The feet are fascinating. They contain 26 bones, 33 joints, and more than 100 little muscles, ligaments and tendons. Get sweaty feet? They also have over 250,000 sweat glands! They are one of the most sensitive structures in our body. Feedback from our feet provide data for our brain on how to move, hold your posture, and anticipate future movements. They are changing and molding as we develop from a toddler through adulthood and well in to old age. The feet are pliable and are the first area we will see change as we compensate. Foot shape and position are even correlated with facial structure and palate height (check it out here). Your foot position and shape will tell us a lot about your legs, hip, back, and how you move on your left compared to your right. The feet provide a snapshot of how you developed up to the time you arrive in the clinic.
The feet are a big deal for me. Not only professionally, as your feet will help “walk” me through your history and guide treatment, but personally as well. Foot issues as a kid and resulting surgery has sparked a passion in me about feet and how they relate to the body standing on top of them. Most people with overuse foot injuries (from running, walking, etc.) do not have pain because of the foot itself. Rather, it is another issue higher up in the body that drives abnormal and excessive force to the foot. This leads to pain and discomfort.
Let’s break this down. Some of the most common injuries we will see with athletes and non-athletes are plantar fasciitis, Achilles tendonitis/tendonopathy, and calf strains. These various tendon, ligament, and muscle issues hurt and force people to seek medical attention because they have excessive strain and force going through them. The excessive stress results in tissue breakdown and pain. They key to resolving the injury and returning the individual back to activity is figuring out WHY there is so much stress going through these tissues. Assuming there is no neurological, immunological, or traumatic issue, chances are these tissues did not randomly decided to be painful. Rather, it is compensating for something above and resulting in the excessive stress. The gastrocnemius (calf muscle), Achilles tendon, and plantar fascia are one continuous tissue complex. That is, they work together and it is very hard to dissect them apart. Excessive stress through this complex will lead to breakdown at one of these areas.
Please refer to the above picture our twin aides, Lyndsay (in front, grey tank top) and Lauren (in back, purple tank top). If you imagine Lyndsay’s center of gravity just behind her belly button and draw a plum line straight down, you can see the center of gravity is essentially over her toes. Now look at Lauren, whose center of gravity comes down to be nearly in line with her heel. Lyndsay’s tight back is causing significant lumbar lordosis and anterior tilt of her pelvis. This orientation will bring her center of gravity forward and she now has to use her calf muscles to keep her body upright. She is over-stressing the complex we talked about (gastroc (calf), Achilles, and plantar fascia) to hold herself up against gravity. People who present like Lyndsay are much more likely to have calf, Achilles, plantar fascia, and metatarsalgia pain than people who present more like Lauren. Lauren’s hip and thorax is in a position such that she is not required as much to use her calf, Achilles, and plantar fascia to hold herself up against gravity.
Someone like Lyndsay (in front, grey tank top) will need to work on her thorax and pelvic position and function in order to treat an injury in her calf, ankle, or foot. It is very common to see runners and walkers with re-occurring Achilles problems and plantar fasciitis (heel pain) because they have never addressed their pelvic and thorax position and function. When someone like Lyndsay comes to the clinic with calf, ankle, or foot pain, we need to get her on a program to engage her abdominals, glutes, and hamstrings while inhibiting her back muscles, hip flexors, and calf muscles. Additionally, she needs to be able to breathe without using her back and neck muscles (read more about The Importance of Breathing) in order to keep the correct muscles working and the over-worked muscles inhibited. People who have chronically tight calf muscles usually always have chronically tight back muscles.
If you have been dealing with calf, ankle, or foot issues, be sure you are addressing the body standing on top of the foot. It is not the foot’s fault it is hurting. You may need a period of immobilization and rest to allow the tissue to heal, but then you have to address the mechanics and position of the body to prevent re-injury. As Dr. Seuss once wrote, “You have brains in your head and feet in your shoes, you can steer yourself in any direction you choose!” Just make sure the body between your brains and your feet are appropriately balanced and positioned and you will really be able to go any direction you choose. Perhaps one day you can be rock stars like Lyndsay and Lauren!
This post was written by Craig Depperschmidt