How Physical Therapy
and Pedorthics can
work together
A lot of the lesser toe deformities and midfoot/
forefoot pain conditions are secondary or even
tertiary problems related to or symptoms of
underlying biomechanical deficits. Hallux
valgus, or bunions, are caused by excessive
and abnormal stress through the 1st MTPJ.
Why is that abnormal stress happening? A
short Achilles tendon, posterior tibialis tendon
dysfunction, leg length discrepancy, joint
mobility or range of motion restrictions and
intrinsic muscle dysfunction can all contribute
to abnormal stress on the 1st MTPJ during gait.
Metatarsalgia, or pain under the ball of the
foot, is often caused by early and/or excessive
loading of the lateral rays during gait. Why
are they being loaded early? A hypomobile or
dysfunctional 1st ray, a Morton’s toe, a short
Achilles tendon, limited dorsiflexion range of
motion at the ankle, oversupination, transverse
arch collapse, and lesser toe deformities can
cause early and excessive loading of the lateral
rays.
Hammertoes can have several different causes
including but not limited to, tendon and capsule
restrictions, muscle imbalance and ill-fitting
shoes. Poor shoe fit can also cause blisters, corns
and callusing.
Calluses are superficial indicators of areas on
the foot where there is too much pressure and
friction. The excessive pressure and friction can
be caused by extrinsic (socks, shoes, activities)
or intrinsic (foot mechanics) factors. As calluses
thicken they can become painful and could
lead to blister development under the callus
which is particularly problematic for clients
with diabetes. Thick, painful calluses can also
change a person’s weightbearing tendencies
and gait mechanics. Changes in gait and/
or compensatory movement patterns risk
overstressing and injuring other areas within the
kinetic chain.
As we all know, it’s important for people with
any of these conditions to have a pedorthic
"Physical therapy is a necessary adjunct treatment
to pedorthic interventions for addressing the
original causes of the pathology and for restoring
functional mobility."
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Pedorthic Footcare Association | www.pedorthics.org
While I admit it doesn’t readily come to mind,
physical therapy can play a large role in the
comprehensive care of many foot and ankle
conditions. There are of course the obvious ones
like plantar fasciitis and post-fracture, but we
can also help with conditions like hallux valgus,
metatarsalgia, hammer toes and even painful
calluses.