I have a 36-year-old Caucasian female client who I’ve been training for about four months. Her primary goal is to lose weight after giving birth to her first child 13 months ago. She appears healthy with a BP of 126/66 and a RHR of 65 bpm.
My concern is the client complains of pain in the bottom of her left mid-foot region (sole/in-step). This problem presents itself upon waking in the morning and after lying down/resting for up to 30 minutes. She tells me that, apart from the pain, she also finds it difficult to balance if she gets up and walks immediately after lying down. To counteract this problem, she usually slips on a pair of shoes with a large in-step to support her feet. This has only come about postpartum. Initially after giving birth, she felt a strange sensation in her feet, as if they were in warm water, but it has now progressed to this pain I'm describing. Furthermore, since giving birth, my client can no longer voluntarily separate toes two and three from one another in her left foot, which is something she could do in both feet without much effort before giving birth.
She did experience a long and difficult labor, which eventually resulted in a Cesarean section. She was also given an epidural. Could this have possibly damaged nerves or resulted in this problem my client now faces?
Recently I've come across an article by Chuck Wolf entitled “Functional Anatomy and Muscle Action of the Foot,” which I find very interesting but not altogether helpful regarding this particular problem. Can you please help?
As a further matter of interest, while training the same client on the Elliptical machine, she almost always experiences a “pins and needles” sensation after about 12 minutes of continuous training. I have read a Research Corner Q&A from Steve Rhyan entitled “Pins and Needles from Elliptical Machine,” and I have discussed this with my client. She assures me that this sensation she experiences is by no means painful and does not bother her. This leads me to wonder, however, if her foot pain and the pins and needles sensation could be linked somehow.
The issues you describe appear to be consistent with “mid-stance plantar fasciitis.” During pregnancy, the woman undergoes many changes, especially hormonally. When estrogen and progesterone levels increase, ligaments become more laxed. As weight increases and center of gravity moves forward, the pelvis rotates anteriorly. This usually creates an internal rotation of the femur, tibia and splaying (spreading) of the foot. The bones and joints sustain more tension by eccentrically loading the muscles, ligaments, tendons, nerves and joints. This status can remain for relatively long periods of time and can lead to increase tension and elongation of the long plantar ligament sprain and increased risk of plantar fasciitis. When the foot is splayed and more pronated during this period, more tension is placed upon the mid-tarsals and metatarsal heads, especially the second and third metatarsals. This can create a neuralgia-like condition that can be temporary or chronic, depending on how the individual responds. Additionally, if weight gain and fluid retention has created an equinus condition of the foot or ankle, this can contribute to the problem as well.
After speaking with my podiatrist colleagues, they agreed that the client should be placed into a slightly wider shoe and possibly use an arch support, either an over-the-counter such as a Spenco Arch Support or use that which accompanied the shoe, if it is adequate enough.
As far as the “pins and needles” when using an elliptical, there are many issues that can contribute to that condition. Check the following:
- Is she still retaining water?
- Has she lost the weight from pregnancy?
- Does she have an exaggerated anterior pelvic tilt which contributes to internal lower extremity rotation, increased dorsiflexion and too much pressure on the forefoot?
- Does she use the equipment in a constant forefoot dorsiflexed position?
- Are her shoes too tight?
If her feet are extended, such as a dorsiflexed forefoot, the muscles, tendons and ligaments of the foot are lengthened and undergo a prolonged stretch. This can create micro-trauma and injury, especially between the metatarsals, and it can lead to this sensation.
Good luck, and I hope this is helpful.