leg/ankle/foot
Dynamic (treadmill) barefoot multi directional gait analysis

Failure 2: Your orthotic construction/development
The most common error? You’ve been fitted with an arch support. Your arch was NEVER designed to be a primary weight-bearing structure. An arch support does very little to correct the mechanics of your foot and that’s what has led to your foot pain, leg pain, knee pain or hip pain. To make matters worse the forced correction into your arch can be so uncomfortable that you won’t even wear them. On the rare occasion that your orthotic has a mechanical correction, it’s often based on a faulty or incomplete assessments. See Failure 1 above.
Lastly, your orthotic has been constructed of a rigid unforgiving plastic shell. This shell does not allow your foot to flex, adapt and function normally and can create another series of issues.

Step 4: Surgery
Don’t go here! Please let me see you first. My assessment is free . If I feel I can help you with orthotics, my average cost is only $85. Please read my testimonials on this website and Facebook.

LTC Tony Bare (ret), DPT, ATC, OCS
Physical Therapist
Laramie, WY

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