Myofascial Foot Health

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Originally Published in Massage Magazine: June, 2013

Myofascial tensegrity is the dynamic, adaptable architecture of human movement: the exquisite balance of intelligent tensile, contractile soft-tissue that supports and mobilizes bony structure.  In other words, stretchy, springy stuff constantly regulating, limiting and supporting the movement of the rigid, solid stuff.

Naturally desirable tensegrity is evidenced by pain-free, soft tissues providing integrity and mobility, without the use of external braces, crutches, splints or supports.

Splinting aids are needed in trauma healing.  There’s also a time to put down a splint, crutch or brace, to avoid atrophy, chronic weakness and dependence.  This wisdom isn’t always applied to feet.

“Put it where you want it and call for movement.”

Ida Rolf’s quote is often mentioned by my Myofascial mentors and colleagues, stating a central strategy for achieving structural change.

This strategy is implemented via skillful positioning and myofascial touch: slow, steady, suggestion to the desired structures and layers of tissue, encouraging reorganization. This requires vectors of consistent pressure while engaging the owner of the nervous system to inhabit their tissues with movement and awareness.

I call fascia the organ of normalcy.  It’s the guardian of limits, defining ranges of adaptability available to maintain mind’s impression that everything’s “within normal limits”.

Fascia does respond to repeated pressures, postures and movements through adaptation and reorganization, eventually defining a new range of “within normal limits”.

I want to empower you to use the myofascial tools and skills you already have to address root cause of many foot problems by encouraging natural foot balance, motion and function.

Treating feet: to think outside the box, first think about the box.

Ponder the daily myofascial treatment a majority of feet receive, and explore its effects on tensegrity.  This awareness will help you strategize to restore natural foot function by facilitating the opposite of the fascial restrictions encouraged by the treatment I’ll describe.

Treatment is defined as: the manner in which someone behaves toward or deals with someone or something.

There’s a self-care treatment nearly everyone applies to their feet daily: shoes!

Most will agree a protective covering for feet is a needed tool and deal with this need by putting aShoe Treatment on before heading out the door.

Do your shoes position your foot differently than when you’re barefoot on the ground?  Likely yes.

Do you “call for movement” within your Shoe Treatment’s altered positioning? Yes.

Shoes are like little myofascial bodyworkers placed on your feet: they apply positioning and vectors of sustained pressure while active.  We endure these reshaping forces for a full-day session, everyday.  Most shoes are poor bodyworkers, as they don’t respect positioning of natural anatomy, nor answer questions or offer feedback.

Inhibiting natural anatomical positioning and freedom of movement, shoes are the box we’re trapped in: splints, braces and crutches!

The development of feet was arrested by the first pair of shoes that inhibited movement.  A majority of westerners have grown up normalizing some degree of foot atrophy, weakness and dysfunction ever since their first pair of inhibiting, or rigid footwear.

Have a proactive client curious about fixing their foot problems?  Here’s the goods to help you help them.

Natural foot structure vs. shoe architecture.

An arch is defined as a curved structure that supports weight over open space, as supported by its two ends. 

Foot arches are meant to do exactly this!  Arches only need “support” that lifts the arch from the center when there is dysfunction and/or pathology present.

We know the evils of High-Heel addiction and extreme postural distortions it creates, but a majority of modern athletic shoes also incorporate subtle features that unbalance the foot’s natural tensegrity.  We might not feel the detriment, until we’re well down the road to dysfunction, as the positioning imbalances fall within “normal” range of motion.

Here’s the thing: we shouldn’t maintain an imbalanced or immobilized position all day, nor strengthen it’s tensegrity with exercise!

Learn the following shoe features. To treat their negative effects, focus on lengthening contracted regions of tissue, and mobilizing the immobilizationscreated by them.

1. Heel Elevation

1: Heel Elevation, is heel height above the ball of the foot. Drop is the shoe industry term.  If a shoe has a 15mm thick heel, and the sole is 5mm thick at the ball of the foot, the shoe has 10mm of Drop.

Heel elevation creates plantar flexion, shortening plantar flexors and lengthening dorsiflexors.  Additional weight is placed on the ball of the foot.  Toes are placed in extension – shortening extensors and lengthening flexors.  A narrower portion of the talus is placed in support of the talocrual joint, increasing instability.

2. Toe Spring plus Heel Elevation

2: Toe-Spring, the upward lift of the tips of the toes – elevates the tips of the toes above the ball of the foot and out of contact with the ground.

Like heel elevation, toe-spring amplifies toe extension, shortening extensors, over-lengthening flexors.  Added to heel elevation, toe-spring creates additional confusion in tensegrity.  The ankle-crossing long toe tendons become out of balance with foot intrinsics and the foot has to work much harder to stabilize both the arches and the ankle.

Exercise #1: Arch Lifting Toe Flexion

Exercise #1:  Standing barefoot, flex your toes as though you are gripping the ground, notice how this lifts the balls of your toes off the ground!  This is the arch-supporting force of two well aligned ends, empowered by a distal phalanx that can contact the ground level with the heel.  If phalanges are elevated and inhibited above the metatarsal head, tightening flexors does less to lift the arches, and more to just tighten plantar tissues, because the long flexor insertion on the distal phalanx can’t get beneath the arch to give leverage for lift.

3. Toe Taper encourages pronation.

3: Toe-Taper, the tapering of the toe box to a point, beyond the ball of the foot.

The shoe industry defines width measurements at the metatarsal heads, or ball of the foot, and inhibits natural anatomy by tapering, or squeezing the toes together beyond the ball.

This is detrimental for multiple reasons.  Each metatarsal needs it’s distal phalange (attachment of the long flexor) to be level with the heel, in contact with the ground, aligned with the ray of the metatarsal and tarsal bones it supports to experience optimal lift of the arch that the flexors can provide. (as evidenced by the exercise above).

The medial arch may be the greatest victim of toe-taper thanks to the sesamoid bones under the ball of the big toe.  The Flexor Hallucis Longus (FHL) tendon tracks between the sesamoids to insert on the distal phalanx.  This tripod formed by the two sesamoids and distal phalanx are an adaptable three-legged table, that when flexed in alignment with the 1st metatarsal, medial cuneiform and navicular provides lift and tensegrity for a happy medial arch.

Toe-taper deviates the distal phalanx toward the midline of the foot, shortening Adductor Hallucis, lengthening Abductor Hallucis, and pulling the toe out of alignment with the metatarsal ray. The sesamoids move medially as the FHL tendon pulls the sesamoids where the tendon insertion tugs them. Unfortunately this encourages pronation. The greater the toe-taper, the greater the tendency for pronation. If the tip of the toe is deviated medially, the FHL tendon and bones of the first ray start to bow and move toward a bunion formation, FHL loses it’s leverage for lift and the arch spills in pronation.  In other words, if you stand on the edge rather than the center of the three-legged table, it’ll want to tip.

Exercise #2: Align and Anchor Toe.

Feel the correlation between big toe positioning and pronation.

Figure A: Have client supinate and align big toe with 1st metatarsal.

Figure B: Anchor toe and ask to pronate.

Have your client stand comfortably, ask them to pronate and supinate their medial arch. Once they’ve found both motions, ask them to supinate, while supinated, abduct their big toe into straight alignment with the first metatarsal ray (see Figure A.). Gently anchor their toe to the ground with fingers from both hands – thumbs on the toenail, first fingers on the sides of the toe, hold their great toe right where it is on the ground (see Figure B)- ask them to pronate.  Most folks instantly feel the support of aligned bony structure- it’s very difficult to pronate further through this positioning.  As the therapist, notice how the force of their body weight is expressed through the end of their toe.  When aligned, notice how the weight and force is felt through the tip of their toe and toenail.  Experiment with moving them back toward tapered-shoe position, or bunion deformation, feel how the force starts to come through the side of their toe, or their callouses or bunion if present!  If your client still pronates through this exercise, it may indicate pathologies/hyper-mobility issues needing referral out for strengthening PT, splinting orthotics and footwear, or surgical interventions.  Clients who tend toward supination rather than pronation issues need another approach, but their numbers are fewer and we’ll talk about them another time.

If this helped inspire you to rebuild feet, the good news is there are many more resources and consumer products available to help: books, foot-shaped shoes, toe spacers, metatarsal pads, exercise programs and more. Many make a great addition to practice retail offerings.

To start today:

Choose a healthy daily shoe:

-Flat ground contact: no heel elevation, no toe-spring.

-Foot-Shaped: widest at the end of the toes, not the ball of the foot.

-Motion enabling: flexible and free, not inhibiting.

Or find a safe place to go barefoot.

Try it for just 15 minutes and see how your feet respond before repeating or adding additional time. Increase gradually.

Day by day, step by step, we get there.