Feet and Ankle HealthJun 24, 2020
written by Krissy Gullen, PT, DPT
Did you know?
The foot/ankle contains 26 bones, 33 joints, and greater than 100 muscles, tendons, and ligaments, making it a very complex structure—and one of the most commonly injured!
In this blog, I have compiled a list of principles to help to alleviate foot/ankle pain. I hope to bring light and clarity to foot/ankle problems and give you strategies to try if you are suffering with foot or ankle problems.
Please note, this material is intended to be informational and not to be used as medical advice. If you have any questions, please don’t hesitate to contact us.
Zero to One Hundred
Did you know?
When you walk, as you step from one foot to the other your foot/ankle has to undergo forces of about 1.5 times your body weight. When it comes to running, the forces are even greater- up to 3 or 4 times your body weight. Multiply this by 2,000 steps per mile, and it isn’t hard to imagine why foot or ankle pain may pop up.
Walking and running are great forms of exercise. However, the mechanics of the gait cycle are complex and the demand on the body is more than people often realize. Rather than simply setting out to start walking or running as far or as fast as you can, it is crucial to pace yourself with a progressive walking program to allow your body to adapt over time to your new walking or running regimen without injury (check our website and social media for upcoming blogs on walking/running programs).
Consider your footwear
Most shoes on the market today are stiff, heavy, and don’t align with the natural shape of the foot.
They are designed more for fashion than function. Instead of shoes conforming to the natural shape and mechanics of our feet, our feet are forced to conform to shoes.
Some shoes can even contribute to foot deformities over time.
Narrow or pointed shoes, for example, may exacerbate bunions, and high heels allow shortening of the muscles and tendons at the back of the leg- namely, the Achilles tendon.
Our feet are perfectly designed with their own in-built arch supports.
Joints, ligaments and muscles work together to form three natural arches. These tissues have just the right amount of strength, shock absorption, elasticity, and spring. Stuffing your feet into overly cushioned shoes claiming to provide lots of lift and support is like slouching into a soft couch—in other words, you’re letting your muscles turn off and become weaker.
There’s a powerful connection between the feet and the brain that helps you with balance and responding to changes in the environment
—think hot sand, uneven terrain, or standing on a boat going over choppy waters! This sensory input is picked up best by feet in their natural state, without impedance from clunky shoes. There’s no wonder sports like gymnastics and martial arts require athletes to go barefoot for enhanced balance and agility.
Shoes should be lightweight, flexible, and wide enough for your feet and toes to spread comfortably, and have little to no heel. While heavy-duty shoes, lifts, and orthotics certainly have their place, in most cases I tend to be a proponent of minimalist shoes that are protective and comfortable, so you can let your feet do what they’re made to do.
Improve your Ankle Range of Motion
Having enough ankle range of motion is a key part of being able to walk and run. If you lack ankle mobility, it will change the way you walk--more than likely you will compensate at other areas like your feet, knees, or hips. How much range of motion do you need? How can you tell if you’re lacking mobility in your ankles? The easiest way to check for adequate range of motion on yourself is with the wall lunge test.
Check out this video and try it out for yourself:
If you find that you do have some difficulty with ankle range of motion in this direction, you can improve it by simply turning the wall lunge test into a mobility exercise and practicing daily.
Another area besides joint stiffness that could be limiting your ankle mobility is tightness of your calf muscles. The calf muscles are actually a group of 3 muscles — the gastrocnemius, soleus, and plantaris. All three come together in the Achilles' tendon to attach at the heel. If you do have some stiffness here, you may benefit from foam rolling and stretching on an incline or step.
Train Your Arches
I’ve heard countless people worry about having flat feet because they were told they “pronate”.
It’s important to remember that every body is different--some people naturally have high arches, while others have lower arches. The foot is actually meant to be able to pronate-- this is what allows the body to be efficient and absorbs shock.
The key to healthy feet is being able to move into and out of pronation and supination.
Being stuck in either of these foot positions may cause excess stress in your foot and ankle. In general, the shape of your feet matters less than their ability to move well and their capacity to handle stress or load. If you are suffering from foot/ankle pain, it is a good idea to take a look at your arches because they very well could be a weak area contributing to your problem. The good news is arches can be strengthened and you don’t necessarily need to rely on a bevy of orthotics or shoe inserts long term.
There are four layers of small but strong muscles that help to maintain the arch. Like any muscles, these muscles can be strengthened. Even if you have flat feet, you can exercise these muscles to improve their strength and coordination to improve your arch.
Strengthen Your Hips
When dealing with foot and ankle pain, it is important not to get tunnel vision on the site of the pain. Oftentimes, the problem actually has more to do with weaknesses higher up the kinetic chain, like at the hips. If you do not have enough flexibility in your hips to allow your leg to extend behind you, for example, this can cause you to rely more on your knees and feet to propel you forward as you walk. On the same note, if you lack strength in some of the large stabilizing hip muscles, it will make it very difficult to deal with the forces on your legs as you move, causing extra stress and strain at your feet. There are lots of ways to improve the strength of your hips, but here examples of a few of our favorites:
Stand on one foot. Now try it with your eyes closed. How long did you last? You should be able to stand steadily for at least 30 seconds. People are often surprised by how difficult this is—they expect to do better! But, balance is like anything else in the body: if you don’t use it, you lose it.
After a foot or ankle injury, the body tends to shut down some of the local muscles while healing is occurring. This, plus any stretching out of ligaments that happened at the time of injury can cause ankle instability that makes it difficult to balance. A huge part of rehabbing, then, is simply rebuilding that mind-body connection and coordination of muscles of the feet, hips, and core.
The easiest way to get better at balance is... practice! Practice standing on one foot, staggered stance, heel to toe, feet together, eyes closed, and on soft or uneven surfaces. Make sure to have a countertop or chair close by to hold on to for safety.
Hands-on Treatment for Your Feet
An extra set of eyes and a hands-on approach from a physical therapist who will listen to your story and walk through your journey with you will elevate your recovery even more. Physical therapists are highly trained clinicians and movement specialists with the expertise to provide you with the care and individualized programs that are exactly what you need. You can often leave a physical therapy session with a good therapist and have your concerns eased and pain decreased in as little as 1 visit.
Krissy Gullen is a Doctor of Physical therapy with a background in competitive gymnastics and dance. She is also trained in Clinical Pilates which she incorporates in her treatments to help Evergreen patients recover from and prevent future injuries.
To schedule a free consult with Krissy call us at (626) 683-8536 or request an appointment through our home page and don't forget to subscribe to our blog!
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