Foot Manipulation Or Mobilization - An Overview

What Is Foot Manipulation or Mobilization?

Foot Manipulation is a manual therapy to improve foot and ankle function by targeting stiff and dysfunctional joints. Foot mobilization therapy (FMT) is a specialized and highly effective treatment modality for foot issues. FMT is mainly used in combination with other treatment modalities like orthotics (orthotics are shoe inserts designed to support the foot and correct imbalances), strengthening or conditioning, and rehabilitation.

The root cause for the foot pain is evaluated rather than providing symptomatic relief. In earlier times, chiropractors, osteopaths, and physiotherapists carried out FMT. Presently, FMT is carried out by specialist podiatrists to reduce pain and restore joint function. In most cases, a single treatment provides significant results, but multiple treatments may be required in certain long-standing conditions.

Is the Therapy Painful?

Mostly, FMT is not a painful procedure. Podiatrists use certain soft tissue techniques and tool-assisted massage (TAM) to improve the dysfunctional tendons and muscles. The massage feels like a deep soft tissue massage and may be uncomfortable but not painful. The discomfort may remain for a few days following the procedure.

What Are the Conditions in Which FMT Is Beneficial?

FMT can be useful in the following conditions:

• Bunions - Bunions are painful bony projections at the base of the big toe joint that develop when the big toes lean towards the remaining toes. Pain can occur in the bony projection due to shoe irritation and the alteration of mechanical forces on the ball of the feet.

• Plantar Fasciitis - Plantar fasciitis occurs due to overuse injury of the plantar foot surface and is characterized by heel pain. The condition is commonly seen in young runners and middle-aged individuals who are overweight.

• Achilles Tendonitis - Achilles tendonitis occurs due to overuse of the Achilles tendon (tendon which connects the heel bone and calf muscles) and calf muscles, resulting in tendon inflammation.

• Hammertoes - Hammertoes are conditions in which the toes curl downward due to the middle joint of the toe pocking out. Ill-fitting shoes can worsen the condition, and corn may develop at the site.

• Morton's Neuroma - Morton's Neuroma is characterized by the thickening of tissues around a nerve that leads to the toes. It is a compressive neuropathy (nerve damage) of the interdigital nerve of the forefoot region. The commonest location is between the third and fourth metatarsal heads.

• High Arch Feet - A high arch foot refers to a raised foot arch (elevated more than normal). The longitudinal arch of the foot is raised, and the condition is seen in children and adults.

• Flat Feet - A condition characterized by the absence of a normal foot arch while standing.

• Osteoarthritis - It is a degenerative disease of the joints characterized by the breakdown of the joint tissues over time. Commonly seen in elderly people.

• Ankle Sprain - An injury that takes place due to a tear of the ligaments that support the ankle, and it happens when one twists, roll, or turn the ankle in an awkward position.

• Cuboid Syndrome - A condition characterized by dislocation of the cuboid bone.

• Heel Spur - Heel spurs are bone growths in the heel region. The most common location is on the underside of the heel bone, at the region of attachment of the plantar fascia. The plantar fascia gets overstretched due to obesity, ill-fitting shoes, running, etc. In response to the stress, extra bone develops, resulting in heel spurs.

• Other Conditions -

Some other conditions in which FMT is beneficial are:

• Heel pain.

• To improve orthotic outcomes.

• Sports injuries.

• Musculoskeletal injuries.

• Posture problems.

• Weak ankles.

• Knee or calf pain.

• Pain in the ball of feet.

• General foot pain.

• Pregnancy foot pain.

• Arch pain.

What Are the Conditions in Which FMT Is Not Indicated?

The conditions in which FMT is not indicated are:

• Hypermobile joints.

• Suspected fractures.

• Post-operatively except in cases where the patient is fully weight-bearing.

• Joint coalition or surgical fusion of joints.

What Are the Benefits of FMT?

FMT is a manual therapy in which hands-on manipulation of stiff and dysfunctional joints is done by a trained specialist to improve joint alignment and function. FMT is beneficial in the following ways:

• Elevates the range of motion of the joints by increasing synovial fluid production.

• Improves joint and bone alignment, and thus, the tendons, muscles, and ligaments function effectively.

• Improves postural balance and stability.

• Promotes healing in case of injuries.

• Improves the therapeutic effect of plantar orthotics.

How Is the Procedure Carried Out?

In the initial appointment, the podiatrist evaluates the cause of foot pain or stiffness by conducting a comprehensive assessment. The range of motion of the joints, the movement patterns, and the patient's gait are analyzed. The practitioner then explains to the patient about the foot issue, the FMT procedure, how it benefits the patient, and the joints to be manipulated. The specialized podiatrists then manipulate the joints using hands and specific massage tools. Usually, an FMT session lasts 10 to 30 minutes, though the period depends on the stiffness severity and the number of joints affected. It is advised to attend the session with loose or short clothing. The physician may prescribe home exercise programs to be carried out between the therapy sessions. On average, most six treatments are carried out for three weeks because the connective tissue scar takes about three weeks to regenerate.

What Are the Associated Risks?

Foot manipulation therapy is a non-invasive procedure, so it is considered a safe treatment option. There are no known side effects associated with FMT. Only the foot’s natural range of motion is used for improving strength and flexibility. The patient undergoing the therapy can remain active after the procedure. FMT is an effective, safe, and powerful option for many conditions, but some conditions, like fractures, hypermobile joints, fused joints, etc., require an alternative treatment option for management.

Conclusion

FMT is a powerful, safe therapy that can be beneficial for many foot issues. The stiffened and dysfunctional joints are manipulated by hands or using massaging tools only with the normal range of motion so that there are no ill effects.