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#HURDLEMOMENT: A Podiatrist Answers All Of Your Foot Questions · Hurdle with Emily Abbate

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Speaker 1: Hey, everybody, Emily a body here. You are listening to Hurdle,
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Speaker 1: a wellness focused podcast. Reconnect with everyone from your favorite
0:21
Speaker 1: athletes to top experts and industry CEOs about their highest hies,
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Speaker 1: toughest moments, and everything in between. We all go through
0:30
Speaker 1: hurdles in life, and my goal through these discussions is
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Speaker 1: to empower you to better navigate yours and move with
0:36
Speaker 1: intention so that you can stride towards your own big
0:39
Speaker 1: potential and of course have some fun along the way. Today,
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Speaker 1: I am so elated to bring you my conversation with
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Speaker 1: doctor Emily Splickel. She's a New York City paediatrist, a
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Speaker 1: human movement specialist, and CEO of Noboso, a come that
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Speaker 1: makes all good things for your feet, including insoles and toastspacers, socks,
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Speaker 1: foot where you name it.
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Speaker 2: We are talking today about all things feet.
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Speaker 1: I know, sexy topic, but honestly, the second I mentioned
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Speaker 1: on social media that I was navigating a little bit.
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Speaker 2: Of planter fasciitis.
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Speaker 1: I also talked about it in an episode here on Hurdle.
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Speaker 1: My messages, my emails, your questions went wild. So clearly
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Speaker 1: feet are a hot topic and that's why I have
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Speaker 1: doctor Emily Spleckelk here on the show. Today, we are
1:39
Speaker 1: talking about all of your hot foot questions. I like
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Speaker 1: dying thinking about like this wording. It makes me laugh
1:47
Speaker 1: from goodness. What to do about plant fasciitis and how
1:50
Speaker 1: to treat it and maybe even prevent it. Plus we
1:53
Speaker 1: wrap about achilles pain, stress, fractures, bruise toenails, and a
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Speaker 1: bunch of.
1:58
Speaker 2: Other good stuff.
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Speaker 1: If you have more foot questions that aren't answered in
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Speaker 1: today's episode, hit me with a listener question by clicking
2:06
Speaker 1: on over to the show notes and get an answered
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Speaker 1: in an upcoming.
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Speaker 2: Episode of Five Minute Friday.
2:13
Speaker 1: Make sure you're following along with the show over on
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Speaker 1: the socials.
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Speaker 2: This is at Hurdle podcast.
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Speaker 1: I am over at Emily a body And if you
2:20
Speaker 1: are not yet subscribed to the weekly Hurdle newsletter, I'd
2:24
Speaker 1: love to be in your inbox every single Friday. The
2:27
Speaker 1: link to subscribe, which is absolutely free, is in the
2:31
Speaker 1: show notes as well. And with that, let's get to hurdling.
2:44
Speaker 2: Today.
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Speaker 1: I am sitting down with doctor Emily Splickele. She is
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Speaker 1: a functional podiatrist. How are you doing today?
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Speaker 3: Doing awesome? Thanks for having me on.
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Speaker 2: So happy to have you here.
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Speaker 1: I feel like the fact that there's a word in
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Speaker 1: front of a podiatrists is probably something that we should
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Speaker 1: address right from the get go.
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Speaker 2: So what does it mean to be a functional podiatrist?
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Speaker 3: A functional pedietrist, almost like a functional medicine doctor, right,
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Speaker 3: is looking at the body from a very integrated, holistic perspective,
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Speaker 3: which is what I do. I'm looking at functional movement,
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Speaker 3: which is part of it. So the way that we walk,
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Speaker 3: the way that we move our repetitive patterns every day.
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Speaker 3: But then because of the type of patient that I treat,
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Speaker 3: I am factoring in stress levels, diet, sleep patterns, gut
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Speaker 3: biomes a lot of the stuff that a functional medicine
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Speaker 3: doctor would as well.
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Speaker 1: It's so interesting, right because when we think of the
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Speaker 1: feet clearly not directly next to the stomach, but you
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Speaker 1: say something like we think about the gut and there
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Speaker 1: is a correlation between even that, right, It's probably something
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Speaker 1: that a lot of your patients come in and they're like,
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Speaker 1: what do you mean my gut has something to do
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Speaker 1: with how my feet feel.
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Speaker 3: I feel like gut health really became a little bit
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Speaker 3: more in the known because of COVID. I don't know,
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Speaker 3: maybe in my world, it has because COVID really showed
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Speaker 3: like inflammation like this is what inflammation does. COVID can
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Speaker 3: destroy your gut and put a lot of inflammation in
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Speaker 3: the gut itself, and then that can cause a lot
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Speaker 3: of these obscure symptoms that people would start to connect to,
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Speaker 3: from brain fog to buzzing in the nerves. I've actually
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Speaker 3: seen quite a few patients with COVID who would get
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Speaker 3: buzzing and vibrating in the nerves in their feet, and
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Speaker 3: it's all inflammatory based.
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Speaker 1: This is some important information to know, only the beginning
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Speaker 1: of what we're going to dive into today. So before
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Speaker 1: I start asking you the hard hitting feet questions, why
4:40
Speaker 1: don't you give us a little bit of background into
4:43
Speaker 1: how you began practicing.
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Speaker 2: I know, not all that long ago.
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Speaker 1: You moved from New York to Arizona, So give us
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Speaker 1: a little bit of your backstory.
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Speaker 3: Yeah, lived in New York City for twenty years, absolutely,
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Speaker 3: love love love the city. Started there actually with the
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Speaker 3: background in forensics at John Jay College of Criminal just
5:00
Speaker 3: so completely not related defeat, and then took a break
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Speaker 3: from that and actually became a personal trainer. So I've
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Speaker 3: been in the fitness industry for over twenty years, and
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Speaker 3: during my time in fitness, I reconnected to my love
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Speaker 3: for movement. I was a competitive gymnast for thirteen years,
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Speaker 3: so that is at my core of movement and barefoot
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Speaker 3: movement is being a gymnast. So then when I was
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Speaker 3: going through or being a personal trainer fitness, I wanted
5:28
Speaker 3: a more advanced degree, so I started looking at graduate
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Speaker 3: school medical schools fell into pedietary kind of by chance.
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Speaker 3: There's a pedietary school in New York City in Harlem,
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Speaker 3: and that is where I went to school. When I
5:41
Speaker 3: was going through pedietary school, it was so isolated and
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Speaker 3: disconnected from the rest of the body, and I was
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Speaker 3: still being a personal trainer in teaching classes and I
5:50
Speaker 3: was like, wait, there's something that's missing here. So before
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Speaker 3: I completed my residency, I actually went back to school
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Speaker 3: and got my master in Human Movement, and that helped
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Speaker 3: me to connect what I was appreciating and intuitively connecting
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Speaker 3: with fitness and movement to pedietry. Feet became this master's
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Speaker 3: in human movement, and then it just further evolved just
6:16
Speaker 3: off of my own curiosity for breathwork, polyvagel theory, emotion, stress,
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Speaker 3: fascia nervous system, and it just kind of snowballed from
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Speaker 3: there into what I do now.
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Speaker 1: Well, you mentioned a buzzword, fascia, and that is the
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Speaker 1: first thing that I want to talk about with you
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Speaker 1: here today, specifically planter fasci itis. I am dealing with
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Speaker 1: it right now, although I'll knock on every piece of
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Speaker 1: wood that is near me as you and I speak, I.
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Speaker 2: Feel as though I'm coming out of it.
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Speaker 1: But it is I am sure you get it all
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Speaker 1: the time, the biggest pain point for so many So
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Speaker 1: why don't we start with what could be? And I
6:58
Speaker 1: know they are endless, but some of the pauses of
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Speaker 1: experiencing plant fasci itis, and if you will kind of
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Speaker 1: break down exactly what that actually means is going on.
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Speaker 3: Yeah, So, plantifasciitis is irritation or microtearing to the planter
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Speaker 3: fascia on the bottom of the foot. And what the
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Speaker 3: plant of fascia is just quick anatomy lesson. It's the
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Speaker 3: thick band of connective tissue that runs from the heel
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Speaker 3: and it splits into five slips that goes into the
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Speaker 3: base of each toe. So your plant fashi extends the
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Speaker 3: entire foot and can be influenced by the digits, which
7:32
Speaker 3: is important when I go into certain recommendations. Your plant
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Speaker 3: fascia is a rubber band and it is part of
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Speaker 3: how we transfer energy. So if you are running, jumping, walking,
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Speaker 3: whatever it is you're doing, you have to be able
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Speaker 3: to load and unload energy to obviously move and move efficiently. Now,
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Speaker 3: depending on your baseline elasticity or this rubber band effect,
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Speaker 3: you may overload or not have the stretch that is
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Speaker 3: required for the activity you're doing, so then you start
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Speaker 3: to micro tear it, and then that microtearing just creates
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Speaker 3: a pain cycle. We won't go into is it inflammation
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Speaker 3: or not. What's going to is this pain cycle that
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Speaker 3: is triggering and talking to the patient or the individual
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Speaker 3: as a sharp pain especially after a period of rest,
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Speaker 3: and I don't know if you experienced this, but it'll
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Speaker 3: be first step in the morning as very classic plant
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Speaker 3: refetcy ideas, or you've been sitting a while and then
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Speaker 3: you get up and you walk across the room and
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Speaker 3: you have that sharp stabbing pain in your heel. Again,
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Speaker 3: why that happens is because irritated tissue is sticky, so
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Speaker 3: it kind of gets stuck down and then you go
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Speaker 3: to stand up and you're like and you kind of
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Speaker 3: rapidly restretch it again, and then that causes this sharp pain. Now,
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Speaker 3: some of the most common causes that I see in
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Speaker 3: my office is a delayed stabilization of the foot is
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Speaker 3: one of the most common. Now that could be from
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Speaker 3: foot type, so flat feet, and there's many types of
9:07
Speaker 3: flat feet, so we'll just keep it broad for now,
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Speaker 3: but flat feet cause a slower foot, so you are
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Speaker 3: not stabilizing as quickly foot wear can do it, meaning
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Speaker 3: that if you wear overly supportive shoes all the time
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Speaker 3: and you suddenly overload the foot, and you're so used
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Speaker 3: to the shoe doing the work versus your foot, you
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Speaker 3: can overload it. Or if you always wear cushion shoes
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Speaker 3: and you suddenly be into more of like a barefoot
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Speaker 3: or a minimal environment, you're going to overload the foot.
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Speaker 3: So sometimes people would associate this with their rapid transition
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Speaker 3: into bare foot shoes or minimal shoes, and they blame
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Speaker 3: the shoe. It's not the shoe, it was the transition
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Speaker 3: that they did. And then sometimes it can be from
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Speaker 3: very stiff, rigid feet, like really high archies or susceptible
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Speaker 3: to plantifaestiatis as well, and then some of it could
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Speaker 3: just be activity dependent. I used to see it a
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Speaker 3: lot and say like crossfitters doing box jumps and they
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Speaker 3: just didn't have the recovery or the balance between stress
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Speaker 3: and recovery to the tissue and eventually it broke down.
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Speaker 2: Yeah.
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Speaker 1: Yeah, so so many causes. Clearly here, it's not like
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Speaker 1: a one size all like, oh, you have planter fasciais
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Speaker 1: this is what you have to do to fix it.
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Speaker 1: I know in my case, I am realizing that I
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Speaker 1: haven't been actually using my toes much in my stride
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Speaker 1: and so because I am relying on the rest of
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Speaker 1: my feet to do the work, that is where the
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Speaker 1: pain kind of started from. And now a big part
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Speaker 1: of my physical therapy is literally just getting onto my
10:43
Speaker 1: toes more like learning how to incorporate them into a
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Speaker 1: lot more of my movements and stuff like that.
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Speaker 3: So that's why it's important that I said that your
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Speaker 3: planet fascion goes all the way to your toes, So
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Speaker 3: you need to use your toes, strengthen your toes, engage them.
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Speaker 3: They're part of the party as well, right, and if
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Speaker 3: we don't use them, then things like this can happen totally.
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Speaker 1: And I know that there are a lot of individuals
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Speaker 1: who ask a question like, well, how do I use
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Speaker 1: my toes? How do I warm up my toes? Do
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Speaker 1: you have any thoughts, feelings, opinions on that.
11:15
Speaker 2: The action of.
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Speaker 3: The toes is that they are designed to be long, straight, flat,
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Speaker 3: and in contact with the ground, So that's that's the
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Speaker 3: ideal digit alignment is and spread right, so long, straight, flat,
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Speaker 3: spread and engaging. The engaging, which is called toe flex
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Speaker 3: or strength, is really a key foundational functional action of
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Speaker 3: the foot, and you can strengthen it by just pushing
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Speaker 3: your toes into the floor, which is called short foot.
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Speaker 3: And when you push your toes into the floor, what
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Speaker 3: you should see or feel is that your arch kind
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Speaker 3: of starts to lift or contract. There's a response that
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Speaker 3: happens from toe constractures, which is this lifting of the arch.
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Speaker 3: The way that I teach it to be more functional
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Speaker 3: is that when you push your toes down, I need
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Speaker 3: your pulvic floor to lift, because that's the way that
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Speaker 3: it actually works when we are moving in the real world.
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Speaker 3: And technically I would want to add in the diaphragm
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Speaker 3: as well, so you would want to be exhandling as
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Speaker 3: you push your toes down as your public floor lifts,
12:28
Speaker 3: so you're stacking those three things.
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Speaker 1: I'm literally sitting here like doing it as you're talking
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Speaker 1: to me, practicing.
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Speaker 2: All of this movement simultaneously. Okay.
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Speaker 1: So for those that have chronic planter fasci itis, maybe
12:44
Speaker 1: it's someone who feels as though they cannot remember the
12:47
Speaker 1: last time they didn't have pain in their planter fascia
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Speaker 1: is their hope for them?
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Speaker 2: What do you tell them?
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Speaker 3: This is actually a lot of what I see in
12:57
Speaker 3: my practice, and especially when I was in New York City,
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Speaker 3: it was almost every single one of my patients were chronic,
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Speaker 3: non responding plant or fasciosis let's call it. So it's chronic,
13:05
Speaker 3: it's degenerated in nature, and they were doing what doctor
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Speaker 3: Google told them to do, or what their friend told
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Speaker 3: them to do, or maybe some other peddietist, whoever it was,
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Speaker 3: and they were really treating it actually more as an
13:19
Speaker 3: acute condition, and an acute condition responds to plant or
13:25
Speaker 3: fasciitis treatments differently than chronic. Chronic plant fascial stress is
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Speaker 3: when you've either had your symptoms for longer than six months,
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Speaker 3: so consistently for six months, or you get this waxing
13:40
Speaker 3: and waning that it'll kind of spike and that'll be
13:42
Speaker 3: there for a month and it'll go quiescent and that'll
13:45
Speaker 3: come back a couple months later. And there's patients that
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Speaker 3: I could have that for years, like ten years, that
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Speaker 3: it's persisting like this waxing and waning. What I want
13:54
Speaker 3: to do in those patients is rule out any sort
13:57
Speaker 3: of thickening, degeneration, and even a partial tear of the
14:02
Speaker 3: plant or fascion. And it's very common in chronic cases
14:06
Speaker 3: to have tearing of the plant or fascia. And when
14:10
Speaker 3: your plant or fascia tears, it actually phrase. So the
14:14
Speaker 3: listeners could almost like visualize like a rope that's like
14:18
Speaker 3: torn or frayed at the ends and it's kind of
14:20
Speaker 3: chaotically sitting there and then the pieces sit next to
14:24
Speaker 3: each other and then kind of get readheed to this phray.
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Speaker 3: It's like a messy, disorganized haystack, if you want to
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Speaker 3: think of it. So we need to bring organization to
14:34
Speaker 3: that tissue. In my office, I do regenitive injections, so
14:37
Speaker 3: either PRP, different growth factors. There's amniotic and placental injections.
14:42
Speaker 3: The FDA is getting kind of weird with some of them,
14:44
Speaker 3: so there's only certain ones on the markets now. But
14:48
Speaker 3: that's what I specialize in in my practice. I did
14:52
Speaker 3: surgery for five years out of residency, and that's where
14:56
Speaker 3: people would do a fasciotomy and they would just cut
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Speaker 3: and release fascia and then just move the pieces far
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Speaker 3: apart from each other and say like, Okay, you're not
15:05
Speaker 3: going to have any symptoms if it's just like not
15:07
Speaker 3: even connected. Very successful these fasciotomies. However, there is a
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Speaker 3: research that shows if your plant or fascia is cut
15:17
Speaker 3: the digit stabilization and your forefoot, you actually start to
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Speaker 3: get a delay and a disconnection in how that part
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Speaker 3: of the foot optimizes or stabilizes. So I opt more
15:31
Speaker 3: for a regeneritive technique.
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Speaker 2: Okay, so there is hope, is basically what you're saying.
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Speaker 3: There is hope, but you need to make sure you
15:38
Speaker 3: understand what you're dealing with. And I just wrote a
15:40
Speaker 3: blog on this and did an IG post of that.
15:43
Speaker 3: You really have to understand because if you're being treated
15:46
Speaker 3: like you have acute plant or fasciitis, you're not going
15:50
Speaker 3: to respond or you might respond for a week, and
15:53
Speaker 3: then as soon as it you stress it again, it's
15:56
Speaker 3: going to come back. So having an accurate diagnosis and
15:59
Speaker 3: an understand is super important, and that's part of why
16:03
Speaker 3: I do podcasts like this, is to advocate that patients
16:07
Speaker 3: understand and take ownership of their body and question things
16:10
Speaker 3: and say, no, I don't think this is right. I
16:12
Speaker 3: think I might actually have maybe a tear.
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Speaker 1: Please investigate, right, investigate, So make sure you speak one
16:19
Speaker 1: on one with an expert. The advocating is great, but
16:23
Speaker 1: then it is in the power of the powerful hands
16:26
Speaker 1: of the listener to take this information and do something
16:30
Speaker 1: with it and advocate for themselves.
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Speaker 2: Exactly perfect.
16:33
Speaker 1: Okay, let's switch gears a little bit and talk about toenails. Wow,
16:39
Speaker 1: love all of these topics for us bruise toenails.
16:42
Speaker 2: I'm a runner. I'm sure you meet with a lot
16:44
Speaker 2: of runners.
16:45
Speaker 1: Obviously, tonail bruising not exclusive to the running community, but
16:48
Speaker 1: seen very frequently. For someone who has a bruised toenail
16:52
Speaker 1: or toenail pain, how do they go about doing something
16:56
Speaker 1: about that or should they just be leaving it completely alone.
17:01
Speaker 3: I do not advocate bathroom surgery, so whatever I recommend
17:06
Speaker 3: I didn't tell you to do it. So any of
17:10
Speaker 3: these the blood under the nail. So you're running, and
17:14
Speaker 3: what happens this is primarily to the second. You can
17:17
Speaker 3: see it in the first, especially with like the marathons.
17:20
Speaker 3: I would see a ton of patients getting it into
17:22
Speaker 3: the great toe as well, but primarily the second, because
17:25
Speaker 3: the second is longer on many people. So you're jamming
17:29
Speaker 3: into the shoe when you run, and then you're essentially
17:32
Speaker 3: not bruising it. You're creating a micro injury that bleeds
17:36
Speaker 3: underneath the mail, underneath the nail, So the blood stuck
17:40
Speaker 3: under the nail. It's called a subungle hematoma. It's your
17:44
Speaker 3: medical term for it. And it can be very painful
17:47
Speaker 3: because it is pressure. So this pressure of the blood
17:51
Speaker 3: under the nail is just extremely kind of pressure increasing.
17:57
Speaker 3: It's in a fixed space. So what you want to
18:00
Speaker 3: do is you have to relieve the pressure. Is ultimately
18:03
Speaker 3: what you're trying to do in an acute setting. Right,
18:06
Speaker 3: So what I would do again, this is not your
18:08
Speaker 3: bathroom surgery, but I would use a sterile instrument and
18:12
Speaker 3: I would poke poles in the nail to allow it
18:15
Speaker 3: to bleed through. Now, when you do that, Almost all
18:19
Speaker 3: patients notice in an immediate decrease in the pain because
18:22
Speaker 3: I relieve the pressure, the blood comes out. And then
18:26
Speaker 3: this is the important part because if this is happening
18:28
Speaker 3: a lot to your listeners, trauma is the number one
18:34
Speaker 3: trigger to fungal nails because now you have this opening
18:39
Speaker 3: and fungal infections in the nail are in and under
18:42
Speaker 3: the nail bed. So trauma, you want to be really
18:45
Speaker 3: careful and watch the nail and how it grows out.
18:48
Speaker 3: If there's too much blood under the nail, you disconnect
18:53
Speaker 3: all the fibers that are connecting the nail to the
18:55
Speaker 3: nail bed, and you could actually lose the nail. If
18:58
Speaker 3: you do lose the nail, then I do advise seeing
19:02
Speaker 3: a pediatrist. I know it might seem really small or
19:05
Speaker 3: like a small issue, but to make sure the nail
19:07
Speaker 3: grows out appropriately and in a way that you're not
19:12
Speaker 3: going to get fungus. So I would actually give patients
19:15
Speaker 3: a topical anti fungal laquer as the nail is growing out,
19:19
Speaker 3: because I do not want fungus at any point to
19:21
Speaker 3: get under that nail bed.
19:24
Speaker 1: So hypothetically speaking, if someone you were speaking to right
19:28
Speaker 1: now had lost their pinky toenail somehow and had no
19:32
Speaker 1: idea how it happened. Is it bad to get a
19:35
Speaker 1: pedicure and have them paint the pinky as though there
19:38
Speaker 1: was a nail there?
19:40
Speaker 3: No, that's totally fine. You know, the pinky nail of
19:44
Speaker 3: all of the nails is the one that you will
19:47
Speaker 3: probably get some hypercha fy to it, so some thickening,
19:51
Speaker 3: and the thicking doesn't necessarily mean that there's fungus in it,
19:54
Speaker 3: But a lot of people's pinky toenails just look random.
19:59
Speaker 3: They're super small. You cut them off, there's like no
20:02
Speaker 3: nail there then, so it's just kind of this interesting
20:05
Speaker 3: vestigial nail. So yeah, I don't know. If this is you,
20:11
Speaker 3: you can.
20:11
Speaker 2: Paint spoiler alert, it's me.
20:14
Speaker 3: You can totally paint it.
20:16
Speaker 1: Okay, good, I feel more confident knowing that I literally
20:19
Speaker 1: did this about an hour and a half ago. So
20:21
Speaker 1: for those that are wondering, But what about the bigger tonails, Like,
20:24
Speaker 1: is that something that you shouldn't be doing if you've
20:26
Speaker 1: lost maybe did you refer to it as the great
20:29
Speaker 1: toe before?
20:30
Speaker 3: This is the great toe?
20:31
Speaker 1: Yes? Okay, if you lose the great toe, the biggest
20:34
Speaker 1: toe you got is it bad to paint that?
20:37
Speaker 3: Honestly, I wouldn't. One is just going to look like crazy,
20:43
Speaker 3: it's not going to look the same. But there are
20:46
Speaker 3: these medical products that you can It's essentially acrylic, but
20:52
Speaker 3: a medical acrylic and it goes on like a nail
20:56
Speaker 3: and it is intended to guide the way that the
20:59
Speaker 3: nail is growing out that you can paint. And I
21:01
Speaker 3: would not do this from a nail spa on the corner.
21:06
Speaker 3: I would go to a pediatrist to do it more medically,
21:09
Speaker 3: and then yes, you could paint that and you would
21:11
Speaker 3: essentially follow that as the nail grows out and it
21:15
Speaker 3: takes year. Here's a fun fact. It takes a year
21:17
Speaker 3: for a nail to grow out. Your toenails to grow out.
21:20
Speaker 3: But the pinky guy is a little less.
21:22
Speaker 1: Another question that came in does the drop of a
21:26
Speaker 1: shoe matter? I know this is a yes, but let's
21:29
Speaker 1: talk a little bit about what someone may need to
21:31
Speaker 1: know about shoe when it comes to either stack height
21:35
Speaker 1: or drop.
21:36
Speaker 3: Yeah, so, keel toe drop is really what this this
21:39
Speaker 3: listener is referencing. The heel toe drop is the angle
21:42
Speaker 3: between the heels of the toe. Right, So how much
21:45
Speaker 3: there is this declination, how much of a you know,
21:51
Speaker 3: think like high heels, right, so how much are you
21:53
Speaker 3: pushing the foot into what's mimicking like a heeled position
21:57
Speaker 3: or a plant or flexion of the ankle. Now, the drop,
22:03
Speaker 3: why that was initially put into shoes running shoes, was
22:07
Speaker 3: to offload the achilles tendon. It's just putting it on
22:11
Speaker 3: a little less tension and to pull the foot into
22:16
Speaker 3: more of a neutral position. So it also offloads the planter,
22:19
Speaker 3: fascia and other structures of the foot. Now that is
22:23
Speaker 3: in certain foot types. Not all foot types will respond
22:29
Speaker 3: the same to a heel toe drop because they start
22:34
Speaker 3: on a flat ground, beautifully neutral or maybe even higher
22:39
Speaker 3: arch and rigid. So you don't want to be pushing
22:42
Speaker 3: those feet into a more rigid, plan reflex supinated position.
22:48
Speaker 3: Let's say, So this is where I try to put
22:51
Speaker 3: as many people into a transitional drop, which is between
22:56
Speaker 3: eight and ten millimeters. A traditional drop for the listeners
23:00
Speaker 3: is between fourteen and sixteen millimeters, So it's it's not
23:04
Speaker 3: that much. It's not like five inches, right, but it's
23:07
Speaker 3: enough to overload the tissue in certain ways. Transitional eight
23:12
Speaker 3: to ten millimeters zero drop, which is kind of like
23:15
Speaker 3: these quote unquote barefoot shoes that are out there is
23:19
Speaker 3: zero to three millimeters. I'll give a couple brands of
23:23
Speaker 3: different ones. Vivo Barefoot is probably the most well known
23:27
Speaker 3: zero drop zero shoes, kind of like the name, but
23:31
Speaker 3: it's spelled different with an X. Is another zero drop
23:34
Speaker 3: shoe that's on the market. More that transitional is going
23:38
Speaker 3: to be like on running ultra falls under transitional, and
23:43
Speaker 3: then like your new balanced sockeny all of those are traditional.
23:48
Speaker 3: Now stack is different. Stack is not the same as
23:52
Speaker 3: a heel toe drop, even though heel toe drop shoes
23:55
Speaker 3: have a stack under them. But the stack is how
23:58
Speaker 3: much cushion and elevation is the entire shoe lifted off
24:03
Speaker 3: of the ground. The higher the stack, the more removed
24:09
Speaker 3: you are from all of the sensory information from the
24:12
Speaker 3: ground that you need to move. So I am for
24:16
Speaker 3: the most part anti stack, because I want people to
24:20
Speaker 3: connect to the ground from a sensory perspective. The shoe
24:25
Speaker 3: that all the listeners know that push stack to be
24:28
Speaker 3: super trendy is Poka, and they started as a ultra
24:33
Speaker 3: marathon shoe. So there was a reason for all that
24:36
Speaker 3: stack and that cushion because you were defined physiology by
24:41
Speaker 3: running ultra marathons, right, So it was like, hey, let
24:45
Speaker 3: me just take some of that impact from you by
24:48
Speaker 3: giving you this stack or this cushion. Now it's super trendy.
24:52
Speaker 3: All the shoes are stacked. It's a trend now, but
24:56
Speaker 3: I would ideally want someone with as little stack as
24:59
Speaker 3: possible to optimize natural foot function.
25:08
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28:28
Speaker 2: Knowe what's going on with your body? Trust me, it
28:30
Speaker 2: is the kind of knowledge that we all need.
28:38
Speaker 1: So aside from the hookahs, a lot of individuals listening
28:42
Speaker 1: to this may lean into a high stack Heit shoe
28:45
Speaker 1: for something like racing. Those shoes as well, many of
28:49
Speaker 1: them including a carbon plate. What should someone know about
28:53
Speaker 1: integrating carbon plated shoes into the routine if they want
28:57
Speaker 1: to keep the betterment of their foot health in mind.
29:01
Speaker 3: Yeah. So carbon plates are a well known orthopedic cadorthic
29:07
Speaker 3: kind of within this medical foot space material that was
29:13
Speaker 3: used to transfer energy. When you take something that is
29:18
Speaker 3: medical and get twist it to be consumer based, you
29:24
Speaker 3: now don't know the quality of the carbon that you're getting.
29:28
Speaker 3: So the you know, miracle responses of what we think
29:33
Speaker 3: of any sort of ad just take it with the
29:36
Speaker 3: grain of salt. Because it has to do with the
29:39
Speaker 3: stiffness and the thickness of the carbon fiber that's being used.
29:44
Speaker 3: So it's not going to make you win the race
29:46
Speaker 3: guarantee because of the shoe, is what I'm trying to say. Now,
29:49
Speaker 3: carbon fiber is stiff, So this is one thing that
29:53
Speaker 3: is an advantage of carbon fiber is that it is
29:57
Speaker 3: going to be harder and stiffer, harder. Different interfaces with
30:01
Speaker 3: the foot are more neurologically stimulating. So if you have
30:07
Speaker 3: a shoe with the stack with the cushion that is
30:09
Speaker 3: not really sensory friendly, but you put a carbon fiber
30:13
Speaker 3: interface on it, now you've put stiffness back into the interface,
30:18
Speaker 3: which just upped some of the sensation to the foot.
30:21
Speaker 3: So I actually would favor that environment more. I would
30:26
Speaker 3: just again say like, is this shoe gonna make me
30:29
Speaker 3: you know, super Emily?
30:32
Speaker 2: I don't know.
30:32
Speaker 3: I doubt it.
30:33
Speaker 2: But it's just.
30:35
Speaker 3: Another trend that everyone is using carbon fiber right now
30:38
Speaker 3: within the footwork space.
30:41
Speaker 1: For someone that is navigating clanter fasciitis, and they may
30:46
Speaker 1: be thinking about alternative treatments aside from talking with a
30:49
Speaker 1: physical therapist or a diadris and getting an actionable like
30:53
Speaker 1: exercise plan. Can that person be considering something like ibuprofen
31:00
Speaker 1: or ice rolling or what else would you recommend to
31:02
Speaker 1: them when it comes to managing that pain.
31:06
Speaker 3: So pain associated with an acute itis here we'll talk
31:10
Speaker 3: about plantifreesci itis. Yes, you could do icine. There is
31:15
Speaker 3: some controversy around icing. Does it work, does it not
31:18
Speaker 3: work in the acute setting? And just across the board.
31:23
Speaker 3: What ice does is it vasoconstricts, which means it's just
31:26
Speaker 3: narrowing your blood vessels. If you do that in acute
31:30
Speaker 3: setting you sprain your ankle boom, put ice on it
31:34
Speaker 3: right away. It's going to limit the swelling because it
31:37
Speaker 3: just constricted the blood vessels that dilated as a response
31:40
Speaker 3: to the injury, right, So that's the strategy behind it. Similarly,
31:46
Speaker 3: or in addition to this vaso constriction with the itises
31:49
Speaker 3: is that it has a numbing effect, so it is
31:52
Speaker 3: actually just numbing the area so you do not perceive
31:56
Speaker 3: the pain. Does that give you a little like time
31:59
Speaker 3: out from the sensation? Sure, and that's great. Now does
32:03
Speaker 3: it accelerate the healing process? That's where some of the
32:05
Speaker 3: research is like a little back and forth on it.
32:08
Speaker 3: But I think from a roll in the healing process,
32:13
Speaker 3: it is something that you could do, I like rolling
32:16
Speaker 3: the foot on a frozen water bottle, because you're getting
32:19
Speaker 3: then the foot massage that I want you to do anyway,
32:23
Speaker 3: and if you're going to do it on ice, then okay,
32:25
Speaker 3: we're numbing the area, we're getting some bvaso constriction. There's
32:28
Speaker 3: we're killing two birds with one stone or checking more boxes.
32:31
Speaker 3: In addition to that, you can do oral anti inflammatories. Again,
32:35
Speaker 3: this is where knowing do you have a cute or
32:37
Speaker 3: chronic so chronic plant or fasciosis, right, not going to
32:42
Speaker 3: respond to this stuff the same that acute setting. You
32:46
Speaker 3: will respond like a majority of textbook patients to what
32:50
Speaker 3: we're talking about right now, could you take oral anti inflammatories? Yes,
32:55
Speaker 3: this is my advice on it. Successful oral anti inflammatories
32:59
Speaker 3: for let's say a cute nifaestiitis is that it has
33:01
Speaker 3: to be taken every single day exactly is prescribed. You
33:04
Speaker 3: can't take it when you feel pain and then tomorrow
33:07
Speaker 3: you feel like, wow, it's actually not that bad, So
33:09
Speaker 3: I'm not going to take it. It's not the point
33:10
Speaker 3: of the medication. It's not a pain killer. It is
33:14
Speaker 3: trying to modulate the inflammatory process that is happening. So
33:19
Speaker 3: I would always put my patients on mobik, which is
33:22
Speaker 3: a one pill, once a day medication. So it's just like, hey,
33:26
Speaker 3: you wake up, take it. Just do this for two weeks,
33:29
Speaker 3: not something high compliancy, easy to take. I do speak
33:34
Speaker 3: about systemic enzymes a lot in my practice as well,
33:38
Speaker 3: and they are a supplement that naturally modifies the body's
33:43
Speaker 3: inflammatory process. So that could be if any of the
33:46
Speaker 3: listeners are saying, I don't like medication, what are some
33:49
Speaker 3: supplements that I could take more in a natural way,
33:53
Speaker 3: then I say systemic enzymes. Bromlin is in some of
33:57
Speaker 3: the systemic enzymes. Megas are naturally anti inflammatory. Rezveritol so
34:03
Speaker 3: there's a lot of naturally anti inflammatory supplements that are
34:08
Speaker 3: out there as well.
34:10
Speaker 1: Great and something else that we haven't touched on just yet.
34:14
Speaker 1: We did talk about the carbon fiber plates, but we
34:17
Speaker 1: haven't chatted about insuls. How do you know if you're
34:21
Speaker 1: someone that could benefit from an insult.
34:24
Speaker 3: Yeah, insul to the listeners is probably having them think
34:29
Speaker 3: art support. Right, If I need an insul, that means
34:32
Speaker 3: you're essentially saying I need an art support. Now, that's
34:35
Speaker 3: what ninety nine percent of the insuls on the market
34:38
Speaker 3: are are art support based. Now, at Naboso, we develop
34:43
Speaker 3: a sensory insult, so it's totally flat, has texture across it,
34:48
Speaker 3: and it is functioning different. So I want to first
34:52
Speaker 3: reference the art support insults. Now, part of my acute
34:57
Speaker 3: plant or fascial treatment or foot stress treatment is to
35:02
Speaker 3: offload the foot and the tissue. So that's going to say, Okay,
35:05
Speaker 3: I need to just support you.
35:07
Speaker 2: A little bit.
35:08
Speaker 3: I'm going to put you in like a little bubble
35:10
Speaker 3: for a period of time to make sure that the
35:12
Speaker 3: tissue can heal itself and that we don't overload the
35:15
Speaker 3: system more than we already have. That's where I would
35:18
Speaker 3: actually look at art supports, and that is where I
35:22
Speaker 3: would also look at foot type. So if you have
35:25
Speaker 3: a flatter foot and you have a cute plant of
35:28
Speaker 3: fesci itis, I need to give you a timeout, and
35:31
Speaker 3: that timeout is going to be with an art support.
35:34
Speaker 3: Doesn't need to be a five hundred dollars orthotic because
35:37
Speaker 3: this is temporary. I'm just trying to put the fire out.
35:41
Speaker 3: So for that I often recommend power Step. There are
35:45
Speaker 3: many over the counter art supports or insuls out there,
35:49
Speaker 3: not all of them are created equal, so just know
35:53
Speaker 3: you get what you pay for. So I recommend power Step.
35:56
Speaker 3: It's the one that I get the best response with
35:59
Speaker 3: patients and the best positive feedback from the patients from
36:04
Speaker 3: the sensory insult side, which is what we have at
36:06
Speaker 3: Niboso is an insul that is designed to actually strengthen
36:10
Speaker 3: your feet. So that's where I would incorporate that. Once
36:14
Speaker 3: we put the fire out and we now want to
36:17
Speaker 3: strengthen your foot so that plantifaesciitis or foot stress doesn't
36:21
Speaker 3: come back, we need to strengthen your foot, and could
36:24
Speaker 3: we do that with a sensory insult such as Noboso.
36:28
Speaker 2: This is also helpful.
36:29
Speaker 1: So one other topic that we should touch on something
36:33
Speaker 1: that I know is frequent with people, whether they are
36:36
Speaker 1: active or not super active, is fractures. Foot fractures happen
36:40
Speaker 1: all the time, whether it happens during movement, whether it
36:44
Speaker 1: happens or when you're literally.
36:45
Speaker 2: Kicking something in your home.
36:47
Speaker 1: When it comes to getting back to quote unquote normal activity,
36:51
Speaker 1: is there a quote unquote typical amount of time that
36:54
Speaker 1: you should be resting if you happen to get a
36:57
Speaker 1: stress fracture in your foot.
37:00
Speaker 3: Yeah, So a stress fracture is the healing process, and
37:06
Speaker 3: then the return to activity after a stress fracture is
37:10
Speaker 3: dependent on the severity is the stress fracture in the
37:13
Speaker 3: first place. So the most sub acute stress fracture out
37:18
Speaker 3: there can take as quick as two weeks to heal,
37:21
Speaker 3: and I would have them immobilized for two weeks and
37:25
Speaker 3: then I would do a gradual return to stress to
37:28
Speaker 3: the foot, probably over four weeks. So we wouldn't want
37:32
Speaker 3: to go from okay, two weeks clear to now I'm
37:34
Speaker 3: running ten miles again. We don't want to do that
37:37
Speaker 3: if someone does not treat the stress fracture right away
37:41
Speaker 3: and they keep stressing it right, no pain, no gain.
37:44
Speaker 3: When they're running, or they're just like, I feel something,
37:46
Speaker 3: but then I ce it and they don't know. This
37:48
Speaker 3: is very common that let's say runners will experience something
37:51
Speaker 3: and they think maybe it's just like a little more
37:54
Speaker 3: of an itis, not a stress fracture itis, Right, walk
37:57
Speaker 3: it off, it's good, okay, And then they actually are
38:00
Speaker 3: running on it for like a good six weeks. That
38:03
Speaker 3: can take closer to a average fracture healing, which is
38:07
Speaker 3: six to eight weeks, So they would be in a
38:09
Speaker 3: walking boot for the six to eight weeks. I then
38:12
Speaker 3: would have to retransition them back over probably a similar
38:17
Speaker 3: six to eight week period. But what I'm doing is
38:20
Speaker 3: not saying okay, walk or lightly run like shorter distances
38:27
Speaker 3: as the technique to strengthen the foot. We need now
38:31
Speaker 3: to take a step back and say, Okay, why did
38:33
Speaker 3: you get the stress fracture in the first place. Was
38:35
Speaker 3: it the shoes that you're wearing. Is it a disconnect
38:37
Speaker 3: from the foot? Is your foot is not strong, your
38:40
Speaker 3: foot's not connected to your core. And then go back
38:42
Speaker 3: to that and say, let's do intrinsic muscle strengthening. Let's
38:46
Speaker 3: do foot to core activation. Let's slowly build this over
38:50
Speaker 3: the six to eight weeks. So after the eight weeks
38:53
Speaker 3: you are fully back to running and actually stronger than
38:57
Speaker 3: before you first got your stress fracture.
39:00
Speaker 2: Got it okay?
39:01
Speaker 1: So varies from first person to person, but really important
39:04
Speaker 1: to make sure you're prioritizing the strengthening of the foot
39:08
Speaker 1: before you get back to the activities that you were
39:10
Speaker 1: doing before this injury occurred.
39:14
Speaker 2: Two more things I want to touch on.
39:16
Speaker 1: First thing, Achilles tendons thankfully knocks on everything around me.
39:21
Speaker 1: I personally haven't dealt with anything rof when it comes
39:25
Speaker 1: to my achilles, but obviously a huge pain point for
39:28
Speaker 1: so many people.
39:30
Speaker 2: What is it that we should know?
39:32
Speaker 1: I know, we talked about everything from anti inflammatories to
39:35
Speaker 1: icing for a Planter fasciitis. I'm sure that some of
39:38
Speaker 1: those takeaways may be the same here, but talk to
39:41
Speaker 1: us about the Achilles tendon.
39:44
Speaker 3: Yeah, Achilles tendonitis is the biggest beep to treat because
39:49
Speaker 3: when someone comes in, I'm just like, no like Achilles
39:53
Speaker 3: tendon It is so hard to get under control, and
39:56
Speaker 3: it's because we use it literally every step that we take,
39:59
Speaker 3: so it is so hard to offload it or give
40:03
Speaker 3: it the rest that it needs without literally being in
40:07
Speaker 3: like a boot. Now Achilles tendonite is similar to the
40:10
Speaker 3: planet of fascis and the elasticity injury that you've overloaded,
40:14
Speaker 3: the demands of the tissue, micro tearing, all of that.
40:17
Speaker 3: But here's the thing about the plant, the Achilles tendon
40:19
Speaker 3: that's different from other tissue in the body is the
40:22
Speaker 3: blood supply is probably some of the worst of any
40:26
Speaker 3: of the tissue in the body, and it just has
40:28
Speaker 3: to do with its anatomy. So part of this healing
40:32
Speaker 3: process is first be patients got to be patient. It's
40:36
Speaker 3: going to take probably five times as long as you
40:38
Speaker 3: think it actually is to heal it. Second one is
40:42
Speaker 3: certain things that you could do is like a heel lift,
40:45
Speaker 3: heel toe drop, like the shoes that we mentioned, actually
40:48
Speaker 3: go into those for this and stay in those. Avoid
40:52
Speaker 3: totally barefoot, minimal shoes, avoid doing barefoot activities because you're
40:56
Speaker 3: trying to give the tissue time out so that it
41:01
Speaker 3: can heal itself, knowing it's going to take longer to
41:04
Speaker 3: heal than normal. Third thing, and this is where a
41:07
Speaker 3: lot of the research sits is eccentrics. And I'm sure
41:10
Speaker 3: that you have heard of that to some degree of Okay,
41:13
Speaker 3: you have to do eccentrics four it could these tendon issues,
41:16
Speaker 3: and that is doing the negative. So instead of doing
41:20
Speaker 3: a cafraise, you get up on your toes and you
41:23
Speaker 3: slowly lower your heel down. The proper eccentric load is
41:29
Speaker 3: actually much higher than people think, so you have to
41:31
Speaker 3: do many more repetitions than you think. You actually have
41:34
Speaker 3: to load it. So I want people to either put
41:37
Speaker 3: a backpack on and put a lot of stuff in there.
41:40
Speaker 3: I don't know what it would be. I was going
41:42
Speaker 3: to say your school books, but that and to load
41:47
Speaker 3: yourself so that you can actually load it. You want
41:50
Speaker 3: to do it in different times or tempos, so it's
41:53
Speaker 3: really important to do the eccentric side of it. And
41:56
Speaker 3: then anything from a topical. Yes, do the Orleans inflammatories,
42:02
Speaker 3: but what I work with a lot of patients is
42:04
Speaker 3: doing red light. Actually really like red light therapy with
42:07
Speaker 3: a lot of these soft tissue injuries. So you can
42:10
Speaker 3: get a red light box if you want to go
42:12
Speaker 3: to a red light sauna facility that's in your town, awesome,
42:16
Speaker 3: do that laser so some physical therapists will do laser.
42:20
Speaker 3: You can do that as well. I like topicals like
42:23
Speaker 3: topical CBD and things like that work really well on
42:26
Speaker 3: the tissue as well. That is really like the big
42:31
Speaker 3: things and it's again.
42:33
Speaker 1: Time time time, all right, last topic here, just regular
42:39
Speaker 1: foot maintenance. It's probably not something that a lot of
42:42
Speaker 1: people think about, like what should I be doing regularly
42:44
Speaker 1: for my feet, but it's an important question, especially if
42:47
Speaker 1: we do want to remain injury free, and like we
42:50
Speaker 1: talked about before, keep all those toenails, so anything that
42:53
Speaker 1: we should keep in mind when it comes to regular
42:55
Speaker 1: practices of taken care of our feet.
42:58
Speaker 3: I have three pillar for movement longevity and those three
43:02
Speaker 3: pillars are foot strength, foot recovery, or mobility kind of
43:08
Speaker 3: call them the same. And then sufficient sensory stimulation of
43:12
Speaker 3: the feet so with the foot, strengthen knee and would
43:15
Speaker 3: be some of the stuff that we spoke about. But
43:17
Speaker 3: it's not just doing like towel crunches and picking up marbles.
43:21
Speaker 3: We want your feet to be connected to your core.
43:26
Speaker 3: So any foot contraction I need incorporated with the pelt,
43:30
Speaker 3: floor and the diaphragm because that's the way your feet
43:32
Speaker 3: actually work. So it's very intentional or intent full foot exercises.
43:38
Speaker 3: I actually am not a fan of doing towel crunches,
43:41
Speaker 3: because it's kind of like doing bicep curls and then
43:43
Speaker 3: saying like, there, my bicep is functional, but that's really
43:47
Speaker 3: not the way your bicep works. Second, with the recovery,
43:50
Speaker 3: would be five minutes of releasing the feet and the
43:53
Speaker 3: lower leg, specifically the soliest which is the bottom calf muscle,
43:58
Speaker 3: every single day, five to eight minutes if you can.
44:02
Speaker 3: I'll tell people to release their feet while brushing their teeth.
44:05
Speaker 3: So it's just something to give it a little bit
44:07
Speaker 3: of a reset every single day. And then the third
44:11
Speaker 3: is that sensory stimulation that is going barefoot, even around
44:15
Speaker 3: your home for at least thirty minutes, get out of
44:18
Speaker 3: your shoes, that the toes spread, splay, breathe. Even better
44:22
Speaker 3: is be barefoot out on the grass, so you get
44:24
Speaker 3: kind of this earthing component to it as well, which
44:27
Speaker 3: is super awesome for inflammation and recovery. But you want
44:30
Speaker 3: to do something sensory for the foot. So those three
44:35
Speaker 3: are my pillars of supporting the foot. And then, honestly,
44:39
Speaker 3: when you do these things, the fourth that kind of
44:41
Speaker 3: ties in their circulation. We need really really good circulation
44:44
Speaker 3: of your feet, but you will get that through sensory
44:47
Speaker 3: stimulation being barefoot spreading and then releasing the bottom of
44:50
Speaker 3: the foot.
44:51
Speaker 1: You mentioned that there could be more pain for someone
44:55
Speaker 1: navigating planter fasci itis after longer periods of inactivity, whether
44:59
Speaker 1: that be for a night's sleep or perhaps sitting at
45:01
Speaker 1: a desk all day and then getting up for someone
45:04
Speaker 1: to maybe attempt to keep that initial pain at bay.
45:09
Speaker 1: Could doing something like drawing the alphabet help in that situation,
45:13
Speaker 1: getting that foot moving again before you get.
45:15
Speaker 2: Up or is that an old wives tale?
45:18
Speaker 3: I would say that is an old wives tale. But
45:21
Speaker 3: what I will give you to do is do something
45:24
Speaker 3: to the bottom of the foot. Whether it is just
45:27
Speaker 3: like a hand massage to the fascia right, you could
45:31
Speaker 3: do that, or if you have a percussive gun something
45:34
Speaker 3: like they're a gun for the listeners, that's probably the
45:36
Speaker 3: most well known on the market. And then you're just
45:38
Speaker 3: kind of lightly engaging and waking up and starting to
45:41
Speaker 3: warm it up, because remember what causes that acute sharp
45:45
Speaker 3: pain when you step down first step in the morning
45:47
Speaker 3: is that the tissue is sticky. So we're just trying
45:51
Speaker 3: to warm it up and bring the circulation so that
45:54
Speaker 3: you're not stepping down with that rapid pull.
45:57
Speaker 1: All right, gotta keep my little hyperval next to my
46:01
Speaker 1: bed now perfect well, Doctor Emily, this has been so
46:07
Speaker 1: so helpful, so many good tips, tricks and takeaways here.
46:11
Speaker 1: How do the hurdlers follow along with you? How do
46:13
Speaker 1: they keep up with you so that they can get
46:15
Speaker 1: more in the future.
46:16
Speaker 3: Absolutely so. My Instagram is d r Emily DPM. I
46:21
Speaker 3: put a lot of content on there so people are
46:23
Speaker 3: hungry to continue to learn more about their feet. Follow
46:26
Speaker 3: me on Instagram. My pedietry practice is my name, so
46:30
Speaker 3: Dr Emilysplicckle dot com. I do see patients virtually so
46:34
Speaker 3: not just in person, so that is fun. And then
46:37
Speaker 3: for any of the Niboso products, which is a company
46:40
Speaker 3: that I founded, that website is Niboso Naboso dot com.
46:45
Speaker 3: And then to learn more about feet, I wrote a
46:49
Speaker 3: book called Barefoot Strong. And actually if you go to
46:52
Speaker 3: the website for the book, I also have a foot
46:54
Speaker 3: type quiz so people can go on there and actually
46:57
Speaker 3: determine their foot type and what it means. And that
47:00
Speaker 3: website is barefootstrong dot com.
47:03
Speaker 1: So many great resources here. Again, doctor Emily, thank you
47:06
Speaker 1: so much for your time. I have a feeling that
47:09
Speaker 1: you'll be back and there will be more questions to
47:12
Speaker 1: be asked. I'm over at Hurdle Podcast and at Emily
47:15
Speaker 1: Abadi another hurdle conquered.
47:18
Speaker 2: Catch you guys next time.