All posts in Ankle

Tailbone Pain

The Zimmer EnPuls and the PiezoWave system is intended to relieve pain, improve circulation and reduce inflammation of myofascial pain. It is especially helpful for coccyx pain, tailbone pain, knee pain, low back pain, hip pain, plantar fasciitis and tendon injuries.

Other indications for the Zimmer EnPuls and PiezoWave include chronic painful muscular hardening, myofascial trigger points in the areas of the: Upper extremities; Cervical spine; Shoulder girdle; Thoracic spine and lumbar spine; Hip area; Lower extremities.
If you have tried other therapies and been disappointed or did not get the results you expected, please call the office at 310-444-9393 to experience the pain relief effects of the Zimmer EnPuls and the PiezoWave technology.

Laser for pain

When I looked to purchase a new Laser for my practice, I really did my research. I picked a Laser that I could use while performing deep tissue massage. The Laser plus massage provides pain relief faster than Laser alone.

Here is what I am seeing after using the laser in my day-to-day practice…

Patients like the soothing warm feeling of the Laser with deep tissue massage better than hands-on only.

Laser is best known for healing and anti-inflammatory effects. I am not disappointed by the results.

For an acute injury, the sooner you get in for the Laser treatment the quicker the healing process.

Patients like when I apply the Rock Tape after the Laser.

For long term chronic pain problems, combining the Deep Muscle Stimulator, Radial Pulse Therapy, exercise, and nutrition are getting the best results.

The Laser is useful for treating large painful areas like the low back, and in a short time obtains pain relief.

The laser is solving difficult knee, shoulder, ankle and foot pain.

Typical Laser sessions can last from 5 – 15 minutes.

The current price of a laser session in my office is approximately $40. Other Doctors are charging $60-90 for Laser treatments and they are using less quality devices.

Laser treatments are safe, they last, they are effective for analgesia of painful conditions, they penetrate deeply.

Call the office at 310-444-9393 to try the Laser with massage.




Because your feet are subject to enormous use and constant wear, even small abnormalities can cause big problems. Orthotics – inserts for shoes – can effectively correct many physical problems that arise from improper foot mechanics. Ask me to perform a gait analysis on you.


This service includes video analysis of your gait using a specially equiped treadmill, and a precise, computerized assessment of the biomechanics of your feet as you walk. This test will help determine if you need orthotics.

Consider a Gait Analysis if:

You suffer from general aches and pains from the foot to the lower back

You have “flat” feet or “high arches”

You suffer from pain anywhere in the foot, or in the ankles, knees, calves, hip or low back, either chronically or with athletic activity

You have calluses or corns

You have abnormal wear on your shoes

You have arthritis in your lower back


Achilles tendonitis

These exercises are often recommended for Achilles injuries. They are called the Alfredson ‘180 repetition’ calf raise program. The regime is named after the researcher Hakan Alfredson, who stumbled upon this treatment while he was trying to rupture his own degenerative Achilles tendon with repeated bouts of high volume exercising through pain. Instead of rupturing, his Achilles improved. 

Stand on the bottom step of a staircase, facing inwards, hands lightly supporting at either side. The forefoot of the affected leg is placed on the edge of the step.

Lower your body down by dropping the heel of the affected leg over the edge, with control; then place the foot of the non-affected leg on the step to raise the body back up to the starting point. 

If this proves too difficult, or if both Achilles are affected, it is possible to raise back up on two legs (thereby sharing the concentric load) and coming down on a single leg (this is the “2 up, 1 down” concept).

Perform 3 x 15 eccentric heel drops with the knee straight and 3 x 15 repetitions with the knee bent, repeated twice daily.


Plantar fascitis & foot pronation

Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping. Runners who excessively pronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the plantar fascia.

Symptoms: A chronic mild ankle sprain could have symptoms related to stretching of the ankle ligaments; mild pain; mild swelling on the outside of the ankle; some joint stiffness or difficulty walking or running.

Plantar fascitis can be heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia. Sometimes there may also be pain along the outside border of the heel. This may occur due to the offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet. Pain is usually worse first thing in the morning. After a few minutes it eases as the foot gets warmed up, but can get worse again during the day especially if walking a lot. 

How to best treat and prevent this from happening again: Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation. However a good plantar fascitis taping technique can help the foot get the rest it needs by supporting the plantar fascia.

Cold therapy can be applied regularly until symptoms have resolved.

Stretching the calfs and plantar fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The plantar fascia tightens up making the origin at the heel more susceptible to becoming inflamed. Tightening of the plantar fascia happens in particular over night which is why pain is often worse in the morning. A plantar fascia night splint is an excellent product which is worn over night and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

Arch supports or custom made orthotics are often required.

In office treatment includes using the warm laser, the Deep Muscle Stimulator (DMS), or the ‘scrapping’ tools called Graston or SASTM. I like to use K-tape as well.


Laser Treatments

Laser therapy has been around for a long time but it is considered cutting edge treatment for musculoskeletal injuries and pain.
Laser therapy stimulates cellular activity, expediting the healing processes to reduce inflammation and repair damaged tissue. 

You can feel the warm deep tissue penetration. This deep heat significantly increases the body’s cellular production of ATP (Adenosine-triphosphate) to reduce inflammation and heal the inflamed area.

Here are some of the benefits of using the deep tissue penetration that laser provides safely and effectively:

Healing and pain relief with no side effects, drug interaction effects, or invasive surgery.

Treats acute and chronic conditions as well as post surgical pain.

Pain relief is often felt immediately.

Most laser treatments take only 10-20 minutes.

Are you a potential candidate?

  • If you have pain that is of musculo-skeletal origin, laser therapy may be for you:
    This includes sports injuries, back and neck pain, any joint pain (knee, shoulder, ankle, etc), bursitis, tendonitis, tennis elbow, contusions, strains and sprains, carpal tunnel syndrome, chondromalacia patellae, arthritis, fibromyalgia, heel spurs, plantar fascitis, migraine headaches, neck pain/whiplash, nerve root pain, postoperative pain, repetitive stress injuries, TM joint pain and more.
  • If you have the wound that is slow to heal and has been resistant to treatment, you may be a candidate for laser therapy. This includes slow healing fractures, as well as soft tissue injuries and ulcers.
  • If you have multiple trigger points (sore spots in the muscles) that do not go away, you may be a candidate for laser therapy. This includes areas associated with fibromyalgia.
  • If you have had Prolotherapy or PRP, and wish to accelerate the response of healing, you may be a candidate for laser therapy. This includes any area that has been treated with Prolotherapy/PRP injections.
  • If you need Prolotherapy or PRP therapy but are afraid of needles, you may be a candidate for laser therapy.
  • Laser therapy stimulates the same areas that Prolotherapy targets. It does it without needles, but requires a lot more time and repeated treatments to gain the result that can be gotten from Prolotherapy and laser together.

Feel free to call me directly at 310-473-2911 or call my cell phone at 310-339-0442


Ankle Rehab – Peroneals

Posted: 09 Sep 2010 04:05 AM PDT for ankle sprains often include strengthening of the peroneus longus muscle, usually with Thera-Band® elastic bands or ankle weights. Based on its origin and insertion, the peroneus longus muscle is thought to be responsible for ankle eversion and plantar flexion. However, in terms of its true function, the peroneus longus is an important stabilizer of the first ray during closed-chain weight bearing, creating a rigid lever for push-off (Subotnick, 1975).

Electromyographic (EMG) evidence shows that the peroneus longus peaks in activation during the latter half of the stance phase when the weight of the body is over the forefoot in a plantar-flexed position.  Despite this evidence, peroneus longus exercises are often prescribed in an open-chain against resistance during eversion movements. the Journal of Strength and Conditioning Research, physical therapy researchers investigated the effectiveness of more functional closed-chain exercises on activation of the peroneus longus while measuring EMG activity. They evaluated closed-chain plantar flexion (heel raises) with a 5 pound laterally-directed resistance provided by a yellow Thera-Band resistance band placed around the middle of the foot. A yellow band stretched to 200% of its resting length will produce a force of 5 pounds (Page et al. 2000). According to the authors, “The pull of the band in the lateral direction and away from midline imparts a force to the foot that induces supination/inversion of the foot…The force of the band acts as a perturbation of the peroneus longus.”

The EMG activity of the peroneus longus during this exercise was compared to a heel raise without resistance and open-chain eversion against a 5 pound cuff weight placed around the mid foot. The researchers found that the Thera-Band-resisted heel raise produced 8% more muscle activation than the standard heel raise, and 40% more activation than conventional isotonic eversion. These findings support a more biomechanically-specific exercise using Thera-Band elastic bands for functional strengthening of the peroneus longus. The authors concluded that this exercise “may facilitate more effective training outcomes from programs targeting the peroneus longus,” although more research is needed to confirm this assumption.

REFERENCE: Bellew JW, et al. Facilitating activation of the peroneus longus: electromyographic analysis of exercises consistent with biomechanical function. J Strength Cond Res. 2010 Feb;24(2):442-6.


Vibram Five Fingers Shoes

The Vibram Five Fingers shoes are pretty good  for me so far. I’ve been intriqued by them from the beginning and I finally saw a lot men & women wearing them at a workshop I was attending about 3 weeks ago. I went to a local REI Store and they were sold out. In fact all of the REI Stores I called were sold out. They even said, the back order was already sold out!  A couple days later I went to the WLA  ‘Act 16’  Store and they had a good supply. I got two pairs, one has a slightly thicker sole than the other.  I don’t think  they are just a fad. I understand the mechanics of walking and running, and I like the idea that these shoes can increase the arch on the bottom of the foot. The Vibram 5Fs make sense in that regard. They feel safe, comfortable, but they are still a pain in the ass getting your toes in the proper slot. Although it is getting easier. I like wearing them during my workouts and other sport activities. I especially like the way they feel during my kettlebell workouts. They do look weird, but I have worn them to the office and most patients don’t even say a word about them.  I’ve only worn them on relatively short walks so far. No long walks or trail hiking yet. During the short walks outside, (about 30 minutes)  they’re fine.

If you feel motivated to go barefoot, by all means go barefoot. Wearing the Vibrams 5F feel safer to me on hot concrete, dirt, asphalt and uneven pavement. Wearing them allows you to naturally train yourself to lighten your step. 

Interesting side note, I feel happy when I get to take the V5Fs off at the end of the day. Let’s see what happens after another few weeks.

The next shoe I want to try is the RunAmoc from Soft Star Shoes. Any body have a pair yet?


Navicular Drop Test

Use this test to help you determine if you need orthotics.

All you need are a marking pen and a piece of 3″x5″ card stock. With the patient sitting comfortably (feet on the floor, but non?weightbearing), palpate the medial aspect of each foot and find the navicular prominence (the most prominent bony landmark found inferior and somewhat anterior to the medial malleolus). Using the pen, make a mark on the patient’s skin at the point of the navicular prominence. Stand the card on the floor next to the medial arch of the foot and mark the card at the level of the navicular prominence.

Next, ask the patient to stand, in a relaxed position. Once the arch is weightbearing, the navicular prominence will be somewhat lower. Make a second mark on the same side of the card at the new level of the navicular prominence. Repeat this procedure with the other foot.

Now measure the difference between the two marks for each foot.

If there is a drop of 4 mm. or more in the arch between sitting and standing, or if there is an obvious asymmetry from left to right, this is objective evidence of a functional foot problem ?? hyperpronation/collapse of the medial arch. This condition is best treated with flexible orthotics designed to be worn during all weightbearing activities.


Ankle Injury Article

Ankle sprains can easily get reinjured – which is especially common during the first year – and this can result in chronic pain or disability. My article offers a home–based proprioceptive training program shown to significantly reduce the risk of recurrent ankle sprain.

California Chiropractic Journal article and photos: