Hiding, camouflaged behind their leather casings, there are armies of feet toe gripping for dear life.

Slip off your shoes and take a peak. Do you see feet that claw the ground? Maybe a hammer toe or two? Maybe one foot is clenched more than the other? Do you find that you get regular cramping into your calves or feet?

A foot that grips is a foot that is seeking stability; a foot that perhaps has lost confidence in itself. My first awareness about the role of the foot was as a fresh faced 18 year old when I took my first dance class. Off came the foot coffins (otherwise known as DM boots) and my shy naked feet walked to the dance floor, where they gripped and shook as they were asked to balance, leap jump and spin for the next hour and a half. Standing on one leg might as well have been balancing on a tight rope. 18 years old and I was unable to organise my centre of mass over one leg without wobbling like a jelly. Fast forward 3 years and regular movement exploration and those shy feet had become extroverts. Instead of balancing on top of the floor they had become one with it, widening and adapting to the surfaces underneath them. My torso and limbs were no longer isolated body parts teetering over their foundations, but instead they spoke to each other and had become a functional unit.

Anatomy

“The human foot is a masterpiece of engineering and a work of art” – Leonardo da Vinci.

As our foot hits the floor it widens and distorts enabling it to adapt to the unpredictable ground beneath it. We call this pronation. As the foot pronates it initiates a chain reaction of bone movement and muscle reaction all the way from our feet to our skull which allows us to load our system ready for movement.

If pronation is Ying then supination is Yang. A foot in pronation is a mobile adaptor however a supinating foot is on its journey to becoming a rigid lever from which to push off of (think of your back foot in walking). The bones of the foot tighten, the muscles shorten and the arch lifts to create a stable platform.

Lets return to those overworked toes searching for stability. Given a choice between chilled out and relaxed pronation and rigid lever supination those exhausted toes are trying to achieve the latter. If you can not trust the body above you to work as a synchronised team to support you as you twist and turn, those digits are going to save the day by clawing back some support. Where do the muscles that enable this strategy originate from? In the feet and behind the calves. Where do most people get cramping and tightness? Yup you guessed it in the feet and into the long toe flexors behind the calves.

Flip Fops

Flip flops or thongs as my Australian cousins call them are fantastic at helping you to keep cool in the summer however they have a sinister side. Have you ever tried running in flip flops? The only way to do it without losing those rubber time bombs is to grip them with your toes with every single step. Even gentle walking with them requires a toe gripping strategy to hold onto those slippery suckers. As summer arrives so does knee pain, neck stiffness and back pain thanks to our friendly Havaianas. If you have ever had difficulty activating your Gluts you might want to check out if they have been hiding all this time in your toe flexors and calves.

So are you a toe gripper?

To try this experiment you will need a friend to help out. Stand with your feet about hip width apart and ask your glamorous assistant to stand behind you and gently push you forward from between the shoulder blades (this is called perturbation). If you find that one or both feet instinctively curl under and grip the floor it is likely that you have adopted a toe gripping strategy.

Now close your eyes and, if you trust you glamorous assistant, ask them to take your hand and guide you on a walk around your sitting room. Having your eyes closed will allow you to really tune in with how well your feet adapt to the floor. Ask yourself if one foot feels harder, does it feel less stable, do other muscles compensate more for this instability?

Congratulations you have now become proactive in understanding how your body functions.

“So what do I do about it?”

Most articles reward the reader for having got to the end with a solution – ‘Fix your feet in 3 easy steps’. I am afraid I am going to disappoint. Every body is different. Your body has chosen to function the way it has based around its unique history, injuries, habits, fashion sense etc. and to promise a quick fix would be fraudulent.

I have seen toes gripping from ankle sprains, gripping to stabilise movement onto the other weaker and more painful leg, from hip replacements and of course from flip fops. I have seen toes gripping for week hands, unstable shoulders…the list is endless. What I do know is that your strategy will be serving you at this time and allowing you to continue functioning. Might it be causing pain?….sure. Is it optimal?….probably not. Is being aware of it pretty cool?…..definitely.

Next time you get a cramp in your foot or you calf maybe take a quick peak down and see what your feet have been getting up to. Perhaps even take your shoes and socks off and have a walk around the house or on the grass outside and remember what it feels like to be grounded and to trust your feet again.

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As you are reading this see if you can lift yours up off the floor as the ball of the big toe stays grounded. Do they rise equally? As you lift them up can you see the arch under your foot start to pick up and your shin start to rotate outwards? If the answer is yes pat yourself on the back, if no then we have some work to do!

This is not an uncommon asymmetry to find in clinic, which if discovered early can be treated with some osteopathy joint manipulation and Anatomy in Motion movement drills, however if left unchecked can lead to a host of clever compensations through out the body including the dreaded bunion. Three of the most common ‘cheats’ I see to enable the body to remain 100% functional are achieved by by-passing the big toe. Try standing up and taking the right leg behind you as if we were walking forward. As your weight moves forward the big toe  has to bend and this is where the problem starts. Out comes the road map and the brain looks for a detour.

Ingenious compensation number one:

Turn left.

Instead of bending the big toe the foot turns out and pivots over the inside edge of the big toe. For a short time this seems like a good strategy, but unfortunately with every step we take the big toe starts to adapt to the stresses and strains placed upon it and we develop a bunion or a condition called halux valgus (a big toe that ends up pointing towards the other toes at an angle). The other problem I often see is that as the bony rigidity of the foot is compromised we end up pushing off from the soft tissue under the foot instead. The result ‘plantar fasciitis’ or strain to the connective tissue under the foot which feels like walking on broken glass. Neither conditions ideal when wanting to slip on a pair of sling backs (so I’ve been told).

Ingenious compensation two:

Turn right.

This is less common, but the body can prevent pressure through the big toe by inverting the ankle (think inversion sprain), lifting the big toe off the floor and pushing off from the outside of the foot instead. This can lead to an interesting wear pattern along the outside of your running shoes, a tendency to repeatedly sprain the outside of your ankle and discomfort along your iliotibial band as the body uses this instead of the hip flexors to whip the leg forward into swing phase.

Ingenious compensation number three:

If you can not go round, and going under is not an option then the only other way is to go over.

By shortening your stride length and lifting the leg up early, the big toe does not have to bend so much. Apart from always walking in circles (actually the body manages to compensate further up the chain-it is always going to be successful!) this will result in a shortening of the hip flexors and inhibition of the core and buttock muscles, which can reek havoc around the body in terms of back pain, hip pain and even head aches. In fact the whole process becomes more metabolically taxing, as the leg is dragged forward instead of relying on the elastic recoil of the fascial system. We want movement to be pain free and effortless with a spring in your step as opposed to walking around with one concrete boot on.

If you are experiencing toe pain, a bunion, plantar fasciitis, knee pain, hip pain, back pain…….(the list is endless) start by taking a look down at our ostracised friend the big toe. He is nicknamed the ‘great toe’ for a reason and you may just be surprised about how powerful he really is.

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The majority of ankle sprains involve stretching the muscles and ligaments along the outside of the leg and foot. This is commonly known as an inversion sprain. In its innate wisdom our body decide that this is a position that should be avoided at all costs. Sensible you might think in the short term, however when this becomes a habit that is adopted long after the heeling process has taken place we open ourselves up to compensations that can be globally disastrous.

One case in clinic this week proved to be just such a puzzle.  A young lady presented with pins and needles down her left arm and weakness into her hands, that had come on slowly over the previous couple of weeks. On first examination it was a simple case of thoracic outlet syndrome, or was it? After a thorough case history and having ruled out any cardiovascular issues we started to unravel the puzzle and traced back through her case history until we came to an ankle inversion sprain that had occurred several years ago. Unfortunately she was unable to remember which leg, so we decided to map out her feet using an anatomy in motion assessment. Based on the findings we made an educated guess at it being the right leg as it was locked down into pronation protecting it from future trauma.

“Let me check a photo on my phone as I am sure there is a picture of me with a bandage on it” she said.

Bingo! There was the right leg clad in strapping.

We then proceeded to analyse her gait using the ‘flow motion model’ created by Gary Ward and saw that her pronated right foot was preventing her from accessing her left leg cleanly during walking. Gary has ingeniously mapped how every bone of the body should move as we walk and when we are missing one of these phases certain muscles will never get a chance to lengthen and this is what we were seeing here.

In terms of clinical diagnosis the lady was suffering from thoracic outlet syndrome, which is where a bundle of nerves that start at the neck and meander off down the arm are compressed under the collar bone by tight chest and neck muscles. The solution to her pain – reintroduce the foot back to the brain in a safe and controlled environment demonstrating that there was no longer a threat to the ankle, then re-integrate the foot back into the 3 dimensional movement that was missing during walking. This phase of gait also just so happened to stretch both the neck and chest muscles that were causing the nerves to be compressed in the first place. Would stretching the muscles around the chest and neck in isolation have worked as well – most probably yes. Would the results have lasted – I think probably less likely.

By taking the time to understand your history we can treat the cause and not the compensation. Instead of rubbing the painful spot, we can unravel the reason and remove the brakes preventing your body from healing itself. Sure the conventional 30 minute treatment becomes a 2 hour detective session, but the solution creates the home work and the home work makes me redundant. Just the way I like it.

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Biomechanics and pronation

The foot is a genius piece of engineering. As it hits the floor the bones unlock allowing it to blend to the rough terrain underneath (at least before the advent of pavements, carpets and hard soled shoes), where its intrinsic muscles can stretch like tiny trampolines ready to catapult our mass forward. As the foot melts a tiny bone with no muscular attachments called the talus, slides over the heel and the journey of pronation is transferred up through the knee, hip, back and into the arms and head. Each muscle that attaches over these joints is stretched and human locomotion takes place – a beautifully synchronised orchestra of anatomy that has enabled us to evolve into the creatures we are today.

Case history

So what happens when this all goes wrong? Today I had one such example walk through the clinic doors. This chap was a high level cricketer who on assessment was unable to pronate his left foot. He was suffering from long term back pain and had experienced disc prolapses between several of his vertebrae. When we analysed his cricket fast bowling technique we realised that his front foot never had the chance to pronate due to the follow through action of his arms and the need to abort to the left so he did not follow down the crease. A foot that does not pronate is a foot that does not shock absorb, and results in a spine which is most likely going to be loaded asymmetrically with every step it takes. The effect up through the body is equally immense, the buttock muscles do not get a chance to load, the stomach muscles switch off, the pelvic floor is only required to function in certain quadrants, even the eyes have trouble accessing certain positions. This gentleman could not look up and left without the muscle strength blowing out in his legs!
So is pronation bad? In one word no, however if we delve a little further this might need expanding upon. Pronation is essential for human locomotion however a difference between left and right is an issue and so is a lack of supination (pronation’s mirror image which is required for the foot to lock as we push off it). I would rather see in clinic two equally over pronated feet rather than one pronated and one supinated.
So how did the story end. We introduced the gentleman’s left foot to pronation using the Anatomy in Motion ‘flow motion’ model and a couple of yoga wedges and the body let out a huge sigh of relief. “My foot feels lighter and walking seems so much easier”. The buttock muscles sprang into life and when fully integrated, his body weight shifted forwards as his body found centre and the pain in his back reduced significantly – all from 5 minutes of pronation work.
For more information on how your foot can be scanned as part of our regular initial consultation please feel free to get in contact or take a look at the ‘consultation’ menu at the top of the page for more information.

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