Foot pain: a whole-body approach
Get to know your feet and how to treat them right through better footwear choices and healthy movement habits. You can use the tips, tutorials and video links in this article to add more foot-friendly movement to your life.
Disclaimer: the advice below is not intended to replace medical advice. If you have a severe condition causing pain please see your doctor.
If you experience foot pain, you’re in good company. As a population we’re plagued with issues like fallen arches, plantar fasciitis, bunions, neuromas, hammertoes, ingrown toenails, bursitis… (I’m sure there are more.)
Many of us believe that these issues are genetic and out of our control. But what if they were part of a bigger picture that’s not just about how we’re genetically programmed, but also how we live and move? Our foot issues aren’t separate to other body issues such as pelvic floor disorder, lower back pain, knee weakness, shin splints, chronic headaches or even shoulder issues. They’re a part of our whole-body health.
The foot: a high-performance machine
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) might walk long distances over different terrains on a daily basis, challenging those small joints and muscles as nature intended.
Maybe we no longer need to walk many miles a day over different terrains and therefore 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 ground to walk on… But if we think of the human body as a sum of its parts, requiring the health of each individual part to work optimally as a whole, we start to understand how something as intricate as the human foot might affect – and be affected by – the rest of the body. We can also see how we might start to experience pain (in the foot or elsewhere) if things aren’t working so well.
It’s all connected
We can think of the body as a community of trillions of cells, each needing to receive some of the nutrition we eat and the oxygen we breathe. Our cells get their glucose and oxygen through blood flow, which is created via mechanical stimulation. So any parts of the body that don’t move well are effectively being starved of circulation and the nutrition they need to survive.
We could go further and say we are a system of systems, all held together by fascia – a conductive connective tissue matrix. This gelatinous substance holds our cells together in different layers, allowing the muscles to slide effectively and our joints to move as they should, as well as being the highways of communication between the spinal cord and the rest of the body. If there is a tightness or restriction through lack of movement in any part of the body, the bioelectrical signalling systems that flow through us via the fascia will also experience these blockages.
The takeaway? Whole body movements can have a positive impact on the comfort and health of your feet.
Are your shoes cramping your style?
We rarely give our feet much consideration until they cause us pain. But even if your feet feel fine right now, you can stave off future problems by making informed choices about your footwear. Most shoes on the market don’t allow your 33 joints to articulate individually, because they have one or more 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, which no matter how small, will displace your pelvic alignment
- a shape that won’t stay on the foot without your toes gripping, such as flip-flops or backless slippers
Interestingly, choosing comfort over aesthetics doesn’t necessarily mean your shoes are better for your feet. The more ‘comfortable’ a shoe is, the more support and cushioning it is likely to have, which is going to reduce the amount of work and movement your intrinsic foot muscles can do, and limit the way your brain perceives your contact with the ground.
How to check your shoes
Even a quarter-inch difference between toe and heel can change your alignment. To check whether your shoes have a heel, take one off and have a feel of the thickness of the back of the sole 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, 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). That can lead to extra stress on your joints, muscles and bones, that in turn can cause pain not just in your feet but elsewhere in your body.
At the toes, check the toe box (the front part of your shoe). Is there plenty of space for toes to wriggle, or are they cramped in together? Toes pushed into a tight toe-box can lead to friction between the bones higher up the foot, creating problems like neuromas.
Also check the toe spring – i.e. whether the shape of the shoe is elevated at the front, lifting the toes into a constant high position and reducing their mobility. Elevated toe-springs are common in running or trainer-style shoes. To check if your favourite shoes have an elevated toe spring, put them on the ground and see if there is space under the tip, where your toes would be.
How do genes fit into the picture?
Genetic factors play a role in health problems (foot-based and otherwise), but what’s far more important is how or which of the genes we’ve inherited play out.
Heritability can be behavioural as well as genetic. We pick up posture and walking patterns from our parents or caregivers, because as we develop through childhood we learn through observation. If your feet turn out when you walk, it might be something copied from everyone around you.
A lifetime of wearing shoes with a narrow toe box encourages the big toe to turn in towards the smaller ones. If at the same time we’re turning out our feet, which creates increased side to side motion rather than front to back motion, we’re repeatedly rolling over the side of the big toe joint rather than off the tip of the big toe as we should be. This causes inappropriate loading of the joint, which in turn can lead to bunions (more on those later!) It’s not always a genetic problem, but it could seem to run in families if we copy our parents’ turned-out gait and wear the wrong kind of footwear.
Hypermobility is a genetic tendency that can affect foot (and whole-body) health, because highly flexible joints often lead to compensating tightness elsewhere. If you have an element of hypermobility in some of your joints, it could be that the joints above or below have to tighten to try to support the body. People in this situation need more stability so the non-hypermobile joints can free up. If your mid-arch is completely collapsed, foot exercises can be useful but are unlikely to be able to solve that problem altogether as it’s likely there’s hypermobility in the foot. It may be that you do require support while walking such as an orthotic or insole.
Plantar fasciitis – not just a foot problem
The plantar fascia is a large, strong tendon that goes from the heel and fans out to separate attachments on the toes – it’s literally the spring in our step. Plantar fasciitis was so named because it was assumed that the heel pain was caused by an inflammation where the fascia 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.
Fortunately, there are whole-body approaches which might offer relief.
The “posterior chain” is a group of muscles on the back of the body that is connected through lines of fascia (the connective tissue we mentioned earlier). If the muscles on the back of your leg tighten due to time spent sitting, wearing heels or playing football (for example), those tight muscles might pull on the joints, causing the knee to buckle slightly, the weight to move forward and away from the heel. This puts pressure on the plantar fascia, pulling unnaturally on its attachments to the heel. The result – pain.
Over the long term, we can change our movement patterns to stop tucking the pelvis and encourage more length in the posterior chain (hamstrings and calves), therefore releasing tension in the tissues of the sole of the foot.
Bunions are 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, and I’m developing one on my right foot, much to my annoyance, despite what I thought was fairly good foot movement.
It’s often assumed bunions are genetic because our 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.
I thought I was doing all the right things but even as an instructor I didn’t realise until it was pointed out to me that my ‘correctives’ were bypassing the relevant problem. When the brain is challenged with a new movement pattern it can either pay attention and learn or continue to perform a habituated pattern – all too often we don’t realise that’s what we’re doing. Check out this short video to see what I mean.
Healing and circulation
It seems intuitive to rest our feet when they’re painful, but sometimes immobility can cause problems and gentle movement can help us heal faster. For example, when the big toe is held pushed up and in 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 becomes restricted, would limit blood supply and cause the cells to die.
So whilst support during a flare up of pain might be necessary it’s important in the long term to make sure that we’re not reducing blood supply – a better solution might be to start transitioning to footwear with a lower heel and wider toe box which allows the toes to spread, so that we can encourage a natural arch in the foot.
Steps you can take to look after your feet
- Be aware of your footwear and consider implementing changes. 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 a wider toe box than you currently wear is an improvement.
- Passively stretch your toes using alignment socks or toe spacers, starting with short periods of time and building your tolerance. Wearing toe separators like these whilst performing foot exercises can increase the benefit you get from them.
- Stretch your calves and hamstrings regularly – see my recommendations here.
- Change your sitting posture to encourage a neutral pelvis and ribcage – instructional video here.
- Stretch/move your hips by sometimes crossing one ankle over the other knee while sitting like this.
- Play with your feet while stretching your hips – instructional video here.
- When standing, notice whether you have a bend in your knees. With straight (fully extended) legs, 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.
- Sit on the floor, cushions, low stools, bolsters, fit balls, anything that varies from the sofa occasionally to change the angles of your joints. If you rarely sit on anything lower than a chair, start with short stints and cycle through different positions.
- Check your standing alignment. If you regularly stand with your weight shifted forwards you will be putting more weight down on the front of your feet. By shifting your hips back and adjusting your feet like this you will not only take the pressure off your feet but also engage your bottom and use your core more without even trying (once you’ve got used to it of course).
- Use a soft ball to mobilise the bottom of your feet as well as the joints, and a top of the foot stretch to ease tension in the top of your feet, like this.
- Walk on different textures barefoot like this. If you don’t have a gravel drive 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 the bottom of your feet, 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, and if you’re lucky enough to be near the sea, get your toes in the sand and feel the waves over your feet.
- For bunions, short foot with big toe lifts – taking care to notice what direction you lift or press the big toe in. A bunion sleeve something like this may also help.
- For neuromas, metatarsal pads may help ease the pressure on the nerve ending causing pain.
- For plantar fasciitis, regular calf stretching and glute strengthening.
- For collapsed arches, this depends on where the collapse is coming from and whether it is causing a problem. Flat feet don’t necessarily cause pain and may not be a problem but if they cause your knees to drop in then and learning to rotate your knees away from each other and then performing glute (bum) strengthening exercises to retrain that alignment will help. There are conditions that will require some arch support while walking but it definitely still has value to practice both foot and glute strengthening.
For more information on how to improve your foot health, improve balance, reduce pain and potentially indirectly improve other conditions, get in touch here.