Foot for thought

In standing, walking, running and jumping, the first thing that comes in contact with the surface we are negating is our feet. This makes it of great importance that this contact is as correct as possible in order to create a good foundation for the rest of the body, and hopefully prevent foot and ankle pain, and even pain in other, more remote parts of your body. As you may have guessed already, this article will discuss the importance of feet, loading and footwear!

A newborn baby communicates with the surroundings using mouth, hands and feet, and thus these areas occupy the majority of the adult brains sensory cortex. Sensitivity of feet is hence crucial for upright standing and locomotion (walking). You have often heard people refer to your body as a temple. I am not going to be that holy and rather refer to your body as any building, reaching from a shed to a palace. Common for every building standing the test of time is having a good, solid foundation. Without a solid foundation, the building will have problems with time. Just look at the leaning tower of Pisa. Due to an insufficient foundation and loose soil, the present day tower is leaning an astonishingly 4 degrees of a perfect vertical structure. If we transfer this analogy to your body, seeing your feet as the foundation of the rest of your body, you begin to understand why your feet are such an important part of your posture and gait, and even pathologies and pain. Insufficient foot loading and biomechanics are not only limited to conditions in the lower leg. A faulty “foundation” could in some cases cause overloading of the knees, leading to faulty hip and pelvis position creating an unstable base for the spine stretching all the way to your head and neck. Since your body is a living organism it will try to counteract this global instability by muscle activity, but overuse of muscles not designed for maintaining posture will lead to soreness, tightness and pain. In other words, wrong position of the feet can be one of the causative factors of shoulder-, neck- and headaches, not to mention pain in the feet, knees and lower back!

So how do we correct this? Or even; should we? Will shaking up the foundation really benefit the whole situation, or will it open a can of worms better left sealed?

To answer this question, we have to take a closer look at the mechanisms behind the faulty foot. As modern human beings we spend most of our time with our feet in well fitted shoes walking on flat surfaces without engaging the fine, intrinsic muscles of the feet. This leaves the complex foot muscles idle, and being idle for a prolonged period of time leads to hibernation. If the muscles are not called upon for duty, they will simply waste away. If you have ever seen the early astronauts returning from space, the first thing you see is them being rolled out in wheelchairs. This is because after spending a prolonged time in an anti-gravity environment, the postural muscles are getting so weak they are not sufficient enough to maintain balance. You can see the same phenomenon in patients after prolonged bed rest following surgeries, or more locally after removal of a cast. This does not mean that you will not be able to walk again. One of my professors from whom I received my training as a physiotherapist always stated that the brain does not know the specific muscles, but the movement they elicit. Your brain has not forgotten the natural movement pattern and conscious re-education through purposeful movements can be done to restore a good foundation and muscle co-activation, as long as there is no structural damage to the foot. This does not come over night, and requires a lot of joint mobilisations, facilitation and sensomotoric training, and a great deal of commitment from the patient to do home exercises.

But in some cases sensomotoric stimulation and home exercises are not enough to come to terms with the problems. This could be because there is a permanent, structural change to your framework, or that the pathologies have gone so far that it is too hard to rectify. In some cases, attempting to physically correct problems and stress the feet through exercises can do more harm than good. In these cases, prescription insoles and handmade orthotics is a great tool in order to prevent pain in the feet, or further up the chain like knees, hips, back and even neck, as we discussed previously. Insoles and orthotics serves as measures to correct loading difficulties when you are using them in order to battle pain and discomfort. But, it is important to remember that insoles and orthotics are not fixing the problem, just bypassing them while you are wearing them and are thus only helpful when they are fitted in your shoes. They are just like a pair of glasses. They only really help you when they are used, and do nothing to improve your vision otherwise!

Platform used to assess foot biomechanics

In the clients I see here at the clinic, I often use a mixture of the two treatment modalities when working with their problems. By combining knowledge with the other team members, we are finding a balance that suits every specific person. We have post graduate training in foot assessment and do individual biomechanical assessments to dictate the further steps in our treatment protocol, and get our insoles and orthotics produced by PPL Biomechanics, which are the leading supplier of orthoses and post graduate educator of biomechanics in Ireland.

If you have more questions regarding feet, shoes or orthotics, please do not hesitate to contact us, and we will be happy to help you to our best knowledge!

Chris Smetana, MISCP