Foot as the Foundation of the Body
By Dr. Kelsey Armstrong
Dysfunction in the foot is often the first cause of global movement dysfunction
-Dr. Gerry Ramogida
As a podiatrist, I may be biased about the role of the foot in providing a stable foundation; it is what we stand, walk and run on. If the feet are not functioning properly, then our base of stability would be lost or compromised. If the base is unstable, then the other areas that depend on this support would also be compromised, i.e., hip, knee, lower back, etc. In addition, these areas have to adjust accordingly to maintain some level of support. This change of alignment of the body is one important cause of foot and ankle injuries.
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The foot withstands three times the bodyweight when walking and up to eight to ten times bodyweight when running. It is able to withstand these large forces by being able to withstand, dampen and redistribute them. This is done by the interconnection of the foot’s 28 bones, 33 joints and over 100 muscles, tendons and ligaments. In addition, there is a structure called the fascia, which is a fibrous network, connecting the entire body.
Let us take an example to explain this interconnection. Let us say an individual is standing still and is getting ready to walk. What happen first? One of the heels lifts off the ground to move the foot forward. This happens by the soleus and gastrocnemius muscles at the back of the leg contracts or squeezes. This cause the muscles to pull at the tendon. The tendon, in this case, the Achilles tendon, pulls on the heel bone, called the calcaneus, lifting the heel up. If there is a break or injury to any part of these connections, then movement could be abnormal or nonexistent, i.e., Achilles tendon rupture does not lift the heel up when walking.
The foot is necessary for alignment of the body. The foot, like most body parts, generally move in three ways: Up and down (sagittal plane), side to side (transverse plane), and in and out (frontal plane). If the foot is unable to move in any of these planes “normally,” alignment issues will occur.
For example, if there is limited sagittal plane motion of the ankle joint, there will be a tendency to shift the bodyweight forward, as it more difficult to place the heel on the ground. The next big joint, the knee joint, follows the foot/ankle joint. The hip joint moves back to try to maintain some balance of the body, while the lower back arches forwards. These joint changes of alignment increase pressure on these areas, increasing the probability of knee arthritis, hip arthritis and lower back pain.
Bad alignment is one factor in injuries of the foot and ankle, but the best definition would be “the response to inadequate preparation for movement.” The body was not prepared to move, and was unable to withstand the subjected forces. The response was for the body to break down, i.e., bone injury (stress fracture), tendon injury (Achilles tendonitis), fascial injury (plantar fasciitis). If the body is not aligned properly, the body’s ability to tolerate movement is weakened, increasing the probability of injury.
Looking at foot and ankle injuries in this fashion allows for prevention of injuries to be about preparation of movement. If there is adequate preparation, then injuries should not occur. There are two ways to accomplish this: one, train the body adequately, and two, align the body optimally.
Training the body adequately requires a gradual increase in the intensity and volume of the activity on the feet. For example, when starting a walking program, I suggest to my patients to start only three days a week (Mondays, Wednesdays, Fridays or Tuesdays, Thursdays, Saturdays) with ten minutes each time. After two weeks, increase the walking time to fifteen minutes and so on. This way, the body will start to tolerate more activity. Yet with this increase in activity, the body gets tired and other muscles and ligaments try to carry the load. This is why the entire body should be prepared for movement in all three planes. Activities like yoga, circuit-training and cross-training are all great exercises, because they all work the body in other planes beside the up and down movement mostly seen in walking and running.
There are two ways to align the body optimally: naturally and mechanically. Naturally, the only way to do this is by stretching. In my opinion, the three most important stretches for the foot and ankle would be the calf stretch, plantar fascia/big toe stretch and short foot. Along with these stretches, I recommend that people reduce the heel height of their shoes. Constant wearing of high heeled shoes can cause the tightening of the calf muscles, which leads to permanent shortening. This shortening can lead to lack of body alignment, discussed earlier. Lowering the heel height will allow the calf muscle to function properly in its normal range of motion.
Mechanically, there are two devices I use that help with body alignment: Correct Toes and orthotics. Correct Toes are devices created by a podiatrist in Portland, Oregon. It is a toe separating and straightening device that helps restore normal usage and function of the toes. The importance of such a device is related to the structure of shoes. The tips of any shoe has a slight lift upwards, called a toe spring. This toe spring lifts up your toes. Wearing shoes long enough will allow the toes to get accustomed to being in this position. Since this is an unnatural position, it causes an inherent weakness in the small muscles of toes. These muscles cannot function properly in their weakened state, causing an imbalance of the foot and other parts of the body. Correct Toes positions the toes in the proper position, allowing the muscles the opportunity to function properly. If they function properly, the muscles will get stronger for their particular activity.
Most people are familiar with orthotics – hard plastic insoles that help support your feet. People think of these as simply arch supports, but they are much more than that. I like to define orthotics as orthopedic devices that redistribute forces of the foot to a more optimal position. Again, it causes muscles to function normally, allowing the body to maintain proper alignment.
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