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General Wellbeing - From the feet up
Following on from the series of newsletters that started last year and finished earlier this year in our January edition, I would like to look at the feet and discuss why, in certain circumstances at least, your therapist should be looking at your foot biomechanics (the way they're functioning) and whether that's influencing your pain elsewhere. We know from the previous newsletters that poor posture can be one of the main causes behind musculoskeletal pain; so it makes sense that as most of our contact with the ground is through our feet they could play a part in our overall posture, as well as how we walk (our gait).
Before we do this we need to look at how feet differ if they have never worn shoes, i.e. how they were meant to be, prior to the invention of shoes and therefore anatomically speaking what should provide us with the 'best' overall function from them. From the picture below (and across to the right) you'll see that the toes are splayed, especially between the big toe and the second toe. Now ask yourself when was the last time your saw feet like that in the UK?
It's not to say that all shoes are bad, or our feet aren't able to adapt to wearing them. However, we must accept that wearing shoes affects the shape of the foot, and if that's the case, they must also affect the way it functions. Based on this, it is also not too far a jump to say that if shoes change how the foot functions, they could affect our overall posture and our gait. Going back to the premise that poor posture can be one of the influencing factors behind muscle and joint pain. It now makes no sense to ignore the feet in those people who are suffering with pain and have jobs / lifestyles, or who participate in sports, that require them to stand/walk/run for long periods.
Common foot influenced problems
Below is a list of problems that I believe (in some cases) can be either caused, or influenced by poor foot mechanics in 'active' people:
- Plantar fasciitis (inflammation and pain in the sole of the foot)
- Runner's knee
- Medial Tibial stress pain/fractures
- General knee pain (especially for people lifting weights)
- Knee meniscus injuries
- Hamstring tightness
- Hip flexor tightness
- Low back pain
- Neck and shoulder pain
- Tension headaches
From the list above it now reads like correcting poor foot movement, which would be nice and neat, could solve most problems and if it was that simple I would probably just retrain as a podiatrist. The truth (like everything) is more complicated than that, the body is an intricate connection of bones, joints, muscles, tendons, ligaments and various different other tissues; therefore none of these (in my opinion at least) should be looked at in isolation.
To elaborate, let's assume that poor foot mechanics whilst walking (or running) can cause inhibition (poor function) of the glutes and dominance in the hamstrings, it must equally be possible then for the reverse also to be true. What happens if you naturally happen to have tight hamstrings? Could that affect your foot movement, by restricting leg extension? In effect you get a 'chicken and egg' scenario; so what happened first? Did the poor foot mechanics cause the tight hamstrings, or did the tight hamstrings affect the foot? Then you need to add in any prior injuries, surgery, and general wear and tear.
Now we can see that this is where the ability, experience and training of the therapist comes to the fore, they need to work out which is the best route to help getting (and keeping) you as pain free as possible.