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What you’ll hear in this episode:

• What Ankle Distortion Syndrome is
• How it is treated
• Who is prone to ADS

This is the final installment of Dr. Khris Ramdeen and physical therapist Eric Finger’s three-part series on postural abnormalities. Today, they’re talking about Ankle Distortion Syndrome (ADS) also known as Pronation Distortion Syndrome. ADS is caused by excessive pronation of the foot. Pronation refers to the natural side-to-side movement of the foot as you walk or run. Excessive pronation can cause, in layman’s terms, flat-footedness and knock-knees.

People with naturally flat feet are prone to ADS, but they are not the only ones. One of the most affected groups is young women going through puberty. This group is particularly prone to not wearing supportive shoes (like sandals) while their physical structure is rapidly changing. During puberty in females, the pelvis starts to broaden and that changes the way the knees and ankles are connected to the hips. If that skeletal change is not accompanied by proper, supportive footwear, it can cause issues and pain in the knees and ankles. Additionally, people who work out improperly are prone to ADS as well. The most common culprit is people not doing squats appropriately.

“The tendency,” Finger says, “is for folks to be more quad dominant.”

What works better, he says, is to be more glute-dominant. The exercise should be like sitting in a chair.

Listen to the fifth episode of Apple a Day Doc Talk with Dr. Ramdeen to hear more about what causes ADS and what Finger recommends to treat it. If you like what you hear, be sure to share it with a family member or maybe a gym buddy! You can find more Apple a Day Doc Talk here!

Apple a Day Doc Talk is a founding_media podcast created in partnership with Dr. Khris Ramdeen.

Host: Dr. Khris Ramdeen

Guests: Eric Finger, Move Empower Concierge Physical Therapy

 

Transcript:
this is a founding media podcast
welcome to the apple with the doc talk podcast the show the combines concepts of fitness with medicine to focus on primary prevention and disease management I’m your host Dr Khris Ramdeen this week we are finishing up our series discussing postural abnormalities of sitting down with physical therapist Eric finger to discuss what these abnormalities look like what can be done to prevent them and what to do when you have them if you Mr other conversations about upper and lower crossed syndrome so make sure you go back and take a listen on this episode Eric and I are digging into ankle distortion syndrome also known as pronation distortion syndrome
First I want to introduce Eric Eric is that mobile physical therapist so he’s here in the Austin area told come your house so go to your business wherever you are yeah right yeah and he is a midwesterner began his formal education at the university of Kansas and he was on the varsity swim team right yeah and so got your bachelor science there in exercise science and then completed your graduate training at Texas Tech University health sciences center in two thousand two he then graduated and had a very impressive postgraduate continuing education regiment at becoming an A. P. T. A board certified orthopedic specialist and a fellow of the American academy of orthopedic manual physical therapy and this is a distinction that less than ten percent of physical therapists have in the United States so tell me a little bit about that Eric yeah my U. S. certification AS so you know after you know getting out of school in such a kind of this like I need something I need to go back into a little training and such so you know in the physical therapy ward big world you know go on board certification is the kind of the next step committee looking at your competency and such and it is a great way to kind of refresh on things learned as things and really help with my practice and went into a man of therapy fellowship which was great working with some of the top there is here in the country and here locally to they were filed lead Ackley and such so manual therapy really allowed me to you know learn techniques from just you know be more better better at diagnosis and looking you know in analyzing movement and also just treating joints and muscles much much better soft tissue work could you talk about doing right exactly yeah soft tissue work joint mobilizations and she’s really analysis to I think you’re really having a better keen I had had it doing what PT’s do we we can analyze movement all day I catch myself even just when I’m walking around who look at that as one of the reasons why I like working with Eric and we take our mutual patients because he’s also very into fitness so understands this population very well he likes to compete in triathlons and escape from Alcatraz Ironman seventy point three right yeah they’re pretty intense guy the name of that yet but that’s about the travelers are fine you know PMR swimmer and such to come my way to kind of stay in the do a little competition and keep my fitness up there it’s good it does give us a good insight into the patients we take care of to you know asking questions about these things is that he’s able to say Hey I do this too exactly and you’re married you’ve got three kids tell me about the family now boy so we got to a twelve year old and nine year olds and then keep it interesting a two year old it’s quite busy at our house that come with three babysitters there than here well yeah we’re we’re ones in training and she’s doing a heck of a job so yes great excellent stuff excellent where thanks again thanks for coming
I just want to talk a little bit of another common postural abnormalities that we see ankle distortion syndrome let’s talk a little bit about that and tell me what you know you look for what you see when you think of when you hear that term and construct so yeah English Dorsen center what when I think of is I go down to the foot I’m thinking of what we call an over pronation resume pronation is think of of a foot that is flattening out losing its arch in in rolling in word if you will the the importance of this aware this can become an issue is that it doesn’t not only does it affect the tissues and then in the in the mechanics at the foot right it can affect everything up the chain when I see chain meaning the knee the hips and then the hips are intimately attached to the spine so even issues up there so it’s yeah it’s it’s not just a foot issue it can be in a whole and entire body right and one of the things we’ve been saying through this three part series is that these postural issues they’re not just you know aesthetic issues okay the one little thing in that connection that you talked about can run its way all the way up you know the needs to the hips the spine and in cause problems cause issues because over use problems in the in the tendons and the the the the muscles and even kind of if if your mechanics are off make the joints work overtime and you can start getting some you know where wearing issues there as well this is a common issue that you see partially speaking you know at the foot in anecdotally you know from my my experience I you know being down here in the south it’s hot sauce right bar you know majority of the year so people tend to wear more you know flip flops and such your shoes without support right and what I saw in the clinic you know when I was charged for my business was teenagers especially females girls going into puberty when their bodies are changing and they have these issues down at the feet can really wreak havoc on their knees and that’s and then that means you do you do you know your folks are like what happened I don’t have an injury or such right now so I think a lot of it the feet can really you know by you know poor choice of shoe wear or having you know lack of support down there are you really yeah our support and really am costs mission is not saying that we have to wear shorts shoes all the time but if you have a propensity you know if your genetics do play a role here if your parents had really flat fee my feet and and you know and you’re not doing exercises that would engage those muscles down the photos postural muscles if you will in the foot right yeah you can set yourself up mmhm for some issues okay and then who you mentioned genetics a little bit right you know if your if your parents have a when your parents have it you may have that flat archer talking about which causes your feet to core collapse towards the midline the center of your body and brain because that pronation issue any other any other one that you think about that’s likely to suffer from this either through lifestyle or genetics even yeah I think folks you know when I take a step back and roads talking about the you know you know teens going right such as the helpless starts to brown with females the angles from of the of where the legs meet the leg bone meeting down to me that ankle can change and you can start developing some kneecap pain and such maybe folks were hyper mobile just by in general hyper mobile meaning he really lacks you know that person who can straighten their elbows out and right it’s a reverse curve someone who can pull their finger back cata hyper elasticity tell you exactly you know I keep doing this you can see that where it where it becomes a problem though is is as we mentioned how where when that when that foot hits and collapses it really does make a change at the knee as well up at the hip and such and that’s where we can start getting yourself in trouble for doing a repetitive activity and
what are the typical symptoms that you see obviously they have the flat arch and with knee pain hip pain what it one of the types of symptoms to see yeah S. so from an observation point you what I I mean literally what I see is when I when I have someone come in let’s say with a foot issue or a maybe a knee or hip first thing I’m gonna do is put him in one like its stance yeah well they can balance that tells me a ton and then from there I like to I can kind of see what who’s not doing their job and when you say not doing their job let’s say you put them in that one like its stance and they have this view angle distortion what happens to them when they’re in that state yeah yes so as I see let’s say that foot collapses in as we per day right what we’re gonna see then is that the need to read all it if you can VF rotating in word and the thigh and I’m coming towards mid line we called abduction okay so it’s almost a a rolling in of the of the of the upper and lower lag as that as we call it term valgus collapse well in valgus is pretty much the inward pointing and I need my semi knocked a seminar on these things that could be happening valgus values yeah mmhm so yes that’s that’s the that’s that’s that first thing we’ll be looking at like how well can they stand only does that tell me what to show you know what joints are working but also gives me a little idea on maybe the supporting muscles so we can go up the chain to the hips and into the big muscles the the glute Max and its job is to kind of D. rotate if you will kind of rotate outward to keep the pelvis level in the nation yes you can it it helps combat a strong strong glued to help combat that that falling in or that valgus collapse so come back and
kind of like what we’re talking about with lower cross he exactly who’s having that big curve in your lumbar spine so do you tend to see those occurring together much the lower crossed syndrome in the pronation distortions or ankle distortion I mean it’s hard to say but yet they do kind of follow each other you know because I do see a lot of folks you know when I’m when I’m you know someone who comes in with low back pain I’m treating I’m course what made my observation I’m see looking at their feet to what else could be causing you know this backing expressly addressed asymmetries at the hip no I’m good looking down the chain Canarsie cell and any specific so so let’s see there in that one leg stance the kind of role everything inward and climbs in word what are some of the things that you’d want to do with them besides trying to strengthen their glute Max well I mean I would also in an evaluation and also be looking at our looking at the joints making sure the joints are moving a probably are they moving too much or not enough for some not participating enough sometimes think the hip is notorious for being too stiff and causing that inappropriate movement in word and when it’s not moving well it also has a tendency to turn off the supporting cast that we already talked about the important believes that so I’m looking at joint some looking at the muscles that connect to the affected joints that the bigger muscles is their flexibility appropriate isn’t too tight is it too lax so those are things too and when you see something like that and you know that they’re at their arches are collapsed and that’s at least part of the problem here in rolling them in words
do you recommend that the C. maybe a podiatrist or get arch supports or anything that will help support that arts is that’s a good question yeah so I I will too my first thought is deceived can this can we correct this by just doing strengthening exercises and such if the collapse is so great that also suggests you know potentially going to the podiatrist and such and and going for that kind of that rigid orthotics technologies is been has allowed us now that folks are business corporations are making some really nice off the shelf or thought ex and I typically start there right it’s it’s a little to be honest it’s easier on folks his pocketbook right and there’s some decent ones that you can purchase off the shelf for a fraction of the cost right above that were thought of the orthotic do you have them do that as part of your regimen or or is it may be case by case basis case by case kind of looking at you know their activity levels they’re they’re you know how are they how compliant they can do the exercises I mean truthfully I’m looking at a lot of different things this is kind of like it it’s going to help but it’s not really going to treat the underlying issue it’s just going to support them while you’re inside so correct yes to correct the mechanics yes it’s kind of a kind of like those partial braces for upper crossed syndrome to pull your shoulder this doesn’t really yeah let’s make me gag it’s a yes I won’t totally put into that side but yeah nice corrective measure to kind of maybe a like a like a sham and a house you know right ring things a little more leveling that rolling out in word yeah and then give us a nice base to strengthen off of yeah
how do you make sense and then so when when they have this ankle distortion syndrome or pronation distortion what type of injuries do you find that they’re susceptible to sure sure yes starting down the foot we think of plantar fasciitis yeah I mean yeah you can ask you know someone on the sidewalk in about nine out of ten people say yeah I’ve had it and it’s not fun so that’s a bit of a a repetitive stress injury to the fibrous tissue on the bottom of the foot moving up a little bit is the heel cord the Achilles Achilles tendonitis can develop from that again from those poor mechanics that falling through and think of these as repetitive stress injuries moving up the chain up to the knee knee cap issues or what we call a patella femoral syndrome if you will that you know folks who have that pain that just feels like it’s underneath the kneecap pain after you’ve been sitting alone you stand up in that kind of ache some that pain that when you do like a little squat you feel it can I just yes and you know those and then even even in someone and ask an athlete right talk about if they have this tendency to fall in there and there have been there and they don’t have the strength of up the chain the seal tears because that that position that we talked about that rolling in makes someone very susceptible to tearing ligaments and that’s a that’s a pretty big deal in the yes sorry yeah yeah yeah and when you say up the chain tell us about the Connecticut changes so sorry in what the media we mean when we say that so I’m thinking it think of it the the body is kind of a linkage of different joints are so down that foot we’ve got the if the starting at the ankle which is then linked to that than me and then literally linked up to the hip I like to link the hip to the the spine and you could go all the way up to that that device right on it right yes is the kinetic chain where we keep using this term because if you affect one speaks of it it’s all linked so right not gonna happen in a vacuum and isolated fashion yes check the other exact pieces and as we mentioned in our other podcast the kind of the path of least resistance the bodies so smart if it senses any weakness up the chain it’s it’s gonna say let’s let the forces kind of go through there and that’s where folks can get themselves in trouble for those you know repetitive stress injuries and such right and
any particular exercises in the gym but you would say whoa maybe you might want to avoid that or drop your weights if you had this protein distortion ankle distortion a question my first thought would be anyone who’s doing squats and such before you start really increasing the weight go in front of a mere and do you know or you can and and do a squat and make sure that that you can do it without your knees cutting coming together as if they’re kind of you know get a touch we need to be able to do a a squat in using appropriate way for your legs are you know square in front of you that the knee caps are aligned with maybe the second third toe not deviating in word because that’s where you’re gonna get in trouble so I think the really specific with your technique aware of yours and your body you know body awareness with exercise will really keep healthy and this is why just an assessment with your position with your physical therapist we want to make sure your personal trainer you know you just want to make sure that somebody is looking at this alignment before you start loading that barbell up with low weight and now that way it’s going to be taken in your knees or in your hips and in places where you don’t want it and when you’re doing that squad where you pushing through in your feet when you’re when you’re getting up from being right down low top high how should they visualize or concentrate on force goes yeah yeah so there’s the the tendency is for folks to be more quad dominant my bias and as we talked about my round point the cleats are is to let the the the glued to be the primary mover of the squad to do that to really biased the hips what one has to do is to think about when you squat to really push the hips backwards as if you’re sitting into a chair rail like or you know going down to the commode it’s that’s what that’s what I wanna see we don’t want the knees passing the toes and on the knee caps going past the toes in which one the hips to be doing more of it and you’re gonna notice as you do that your weights can shift back onto your heels right rise you press up and you’ll you’ll notice as you as you push to stand you’ll notice that and I think that’s a great point there the key where the force got to go through your heels and another way to do imagine it’s like sitting in a chair try just sitting in a chair you know getting up for maturing only agrees to that yeah movement you’ll be surprised if you’ll be if if this is something you deal with if you just get rid of the weights and just start working with body weight you will get a workout don’t don’t don’t be confused yeah he started if you really start honing in on your technique you can get a great workout and once you understand that link that my owner connection what you’re supposed to flex how you’re supposed the move with using body weight or no weight when you do use weights are going to be more likely to engage the right musculature right yeah you can be more efficient mover if you will machine and yeah you’re you’re you know I think you’ll notice the the the ability to do it number one more comfortably but also and be able to have more power you feel feel stronger when you’re when you’re when you’re doing the exercise house yeah and speaking of power Eric his started his company called move in power concierge PT and if you’re interested in him coming to take care of you or or you have any questions yeah consultation free consultations him great yeah he that’s great and if you’re interested in doing that please visit the link in the show notes and I’d like to thank founding media for hosting us and we’ll see next we’ll see you next time guys thanks so much for tuning in thanks
thank you again Eric I appreciate you taking the time to discuss all of these topics on the show if you’d like to learn more about the services we put a link in the show notes the apple a day doc talk podcast team includes me doctor Randy producer Mariah gossip in audio engineer Jake Wallace thank you to everyone it found the media for your support the apple a day doc talk is available on iTunes stitcher Spotify or wherever you get your podcasts you can follow me on Instagram at green dean M. D. spelled R. A. M. D. E. N. N. D. or check out the link to my YouTube channel and website in the show notes thanks for listening