Updated: Oct 9, 2018
The foot is a crucial part of our anatomy when it comes to a healthy resilient body, and strong, effective movement. Our feet carry us around all day long, yet most of us take them for granted. Our feet are subject to wearing shoes the majority of the time, often shoes that are selected for aesthetics, rather than function or comfort, which compromises the efficiency of our feet.
The importance of our feet is severely underestimated when treating pain, and preventing injury. Our feet are vital shock absorbers. Every step we take, our foot must absorb our body’s weight and counter the ground reaction force. For this to happen effectively, the foot needs to be both rigid and flexible. As we land the foot needs mobility to absorb the force and mitigate impact stress through a chain reaction of muscles, bones and connective tissue. The foot also however needs to quickly become rigid so that we can push off, and continue our stride instead of collapsing into the ground.
What happens in every heel strike, directly affects everything above the foot. If there is a fault or compromised function at the foot, the force will travel up the chain to the shins, knees, hips etc. Injuries can occur anywhere in the body because of a lack of efficiency at the foot.
Unless there has been an incident of trauma, many injuries occur due to postural dysfunction or pattern overload that has been present throughout the person’s life. Playing a specific sport where one hand is dominant (tennis, golf etc), or being dominant on one side of the body in simple daily tasks, are examples of common ways that postural imbalances can begin to manifest. Often it is not until we are injured that we truly appreciate the significance of the whole body compensation that may have caused the issue.
Research about Myofascial Lines or Anatomy Trains of connective tissue (see diagram of some of these lines) details the interdependent relationship of fascial tissue throughout the whole body. The fascial lines are becoming utilised in smart training as the fitness industry moves toward training fascial systems, just as much as the muscles! A famous quote by Bobath helps to illustrate this point: “The body knows nothing of muscles, only movement.”
How the foot SHOULD work
The ideal gait style is one where the forefoot (not the toes or the heel) lands first. Once the forefoot lands, it will cause the calcaneus or heel bone to laterally shift, and force the connective tissue to pull the arch and big toe like a coil to prevent the foot rolling out. (see right.) A forefoot strike will mean that the foot lands under the body, and the force can be relayed through the whole system.
Running styles where the person lands heel first ,or where their foot lands in front of their body, literally looks as though they are putting the breaks on their running stride from side on, and consequently slows the runner down. This heel strike style creates a shearing effect on the connective tissue thus increasing rate of injury. A forefoot strike captures more energy to spring out of the ground. Moving from a heel strike running style to a forefoot strike will feel like you are more springy. Your body can suddenly use it’s elastic potential so you become more efficient.
As mentioned above, the foot needs both rigidity and mobility. As we land the forefoot unlocks, spreading the toes and bones through the foot to absorb the ground reaction force in the mid foot. As we push off through the forefoot and particularly the first metatarsal big toe, the foot locks back up to provide rigidity to push off. If we look at the bones of the forefoot side on, we see they are capable of moving vertically up and down and thus made for absorbing impact forces. The bones around the ankle are stacked horizontally on top of each other to allow the bones to glide over each other.
Common foot imbalances
1. Inhibited big toe
When the body is suffering an injury or any inflammation is present, research shows that the stability muscles such as Glute Medialis, Vastus Medialis Oblique (VMO), Pelvic Floor and Transverse Abdominis become inhibited. One of the main muscles groups that come to the rescue to try and increase stability, is the adductor group (inner thigh.) The adductor group is heavily connected with fascial tissue through what we call the ‘deep front line’, and has a direct correlation to the medial foot arch, and the big toe.
As the bodies stabilisers become dysfunctional, fascial tissue becomes more glued up and stuck. Body wide compensations result. Often muscles and fascia around the thigh and hip begin to dominate and will internally rotate the femur (thigh bone.) If we imagine the muscles and fascia around the foot and leg as a stirrup, the outside stirrup becomes long and weak ,and the medial inside stirrup becomes short and tight, pulling the big toe up and back toward the ankle meaning the toe won’t hit the ground in walking! The big toe is crucial to catching the ground reaction force and then pushing off in gait. It's also deeply connected to the function of our pelvic floor, so a big toe that can't connect to the ground points towards pelvic dysfunction.
2. Jammed up talus from wearing high heels/heeled shoes
When we wear shoes that have a higher heel than the forefoot, we are locking the ankle joint into prolonged plantar flexion. This causes the talus bone and tibia to glide backwards on the heel bone, which means that each time you land, instead of loading the foot, you are now jamming the foot!
The bones of the ankle are stacked on top of each other in a horizontal relationship so when movement gets restricted, this causes an egregious transfer of energy. This will start to thicken the retinaculum band of tissue at the front of the ankle, further restricting movement. If the retinaculum is restricted from a lack of movement, then connective tissue, muscles and bones cannot slide over each other with rhythm, and movement becomes clunky.
3. Locked up forefoot or flattened arch
The more we wear heeled shoes or orthotics, the move we de-train the arch of the foot, and the mid tarsal joints. The forefoot gets jammed up and immobile as the collagen in the connective tissue becomes less hydrated and elastic, and more like glue!
For every degree of arch mobility you lose at the foot, you will start to gain excessive arch through the lumbar spine. Once this happens, it doesn’t matter how strong the core is, as the pelvis position is too far out of neutral! You can’t strengthen the core when the pelvis is hanging off a cliff! This relates specifically to balance. It does not matter how strong the core is if the foot is immobile, balance will not be optimal. If the ankle and foot cannot properly load, then soft tissue injuries and loss of balance will prevail.
This issue is closely tied up with point number one, an inhibited big toe or first metatarsal joint. Bunions happen when the big toe goes side to side, and not up and down. A bunion is extra bone growth. So if the big toe is moving sideways onto the ground because the arch of the foot doesn’t work efficiently, we are not able to prevent pronation (rolling in.) If we continue smashing the bone into the ground, it’s going to force extra bone growth to attempt to strengthen the area and decelerate pronation. Many people try to remove bunions with surgery, but unless the dysfunction through the mid arch is resolved and the foot learns to load better, the bunion will just grow back.
Plantarfacitis is when the plantar fascia becomes incredibly sore and inflamed. The plantar fascia may become thicker and more rigid to try and cope with the increased mechanical stress of a foot that isn't moving well. This increased tension happens for a variety of reasons such as tight calves/hamstrings from prolonged sitting, faulty gait/running style, inhibited glutes, locked up forefoot and shin etc. Getting elasticity and mobility back into the area is crucial. Usually it’s best to address Plantarfacitis by leaving the angry plantar fascia alone, and look at the adjoining connective tissue through the shin, front of the ankle, big toe, inner and outer calf and thigh, to help correct faulty foot mechanics that may have caused the stress.
Creating Stronger Feet
Traditionally it was thought that our shoes must provide our feet with more support. Supporting our feet detracts from their inherent role as shock absorbers, and diminishes their function. If we lock our feet up in cushy shoes, they become deconditioned. Traditional running shoes have a high arch, a raised heel, tight lacing system, and a raised toe that sits off the ground - all of these features compromise foot function!
Barefoot training is becoming more widespread as the benefits become more accepted. It is important to note that moving from highly supported shoes to minimal support must happen in baby steps over time to prevent injuries. Allow time for your foot to transition if you have been wearing supportive shoes. Muscles adapt rapidly, but fascial tissue can take months to change so be kind to yourself, and manage transitional pain as your foot regains function.
Add some smart movement and myofascial release work to speed things up. Get a thorough postural screen to identify body wide compensations to prevent further issues. Learning to move efficiently is a must. Move and train the body as a whole. Remember the sum of the whole is greater than the parts – look at the whole picture, not just the area that hurts!
Train barefoot so you can see what is actually happening at the foot. Shoes cover up issues and conceal poor foot function (as well as adding to it!)
Train the big toe - Make sure it hits the ground, pivots, and pushes off.
Loosen tight shoelaces - tight shoes restrict the mid tarsal’s movement which crucial to absorbing impact. If the shoe restricts movement, then your foot cannot shock absorb
Avoid heels, thongs, boots or any shoe with arch support
Don’t wear orthotics unless pain is extreme– they lock the arch of your foot therefore preventing sho