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Your Feet: Gateways to Your Knees, Hips and Back

Telma Grant, P.T. Private & OHIP physiotherapy and Chiropractic. If you're in pain, call us. We can help.

Question: Telma, I am starting to get the idea that I should come and see you if I have flat feet and let you examine my feet. I have enjoyed three articles on flat feet. How do you mean that flat feet can cause a problem in my knees, my hips and my back? I do not quite understand that.

Put down the newspaper and stand UP. Take your left foot, roll the arch in and keep it rolled. Now walk. Right away you’ll feel a pull in your leg, either in your knee, hips or in your back. This is an example of how a flat foot affects your walk, and how your walk will, in turn, affect other areas of your body. A person with flat feet is actually walking on his/her arches. Multiply this little demonstration by the number of steps a person will take in life, and the picture for complications from flat feet becomes very clear.

Everybody rolls in on their arches when they walk, but it’s only for an instant and only to transmit the weight from our heels to our toes for the push-off. Walking normally, the heel will strike and then we roll through the mid-foot, it flattens for an instant, but then we push off again we should be pushing off with the toes.

But a flat foot will cause the walker to push off the flattened arch. A strain on the knee results because the motion pulls on the knee. If left uncorrected, the muscles running from the knee to the hip are affected. Now hip pain will surface. If left uncorrected the pain will spread to the back and the body will try to compensate. Depending on the “solution” the body tries, neck pain and headaches could be just around the corner. Another possibility is that a flat foot will predispose the sufferer the heel and foot problem and we talked about that in the last article.

Through writing about this condition, I hope I have made my readers more aware of the dangers of leaving it untreated. We learned that children can be helped and the good news is that physio will also help adults.

Where the foot is flattened because the person is actually walking on their inside arch, but the arch remains in good condition, orthotics are critical and support that arch and stop it from flattening any further.  I do, however, suggest physiotherapy as a treatment before jumping into orthotics.

Why? Orthotics will not correct the muscular imbalance that has caused the flat foot. The physiotherapist will examine the foot, your knees and your back and will emphasize muscles that help to stabilize or correct the flatness of the foot. The most important sets of muscles are the pelvic, hip, back, and abdominal muscles. By training those muscles to be a little stronger, we can help support the hips, the back, the knees and, ultimately the flat foot. The numbers are promising: in 80% of cases treatment will correct the problem.

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Do flat Feet Need Treatment?

Telma Grant, P.T. Private & OHIP physiotherapy and Chiropractic. If you're in pain, call us. We can help.

Question: Telma, what I don’t understand is, why do I need to see a physio if I have flat feet?
Did you know that all children have flat feet until about two years of age? They look like they have flat feet and this is partly due to the fat pad in the inner arch of the foot. We call this the longitudinal arch. In other words, the arch is not fully formed until age two. All children under 2 have flat feet. When considering treatment, we are talking about the child beyond age two and older who has flat feet.
First of all what are flat feet? In medical terms, we call it pes planus. A pes planus or a flat foot is a foot that rolls in. If you look at a person from the back, you see that they are taking more weight on their inner arch then they should and therefore the foot flattens. This is why we call it flat foot.
A flat foot affects how that person walks, you can see this with a computerized gait analysis. The way the weight is taken by the foot changes and if you watch that person walk.
There are three parts to walking. First, the heel strikes the ground, then we roll through the middle part of the foot and then we push off with the first and second toes. This is normal.
When a person has a flat foot he/she takes too much weight through the heel on the side of the foot that is flat. You will hear, what is referred to as the elephant foot, slam, slam, slam. The heel hits much harder than it should. You can also see this in the gait scan because there is a red area under the heel. With time this will put a strain on the spring ligament under the foot, what we call the plantar fascia and the person could come down with plantar fasciitis or heel spur syndrome.
The other way patients will present with flat feet is that they do not heel strike very well. Instead, they roll into the inner arch and push off. You can see this on the gait scan as well.
With this kind of patient, the problem will not be as much plantar fascia, but the problem will be further up the chain. In other words, if the foot is not taking the impact of the ground well, the problem will reflect in the knees, the hips or the back.
If you have a flat foot, it can put a strain on your heel itself. This may give you a heel spur syndrome or may lead you to have knee/hip and back pain.
Ask about our free gait analysis.

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Adults with Flat Feet: It Gets Complicated

Telma Grant, P.T. Private & OHIP physiotherapy and Chiropractic. If you're in pain, call us. We can help.

Question: Telma, why do I need to see a physiotherapist if I have flat feet?


Let’s recap what, exactly, the term “flat feet” means. In medical terms, we call it pes planus, or a foot that rolls in. If you look at a person from the back, you see that they are taking more weight on an inner arch and, as a consequence, the foot flattens you have observed an instance of flat foot. Initially this may not sound like a condition of grave concern but when on considers that a flat foot will affect how a person walks in combination with how much time us grown ups actually spend on our feet, a flat foot has very important implications. It will affect how we walk and, ultimately, problems may develop elsewhere in our bodies.

The observer can see the flattening but a more detailed understanding of each flat-footed person’s condition is possible with a computerizes gait analysis. The client will walk through this examination; the weight of a person is taken in different measures by their feet as he/she walks. Walking may seem like a simple activity, but there are three distinct parts to the action. First the heel strikes the ground, then we roll through the middle part of the foot and then we push off with the first and second toes. This is the normal step of a normal-footed person. When a person has a flat foot walking is very different.

Specifically, two things will happen:

They take too much weight through the heel on the side of the foot that is flat. You will hear, what is referred to as “elephant foot”: as it slams, slams. The heel hits the floor much harder that in should. I’ve actually seen this as it happens in the gait scan: a red area will show under the heel. With time this will put strain on the spring ligament under the foot – – the plantar fasci – – and the sufferer could develop plantar fascitis, or heel spur syndrome.

The heel does not strike very well, and the walker will roll into the inner arch and then push off. This is also very clear on the gait scan. With this particular patient, the complications move further up the body., The foot is not taking the impact of the ground well, creating the potential for knee, hip, and even back problems.

Adults tend to take their feet for granted and, on the surface, having a flat foot doesn’t sound like such a big deal. But left untreated it can lead to something as “small” as heel spur syndrome, as nagging knee problem or persistent back pain that actually limits your activity level. The best solution is to see your physiotherapist for an examination. If you have a question for Telma please contact us.

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Your Shoulder Pain is on the Cuff

Physiotherapy for rotator cuff tendonitis at Telma Grant, P.T.

Question: “Telma, I have shoulder pain and I’ve been told that I have rotator cuff tendonitis. How can physio help?”

The rotator cuff is a set of four muscles of the shoulder. They are so-called because they form a cuff for the shoulder joint. Three are in the back and one is in the front. The rotator cuff muscles connect the shoulder blade to the upper arm, which is the humerus, via tendons. When the tendons become inflamed, the result is rotator cuff tendonitis or inflammation of the tendons. Sports where athletes are particularly prone to rotator cuff tendonitis include golf, baseball, tennis, and swimming.

The important thing in treatment with respect to rotator cuff tendonitis is to realize the principle that no muscle operates independently, all muscles work in pairs and they pull against one another like a pulley system. In the shoulder, one of the muscles that work with the rotator cuff is the chest muscles called the pectoralis. What happens when you get rotator cuff tendonitis is that the length-tension of the muscles, and therefore the tendons have been changed. The most common presentation is that the shoulder joint, or the humerus or upper arm, turns in and forwards. We say it internally rotates and anteriorizes. When this happens, not only is the rotator cuff or tendon painful, but also the chest muscles, or pectorals, form very tight knots in them that keep the rotator cuff from functioning properly. This happens in each and every case where rotator cuff tendonitis results. Therefore, in treatment, simply treating the rotator cuff itself, where the tendon is hurt, is not sufficient to resolve the problem. As much as the tendon is now overstretched, the front of the shoulder joint, because of the chest muscles, or pectoralis muscles, are now over-tightened.

Treatment involves restoring the proper length-tension of both sets of muscles, taking out the knots, what we call trigger points, in the chest muscles, as well as treating the inflammation in the rotator cuff tendon.

Pitch your rotator cuff injury, call your physio today.



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OHIP Physio for Seniors, Youth, ODSP & OW

OHIP Physio after Hospital. Orthitcs and knee braces at Telma Grant, P.T. Telma Grant, P.T. Private & OHIP physiotherapy and Chiropractic. If you're in pain, call us. We can help.

Telma Grant, P.T. is Clarington’s only private and OHIP funded physo clinic.

The government provides coverage for OHIP physio for seniors, youth and other categories of patients to obtain physiotherapy services at publicly funded physiotherapy clinics. There are a limited number of physiotherapy clinics across the province.

To be covered for physiotherapy services at a publicly funded physiotherapy clinic, you require a referral and:

  • Be 19 years old or younger or
  • Be 65 years old or older or
  • Be receiving benefits under the Ontario Disability Support Program or Family Works or
  • Have been overnight in hospital for a condition that now requires physiotherapy treatment

Get OHIP Physiotherapy

Learn how you can receive government-funded physiotherapy services to help you recover from illness, surgery or injury. If you are a senior, you may benefit from exercise classes designed to keep you healthy, active and independent.

Click here to see a list of all OHIP physio clinics in Ontario.

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Don’t Stress Out About Stress Fractures

Telma Grant, P.T. Private & OHIP physiotherapy and Chiropractic. If you're in pain, call us. We can help.
A stress fracture, also known as a fatigue-induced fracture, consists of one or more small cracks in the bone. It is associated with a pattern of overuse, commonly seen in the lower extremity in athletes.


Repetitive motion is one the mechanisms that result in a stress fracture. The muscles become fatigued and are unable to absorb ground force, which is transmitted to the bone. This overload results in stress fractures over a period. High impact sporting activities that result in this injury include:

  1. Track and field activities
  2. Basketball
  3. Tennis
  4. Gymnastics


The main symptom is pain in the extremities which worsens with activity and subsides with rest.


As with any bone injury, the confirmatory diagnostic test is an x-ray. In some cases, a CAT scan or MRI is requested if the x-ray is not conclusive.


The pain stimulus is the body’s natural mechanism to protect itself from severe self-inflicted injury. The rule of thumb for immediate treatment is:

  • Rest
  • Ice
  • Compression
  • Elevation

Rest (and limited weight bearing) is an important aspect of stress reduction on the bone and surrounding joints. Shoe inserts also help with shock absorption.

Stress Fracture Injury Prevention Tips

If something is tingling, numb or hurting, it is time to stop what you are doing and seek medical attention. If a stress fracture is ignored, the condition can get worse and escalate to a more serious injury. A stress fracture is an early sign of bone destruction, and it must be treated quickly and proactively. It is generally associated with dull, aching pain in a general area. As it progresses, the pain can escalate to sharp, piercing pain in a localized area. Ignoring a stress fracture will lead to further bone deterioration. This can result in long-term consequences ranging from increased recovery time to joint deformity.

If you are participating in ongoing, repetitive activity or a high impact sport, it is important to rest periodically from the task and do the following:

  • Massage the limbs and joints
  • Stretch the muscles
  • Relieve the pressure by reducing weight-bearing on the affected joints

Anti-inflammatory and analgesic medication can help with pain relief. A physician may recommend prescription medication for pain relief and refer patients to physical therapy.

No Need To Stress – Your Physical Therapist Can Help

Recovery from stress fractures is a gradual process. Bone fragments need time to heal. The primary objective of physical therapy during the healing process is to prevent further injury. Once the healing process is complete, it is even more important to seek the counsel of a physical therapist. The therapist will design an exercise program geared towards gradual, progressive recovery of full function of the bones, muscles, and joints.

Physical therapy is an excellent choice for non-surgical treatment for mild to moderate cases of stress fractures. Some of the techniques used by physical therapists include:

  • Cold compress to reduce swelling
  • Strengthening the limbs and joints
  • Bracing with splints to reduce load on the affected joints
  • Ergonomically designed footwear
  • Psychosocial rehabilitation for the professional athlete, looking for a speedy, successful and complete recovery

If you or someone you know has, or is at risk for a stress fracture, give us a call. We’ll be sure to take the stress away.