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.

 

 

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.)

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.

Toe Woe Types

Didja know that hammertoes are not the only type of toe woe?  Yep, it's just serendipity that you end up with a hammer toe.  I like that word.  Serendipity.  It sounds like ice cream cones, chance encounters, sunshine while it's raining... it sure as heck doesn't sound like this:  wait.  scratch that.  I was going to post a seriously gnarly shot of a foot with hammertoes but that would NOT be nice for those who are not movement educators or similar.  You'll have to imagine it or google on hammertoe.  It's intense so breathe through your mouth.

Anyhoo, here are those other toe patterns:

The Claw Toe

So called because of the lovely talon-esque profile of this toe.  Yikes!  Can you imagine the forces coming into the ball of the foot?  It's all about force distribution, y'know.  If the forces can't be distributed onto the length of the toe then all of it must go to the ball of the foot and the tip of the toe in this case.

The Mallet Toe

'Cuz it looks like a mallet.  Not a mullet, that's a god-awful hairdo.  (I always hear Journey in my mind when I see a mullet.)  In this toe profile, the ball of the foot is down (that's called extension in this case), the next joint is in neutral and the very last segment is pulled down toward the floor (into flexion).

The Hammertoe

This one is only different from the claw toe because the tip of the toe is lying down here instead of curling under as in the claw.  

This poor foot really needs a tennis ball to stretch out all these parts that are too tight.  Put the ball under your foot and roll your foot over it for a massage that feels great.  If it's too hard, use a dead tennis ball.  If it's still too intense, use an inflated ball like a Franklin ball.

Hammer toe Woes

Yeesh.  Hammertoes.  Where do they come from?  How did this happen to such a nice person?  We pay our taxes, get our pets fixed, donate to good causes and still!  Hammertoes!  Well, I don't know why bad things happen to good people (or why good things happen to bad people) but I DO know how hammertoes come about.  

Here is my incredible sketch of a normal foot.  (See what happens when one gets a gift certificate to an art supply store?  I buy markers!  and paper!  and a red beret to wear on one side of my head!  And then I figure I am an artiste, so I make a drawing and find out that I actually suck hard.  So I buy a smock!  This is what will make me an artiste!  But non! I still suck hard.  So I start a blog that I can fill with my leetle drawings and I annoy passersby with my sketches.)

Meanwhile....

The green band in my masterwork above represents the muscles that connect the pads of your toes to your heel and the back of your calf.   The pad of your big toe is connected to the heel by the flexor hallucis, and the pads of your four toes are connected to the back of your shinbone by the flexor digitorum longus.   When these muscles get tight, they pull the pads of your toes toward your heel, and vice versa.  Your foot can react in a couple of different ways.  It can:

--overarch your foot.  This causes a sort of "doming" effect in the center of the foot and can be painful because your midfoot is prevented from spreading out like a melting chocolate chip when you stand on your feet.  Instead, the bones are compressed together.  Yowch!

--pull the pads of your toes toward your heel.  If your midfoot doesn't dome upward because it's ornery or because it can't, the tension will go to the next easiest place.  Usually it's to the toes.  In this masterpiece, you can see the end toe-bone (that's a phalange, by the way) is pulled into a hammertoe position.  This elevates the knuckle (where the arrow is pointing) and results in corns, painful calluses, and (let's face it) ugly toes.  Well, okay, not ugly as in Cinderella's ugly step-sister ugly, but still pretty bad.

So, now you've got a tight foot that has resulted in hammer toes.  You can make a big difference in your feet with a few exercises.  The easiest one of all is called Releve.  Oui, releve.  This is not because of the artiste/smock/beret thing, it's just because ballet started in the court of Louis XIV and for some strange reason, everyone there spoke French.  Go figure.  

It's wonderful to use a mirror for this exercise because it will help you to see your feet.  (I apologize for the background and the crummy sound -- it's my home studio and my Gyrotonic machine is there between my feet looking menacing.  In reality, it's actually very loving and sweet.)

Just a sign of the bubble that burst?

I was looking at toes (internet-shopping for some nail polish to go with my new FitFlops for our Indian Summer) when I remembered an article I read a few years back.  At the time, women were having their toes surgically shortened so they could wear stilettos again.  Stilettos are beautiful but they are hard on feet because they force an enormous reduction in the range of motion of the ankle and metatarsal heads (ball of the foot) during gait and they are extremely narrow at the toe box.  Many women, once upon a time could tolerate the sacrifice stilettos require but just can't do it anymore because of pain from bunions, hammer toes, and corns.  So they limp, in their sensible SAS shoes, to the friendly podiatrist's office where they are promised they will skip out in Manolo's.  After the stitches come out.    

Doesn't that seem like a different time now?  It just seems so bubble-headed, so extravagant....  And I don't mean just with money - extravagant with the delicate mechanics of your feet!  Your feet!  You don't get another set, mate.  I wonder if women are still doing this surgery or if it has fallen out of fashion.

Toe Woes

Toes are hassled a lot.  The ball of your foot bears a great deal of your weight while standing and is used like a hinge every time you take a step.  This movement, between the metatarsals and the toes (the MTP joint) is called extension.  Flexion is when you grip your parakeet perch with your toes or pick up Fritos from the floor.

 

The fantastic illustration below is from the wonderful Thieme people... you can preview their combined Atlas of Anatomy at www.winkingskull.com, and then buy it at amazon.  It is very reasonably priced and I think it's the best anatomy text out there.  It certainly kicks Netter's butt.  (It is most definitely NOT Thieme's illustration above, that's my own ridiculous attempt of combining photography and illustration.) 

So, walking moves your MTP joints through a neutral (or flat) position to extension, but not through flexion.  As a result, your feet get a lot more practice with MTP extension than with flexion.  With time and neglect, many feet begin to show MTP extension even when there is no weight on them - yikes!  And that, little one, is the beginning of hammer toes.