(By Grace Rollins, MS, LAc) As I write this it's the last day of April, but I only just learned this month is considered National Foot Health Awareness Month. Well, there are a few hours left in the month so it's not too late to draw attention to the importance of foot health.
Why do foot issues impact us so much? First off, they impact our mobility. If your foot hurts, it can be really hard to exercise or do the daily walking we know is vital for our health. Since so much about our health depends upon physical activity, a foot injury or repetitive strain can create snowball effects.
Secondly, the health of our feet impacts our entire musculoskeletal system. The key word here is system. Our bones, joints and muscles work together in a coordinated fashion, and no one part is separate from the movement and functioning of the whole. In particular, the way we use the many joints and muscles of our feet (or the way we don't use them) has ramifications all the way up your anatomy chains. Your feet alone have 33 joints, 26 bones, and more than a hundred muscles, tendons and ligaments. Why would nature design us with so many tiny joints and muscles in the foot? If you guessed to serve as an active, intelligent interface between the body and the terrain, you win! (The prize is a barefoot walk across the yard.) When such a complex structure loses mobility, strength, sensory input, tissue integrity, or becomes inhibited by pain and deformity, it changes the way we interact with the terrain and impacts the body from toe to head.
A third reason foot health impacts us so much is that feet are sensitive, yo!
They are full of nerve endings that relate to pain, temperature, pressure and proprioception (the sense of how we are oriented in space). The body relies heavily on sensory input from the feet for its sense of balance and feedback on its position in space.
Just think of the athlete, or the average person trying to avoid a trip and fall. The more sensory input from the feet, the more information about the terrain and environment is reaching the brain so it can make the best possible decisions about how to move.
Furthermore, our brain suffers disproportionately from any pain that strikes us in the feet. That nagging pain in your shoulder, you might be able to ignore. That nagging pain in your heel? It reminds you with every single step.
A tale of two feet
Our hero starts off in this world with a perfect, foot-shaped foot and all they want to do is play and run around barefoot. Soon however they are seduced by the shoes their parents buy with the sparkles and dinosaurs. Not to mention it's what all the big kids are wearing.
All the grown-ups seem to be in agreement that the foot needs to be protected and supported (in spite of a long history of humans surviving indeed, colonizing the entire globe, in minimal footwear-- sandals, moccasins and au natural). Following the trends of the time, our hero's two feet come of age inside of padded, restrictive and slightly heeled shoes. As such they rarely get to bend and flex through all their 33 joints, so they start to get stiff. The muscles fail to develop within a full range of motion so never strengthen to their full potential. The tendons lay down less collagen as a result. The toes start to crowd together into the shape of the shoe. The heel of the shoe throws off the weight distribution into the forefoot, causing the toes to curl and bend.
As the years go on, our hero's encased feet grow ever weaker. The atrophied arches grow painful with exertion and micro-tears form in the plantar tendon (leading to a diagnosis of plantar fasciitis). Bunions start to form as poorly distributed weight and dysfunctional gait patterns cause gradual micro-trauma to the joints.
To "protect" the foot, perhaps thinking they are addressing the root issue of all this pain, our hero follows widespread advice to use arch supports, ever more padding, and customized orthotics. They opt for "orthopedic," "healthy" shoe brands that put the foot in a stiff, cushioned mold. Unfortunately, all of this "protection" further immobilizes and therefore perpetually weakens the foot, never allowing it to rebuild muscular strength, tissue integrity and the ability to absorb its own shocks. It also further dampens the remaining sensory input from the environment and impedes blood flow, yet again weakening the tissues.
Our hero starts to opt for flatter, easier terrain to reduce the strain, and sometimes has to avoid more extensive walking and weight-bearing exercise, again failing to expose the foot (and the entire body) to strengthening opportunities. Between all of the shock-absorbing padding and the disinclination to walking, our hero's entire skeleton lacks the kind of normal weight-bearing stress so important for preventing future osteoporosis.
Even with all of the above weakness, atrophy and sensory impediment going on, our hero is tragically of the fashion-oriented persuasion and indulges regularly in the masochistic thrill of footwear with elevated heels, pointed toes, slides and platforms. After a recent bender in these shoes they are down for the count and begging the podiatrist for a steroid shot (which again, weakens the tissues), or even worse, a bunionectomy surgery, which forever renders their great toe inflexible.
Our hero starts to suffer from chronic, one-sided muscular pain in the hip and sacroiliac joint, poor circulation, neck tension and headaches. They go to see an acupuncturist to see if they can get some relief. To their great surprise the acupuncturist asks, "Have you ever considered strengthening your feet?"
Solid steps toward foot health
Hopefully the above story illustrates the road many people have traveled, and why foot problems are common and challenging. In addition to all of those foot-weakening trends, there's the occasional acute trauma to the foot that can be hard to heal. This is actually what landed foot health more squarely on my own radar.
With naturally slender, high-arched feet I was prone to arch pain from a young age. I instinctually eschewed "heels" and felt more comfortable in shoes like Tevas, Birkenstocks, Adidas, New Balance, Tims, and eventually Merrills, Chaco sandals, and the fancier Naot and Naturalista shoes-- all shoes with somewhat wider toe boxes but that are still quite stiff, padded, heavy, and feature a heel rise and arch support. Even with a closet full of these "healthier" shoes I often suffered from sore feet and arch pain.
Then, several years ago I broke the sesamoid bone on my left foot while practicing martial arts. This is kind of like breaking your kneecap, but on the underside of the ball of your foot. Now I had a crisis. The podiatrist told me the only thing I could do was have the bone fragments surgically removed.
Unsatisfied with this advice, I continued to research and experiment, while treating the foot with acupuncture and moxa to control the pain and swelling. At a certain point I came across the work of Katy Bowman, in the form of one of her earliest books on foot health which is no longer in print (she has a great revised version called Simple Steps to Foot Pain Relief-- check it out!). I also found out about Correct Toes (a type of toe spreader I love for stretching the foot bones back into a better alignment), and, minimalist shoes.
The key attributes of foot-strengthening footwear:
FLEXIBLE. The more flexibility it has, the more movement it allows to the 33 joints and all the adjoining muscles, tendons and ligaments. If you have foot joints that are too weak for now, opt for a stiffer shoe-- otherwise go for mobility!
FOOT-SHAPED LAST AND TOEBOX. This means widest over the tips of the toes, not just at the ball of the foot then tapering to a midline point (as most shoes do). If you stand over the insole, do your toes flop out over the edges or do they actually fit?
FLAT. Any amount of heel elevation, even less than a centimeter, throws extra weight into the forefoot, shortens the calf muscles, and contributes to a variety of unnecessary stresses throughout the foot and body. If your feet feel uncomfortable or weird in flat shoes, it means you need a daily calf-stretching regimen. (We have half-moons for sale in the apothecary, or you can use a rolled-up yoga mat or towel.)
LIGHTWEIGHT AND HEEL-STRAPPED. If your footwear is heavy or you need to clench your toes constantly to keep it from sliding off, it changes the way your foot muscles work so you can't have a normal biomechanically healthy walking pattern. (This rules out slides and flip-flops except for short distances.)
As I transitioned to minimalist footwear I wasn't instantly doing barefoot trail running, but this combination of footwear features enabled me to gradually strengthen and realign my foot in order to take excessive strain off of the ball of the foot and allow it to heal. I was able to resume my active life without needing surgery.
Soon, as my feet grew stronger and better adapted to the environment, I found I could no longer tolerate restrictive, conventional footwear. To wear them would send me back into pain pretty quickly! Ironically, the less supportive the shoe, the less pain I seemed to have. It required some gradual conditioning, but about ten years later I'm now at the point that I can hike or trail run for several miles in extremely minimal sandals and it feels way better to me than a padded running shoe or protective boot.
These days I opt whenever possible for minimalist sandals like Bedrock, Luna or Earthrunners, and for just about everything else I wear Vivobarefoot, Magical Shoes, or Wildling shoes. (No affiliate links here folks, just sharing what I love). There are many other great brands out there, and more each year. See our Resources page for more links.
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