What’s the Deal with Feet?
If you’ve been following me on social media for a while, or maybe just stumbled into my website, you’ve probably noticed that there is a lot of stuff on feet. Why? What is the big deal? I mean most of us put on socks to start the day and then shoes and forget about them until the end of the day… when they are achy, stiff, tired, sore, etc. But I mean, that’s normal- Right?
Wrong! Foot pain is NOT normal. Yet so many of us deal with it every day. Most research suggests 25% of the population will have foot pain at any given time. But, how many of us across our lifespan will experience pain that is limiting or restricting at some point along the way? I would venture to say that number is significantly higher. The reality is these numbers are also likely skewed, as so many people never seek treatment for foot pain. They simply “deal with it”, because they’ve been told is normal (by someone else who has pain and isn’t getting care).
Looking back, my fascination with feet really started with dance. Yes, another way that dance has affected my life, my career and my passion for helping others. Feet are so vital to a dancer’s ability to master movements and perform. They must be flexible and strong. Movements require finely tuned articulation of the joints, but stability to sustain the weight and load of a dancer in end-ranges (i.e. en pointe) for seconds, moments, and repetitively over hours (I’m looking at you full length ballets… Nutcracker, Copellia, Swan Lake, etc). As dance has evolved, we now have so many different styles. Much of modern/contemporary is now barefoot. HipHop is often in sneakers. Tap and Irish Hardshoe involve rigid shoes to get the pressure needed to make sounds. So many different ways for the foot to move.
Dancing En Pointe
Strength, Mobility and Stability are all required to achieve this position, maintain balance and alignment.
Fast forward into PT school, where although my Kines/Ortho professors were fantastic (Peter/Mike/Paul/Michelle- thank you!), I felt the foot was addressed so quickly relative to other areas. We spent as much time on the Lumbar spine (5 major bones) as we did the Foot (26 bones each/52 bones in total). I was intrigued, and felt I got all the basics… Until I started working with some amazing Foot & Ankle Orthos in Philly. I re-learned so much: Raw gait, biomechanics, pathology, surgical vs non-surgical interventions. I got it. I knew the foot. Finally. I mean E-I-E-I-O is all you need to understand about the torque of the subtalar joint, right? (Thanks Dr Wapner).
After moving to my position at Bragg, I didn’t have the time to dive into things the way I used to. I tried, but I would get so far behind with my schedule and notes. So I started to just stick to the basics. Patients still got better, at least somewhat. During our phase of tracking outcomes, I still had the best in Foot & Ankle, so I was good, right? Wrong again.
My own activity changed. I was driving more, sitting more, walking less. Too tired to work out as regularly as I wanted thanks to long, stressful hours and a long commute. I started following trends in shoes since, well, I wasn’t walking or on my feet as much so I could look “cute” more often. Then suddenly an old ankle sprain came back to haunt me. A rough high-ankle sprain on my R side, which I rushed back to dancing (Salsa/Latin in heels no less!). It started getting very stiff, painful, restricted. I couldn’t demonstrate squats to patients if I wasn’t in a wedge shoe. So this is it- arthritis? I mean it was bound to happen…
Along the way, one of the team members at a local run store had introduced me to sneakers with a natural toe box and zero drop. No I’m not a runner, but I had always learned that running shoes were OK for every day wear and more “supportive” for being on your feet. I had really, REALLY liked the way the more natural sneakers felt, but my dancer brain struggled with the “clown” toe shape. Instead, I had opted for a standard pair of moderately cushioned sneakers with a 8mm drop (heel higher than toe). Although, I kept thinking about those other ones and didn’t really know why.
When I started back down the rabbit hole of mechanics for my OWN recovery, I realized something. I wanted— no, needed— to try something DIFFERENT. So I did. I quickly realized I started wanting to wear the more natural ones all the time. I felt better. My ankle wasn’t as stiff or tight or painful. My calf wasn’t getting painfully tight anymore. And thus I dove deeper; went back to my research and education on gait, mechanics, muscle function.
Have you looked at a baby’s foot? It’s a TRIANGLE! For those who are somewhat engineering inclined, you know that triangles are the most stable of the simple structures. This couldn’t be by coincidence. And yet most adolescent and adult feet I treat in clinic aren’t triangles. Most are told they have “fallen arches” or “flat feet” , bunions, and that they need arch support. In fact, I had always learned flat feet leads to bunions.
But… WHAT IF IT’S THE OTHER WAY AROUND?? What if the narrow toe boxes that pull the toes to the 3rd toe of the foot (which is not the mechanical middle, by the way) were causing the arches to drop? And what about the heel drop? It’s basically like wearing small heels all day every day… but we think it’s better if there’s rubber? I started finding example after example of “Shod” or shoe-wearing feet vs “UnShod”. Even Albert Einstein figured this out in the 50’s, but somehow no one in the shoe market listened… At least until now! We have more Natural Footwear options than ever, and more clinicians moving in the direction of building strength and stability to improve function, rather than reliance on external supports.
Alas, our feet are our GROUND. We have all the parts we need. 26 bones per foot. 33 joints each. 19 muscles per side (not including the ones which come down from the lower leg). Over 100 ligaments for stability. We have just inhibited ourselves from using them in the way they were designed. You don’t have to be in pain every day. No your feet shouldn’t hurt. It’s not normal. We need to RESTORE mobility & strength. This can then help to REFORM our lives!
