Several patients this last week have come in with foot troubles.  When several people come in with the same trouble, I figure it is time to do an article on this issue.  Specifically, these patient’s troubles were all from the same basic cause even though the manifest symptoms seemed different.

In our modern world we have engaged in a variety of physically deviant behaviors.  By that I mean that we have deviated from the natural behaviors that would support our physical health and instead engaged in behaviors that promote ill health.  The deviant behavior that is up for review today is the wearing of shoes.  More specifically shoes with rigid soles that don’t allow our toes to grab the ground.

Can you imagine that you might develop some problems with your hands if you put on cement gloves every morning that did not allow your fingers to bend or touch anything except the inside of your gloves?  This is essentially what we have done to our feet.  Feet are very complex, with 26 bones and 20 or so muscles.  Do we really think that with all that complexity designed in, that we were meant to just stuff these amazing creations into stiff leather boxes and pretend they should work like the hoof of a horse?  Not surprisingly, they complain when they get disrespected like this.

Like any complex muscle /joint /tendon assembly in the body, these areas need frequent stimulation to produce proper coordination of movement.  Much like the spine, they need to move in natural ways that require balance, coordination, and strength.  Wearing shoes all day does the same thing to our feet that sitting in a chair all day does to our back – not good. The muscles get weak and lose coordination.  Walking requires extremely complex patterns of muscle and joint movement to keep us from tumbling over.  When our heel first hits the ground, our foot is supposed to roll inward (pronation) just enough to unlock the ankle and foot bones so that the foot can absorb the shock of the foot hitting the ground.  This requires the muscles of the arch to be strong yet flexible.  If they are not strong then the arch over stretches and produces micro tears in the fibrous sheath around the muscles.  This is the infamous plantar fascia, which when injured produces the highly painful plantar fasciitis.  This excessive stretching is called over pronation.  This all happens in the first 12% of a single forward step, or gait cycle.

Some times the muscles of the arch get so weak from lack of exercise, they actually waste away producing the appearance of a high arch.  High arches can keep the muscles of the foot from unlocking the ankle and foot when your heel first strikes the ground.  This means the foot stays rolled outward (supination).  The foot does not roll and absorb the heel strike shock which then travels up the leg to be absorbed at the knee or hip, producing problems there.  These folks are said to be excess supinators.  Too much of either pronation or supination produces foot pain, knee pain, shin splints, hip joint troubles, and so on.  How do you know if you have one of these problems?  Typical signs are such things as hammer toes, pain under the toes, IT band tightness and pain, plantar fasciitis or Achilles tendonitis, frequently rolling or spraining your ankle, or general swelling or pain in the foot and ankle.

A couple simple tests you can do to see if you are either over pronating or supinating are the footprint test and Jacks test.  For the footprint test, put some dark paper, like an opened paper bag, on the floor outside your shower.  After you take your next shower (or just get your foot all wet), as you step out, step onto the paper with one foot then the next.  Look at the footprint created.  A normal footprint will show about half of the arch area (inside to outside) wet.  An over pronator will have more than half while and over supinator will have a thin outer edge of the foot leaving a wet area.

The Jacks test is more like one I would do in the office, but you can probably have someone do it on you at home.  Just stand normally barefoot.  Have your testing person lift your big toe up.  If it comes up very easily you are likely to supinate easily and possibly be an over supinator.  If the toe is hard to lift, then you are likely to be an over pronator.  Another pronation test is to simply feel under the arch of a standing barefoot person.  If you can’t get your finger under the arch there is probably a pronation problem.  A high arch indicates a supination problem.  Shoe wear is also a good indicator.  If the inside of the heel is worn – pronation, if the outside is worn – supination.

This issue of either too much or not enough flexing and bounce back of the foot we have been describing, is the most common reason for foot problems, and often the underlying cause of stubborn or recurring knee and hip troubles.  When you research the causes of these troubles you get this crazy list of possible causes like too much exercise, not enough exercise, walking on flat surfaces, poor posture, poor form, old shoes, tight shoes, ligaments that are too lose or too tight, genetics, age, bad diet, and so on.  While these are factors, I believe the real issue is trapping our feet in shoes.  Our toes are designed to grip the ground, exercising the muscles of the arch.  The natural roll and stretch of the foot that should happen with each step we take is inhibited when the foot is confined in a shoe.  There are natural electrical circuits that balance the overall electrical charge of our body that are designed to discharge through our feet.  The action of our foot is meant to be a complex interaction with our world.

So what can we do about these problems?  The ideal answer is to be able to walk barefoot on a beach for an hour every day.  Most of us don’t have that luxury.  Therefore we have to simulate those foot actions we are missing.

Toe Grabs :  when you sit down to watch television, take your shoes off and grab the carpet with your toes.  Flex those toes.  Pick up things with those toes.  This will rehabilitate your arch muscles.

Short Foot exercises:  exercise the supination muscles to contract and let go by raising your arch up without moving your toes.  This uses the muscle on the inside of your lower leg that wraps down around the inside of your ankle bone and down into the inside of your arch.  Just lift that arch up and down, first with both feet then just one foot at a time.  As this gets easier, try balancing on one foot and doing this.

Barefoot Shoes:  this really helps if you can get away with it.  Wearing moccasins or soft flexible slippers, or barefoot running shoes allows your feet to move much more naturally.  Your toes can learn to grab the world again.  Initially these were pretty ugly shoes, but the modern versions almost look stylish in a flat foot sort of way.  Here are some inexpensive ones on Amazon.  Sorry, heels are killers for your feet.

People ask me about orthotics or arch supports.  I used to order them for people and the do help to relieve the symptoms.  But over the years, I did not see them correcting the underlying problems.  They compensate for the weak unbalanced muscles, but don’t correct them.  For long term resolution, we must do exercises and return to more natural walking.

So what about fancy dress shoes, killer heels, and the like?  I would wear them on the same occasions I wear a tux.  Occasional wear as costume is accepted as part of the suffering we do to impress the crowds.  We should be able to handle a bit of suffering now and then just like we should be able to handle a slice of cheesecake now and then.

Love your feet and they will support you better than your best friend.

Take care,

David                    

 
Ellen update:    

Ellen has decided she wants to push her envelope with her recovery by really working on her muscles.  She is engaging people to work with her every day as trainers to keep her motivated.  Here she has increased her arm strength to be able to pump 12 pounds on her good side and 6 pounds on her weak side.