In the current wave of exercise trackers, we are commonly reminded that we should be taken 10,000 steps a day. By anyone’s standards, 10,000 repetitions of an exercise is a lot! I wouldn’t want to do 10,000 press ups. It is no surprise then that the functionality of our feet is crucial to our wellbeing. The foot can be broadly described as having three main functions through gait (a normal walking cycle).
When we walk, jog or run the foot assists in transferring our weight into the ground and absorbing the shock. This is of utmost importance for the body to be able to repeat this process thousands of times a day.
The foot goes through multiple movements during gait, but the two most publicised movements would be pronation (foot rolling in) and supination (foot rolling out). Pronation may be a term you are familiar as is it often documents as being very problematic. It can be documented that upwards of 70% of people over pronate. Therefore, manufacturers of shoes and trainers like to explain how they prevent pronation.
However, it is important to remember that pronation is required by the foot. It is the process of the pronation that enables us to do the three functions of the foot as described above. However, over pronation is the issue and can be problematic. Over pronation can create a collapsing of the arch of the foot that will then transfer pressure up the lower limb, through the knee, and towards the lower back. As a result, issues may arise anywhere through this path (we term ‘the kinetic chain’).
It is similar for supination. As discussed pronation is required for shock absorption. Therefore someone who excessively supinates will produce a lack of pronation which could cause an increase in shock being transferred into the body. This will also make the chance of injury greater.
Finally, it is worth mentioning dorsiflexion. Although a movement of the ankle joint, a restriction in dorsiflexion (the movement of the knee over the toe) is a big contributor to foot related issues. Therefore, the measurement of dorsiflexion of the ankle joint is vital in any foot assessment.
As discussed the above issues at the foot can lead to significant problems throughout the lower limbs and back. However, there are several conditions we commonly see that result in pain at the foot.
Plantarfascitis. This is a pain on the underside of the foot. Often experienced at the base of the heel. Patients often complain of a sharp pain especially in the morning of following long periods of walking. The two most common causes are poor foot biomechanics or a tight calf region causing lack of dorsiflexion.
Tibialis Posterior Syndrome (PTTD). A condition often suffered in long distance runners. The Tibialis Posterior is a muscle that sits beneath the calf and attaching to the shin. The lower tendon of the muscles goes into the foot, wrapping around the medial malleolus (big lump on the inside of ankle). Tightness or weakness in the muscle can create damage the tendon (tendonitis) causing pain. The condition can often result in the patient suffering a ‘fallen arch’ or a flattening of the foot.
During an assessment of the foot, we are looking for signs of excessive pronation or supination. Whilst this takes training and experience to assess there are several key features that we analyze on a visual inspection of the standing foot. These would include position and direction of the Achilles tendon, the structure of the foot arches, presence and area of dead skin and much more. The pictures below show a client’s foot who over pronates. The second picture is the same foot corrected to neutral to highlight the visual differences.
As with any of our rehabilitation modalities, the program provided will be specific to the individual and their injuries. A typical rehabilitation program would include the stretching of tight structures and exercises to strengthen any weakened muscles. However, a common method of correcting foot abnormalities would be the prescription of orthotics. Orthotics are a specially designed inner sole to correct an individual’s foot biomechanics to allow for them to have a neutral gait. At Jon W Sports Injury, we regularly prescribe orthotics and can happily assess and discuss tthe options available to you.