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IMPROVING YOUR FOOT CONTROL TO CREATE A STRONGER YOU
In this article we discuss important aspects of foot control and what simple measures you can take to not only improve your feet but by creating a stronger base to create a stronger body.
As Spinal Physiotherapists you would think that we are not that interested in your feet but you would be mistaken. If we look at the body as a whole you would realise that the feet are an integral part of your body even if they are regularly neglected. Let’s face it when you stand and walk or participate in load bearing or impact activities or sports you need to have strong feet. One could even argue that when looking at lower back pain we should start from the bottom up and address any issues with your feet first.
The foot is one of the most complex regions of our body, consisting of numerous bones and joints, muscles and nerves that have a direct impact on foot function but equally so affect other joints such as the knees, hips and lower back.
The foot definitely gets the raw deal and is neglected in our medical studies for more interesting areas, they are often covered up with shoes (often very inappropriate shoes) and for some of us can even be embarrassing.
Maybe it’s time to embrace our feet and look at how we can improve their function.
Basic terminology
When discussing the feet 2 terms often come up; pronation and supination – what is this and what impact can they have both on your feet and the rest of your body?
PRONATED foot
Simply put this is a flat foot where the arch of the foot is collapsed and results in a more flexible or unstable foot. This foot has a hard time functioning as a rigid lever to move you forwards which often leads to compensatory problems and hence an overload of a wide range of soft tissues such as ligaments and tendons in the foot and lower leg. This foot type is most commonly associated with orthotics prescribed by Podiatrists & Physiotherapists and as a result of the instability of this foot type, daily strengthening is key for optimal foot function.
SUPINATED foot
The supinated foot is the opposite with a more rigid foot and characterised by a high arch and as such is less adaptable at coping with uneven terrain and with impact forces involved in running and walking.
This foot type also loads up key structures in the foot as they are often in a shortened position; common problems that result include heel pain, plantar fasciitis and even fractures in the small bones of the feet.
Due to foot rigidity daily foot mobility exercises are vital for optimal foot function
The Foot and Core activation
A lesser known fact about feet is that our feet are deeply integrated with the stability of our core. Most of you would be somewhat familiar with the concept that core strength involves the pelvic floor with co-activation of transversus abdominus (deep abdominals) and the multifidus (deep back stabiliser). The core trunk also consists of the oblique abdominal muscles as well as the diaphragm, all involved in a co-activation pattern. These activation patterns often make up the essence of core stability training programs.
What is less appreciated is the connection between the foot & the hip. Every time you take a step the forces generated by foot contact are directed up the leg and into the deep hip.
Within milliseconds the hip must prepare itself for single leg stability. Any delay in this hip activation and non-optimal stability leads to a cascade of improper knee and foot alignment which presents in a variety of issues.
This may include lateral hip pain, ITB issues (iliotibial band) and patellofemoral knee pain as well as ankle sprains.
The bigger gluteal muscles such as gluteus maximus do play a role high but within the hip joint are a group of deep hip lateral rotators that play the primary role. These muscles act to centre and place the hip joint in the most optimal position providing the first layer of deep hip stability needed for that single leg loading phase.
Although more will be said about hip stability in subsequent articles what is important to realise is that the foot is the driver of deep hip stability and the cascade of co-activation of the core stability muscles. So, although you may well need to work on both your core stability muscles as well as strengthening the gluteals & deep hip stability muscles how about starting at the foot?
FOOT CONDITIONING
Both the foot types mentioned earlier (pronated or supinated foot) require components of mobility or release work as well as strengthening and conditioning. The focus may differ at different times of a particular condition and your Physiotherapist is best placed to assess your foot and the lower limb biomechanics and based on the history of the presentation advise you further on the most appropriate exercises.
Generally, both feet type need the conditioning exercise for strengthening the muscles of the foot and provide the correct co-activation into your hip, however the pronated foot will need more than the simple releases described below and may need more targeted and specific joint mobilizations. Once again, your Physiotherapist will be able to provide this specific foot treatment.
FOOT RELEASE EXERCISE
There are several ways of releasing the sole of the foot and this usually relies on applying direct pressure to the under surface of your foot while sitting or standing. This can be performed with a Trigger Point ball (smooth or spikey, there are even devices specifically designed for foot releases but even the simple tennis ball can be used.
Our advice is to start with something softer that will compress such as a tennis ball and then as needed to gradually progress to something firmer. Some patients can tolerate the pressure of a golf ball but this release should not cause that kind of pain or discomfort. It does take some getting used to the pressure hence the advice to start with a tennis ball before progressing to something firmer.
While barefoot, either in sitting or standing, place the tennis ball or trigger-point ball under your foot. Start with pressure closest to your toes and in a methodical way work along the centre of the foot back to the heel.
At each sensitive spot maintain the pressure on the tennis ball for between 30-90 seconds; you must be able to tolerate the pressure so only press down to a level that has some discomfort but is not sharply painful.
Do not roll back & forth over the sole of the foot, this is likely to be much more painful, can over sensitive the nerves on the sole of the foot and possibly also cause trauma to the soft-tissues which ultimately will only impede your progress.
Over time you will find you can apply more pressure or hold it for longer. Also remember to explore areas on the sole of each foot on the inside and outside to complete the foot release.
On average you should find 3 sensitive areas down the centre of the foot and 1 or 2 along the sides.
It will take you approximately 5 minutes to perform a thorough release of the sole of the foot, with approximately 45-60 seconds at each of the points.
Then perform it for the other foot as well – this is because we use both feet for walking!
FOOT STRENGTHENING
There are any number of foot strengthening exercises, most are geared towards the muscles of the foot which are often referred to as foot intrinsic muscles. The below exercise emphasises the big toe and works towards grounding your foot to create optimal foot stability which in turn assists the co-activation of the deep hip rotators and core trunk muscles.
‘Short-foot exercise’
Think of the under surface of your foot as a triangle with the apex at the big toe & the base covering the heel and the purpose of this exercise is to use muscle of the big toe & other intrinsic foot muscles to grip the floor and ground the foot firmly with the earth. Exercise are done barefoot to get the best sensory feedback.
Stand with one foot in front of the other and with a small bend in the knees. Place the heel down first, then try and spread the toes of your foot as you slowly allow the rest of the foot and toes to make contact with the floor.
Now try and grip the floor with your big-toe, the big-toe is the initiator for this exercise.
To activate the ‘short-foot’ push the tip of your big-toe into the ground. It is OK if the 2nd – 5th toes also push down.
As the big-toe pushes down you should feel the muscles of your arch engage. Hold this activation for 5 seconds, release and perform 5 repetitions before performing on the other side. Over time increase the holding time to 10 seconds and off course focus more on your problem side but always do the exercise for both feet.
In summary
The feet have been for far too long been neglected and there now exists ample evidence for the inter-relationship between the feet and the lower limb and problems arising in the ankles, knees, hips and lower back. The foot is vital when it comes to the activation of the deep hip rotators which play an essential role for single leg stability used in walking and running activities. Non-optimal foot function contributes to a wide range of foot issues and pain but are often contributing to hip, lower limb problems and low back pain.
For any additional assistance in performing these exercise and how to progress them speak directly with one of our Physiotherapist.
Our Physiotherapists apply an integrated treatment philosophy when assessing you and providing treatment interventions and for any additional assistance please contact us directly to arrange any required appointment.
