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Get to the "core" of foot and ankle injuries!

At every“Ask the Running Doc”a theme emerges. One month it was knee pain, another back pain, and most recently it was foot pain. I had several people asking questions related to foot and ankle pain, such as “I have had plantar fasciitis forever and can’t get rid of it; what should I do?” and “What is this pain on the inside of my arch?” and "Is there a way to make my Achilles stop hurting?”

Although foot and ankle injuries are only reported to be 17% of all running injuries, the foot is very important for anyone who likes to walk, stand, run or move! Which means it should be important for all of us. Unfortunately, the foot has a bad reputation. Its only claim to fame is that it can over-pronate and subsequently cause injury. Well, I am here to tell you that there is so much more to the foot than pronation.

The foot is made up of 26 bones, 33 joints, 19 muscles, 107 ligaments and four arches!

Its job is to absorb shock, attenuate force, provide stability and balance and act as a spring to propel us forward in running. Think about it: the foot is literally the first thing to hit the ground every time you take a step – what is it more important than that?

The research is clear that the pelvic girdle and hips are important for injury prevention, performance and the rehabilitation of overuse injuries; however, if strengthening the hips solved everything, then why are people still getting injured?

I recently went to the UF Running Medicine Conference, and there was an entire lecture about the foot- finally it is getting some credit. I particularly liked the analogy “If you have a shoulder injury, do you strengthen it or brace it?” Of course, the room full of PTs, athletic trainers and even MDs said strengthen it. Then the same question was asked about the foot: “When there is an injury of the foot do you strength it or put it in orthotics?” The room was a bit quieter, and a there were whispers in the rooms “Orthotics? Strengthen? How? I don’t know?”

I liked the comparison because it was blatantly obvious that strengthening the foot musculature is not common practice and should be.  Obviously, there is a time and place for orthotics, but I don’t believe orthotics should be given out like candy on Halloween. Why wouldn’t we at least try to strengthen the 19 muscles that help us absorb, distribute and attenuate force through the entire kinetic chain?

If you have an injury of the foot or ankle, keep doing your core and hip strengthening, but do not forget to address the source- strengthen the foot! Are you starting to wonder if your foot is strong or not now? Great, you should be. 

Okay, Let’s try something.

Take off your shoes and your socks.

Can you spread you toes apart? Even the pinkie toe?

Place your foot on the ground. Can you lift your big toe off the ground without all of your toes moving?

What about your arch: does it collapse in sitting or standing?

If you can't control how your foot moves, then it probably needs some help! How is it supposed to support you, propel you or help prevent injury if it isn't strong enough?

Here are a few exercises to get you started:

1. Toe spreading

2. Toe yoga

3. Short foot or arch domer                           

Once you master these foot exercises, you can start to add them to more functional strength programs. I often tell my runners and patients to do most of their exercises barefoot and focus on maintaining a good arch without gripping the floor with all of your toes. 

Here is a good example of a hip exercise that you will feel in your hip, calf, foot and lower leg because you are doing it barefoot and are forced to use your foot muscles to perform it correctly. 

If you are having difficulty with  a plantar fasciitis, posterior tibialis, Achilles, knee or even hip injury and you haven't addressed your foot, then it is about time you start paying attention to it! You may be surprised because it may even be the missing link to getting your over your injury and back on your feet again!


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