Peripheral Neuropathy

Hi, I'm Dr. Sherri Betz. And we will be working on peripheral neuropathy and severe flat feet that is not a congenital flat foot but is a developed flat foot over time caused by peripheral neuropathy. This is Peggy. We did her assessment in a previous tutorial. You can take a look at that. And we also are working on the trapeze table first, doing the long spring leg series and sciatic nerve glides.

Then, we'll go into the footwork series on the trapeze table. And then, we'll finish on the combo chair, and I'll actually show you some Kinesio taping techniques as well that might be helpful for bunions and hammer toes, and also for taping the arch. Thank you for joining us. We look forward to sharing more information with you in this tutorial. So the first loops that we're gonna use are these COVID-friendly loops that were developed by Balanced Body that are vinyl and easily cleaned between patients.

And then, I have some double loops that we'll be using here too that will need to be washed between sessions. (loops clinking) All right, so we're gonna put this one on first. And I want you to put your right foot in the loop. And I'm gonna make sure since she has some peripheral neuropathy and foot pain, making sure that feels okay to her. And then, I want you just to lengthen that leg out, uh-huh.

And then, press it down to the table. That's great. Take it up, keeping the knee straight. And then, press down. Excellent. So we're trying to improve her hamstring length.

And the interesting thing about this exercise is that what does this have to do with thoracic kyphosis, right? What it has to do with thoracic kyphosis is as she pushes the leg down, she presses into her head and her back. So when you tuck your chin and press your head down, she probably didn't realize that she was doing that, but you can feel that when you press your head down, right? Okay, now, we're gonna take the leg across the body. Now, this is gonna be like a sciatic nerve glide because the sciatic nerve is lengthened in this position.

And I wanna have her circle, uh-huh. And try to go down as far as you can. That looks really good. You're doing a great job keeping your leg straight. If the leg is bent, it doesn't actually floss the sciatic nerve.

So because she has the neuropathy, I wanna really keep that nerve healthy and flowing in its pathway. That looks great, one more time. And release. Very good. All right. Now, I'm gonna come around, and we're gonna do the other side.

(footsteps tapping) (loop clinking) Okay, left leg in the loop. Keeping your toe pointed as much as possible, gonna really work through that little hammer toe there. I wanna get it to point. And then, I want you just to go straight up and down this first set. Reaching long, hinging at the hips.

That looks great. Pressing down. And up. All right, I'm gonna go ahead and add something that I really like to add for coordination and for your mobility. So placing your hands on the tower bar, uh-hmm. And I want you to push the bar over your head and just keep it there for a moment.

Push the leg down straight. That'll stretch you out really nicely. That's gonna feel good. You're gonna feel like a new person. All right, now, press and lengthen. Beautiful. You can really see that waistline stretch.

And then, we're gonna add a little coordination component by having her bend her arms and press up toward the ceiling. So bend your arms, push the bar toward the ceiling, coming through like that. So you have to make sure the bar's high enough that it doesn't clip their head, right? Push down. And notice that I don't have any springs on the bar.

There's no need to put the springs because I'm not really working on strength or her scapula right now. I'm just working on some coordination and shoulder mobility. Pressing the foot down as the arms go up, and bend to come in. Breathing in. Breathe out to take the arms overhead. (breathes audibly) Great. So you see how I layer on the complexity, right?

And then, one more, stretching out. So we get the foot going first, then we do the arms, and then we combine it all with breathing. Okay, bend your arms and let the bar go overhead. And then, place your hands by your side. We're gonna do the flossing of your sciatic nerve now.

So now, take it around and come up. And let me know if that's painful at all as you go around. That's actually better. Yeah, that's okay. Yeah.

Where do you feel it? Along the side of my- Along the side of her leg and calf. So we're gonna do a little bit more with that in just a moment. That looks great, pressing down and around. Excellent. One more.

Exhale, press down and up and around. All right. Wow, really well done. You did a great job keeping your knee straight. That has sometimes been a problem for her. She has a hard time keeping that knee straight.

So we're gonna do something different here with the double loops. And I just wanna show you, in some cases, she has had some cramping in that foot. And we've had to switch to the double loops because keeping that toe pointed and that arch lifted for a long time has been difficult. And so I'm gonna put the double loop on there so that she doesn't have to worry about keeping the toe pointed. So let's take this leg up, and this can add that additional flossing component to the sciatic nerve.

So I'm gonna have her flex her foot, take it down, straight knee. Uh-hmm, like that. And then, point to go up. So in this case, she can flex the foot and not have to worry about the strap coming off of her foot. Good. All right, now, take the leg across the body. And now, I want you to circle your foot.

Uh-huh, so as she circles downward, stop here in that sickling position. That's gonna give her the greatest stretch to the peroneal portion of that nerve. And so you might feel a little more intensity there, right? That's it. So if you do that, as you go around, take it up and across.

And then, flex this foot down. Uh-hmm, just like that. Great. I love that. All right. So that's something that you would normally do on both sides, but we'll just do it on one side for today.

Now, we'll be working on footwork on the trapeze table, dealing with peripheral neuropathy, leg strength, and leg alignment for Peggy. So Peggy, if you could lie down on your back. And just relax there for a moment while I set up the tower bar. Using the tower bar safety strap, (straps clicking) and I'll usually place the tower bar pretty high, especially for the first time somebody's doing an exercise. And then, I might not even use springs at first.

But for today, I'm gonna use one blue spring, (spring clinking) medium tension spring. If I were using a different type of spring setup, I would use a light, short spring. (spring clinking) All right, so now, what I want you to do is take your feet up onto the bar. And then, put the balls of your feet on the bar. Uh-hmm. And then, the other one.

Yes, that's good. And we're just gonna have a, just a hip-width apart stance and, does everything feel okay? So I have to be mindful about her tenderness of her feet. So we'll see if she's okay with that. And then, I want you just to push the bar up toward the ceiling.

Uh-hmm. And I'm gonna watch to see that she maintains her spine alignment. And I want you to think of rolling your pelvis forward just a little bit. She's in a little bit of a tuck, and we know that she doesn't have very much lordosis. So we wanna make sure that we don't add to that problem.

Bend the knees. Let the knees come apart slightly, and bend the knees and let the bar come down. So just kinda get used to how the bar works. Keep your tailbone down, and then press up again. Uh-hmm. Great.

Bend the knees, inhale. Exhale to press up. Think of wrapping the toes around the bar. I don't know if you guys can see this, but this hammer toe is sticking up a little bit. I'm gonna work with that in just a moment. Good. Breathe out to press up.

Keep the knees apart. So she likes to brace those knees together. I'm gonna make sure she keeps those knees apart. Great. And then, keep that. Right, and then do it again. Breathe in to come down, that's right.

So I paused her a little bit to get her breathing back on track. And then, exhale to press away. Good, there you go. Knees apart. Uh-hmm. Exhale, press away. Okay, staying there, I want you to try to wrap your toes around the bar.

So I'm just encouraging her to flex through that proximal phalangeal joint and see if we can get that metatarsal and the proximal phalanges to wrap around the bar. That's it. Does that hurt? I don't wanna push on it, okay, if it's painful. Okay, now, keeping your legs straight, flex your feet and let the bar come down. Keeping your knees straight, you're just gonna do like an ankle pump.

Yes, that's it. And then, press up. And then, flex and press up. And flex, and press up. And flex, and press up. That looks excellent. One more time.

Okay, now, bend just your right knee and let your left heel sink, just like walking in place. And now, yes, alternating. Uh-hmm. Excellent. Can you feel that stretch? Uh-huh.

Is that a big stretch? Okay. Great job, okay. so I'm gonna let you stretch this right side a little bit more. Yeah, she's limited a little bit in that right side. There we go.

She's definitely flexing more on the left than the right, but she's doing a really good job keeping her ankles and arches lifted. So ankles in neutral and arches lifted. Okay. Now, I'm gonna have you bend your knees. Come down, both knees. Uh-hmm, come all the way down to the bottom of the movement.

Take your right foot off the bar. Extend your left leg, pushing up, uh-hmm. And then, flex just that leg in and out, right? Keep the knee centered with the foot. So if you can see down the line of your leg, make sure that knee is in line with your middle of your foot.

And one of the things too that's easy to keep track of is if you can see your big toe the whole time. So if your knee ends up covering up your big toe, it means it's kinda rolled in like that, right? So make sure you can see your big toe the whole time. Good. One more. Great job.

All right, put the foot down and let's switch sides. Okay, take this foot up. Place it on the bar, press up. Great. Bend and straighten. And normally, we do about 10 reps of everything.

But for today, we're just doing five of everything to give you a sense of the exercise, give you a little more variety. All right. Now, hold there. Flex the foot and point. And flex, and point. Good. Flex, point.

Really good, there you go. She was limited in how much she was doing, but she can do more. This is great. So this is gonna help strengthen those calves and also floss that sciatic nerve and work the arch of the foot and hopefully correct the hammer toe. Good job.

All right. Bend the knee and come right on down. Excellent. Great work, thank you. All right, now, we'll incorporate the combo chair with her exercise program. I'd like you to go ahead and have a seat on top of the platform here.

I've left the handles in so that she can use them to help her get into position. We'll be starting with seated leg pumps. And what I'd like you to do is place your hands on top of these handles, and then sit up tall. And I've got the chair really close to the wall in case she needs that for support or feedback. Because sometimes when you sink back, you can feel your back against the wall.

And then, I want you to keep your back actually away from the wall. I've also used a ball behind the back before to try to keep the body lifted. And you can see that on a previous new tutorial on Pilates Anytime where I worked with Helen in a mixed equipment workout where we used the combo chair in many ways for her body. But for this particular program, we don't need to focus so much on her low back or pelvis. And the upper back, we've already focused on in another segment.

And today, we're gonna be looking at the feet and her leg alignment. So let's put your heels on the bar, and I have the stick in place on the bar to keep the pedals together. So let's pull the toes up toward the ceiling, sitting up really tall. So use the handles to help you sit up tall and not too much so that your back is not gripping. Yeah, so that looks good. Really nice.

All right, now, I want you to press the pedals down, and then let's see how she does with this. Now, you notice that she's pretty far back on the chair, so she kinda pops up when she tries to bring her legs to the ground. So let's go ahead and bring your legs up a little bit, and then scoot forward a little bit on the chair. So perching on the front edge of the chair is a better movement for her with the size of her legs or the length of her legs. All right. Now, go ahead and push down.

I want you to notice what happens to her feet. She's actually doing a pretty good job organizing the left foot, but let's look at that right foot as well. So go ahead and do the pumps, coming up and down. And then, what do you notice there? Yes, is that feeling okay? Is the weight okay for you?

Uh-hmm, yeah. Okay, good. All right, come up and down, pumping the pedals slowly. And I want you to notice just the knees coming together and the ankles rolling in. And then, that right foot starts to really turn out.

Okay, so we're gonna work on that a little bit. So we're gonna press the pedal down, keep it down, scoot forward even more, just a teeny bit. And then, I want you to keep your knees slightly apart. And I might even use my hands to pull apart once I know that she's secure on the bar. So lift the toes up, and I want you to try to keep your toes lifted and just let your toes relax, but lift your feet up.

Yes, that's it. And just point your toes outward like that. That's right. And just let your toes relax. There you go. And then, let the pedal come up, keeping your knees apart. So I just wanna give her that cue first.

Press, that's it. Keeping the knees apart. That looks really good. Yeah, she's doing a much better job with that. Great. All right, now, what I want you to do is press the pedal down halfway.

Uh-hmm. And then, hold. And then, see if you can let go with your hands. And just hold like that. That's right. And press the pedal down.

See how much work she's, yeah, you feel a lot more work in your legs when you let go with your hands. Good. That looks really good. Nice work. Okay. Now, we're gonna switch to your ball of your foot on the pedal and place your ball of your foot up here on the pedal.

You might have to scoot back a little bit. Let me just push the pedal down, and let you adjust your feet, so let's do that. Yeah, now, you can scoot forward again. Uh-hmm. Perfect, sit up tall, and then lift your heel. Heels, plural. (laughs) And then, rise up with the pedals and try to keep those heels lifted.

I want you to wear kind of a sensible church pump, not a stiletto. But just a little bit of a wedge, heel lift here. And then, pressing down. All right. Now, take a little break here, and just let the pedal come all the way up and slide back.

And I'm gonna show you a little trick that I love to use. We have some gel toe separators, and these are just something that I get at Amazon. And they are a Bestrice brand, but there's many brands out there. And these gel toe separators are excellent for separating the toes. So I'm gonna have her work with these on, and these are a brand new pair.

So I'm gonna slide them on, and I'm gonna put 'em in between her toes. And so that she can keep her foot in the right alignment as she's working because she's got that bunion, and it's gonna be a lot better for her to keep those toes separated. And the other thing about neuropathy, sometimes, there is a compression of the nerves as they go in between the metatarsals and down to the toes that, that can cause the burning pain that people feel in their feet. So I'm gonna do our best to help you with that. And then, we're gonna separate that bunion there a little bit.

And so there's little gel spacers in between her toes, and you can hopefully see a little bit better how well that separates the toes. So the first one goes between the first and second toe, and then third and fourth, fourth and fifth here, and then all around the foot. I find that those are much better than just the single separator. They separate the foot much better. Is that comfortable for you?

Okay, so hopefully that feels good and is comfortable. Most people really like these, and they stay on really well. And you can do the whole session with the toe separators here. All right. So now, we're gonna put the ball of your foot on the pedal, and then move your feet back a little bit.

I'm gonna hold the pedal down for you. Rise up with your heels, uh-huh. And then, not too much width through your knees, 'cause you don't wanna roll out on your foot. So remember that's a stiletto position. What I want you to be is a sensible church pump.

There you go. That's it, that looks good. Just holding it like that and rolling in just a little bit. There you go right there. And I want you to feel that position, and then pump up and down. So I try as much as possible to get her in the right position, and then have her pump and work her legs.

Good. Sitting up tall. Much better. So if I strengthen her feet in the proper alignment with the arch lifted, with the bunions separated, that should help her. Uh-huh, it does. Yes, that's good. (laughs) All right. Now, hold there.

I'm gonna remove the stick and let her do a little reciprocal pattern, and I want you to push the right foot down. Uh-hmm. And then, as the right foot comes up, the left foot goes down. So you're pumping in place. Now, can you let go with your hands and do that same thing?

Usually what you see is some compensations, but she's doing a good job keeping the heels lifted and not rolling out or in on the feet. Great job. That looks great. Okay, come on up. I'll put the stick back in. It's usually easier to dismount with the stick in place.

And then, what I'm gonna do is push the pedal down and let you come on up without having to navigate that. And then, stepping off. Perfect. And then, I'll turn the chair. (chair rasping) And I want you to stand on the floor right in front of the wooden platform and put your hands like this with your fingertips on the handles.

Okay. Now, as you stand on the pedal, I want you to keep your posture. And you can see where the pedal is, but I want you to see if you can keep your eyes forward and chest lifted and place your foot on the pedal. Okay. That was better. Pretty good. All right.

Now, I'm gonna help you put the pedal down, so you can organize your foot, 'cause it's a little bit too far back. Yeah, it is. There you go. Sometimes, it's easier to organize the foot when the pedal's all the way down. So now, I want you to take the pedal up and down.

And then, press down. So I want you to notice that she's rolling in through the arch, letting the knee come in, and the arch is flattening, the heel's dropping below the pedal height. So very important that you put on your church pumps again, (laughs) okay? And then, let the pedal come up and down. That looks great.

Keeping the heel lifted. Look at that beautiful arch. So I'm gonna take my foot off the pedal so you can see that and that beautiful arch. So she does not have a congenital flat foot. It's something that strengthening will certainly help. And then, we put the spacers in so that she has the better toe alignment as well.

So that looks really good. Now, we're gonna work on that heel raise that was so hard for you. So keep this foot, uh-huh. And then, let's put the other foot on there. Okay, now, what happened there? Uh-oh. (laughs) Okay, I'm glad you remembered.

Okay, so see if you can press down on the pedal to lift your chest. Yeah, bring your pelvis forward. Now, lift your foot high enough to get it on the pedal without rounding your back. Yeah, so that takes a lot of leg strength and hip mobility, right? Okay, so now, I'm gonna push the pedal down with you.

And then, you can get your foot situated in the right position. That looks perfect. All right. Now, standing tall, fingertips on the handles, and then bring your pelvis forward. Yes, keeping your body vertical. Now, let the pedal come up, and I will remove my foot in just a moment.

I'm gonna put my foot on this side, so you guys at home can see what's happening here. All right. Again, the heel's dropping. And the arch is collapsing a little bit, but not quite as much as on the other foot. So let's keep that heel lifted.

Uh-huh, again, putting on those pumps. Not the stilettos and not the flats. (laughs) There you go. That looks really nice. Okay, now, I want you to hold the pedal down and rise up on this toe, doing some heel raises. And do 10 times like that.

So if you remember from the assessment, she had a hard time doing the heel raise and was unable to do it. And with this, she's got a little bit of support by putting the other foot down. She's got her hands on the handles here, and she's able to do a straight leg heel raise here. So now, what I want you to do is let the pedal come up. Bringing the heel down, let the pedal come up.

Uh-hmm. That's it, it'll come up. The springs bring it up. Hold it there. Now, do a heel raise. So that's gonna be less support, and it's a little harder, right? There you go. This hurts my foot.

Okay, and it's starting to hurt her foot. Okay, is it because the bottom of the pressure? The bottom is tender. It's tender. Go ahead and step down. I'm gonna give you something to help you with that.

Okay, great. So I'm gonna take a yoga mat, and I'm gonna put it underneath your foot. So if you can step onto the platform there, and I'll roll out this yoga mat behind you and see if that's enough cushion for you. Okay. That's better. Is that better? Okay.

Bring your feet together, and getting the feet together will get them straight ahead and get her in the right alignment as she starts. So now, let's go ahead and put that left foot up on the pedal. Uh-hmm. There you go. I know it's hard, that's right. Good job. All right, now, keeping the foot lifted there and the pedal high, now, do your heel raise and see if that cushioning was better for you. Oh yeah.

Oh good. Okay, that's great. So sometimes it's just tenderness in the bottom of the feet. 'Cause as we get older, the fat pad goes away on our feet. So we always get fat where we don't want it, and we lose fat where we actually need it. So unfortunately, that's what happens with aging.

So this is great. So she's getting a little fatigued here 'cause she's bending the knee. You can see this here. Okay. Go ahead and step down with that left foot, and let's do the right side. Okay. So again, standing tall.

Yeah, I need to bring that pedal down for her a little bit. Okay, now, you're gonna push the pedal all the way down first. Uh-huh. Organize your foot so it's a little bit more on top of the pedal. Lift the heel, uh-hmm, and bring the knee outwards.

That's right. But not the foot. So your foot stays straight, your knee comes more over toward the fourth and fifth toes. That looks great. Okay, now, rise up on this left foot. Good.

Uh-huh. Another thing I could do is have you let go with one hand. Uh-hmm. And this is my injured flat foot. Right, and you're able to do that. That's great.

Yeah, so I think it's gonna get well. That looks good. All right. Now, let's see if you can bring the pedal up. And so this left foot is the one that her, take it up to the top, allow the pedal to come up. Uh-hmm, the springs will bring it up.

And then, rise up. So I'm not sure if I reminded you, but we have two light springs on the top notch for her right now. And yes, that looks really good. So she's doing a very similar thing that she did on the other side with that knee slightly bending. And so see if you can keep the knee straight as you rise up.

Uh-hmm, that looks great. One more. Excellent. Okay, go ahead and step down. Right. Really nice. Okay. And we're gonna do the Kinesio tape now for your foot and the hammer toe and the bunions.

So I'll show you some taping techniques for that. She really likes the Kinesio tape 'cause it really helps with correcting the foot alignment and making it feel a little bit better, giving her some support. So I'll show you that in just a moment. Okay, now, we've finished Peggy's session working on her peripheral neuropathy and flat foot and some of the foot pain. We used the toe separators to keep her toes in better alignment as she exercises, which I can't recommend enough.

It's such a great way to exercise with your clients who have bunions or, you know, Morton's neuroma, all kinds of foot deformities where the compression of the foot in a shoe can lead to pain. And then, the sweeping of the toes to the outside of the foot, which we normally call bunions. These are so helpful for correcting that. And they can wear them as much as they feel comfortable doing so. We usually start with doing about two hours a day and working your way up.

And then, I use them throughout the whole session. And I always have a bunch of these available in my studio. So I'm gonna start with this hammer toe right here. And what I have done is I have used some Kinesio tape. I don't advocate any brand of it, but just some kind of elastic tape.

It serves as kind of an extra muscle that the patient doesn't really have. So you tend to like this Kinesio tape, don't you, Peggy? All right. So, I've cut the tape. It normally comes in these strips here, and I've cut it into four skinny strips because it's too thick obviously for the toes. So I just cut it lengthwise into skinny strips.

And then, I usually just tear it somewhere along the pathway. And I don't take it all the way off because sometimes it gets stuck to itself. So I'm gonna start with the Kinesio tape on the top of her toe here, and then pull it down at the proximal phalanges. And then, I just take it across the bottom of the foot, and then bring it around. And then, it holds that hammer toe down for her.

And the one thing that you have to remember about Kinesio tape is it has to really stick to itself on the foot especially if you want it to work. So luckily, this goes all the way around, and it connects and crosses right here on the top of her foot. They will last several days too in the bath. Uh-hmm. And she's saying it lasts several days, and it can last through baths and showers.

So it's really nice that you can wear it for a long period of time. And now, put your foot down, and you can see how it holds that hammer toe down. It already looks a lot better. And so if she wears that regularly, that's gonna really help. Okay, now, the bunion.

And we're gonna do another one for the bunion. And here is another strip, same size. And I'm just gonna make a little criss-cross tape across that. (tape ripping) And I'm gonna pull it onto the inside of her toe. I'm gonna do this bunion.

That one's not too bad, we'll just do this one. And you also notice the discoloration of her feet. Now, I'm gonna show you that I'm pulling that toe outward a little bit. And then, I'm gonna cross over to the top of her foot there and take it across like that. And then, I'm gonna cross under.

And as you see, I can't make it all the way around, but I need to pull out on that piece there and take it across like that. And then, I take another piece to lock it in. And really, there's no real science to this. You just kinda try to make the foot do what you want it to do or the toe do what you want it to do. And then, I'm just gonna take this piece across, and then just try to hold those two little pieces in place and not very tight.

You don't wanna squeeze her toe or squeeze her foot very tight, but you're trying to just encourage. It's like if she had an extra muscle out here that's pulling that foot outwards and that toe outwards. Okay, so that's a bunion. She's got all the stuff, right? (laughs) She's got fun feet to play with. Okay, so put this foot down.

And then, I'm gonna try to keep that toe separated. So I like this plus the toe separator. She's got a pretty significant bunion there. It's pretty reticent. (laughs) All right, so now, what I wanna do is it works really well with this foot because she's got the interlocking piece here. Another thing you can do for the feet is to do a arch support.

And I love this kind of active arch supports that are more elastic like a muscle instead of a physical arch support. I'm not a fan of true arch supports because they push under the foot. They put pressure on the bottom of the foot all day long, and they actually inhibit muscle strength in the foot and make the foot more and more dependent on arch supports. So I'm a fan of keeping your muscles working under the arch to keep the arch lifted. So I will constantly be queuing that through the sessions.

All right. So I'm taking the band underneath her arch and pulling up and across on the inside of the foot. And again, I'm gonna make that criss-cross across the front of her ankle. And then, make another criss-cross across the front of the ankle. And that just, it's not perfect, but it definitely helps the arch stay a little bit more lifted and a little bit of a reminder to keep the arch lifted.

So there you go. And you're all taped up. (laughs) And if you use the black color, it's really cooler because that's what the athletes use. So anyway, I hope you enjoy your taping, and I hope you enjoyed your session. Peggy, thank you for joining me. And I appreciate you donating your body to science for our learning.

I have all this (indistinct). (laughs) She's got all the stuff to share with us. So thank you so much for joining me. I enjoyed the tutorial, and I hope you join me for the next one.