Feet

 

Why are feet so important?

Not many people realise that the human foot is as complex as it is, containing 33 joints, 26 bones and three layers of intrinsic muscles.  Early humans (and hunter gatherer populations that still exist today) would have walked varying distances over different terrains on a daily basis, challenging those small joints and muscles as nature intended.

You might think the fact that we no longer need to walk many miles a day over different terrains means we don’t need the use of all those muscles and joints in the foot.  We have cars and public transport, carpets, tarmac and paving stones for nice smooth flooring to walk over when we do need to, online shopping means if we didn’t want to we wouldn’t even need to leave the house… But, if we were to think of the human body as an integral unit that requires the health of each individual part in order to work functionally as a whole, we can start to understand how the things on the ends of our legs, which are our primary contact with the ground, might have an effect on what happens further up.  You could take that further and say we were actually a community of trillions of cells, each of which needs to obtain some of the nutrition we eat and oxygen we breathe.  If the way our cells obtain glucose and oxygen is through blood flow which is created via mechanical stimulation, any parts of our body we don’t move (like the feet), are effectively being starved of circulation and therefore the nutrition they need to survive.  We could go further still and say we are a system of systems, held together by a conductive connective tissue matrix.  If there is a tightness or restriction through lack of movement in any part of our fascia, the bioelectrical signalling systems that flow through our entire bodies will also experience these blockages.

Coming back to the mechanical view, as a population we’re plagued with foot issues like fallen arches, plantar fasciitis, bunions, neuromas, hammertoes, ingrown toenails, bursitis… (if I’ve missed anything out let me know).  What if the common belief that these issues were genetic and out of our control was largely misinformed?  What if our foot issues weren’t completely separate to other body issues such as pelvic floor disorder, lower back pain, knee weakness, shin splints, chronic headaches or even shoulder issues?

We rarely give our feet much consideration until they cause us significant pain.  When it comes to shoe choices we might decide which ones to wear based on how they look or the latest fashion.  Or maybe that’s not the case but your podiatrist has given you insoles to support your arch, or you’ve had a gait assessment at the running shop and they’ve suggested more supportive running shoes.  Most shoes don’t allow your 33 joints to articulate individually because of one or several of these design elements: a stiff or thick sole, a narrow toe box so the toes are unable to spread, an elevated toe spring which slows down circulation to the feet, a heel of some description which, no matter how small, will be displacing your pelvic alignment, or, they don’t stay on the foot without your toes gripping, such as flip-flops or backless slippers.

The more ‘comfortable’ a shoe is, the more support and cushioning it is likely to have, which is going to be reducing the amount of work your intrinsic foot muscles can do.  If you don’t think you wear a heel take your shoe off and take a look, and feel the thickness of the back of the shoe compared to the front.  If there is any difference at all in the height of the heel and the front, your shoes have a heel.  For every degree of heel height there is an equal degree of spine vertebrae, hip joint or knee joint reaction.  The inch heel that you usually find on a man’s dress shoe or a sturdy walking shoe could be causing up to 20 degrees of misalignment through the rest of the body (depending on the length of your foot).

Bunions

bunions

Bunions are described as an increase in tissue development or swelling around the big toe.  It’s a condition which affects a large percentage of the population, predominantly although not exclusively female.  One might assume they were genetic because their parents and grandparents had them, but the chances are that your parents’ and grandparents’ footwear and postural habits were similar to your own, meaning the bunion happens as a response to the unnatural loading around the joint rather than ‘bad’ genes.  Genetic factors play a role in disease, but what’s far more important is how or which of the genes we’ve inherited play out.  What we certainly do pick up from our parents or care givers is our posture and walking pattern, because as we develop through childhood we learn through observation, so the turnout in our feet is probably something copied from everyone around us.  The combination of a lifetime of wearing shoes with a narrow toe box that encourages the big toe to turn in towards the smaller ones, together with the turnout of feet which creates increased side to side motion rather than front to back motion, has us repeatedly rolling over the side of the big toe joint rather than the body rolling off the tip of the big toe like it should in normal gait, causing inappropriate loading of the joint.

Plantar Fasciitis

Plantar fasciitis was so named because it was assumed that the heel pain was being caused by an inflammation of the large tendon called the plantar fascia where it attaches to the heel bone; ‘itis’ means inflammation.  Commonly prescribed solutions are the use of insoles, extra cushioning, cortisone injections or even routine surgery to cut the plantar fascia to release the tension – all proven to be ineffective or at best temporary treatments for most people.  The posterior chain is a group of muscles on the back of the body that is connected through lines of connective tissue known as the fascia.  If we have chronically tight hamstrings and calves due to the amount of time we spend sitting or wearing heels (or both), those tight muscles might pull on the joints, causing the knee to buckle slightly, the weight to move forward and away from the heel which is held by the plantar fascia and therefore pulling unnaturally on its attachments to the heel.  A better way to treat it might be to change our movement patterns to stop tucking our pelvis and encourage more length in the posterior chain (hamstrings and calves), therefore releasing tension on the tissues of the sole of the foot.

Plantar Facsiosis

However, there is speculation that the condition might be more accurately described as an ‘osis’ than an ‘itis’ – meaning a degeneration of the cells rather than inflammation.  In 2003 a study of 50 people was carried out where small amounts of plantar fascia tissue was harvested during the above mentioned routine surgery.  Whilst no inflammation was found in any of the 50 test participants, what was found was micro tearing and dead tissue, meaning that it would make sense that something was cutting off blood supply and therefore preventing cell regeneration.  When the big toe is moved by the elevated toe spring in a shoe, it also pulls the tissues of the foot and in particular a specific muscle (called the abductor hallucis) which attaches to the big toe.  There is an artery that goes under that muscle that, if it were to become restricted, would limit blood supply and cause the cells to die.  I realise one study of 50 people isn’t exactly conclusive, on doing further research opinion seems to be divided as to whether it’s always a degeneration rather than inflammation and whether it simply develops into degeneration if left untreated.  Either way, a better solution might be to start to take steps towards transitioning our footwear to have a zero point heel and wide toe box which allows the toes to spread, so that we can encourage a natural arch in the foot.

 

Other conditions

Foot mechanics relate to knee, lower back and pelvic floor issues, partly due to the aforementioned reactions of your joints to any degree of heel height and also due to the fact that restriction in any joint in the body will cause more strain on joints up or down stream from the restriction.  If our bones are regularly out of ideal position it causes tissues to adapt, which means that tight muscles then start to pull unnaturally on our joints, such as the quadriceps at the front of the thigh pulling on the knee cap.  If the posterior chain is chronically tight you lose the ability to bend effectively, so there’s a chance that you’re unaware that your back curls when you bend to pick something up.  Neuropathy (damage to the capillaries and nerve fibres caused by high blood glucose levels), can be a symptom of diabetes and autoimmune disorders, so keeping the muscles of the feet innervated will help with prevention of loss of sensation.  If the foot and ankle pronate excessively it affects knee alignment and how well the glutes can engage.

Steps you can take to look after your feet

  1. Change your footwear (I’m not saying everyone should immediately go out and buy some Vibram Five Fingers, we need to adapt slowly so changes to footwear should be appropriate to your current level of strength and joint mobility – anything with less heel and wider toe box than you currently wear is a start);
  2. Passively stretch your toes using alignment socks or toe spacers;
  3. Stretch your calves and hamstrings regularly;
  4. Change your sitting posture to encourage a neutral pelvis and ribcage;
  5. Stretch your hips;
  6. Play with your feet while stretching your hips;
  7. When standing, relax your quads (thigh muscles) until your knee caps relax. Some people find this difficult initially, if you’re not sure whether you are able to relax the knee caps it might help to do it leaning against a wall or sitting on the edge of a chair with the legs extended in front of you;
  8. Sit on the floor, cushions, low stools, bolsters, fit balls, anything that varies from the sofa occasionally to change the angles of your joints;
  9. Walk on rocks barefoot. You can buy a bag of smooth pebbles from B&Q, put them in a tray (a boot mat works well), and spend 2 minutes in the morning walking on them.  This will wake up bottom of your foot, increase sensory awareness and make your intrinsic foot muscles more stable.  If this sounds like too much, notice different textures under your feet around the house, walk on the edge of a rug or feel the texture of tiles or floor boards.  If you have a lawn walk on the grass barefoot, first thing in the morning so you can feel the morning dew under your toes and see full spectrum morning daylight would be ideal, but that’s a whole other blog.

For more information on how to improve your foot health, improve balance, reduce pain and potentially indirectly improve other conditions, get in touch here.

Further information

For more information on how to improve your foot health, improve balance, reduce pain and potentially indirectly improve other conditions, get in touch here.

Disclaimer: the above advice is not intended to replace medical advice, if you have a severe condition causing pain please see your doctor.