Have you ever fixed supination with physical therapy?
February 1, 2018 9:29 AM   Subscribe

I put a lot of weight on the outside edges of my feet. I wear out new shoes within a month, and then my low back and hip begin hurting. I need to fix this. I'm skeptical of doing it with PT.

To clarify, when I say "wear out my shoes" I mean that the outside edge wears down such that the shoes are no longer flat. Whenever I get new shoes my back and hip pain goes away completely.

May or may not be related: I have an injured knee. A couple years ago I had a very small tear in my meniscus that was trimmed in arthroscopic surgery. While in there, they found a hole in my knee cartilage (osteochondral defect). I say "may be related" because one surgeon insists that it's making me walk strangely and causing hip and back pain, another surgeon says it's no big deal at all and that I just have a weak hip joint muscles (the hip and back pain are mostly on the same side as the injured knee, and that side is definitely noticeably stiffer and weaker). Meanwhile, I've noticed the biggest change when I change my shoes, and recently a PT told me that I walk this way because I have weak calf muscles, weak ankles, weak inner thighs, wear arches, and weak toes. My knee doesn't hurt but it does get very stiff, particularly at the end of long hikes, on the downhill. I did all the PT I was supposed to after surgery, and when I complained about stiffness they just kept telling me I had weak muscles. I was very fit before my injury. I'm not as fit now, but I still work out, including strength training, 90% of the days of the year. I get the concept that some particular muscles may be underdeveloped, but I'm at this point I'm just really skeptical of this idea that all my problems are tied to weak muscles. I work out all the time but somehow just about every muscle below my waist is weak? Also, I've never found that PT made any difference. In addition to the PT I did after surgery I did another round for my hip and low back and it did nothing. I then started doing intensive yoga every day, and that helped strengthen the weak side, though it's still weaker than the other side.

I'm getting a new MRI of my knee to evaluate the stiffness issue. I'm also pursuing the foot issues because as I said it's the only thing that's made a real difference to me. The last PT told me to go to another PT place that works with ballerinas so they can look at my gait and recommend exercises to correct it, but I'm so fed up of that that I'm thinking it might be better to just see a podiatrist and get shoe inserts. Any thoughts or experiences?
posted by unannihilated to Health & Fitness (11 answers total) 4 users marked this as a favorite
 
1. There is enormous variation in the quality of PTs. Most, in my experience, have been useless. A small minority have been life-changers. Get a specific recommendation from your orthopedist.

2. You need inserts.

3. Bizarrely enough, a person can have particular muscles undeveloped in an otherwise regularly exercising body - and sometimes overdevelopment of one set can lead to underdevelopment of another. A lot of this is genetic, which they rarely tell you, ie there's only so much you can do about it, but you gotta fight it as best you can.

4. Again, you need inserts... why didn't they prescribe them to you already with such an obvious supination problem? Supination leads to the whole lever-pulley arrangement of the leg muscles going wonky, and that can have a very nasty cumulative effect like what you're seeing with your knee. (I'm not a doctor, just someone with a naturally supinating foot and a variety of leg muscles issues.) By the way, I use Superfeet, although I was prescribed scrip ones (for a variety of reasons that didn't work out for me), and they work fine for me. But your supination issue sounds worse than mine.
posted by fingersandtoes at 10:15 AM on February 1, 2018 [2 favorites]


This is pretty much exactly what orthotic inserts are meant to help with. See a podiatrist.
posted by BlahLaLa at 10:17 AM on February 1, 2018 [2 favorites]


Podiatrist is my suggestion too, I saw one in December related to back problems, and the inserts have made a huge difference.
posted by ellieBOA at 10:21 AM on February 1, 2018


You can work out a lot and have some weak muscles. If you walk on the outside did your feet its specifically weak glutes. I have nerve damage to my glutes and have developed this but I'm strong elsewhere. If your PT can't identify and demonstrate this to you within minutes they aren't a good PT. Most aren't very good at all I've found.
posted by fshgrl at 11:01 AM on February 1, 2018


The recommendation that PT could help you in that way is completely supported by my experience.

I have a different foot alignment problem (hopelessly flat feet and extreme pronation) and have worn orthotics for decades. Last year at this time I saw a physical therapist for the first time and it was life changing, and I do not say that hyperbolically.

I too had exercised diligently for years, including several years of regular weight lifting and occasional running, but the PT work revealed serious weaknesses I had no idea were present. As a result of my weird gait there were muscles in my left hip that were so weak I could barely do a side-lying leg lift (indeed, the hip adduction/abduction machines I used at the gym didn’t address those muscles—a matter of seated vs extended). Worse yet, there were muscles in the inner part of my right ankle/calf that were just literally offline—it took several weeks of work until the PT could even move my right foot into an inverted stance with her hands. Another months til I could volitionally move it in that way. Undoubtedly this is due to my orthotics and I just accept now that strengthening exercises are part of my life from here on out.

This has had major positive impacts on my balance, stability, and overall mobility.

If you’re in the Boston area, memail me and I am happy to tell you who I worked with.
posted by Sublimity at 11:04 AM on February 1, 2018 [1 favorite]


I can only nth the recommendation for a good PT, who can identify and point out which muscles are underdeveloped or neglected despite your strength work.

Ask health-care workers (nurses, ortho surgeons) who they recommend. Also, look for sports PT? I feel like some PT is focused on just "activities of daily life" which, technically, you can do; but especially sports PI is focused on excellence in function. A good body worker can change your life, it's true.
posted by Dashy at 11:21 AM on February 1, 2018


"Weak toes" is a new one to me. As above, podiatrist. PT generally helps get you back to a known-good state or workarounds, but a podiatrist knows how to fix stuff.
posted by rhizome at 11:30 AM on February 1, 2018


Not sure I’d agree, rhizome. I’ve seen podiatrists regularly over the past 20 years and while they’ve been immensely helpful with my messed up feet, they completely dropped the ball with me as a person and a patient who would experience effects all up and down my “drive train” as a result. If they ever did recommend PT it was pretty lightly and for sure my podiatrists never talked about other parts of my body.
posted by Sublimity at 11:38 AM on February 1, 2018


Yeah I have my orthopedist as the main guy in charge and he has sometimes brought in podiatrists/PTs as necessary, but he's the only one I trust with the whole picture.
posted by fingersandtoes at 11:47 AM on February 1, 2018


The last PT told me to go to another PT place that works with ballerinas so they can look at my gait and recommend exercises to correct it, but I'm so fed up of that that I'm thinking it might be better to just see a podiatrist and get shoe inserts. Any thoughts or experiences?

I know you're fed up, but follow this advice, or find a sports PT for your future self.

Wherever you have muscle weakness, you will also be compensating (whether you realize it or not) to deal with it. Overuse of the area that's compensating will eventually cause muscle weakness there too. And it doesn't necessarily matter how much you're exercising now. Each muscle has four sides (front, back, left and right sides), which allow for an extraordinary variety of movement, the odds of you already exercising properly to strengthen the right muscles and give the compensating muscles a break are pretty much nil, especially given this description:

... making me walk strangely and causing hip and back pain, another surgeon says it's no big deal at all and that I just have a weak hip joint muscles (the hip and back pain are mostly on the same side as the injured knee, and that side is definitely noticeably stiffer and weaker). Meanwhile, I've noticed the biggest change when I change my shoes, and recently a PT told me that I walk this way because I have weak calf muscles, weak ankles, weak inner thighs, wear arches, and weak toes ...

A podiatrist may need to play a role at some point, but you need someone with a better understanding of your entire body, and not just a piece of it. Go see a PT, and if they're not helping — or you think they're not analyzing the problem carefully enough — find another one. If you need to see other doctors in addition, a good PT can steer you to what kind of doctor you need. You are not the first person to have this, and someone can definitely help you learn to keep the area strong and healthy. What you're describing here is an awful lot of weakness, and you want to learn how to address all of it properly, so you don't end up with permanent pain or injuries.
posted by Violet Blue at 4:06 PM on February 1, 2018


You need a team: an orthepedist, possibly a PT, definitely a corrective exercise specialist, and a sports masseuse. An orthopedist is going to examine you and 'fix the problem with inserts. Long term, you need your muscles and joints evaluated and to rebuild your gait using a CES or a PT that really really knows their stuff. It isn't just a question of walking on the outside of your feet, but why your body does that, and what else should be fixed in order to restore proper walking.

Yes, your knee doesn't help, but if it is the cause of the problem, your body has compensated by wrecking your ability to walk how you used to.
posted by Nanukthedog at 12:50 PM on February 2, 2018


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