The Foot Mechanic

Gnarly toes

Have you ever seen gnarly toes dressed in a gorgeous strappy sandal?  "Poor thing" we think. Then "Thank God those aren't my feet".  On the other hand, and I'm sorry to be blunt, but perhaps you look down at your own feet and see Gnarly Toes. 

Here's the good news: you don't necessarily have to have gnarly toes. Ever. And if you do have them now, you don't necessarily have to have them forever. But you do have to do something about it other than hoping or wishing.  Are you ready to take it on?

This is the bottom of your foot. As you can see it is made up of many small bones, and each joint has potential for movement.

The bottom of the foot has lots of small muscles to pull on the bones of the foot. Here I've drawn in the line-of-pull of a group that operates on toes 2-5 (the flexor digitorum brevis group).  If this group is too tight, it will pull the knuckles of the toes toward the heel, creating Gnarly Toes. 

Instead of lying flat like this: 

The toes will be pulled into the classical "Gnarly Toe" shape. (You can correct your podiatrist when he calls it a claw toe. Tell him the correct term is "Gnarly".) I illlustrated this shape with just the little toe here, but you can see what I mean, right?

In life it looks like this:

So what to do about this? You need to lessen the tension on that flexor digitorum brevis group so it doesn't drag the tip of the toes down. In other words, you need to stretch out your feet. Generally speaking, muscles that are tight are also weak and unable to generate force dynamically or powerfully. Weak foot muscles make you a slow runner and will lead to calf strain because the calf muscles will try to do the job of the couch potato foot muscles. So there is a two-pronged approach necessary here: stretch and strengthen. Get a tennis ball and a theraband and join me on the video that I will post this afternoon.

 

 

Men in Heels

Here is a NYTimes article about some fashionable young men wearing tall-tall shoes to parties and clubs in the city.

The problem is that usually men have tighter feet than women, so the male foot stubbornly resists the demands of high shoes.  I'm sure we can all agree that tall shoes are very demanding biomechanically.  If your feet can't negotiate with your tall shoes, a few things are likely to happen:  you fall down or you give up and take them off.  This is not acceptable!  Your shoes are way too cute for that!  You've got to develop flexibility in your feet and thank God I can show you how to do that. 

Of course, men wearing "women's" shoes is not new.  I've always adored the Trocks, the ballet company of men who dance in pointe shoes and in drag. You're welcome.

 

A new way of thinking about your feet

We tend to think of our feet in only one dimension:  the-looking-down-at-your-foot-from-above-dimension.  (You thought there were only 3 dimensions, didn't you?) This plane is the most familiar:  the top-view plane:

There's the profile plane:

And then there's the head-on view (also called the transverse plane):

Anyway, the five metatarsals (if you don't know what or where metatarsals are, read this post) move in this transverse, or head-on, plane when you step on your foot.  And they don't all move the same direction.

Look carefully and critically at the foot and you will notice it can be divided into two distinct sections:  what Eric Franklin calls an "ankle-foot" and a "heel-foot". 

Top view:

   

  Bottom view:

 

The first 3 metatarsals (rays 1-3) are related to the talus and we can call this the ankle-foot; while rays 4 & 5 relate to the heel (calcaneus) and voila!  It's the heel foot.  

Here's the profile view:

...and the head-on view:

The heel-foot and the ankle-foot function somewhat separately although they are (obviously) very reliant on each other for stability. The metatarsals don't move forward/back or swing like pendulums... they rotate along the long axis.  Now because: 

-- the 1st-3rd rays move with the midfoot (cuneiforms and navicular) and the talus in one group

--and because the 4th-5th rays move with the cuboid and heel-bone (calcaneus) in another group, we have a cogwheel effect of the ray.

 This motion occurs each time you step on your foot.  The weight comes down, the gears turn, and the sole of the foot spreads out like a puddle of pancake batter.  Pick your foot up, and the opposite happens.  The gears turn the other direction and the foot domes like a suction cup under suction.

Put a pebble on the floor and try to pick it up with the middle of your foot -- not your toes, the MIDDLE of your foot.  (Yeh, go ahead and massage out that cramp you just got.  I'll wait.)  This is your foot doming.  This happens every time you lift your heel in walking, or push strongly out of the starter's blocks in a race, or jump up in the air.

If you're a dancer, visualize standing on the line between rays 3 and 4 -- this is your perspective.  Rays 1-3 and 4-5 turn en dehors as you releve, and en dedans as you plie.  Imagine that you are lifted up into releve because your foot domes first.  Ahhh.  Isn't that magic?  The power doesn't come solely from your glutes, hamstrings or calf muscles (this is SO important for those who have achilles tendonitis!!!!) -- it can also come from the muscles that live entirely between the tips of your toes and your ankle.

I'll post a video of the embodiment of this movement next time.

Do Certain Types of Sneakers Prevent Injuries? - NYTimes.com

Scientific rumblings about whether running shoes deliver on their promises have been growing louder in recent years. In 2008, an influential review article in The British Journal of Sports Medicine concluded that sports-medicine specialists should stop recommending running shoes based on a person’s foot posture. No scientific evidence supported the practice, the authors pointed out, concluding that “the true effects” of today’s running shoes “on the health and performance of distance runners remain unknown.”

via well.blogs.nytimes.com

The problem with assessing your foot posture and then recommending a certain shoe type (cushiony/soft or supportive/rigid or middle-of-the-road) is that your static foot posture is not necessarily indicative of your foot rhythm in gait.  I tend to overpronate on my right foot and yet I have very high arches.  The shoe salesmen from this article would tell me I need a cushiony shoe because of my overpronation, and yet a rigid shoe for my high arches.  See?  Ridiculous. I'm proud of the researcher quoted at the end of the article because he recommends readers listen to their body and pick running shoes based on that.  Yay!  One point for our side!  Researchers don't usually recommend kinesthetic awareness because they like to measure things, and subjective thoughts are impossible to objectively measure.  

I'm barefoot most of the time because that's what Pilates instructors do, but when I do wear shoes I often pick my Vibram toe gloves.  I just wish they were flesh colored, because I'm 5'2" and wear a size 9 shoe.  I look like *$&%* Minnie Mouse.

 

Lisfranc fracture

 The above image is from Thieme's excellent Atlas of Anatomy.  Get it if you don't got it.

I met a new client this week who suffered a Lisfranc fracture in a head-on car wreck.  This is when the midfoot, where the long metatarsals meet the cuneiforms and cuboid, dislocates and/or fractures.  It appears that this fracture is missed probably 20% of the time. (see footnote)

The thing to watch out for with Pilates clients with this fracture is discomfort when the foot is on the Reformer's footbar, on the push-through bar or in the footstraps.  Basically, anytime the foot is positioned with the weight on the arch will be uncomfortable for this client. 

 If you're doing the feet in straps variations, it might be helpful to steal the Gyrotonic foot-loops (not Froot-Loops) because it transfers some of the load onto the ankle.

 

You can get these from Balanced Body here.
 

Reference: (Hardcastle PH, Reschauer R, Kutscha-Lissberg E, et al. Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg Br 1982;64:349-56.)

Gait cycle & the big toe

Every step you take moves through a gait cycle.  Look at the activity of the right foot:  half of the time you are standing on it (stance phase) or swinging it forward and preparing for the next step (swing phase).  The stance phase is made up of  the following events:  heel strike, foot flat, heel off and finally toe off.  Here's an illustration of the gait cycle.

When the foot moves through toe-off (that's the second leg to the right of the shaded leg in the above illustration), normally the big toe is the last bit to leave the ground.  The very last scrap of propulsion your body is going to get is going to come from this moment.  Do you think the big toe can provide much oomph for the rest of the body?  After all, it's not very big....

The big toe is ingeniously designed.  Its tendons are long and thin so that the belly of the muscle is located much higher up, in the calf.  This image is from Thieme's General Anatomy textbook.  It's the mostest awesomest anatomy book ever.  Go visit them at the winkingskull.com or buy it at amazon.

 

This illustration shows the muscle flexor hallucis longus (a long name like that describes the muscle - that is it flexes a joint, it's attached to the big toe, and it's very long) as well as some others.  To find the flexor hallucis longus, look at the base of the big toe and follow that gray tendon upward, behind the inside ankle bone and toward the outside of the calf muscle.  Look at how big the belly of that muscle is!  It's extremely powerful (or at least has the potential to be).  The larger the cross-section of the muscle, the more force it can generate.  As in:

 
Sorry, I got distracted there for a moment.  'K, look at his shoulder, that is the muscle belly of his deltoid.

 

 That's a muscle with a lot of potential for power, and it attaches directly to the bones it affects.  There's no long thin tendon attaching it to a bone far away.  The big toe's ingenious design allows our feet to be bony and light, and yet still have access to power.  Like a long extension cord!  If our feet had to pack the muscle in right on top of the bones, our feet would look like big pillows stuffed with sausages.  Ick.  Nothing fun like this would ever happen again:

Watch sprinters bursting out of the blocks at the beginning of a race; of course that power is coming from the posterior hips and thighs, but don't dismiss the contribution of the big toe and its flexor hallucis longus.  For dancers, this muscle is essential for jumps and releves.

  

 

Bunions

Just what are bunions?  Most people say it's when your big toe "sticks out" or that your big toe "has a bump on it".  Actually, a bunion is when the 3 bones that make up your big toe form an angle instead of staying in a straight line.   

 

(image from Thieme's excellent Atlas of Anatomy - get it if you don't got it)

Bunions are very painful because of the stress placed on the ligaments and because the weird bone configuration creates a difficult shape for shoes.  If you have bunions and you've tried on a pair of stilettos, you know what I mean.  If a bone is jointed to another bone, nature has covered it with thick, smooth cartilage so motion (bending or flexing or whatever) is cushioned, smooth, and gliding.  If the bones don't fit together they way Nature intended, the smooth gliding surfaces are not against each other anymore and, well, Houston we have a problem.

The real tragedy with bunions is that once they start, it's like that stone rolling downhill.   You can see by the illustration above that the angle of the ligaments is a real problem.  The more the big toe joint deviates, the more the hallucis ligaments reinforce the deviation.  (By the way, anything to do with the big toe is labeled hallucis or hallux.  It's from the medieval latin hallex and allux meaning thumb-toe.)  Beneath the ball of your hallux, are two tiny sesamoid bones (from the Greek for sesame, as in seeds) that sit in a bony groove.  They are encompassed within a tendon and act as joint protection and leverage providers.  If they are not positioned properly, their ability to function well is lost.  In the illustration above, you can see the sesamoids are not positioned below the first metatarsal any longer, but have been pulled toward the midline of the foot.  Ouch. Ouch. Ouch.

So, what to do about it?  Well, try to stop bunions from getting worse.  Many people who have bunions have "flattened arches" or pronate too much, so be aware of your weight on your feet and don't stand on the inner border of your foot all the time.  It's not like you don't have a choice, you know.  Strengthening your hip muscles that turn your legs out will help lessen this over-pronation in standing.  Those muscles would be your deep lateral rotators such as the gemelli, obturators, and piriformis, and yeah your glutes too but don't neglect the deep rotators.  Stretch the internal rotators (hamstrings, inner thighs and the tensor fasciae latae) and massage the IT band with a foam roller.  I'll post some descriptions later.

If you have bunions that hurt, stand up and massage the bottom of your foot with a dead tennis ball.  Eric Franklin sells some wonderful massage balls that are softer than tennis balls and very versatile.  He describes many special foot routines in his books that I use all the time with clients and for myself.  His book "Conditioning for Dance" has some great routines, and so does his "Inner Focus, Outer Strength".  

If you really love feet and would like to do a workshop, drop me an e-mail (link at the top of the page) and I'll schedule a Dynamic Foot class for the Carmel/Monterey area.

Plantar vault

The side view of your foot shows its arch.

Image from Thieme's Atlas of Anatomy - get it if you don't got it.

Its shape is reminiscent of the vaulted ceiling of gothic cathedrals:

P.S. If you love Notre Dame in Paris, check out this photo from Martin Deak's flickr stream.

The arch is one of the strongest shapes in architecture. (The strongest maybe?)  It can support unbelievable forces.  These interior arches of a cathedral ceiling support the weight of a stone ceiling.  Similarly, your foot's arch supports all of your weight.  Each time you step, one arch absorbs your weight; if you are running, those forces are nearly three times your weight.  As long as the structure of the arch doesn't break down, its strength is incomparable.

Foot Design and Long Distance Running

Nice article  from the NYTimes summing up the evidence that humans evolved as long distance runners.  The evidence for our ancestor's marathoning?

-humans have a more efficient cooling system than animals (lots of sweat glands, little body hair, and we don't have to pant)

-Ligaments that act like springs in our lower legs and feet

-The length of our toes (an increase of 20% would double the work-load of the foot)

Check out the article for the complete discussion.

 

Phys Ed: Is Running Barefoot Better for You? - Well Blog - NYTimes.com

Finally!  An article on barefoot running that is mostly science, and not all starry-eyed evangelists.  I think barefoot running is a great idea, but I never thought it would make you faster... apparently some people do.  In today's NYTimes - article here.

Daniel Lieberman, PhD, a professor of human evolutionary biology at Harvard University, studies and periodically practices barefoot running. His academic work focuses in part on how early man survived by evolving the ability to lope for long distances after prey, well before the advent of Nike shoes. There “is good evidence that humans have been running long distances for millions of years,” he says, “and most of that was probably done barefoot.” For his own part, “I run a lot,” he says, “and at least once a week, I run about three to five miles on the streets of Cambridge, completely barefoot. I can attest to the fact that it’s a lot of fun.”

via well.blogs.nytimes.com