One of the most aggravating discussions I have with patients on a regular basis goes like this:
Me: “What kind of shoes do you wear?”
Patient: “Oh, I got these running shoes custom fit at this super-special shoe store that uses patented technology to assess my foot strike pattern, weight distribution, favorite color, and most likely soul-mate. They have great arch supports but my feet still hurt.”
Let’s just stop right now and all perform a little thought exercise. Better yet, don’t strain yourselves, just do a Google Images search for “bridge arches”. How many of those arches have an orthotic insert underneath them? None. The arch is a physically stable structure on its own. It is not a weight-bearing structure.
Any podiatrist who tells you your arch needs support is ignorant at best.
There is only one situation in which you need to wear an orthotic insert or buy a “motion-control” shoe: when it is painful to walk without them.
Even then, your goal should not be to donate a significant portion of you disposable income to your orthotist or the shoe company that is selling you a soft cast for your foot for the rest of your life. Rather, you should be focused on restoring the normal joint mobility of the foot and reinforcing that natural mobility of the foot with stronger muscles, tendons,ligaments, and bones.
We have been sold a false bill of goods over the last 40 years when it comes to performance footwear. The belief that we need extra cushion under the heel, a rigid mid-sole to support the foot, and a contoured and tapered toe box is an invention of industry and advertising.
If you are a runner and you heel strike, don’t waste your time arguing with me in the comment section below. Rather, I want to challenge you to take off your shoes and socks and run 100 meters down the sidewalk in front of your house, heel striking along the way. Then come back to my site and let me know how long it took before you decided landing on your forefoot was the more efficient and comfortable way to run.
The underlying problem with all of the foot problems we see (and we see a lot-the injury rate for recreational runners has been nearly 80% per-year for years) is none of us were given a system to do basic maintenance work on our bodies. How are you supposed to get your feet stronger? More mobile? How do you transition to flat shoes? What are you supposed to do if you have a flat arch? Who the heck are we supposed to vote for in the next presidential election?
Let’s dig in and answer (some of) those questions and gain a usable framework to reclaim the natural ability you possess to have strong, healthy feet.
Restoring Foot and Ankle Mobility
Your foot and ankle contain 33 individual joints designed to move as you walk and run. We divide the foot and ankle into 3 main sections: the rear foot (ankle and heel bones), mid-foot (arch and associated bones in front of the ankle and behind the balls of the feet), and forefoot (balls of the feet and toes).
Here’s a couple mobility-based drills to open up your ankles and feet. Keep in mind a few rules: 1) If it feels sketchy, it’s sketchy. Stop it. 2) If it burns, tingles, or is going numb, you’re pressing on a nerve, not soft tissue. Stop it. 3) Test and Retest. We want you to mobilize until you create a change that is observable.
Classic Calf Wall Stretch
Start with the toes and balls of your feet positioned on a wall. Lean forward, pushing the hip of your front leg towards the wall while you squeeze the glute (a.k.a. butt cheek) of your back leg. You should feel it in the calf of your front leg. Alternately, you can lead with your front knee driving over your ankle, either directly in line with the ankle, slightly outside of the ankle, or inside the ankle. This moves the mobilization into the ankle joint and more effectively mobilizes your Achilles Tendon. Glide back and forth, spending 2 minutes per-leg working on the positions that feel tight.
Plantar Fascia Smash
Use a soft lacrosse ball, tennis ball, or another small-diameter ball (especially if you have plantar fascia pain or have never attempted this before, don’t start with hard ball). Your target area is from just behind the balls of your feet to your heel. Start in a sitting position with the ball positioned on the outside of your foot. Slowly move your foot across the ball, keeping your heel on the ground. Wave back and forth and work back towards your heel. Spend 2 minutes per-foot. When this gets easy, stand up to add more pressure.
Look at your hands and spread your fingers as far apart as you can. You should be able to do the same thing with your toes. If you can’t, this mobilization is for you.
Take your right foot and cross it over your left knee. Place the fingers of your left hand in between the toes of your right foot. Grab your arch with your right hand to keep the mid-foot stable. Gently move your toes up and down, side to side, and in a gentle twisting motion for 2 minutes.
Restoring Foot and Ankle Strength
You can mobilize your feet and ankles all day long, but if you don’t follow it up with some motor control (a.k.a. strength) re-training, your body and your brain aren’t going to be able to use that new range of motion you discovered.
Here are a couple of our favorites:
Seated Heel Raises
One of J.C.’s favorite foot strengtheners, this exercise targets the posterior tibialis-a muscle that runs down the back of your lower leg and puts your heel down in good position on the ground. Start in sitting with your feet slightly behind your knees. With one leg at a time, slowly lift your heel until only the balls of your feet and your toes remain on the ground, making sure your heel remains directly behind the front of your ankle. Pause, hold for 5 seconds then slowly lower your heel back to the ground. Make sure you don’t let your heel drift inside or outside from directly behind your ankle. Shaking? You just discovered the new #1 exercise in your foot and ankle strengthening program! Repeat for (you guessed it) 2 minutes per-side.
(The wrong way to do it)
Using the same ball you used for the plantar fascia smash, start in a standing position with the ball under the balls of your feet and toes. Lift your toes up and spread them out as far as you can, then flex your toes down, trying to grip the ball the way you would palm a basketball with your hand. Ante up 2 minutes per-side and bask in the glory of your new-found foot strength.
Selecting Footwear and Daily Habits
All the stretches and strength exercises in the world aren’t going to move the needle on your foot and ankle mobility and strength if we don’t consider the shoes you wear and what you do throughout the day.
In terms of footwear, look for “zero-drop” shoes, or shoes that have no more than a 4mm difference in heel-to-toe drop. If your heel is significantly elevated above your toes and never reaches level with your forefoot throughout the day, your body isn’t going to bother keeping the natural range of motion of those joints and tissues in your lower leg and foot. Shoes with an elevated heel create an environment for your lower legs and feet that stimulates adaptive stiffening of those tissues and joints. You are what you do most regularly. Your chances of developing plantar fasciitis, Achilles tendonitis, or even an Achilles Tendon rupture increase dramatically when your joints and tissues don’t posses their inherent ranges of motion and pliability.
Walking barefoot can be one of the greatest inputs to your feet to restore their normal function. If you can’t walk in the house in your bare feet without pain, spend 2-4 weeks working daily on our mobility and strength prescription above. If pain isn’t a problem, start by spending 1-2 weeks walking around the house in bare feet. When that gets easy, spend another 1-2 weeks walking down your driveway and back. After you adapt to that, start walking to the end of your block and back (a great conversation starter with the neighbors, too). When that gets easy, go for a walk around the block.
If you can walk around the block in your bare feet and you’d call our mobility and strength protocol for the feet and ankles “easy and comfortable”, I’d say you’ve successfully restored the normal strength and mobility of your feet and ankles.
If you’re a runner and you want to transition to running in minimal shoes or barefoot, there’s a little more work to do. Start your run in your minimal shoes (when your feet are fresh) and run 10 percent of your distance in those shoes. Switch back to your regular running shoes for the rest of your run. As long as you don’t experience pain or excessive soreness (lasting more than 48 hours), you can increase your distance in your minimal shoes by 10 percent per-week.
Your feet and ankles are the foundation of so much function through the lower body. We regularly see foot dysfunction with our patients as the root cause of many knee, hip, and even lumbar spine issues. If you’re currently receiving physical therapy for your low back, hips, or knees and you haven’t addressed your ankle and foot mobility and mechanics, it’s time to start working on those old dogs!
Have fun and have a great Fourth of July weekend!
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