Resilient Body Series – Part 3
Foot pain is bad news! Depending on the severity and the underlying cause, the pain can range from mild discomfort to absolutely debilitating. Sometimes injuries happen and pain is unavoidable. But for a lot people, myself included, foot pain can often be prevented. I learned this the hard way (yep, even PT’s get injured). I want to share ways to avoid the kind of pain I dealt with. Or if you are already experiencing pain, then this will help you get on the path to healing.
I’m a runner. I love running. But, about 8 years ago when I was getting back into running, I experienced some IT (iliotibial) band pain. I worked on my form, strengthened my hips and eased up on mileage and my IT band was getting better. However, it would still flare up on longer runs, so I took the well-meaning advice of a fellow PT and placed orthotic inserts in my running shoes to control a little bit of foot pronation, which in theory would also control some of the force placed on the It band. At this point, I was feeling impatient with my body and looking for quicker “fix”, even though I knew better.
After a few weeks of running with the orthotics, I started to develop plantar fasciitis symptoms. My mobile and flexible feet were rebelling at being locked in place by the orthotics. I ditched the orthotics and made sure I had neutral running shoes that would let my foot move. Fast forward many months later: I got my feet back in shape, hip stability under control and have been running regularly without injury since.
Here’s what I learned:
Orthotics were not the answer for my feet. I need to maintain their mobility and keep their muscles strong and responsive (and this is true for everyone by the way). If you feel you must use orthotics, try to look at them as a temporary solution to eliminate pain or manage an acute injury – just like you would use a brace on a sprained wrist. For most people (there are exceptions of course), orthotics do not need to be used as a permanent solution to support the arch. Strength and biomechanical factors need to be addressed first. We have so many muscles within and surrounding our feet – let’s use them!
Now, let’s take a look at how our feet work.
Foot health and function impacts movement through your entire body. I’m going to be brief with anatomical and functional descriptions. My goal here is to cover the basics of how the foot should move and why, share my thoughts on what goes wrong for so many people and then give you some practical tips for making improvements.
Brief anatomy lesson …
Plantar muscles of the foot
Our feet were meant for movement. There are 26 bones in each foot, 28 when we include the 2 leg bones, the tibia and fibula which are part of the ankle joint. The foot also has 33 joints and over a hundred soft tissue structures that contribute to movement and function (ie. muscles, tendons, ligaments, fascial connections). We have 3 arches in each foot, but the medial longitudinal arch running from the heel to the ball of the foot is the one we commonly call the arch of our foot.
Arches of the foot
The stability and mobility of the longitudinal arch is key for optimal foot function and pain free feet. The tensegrity of the fascia in the bottom of foot provides support, and with each step we take, energy is stored and released to propel us forward. This creates efficient movement by reducing the level of muscular contraction required.
Feeling and Function
When the feet are functioning well, they support our body and they help us get from point A to point B. During walking, the foot alternates between phases of flexibility and rigidity. Trouble is often seen when the arch collapses too much (over pronation), putting excess strain on the joints and fascia in the foot and ankle, this can also cause poor alignment of the entire leg. Which in turn can cause pain and dysfunction anywhere in the body because it throws everything off during movement.
The feet also contain a very high number of sensory nerve endings that provide feedback to our body and brain. That sensory input is key to our posture, gait mechanics and balance. One study that looked at balance while standing on one leg found that even a thin sock had a negative impact on balance compared to being barefoot. Other studies have looked at how walking and running barefoot or in minimal shoes can strengthen the intrinsic muscles of the feet which support the arch of the foot, leading to improved foot and running mechanics.
What this information all boils down to is that we were meant to be barefoot. And shoes, while initially made to protect our feet and make them “comfortable”, are probably one of the main causes of foot trouble. The shoes did the work and our feet adapted and got lazy.
Comfortable shoes, with added arch support and lots of cushioning, deprive our feet of sensory input and muscular work that they need to stay healthy. Think about what happens if you don’t use your arm for several weeks because of an injury, the muscles atrophy and become weak. But then the injury heals and you gradually build up your strength again. Well, when we wear shoes all the time those intrinsic muscles that support our arch do not get the work they need and we do not give our feet a chance to stay strong and mobile.
Ok, so how can you improve your foot health and still wear shoes?
We’ve lived most of our lives in shoes and our feet and bodies are quite adapted to that level of cushion, support and protection. We are pretty much required to wear shoes in most public places. We also can’t just jump into wearing minimal shoes without conditioning and training our feet; we’d be asking for an injury. Even if you don’t ever plan to transition to minimal shoes or spend more time barefoot – there are still plenty of ways to get your feet in better shape!
Check out this video for a sequence of movements that will improve the connection between your feet, the ground and the rest of your body. You will need a small ball for the foot rolling portion – I prefer a racquetball because it has some give to it, but experiment with what works for you.
And for those of you truly inspired to get your feet working well again … think more about being barefoot and trying some minimal shoes. I go barefoot as much as possible to keep my feet strong and to get that sensory input that my body needs. I seek out grassy areas where I can feel the unevenness of the ground, the prickly blades of grass, tree roots, etc. Another great idea for waking up your feet comes from Phillip Beach, DO of New Zealand; build a rock path in your yard of make a rock tray/mat to use indoors. Here are some pictures of a short path I use in my yard and a tray I have in my studio.
Rock tray for sensory input
Outdoor rock path
Most of the shoes I wear on a regular basis are considered minimal; they do not have any type of arch support, they have a wide toe box so my toes can spread out and they also have a thin flat sole that allows me to feel the ground. I try to get as close to a barefoot feel as possible.
By making these practices part of my lifestyle, my feet stay strong. I keep moving well, without pain. The connection to the ground that I feel when walking also keeps my posture aligned and healthy. And maybe an even greater benefit is that I also feel more centered and calm and resilient!
Connect with me if you are interested in transitioning to minimal shoes. I have some great tips for getting started. Patience and consistency are the keys to lasting change!
Let me hear your thoughts on this …
