Training the foot (and what happens when you do trigger point work daily)

At the beginning of August, I went to Arizona to attend lectures and meet some of my classmates I have been virtually conversing with for the last two years.  One of the women I met, Emily, is a podiatrist who believes in treating the foot like any other body part and strengthening it to withstand everyday use.  Her website is here: http://evidencebasedfitnessacademy.com/index.html.  I am hoping to attend one of her workshops when she comes back out west, but I started to think about this concept of training the feet and how ignored this body part often is.  Charlie Weingroff refers to the "short foot" in his DVD "Training=Rehab" and Dr. Evan Osar discusses forming a tripod by engaging the big toe, pinkie toe, and heel while standing in his book "Corrective Exercise Solutions to Common Hip and Shoulder Dysfunctions."  When we think of the foot, we often think of the plantar fascia, a sheath of fascia that wraps underneath the foot and attaches near the proximal metatarsalphalanges (Bhenke, 2006).  Beneath the plantar fascia are four layers of muscles that control the motion of the foot when static and during locomotion.  When these deep intrinsic muscles are not as strong as they should be, the plantar fascia becomes the primary mechanism for preventing foot collapse; while the posterior tibialis functions primarily to prevent foot collapse and prevent excessive tension on the plantar fascia, other muscles, such as the flexor digitorum longus, flexor hallucis longus, peroneus longus, Achilles tendon, gluteus medius, gluteus minimis, and TFL all work together to control foot motion and shock absorption (Bolgla & Malone, 2004).  Clearly, as with training any other body part, it is important to focus on strengthening the entire kinetic chain during dynamic motion to gain muscular synchronicity and efficiency.  The short foot is an easy way to begin to bring awareness to the deep stabilizers of the feet.  Two small studies, one performed by Jung, Kim, Koh, Kwon, Cynn, and Lee (2011) and the other performed by Lynn, Padilla, and Tsang (2012) suggest performing short foot exercises were more effective than toe curl exercises at improving height of the medial longitudinal arch (MLA) and decreasing center of pressure.  This makes sense; rarely in regular life do we curl our toes.  However, if we can teach our MLA to not collapse during everyday movement, especially if we are on our feet often (runners, factory workers, hairstylists), we should hypothetically be able to reduce the tension on our plantar fascia.  I find Dr. Osar's cueing useful when teaching a short foot.  I have also seen practitioners physically lift the medial arch and cue the person to feel the activation of the foot muscles with the arch lifted.  (As a side note, I find people prone to supination have a different problem with being able to engage their big toes during movement.  The muscles of the feet lack the flexibility needed to perform pronation, which is a natural movement that occurs during locomotion).  Another important aspect of the foot is maintaining toe mobility so the toes can perform properly during toe-off.  This is particularly important during running gait, when the intrinsic muscles of the foot contract to stabilize the transverse tarsal joint, absorb ground reaction forces and propel the body forward (Dhugan and Bhat, 2005).  If these muscles are not working properly, one risks placing more stress on the surrounding ligaments and joints.  Gaining a sense of awareness of how your foot feels while in contact with the ground and beginning to train some of these deeper, stability muscles can lead to a better sense of alignment all the way up the kinetic chain.

While I was chatting with Emily about her philosophy and experience with feet, she mentioned she recommends everyone stand with a golf ball under each foot at the end of the day.  "Stand on it, don't roll," was her advise.  Trigger points, or areas which are sore when pressure is applied, can occur where ever there is fascia.  The feet, which are used all day, are susceptible to trigger points in the plantar fascia and in some of the deeper layers.  Me, being the slightly compulsive person that I am, decided to stand on a little tennis ball I have that is about the size of a golf ball both in the morning and in the evening (if once is good, twice must be better, right?).  When I started, it was difficult to apply much pressure at all.  I start with the ball right in front of my heel and every 30 seconds, move it forward just a little bit.  After 3 weeks of diligent use, the trigger points in my feet have lessened significantly.  I will save the science behind soft tissue work for a different day, but if you have trigger points anywhere, know that the pain will greatly be reduced if you perform self soft tissue work regularly.  This reduces overactivity in the muscles with trigger points and allows other muscles to begin working.  Even better, see a talented massage therapist at least twice a month and perform soft tissue work on yourself daily.  Your body will thank you.

Yours in health and wellness,
Jenn
www.bewellpt.com



Osar, E., (2012).  Corrective Exercise Solutiojns to Common Hip and Shoulder Dysfunction.  On Target Publications: Santa Cruz.
Bhenke, R.S., (2006).  Kinetic Anatomy: The Essentials of Human Anatomy, Second Edition, Human Kinetics.
Bolgla, L.A., & Malone, T.R., (2004).  Fasciitis and the windlass mechanism: a biomechanical link to clinical practice.  Journal of Athletic Training, 39(1), pp. 77-82.
Jung, D.Y., Kim, M.H., Koh, E.K., Kwon, O.Y., Cynn, H.S., & Lee, W.H., (2011).  A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch during toe curl and short foot exercise.  Physical Therapy of Sport, 12(1), pp. 30-35.
Lynn, S.K., Padilla, R.A., & Tsang, K.K.W., (2012).  Differences in static and dynamic balance task performance following four weeks of intrinsic foot muscle training: the short foot vs. the the towel curl exercise.  Journal of Sport Rehabilitation, [Epub ahead of print].
Dhugan, S.A., & Bhat, K.P., (2005).  Biomechanics and analysis of running gait.  Physical Medicine and Rehab Clinics of North America, 16, pp. 603-621.