Is your FOOT CORE weak?
Foot pain is a very commonly seen in Physical Therapy. The foot is truly where the rubber meets the road, and whether you are a triathlete, weekend warrior, or just like to take strolls in the park, the foot and ankle are subject to high loads during activity and even standing. Some of the most common conditions affecting the foot are plantar fasciitis and Achilles tendonitis, which usually become chronic and limit activity.
A new paper from the British Journal of Sports Medicine proposes a new way of looking at the foot.
“The foot core system: a new paradigm for understanding intrinsic foot muscle function
Patrick O McKeon, Jay Hertel, Dennis Bramble, Irene Davis
Br J Sports Med doi:10.1136/bjsports-2013-092690“
For many years, we have known and focused on the importance of the trunk and hip core muscles when treating lower extremity overuse injuries. With decreased strength of the core comes decreased ability to control the alignment of the lower extremities, resulting in increased and unbalanced load. Common conditions associated with this are IT band syndrome, hip bursitis, and chronic hamstring injuries.
In looking at the foot, these researchers saw a correlation between the way our trunk core functions, and the anatomy and function of the foot. Similar to the core, the foot has many small muscles which sense and control the shape and stability of the arch, which then effects the larger muscles that cross the ankle joint, and their ability to exert force on the foot. Without stability in these muscles, the larger muscles do not have a stable foundation to work off of, resulting in compensation and tissue breakdown.
The foot is truly one of the most amazing anatomical features we have developed. It is composed of not just 1, but 4 arches to help attenuate load as we walk and run. The foot is composed of 26 bones, 33 joints, and over 100 muscles, tendons and ligaments. With all those structures, comes a significant amount of sensation, which helps our brain to determine its posture and allows for the body to make corrections in that posture as needed.
Currently, the standard of care is more along the lines of supporting the arch with orthotics, which we could equate to putting a back brace around the core. This may be good in helping to decrease the pain and irritation associated with injury, but is it good long term for the musculature? It makes sense that with so much sensation and muscular support of the foot, we should be trying to strengthen and train the foot to support itself, rather than applying an external support.
This discussion could definitely lead into one of whether or not we should run barefoot, or even the debate of minimalist shoes, but that is not really where I want to go today. In my practice, I see many patients with foot and ankle pain who doesn’t seem to respond to orthotics and support of the arch, and recently I have begun to add in more active strengthening of the arch and foot. In the past, I had a hard time believing we could change the posture of the arch with exercise, but recently, I have seen good progress with focused strengthening of the arch and the smaller muscles in the foot. I still believe orthotics are good in some cases, but if we can get the foot to improve its posture and strength and return to doing the job it was designed to do, all the better.
One exercise proposed by this article is a foot shortening exercise where the arch is raised and the foot is shortened resulting in more activation of the intrinsic muscles. There are many other exercises we can use for intrinsic strengthening depending on the condition.
Commonly, when I see someone for plantar fasciitis, they have already tried some type of orthotic, and most of the time have had a cortisone injection. Both of these treatments are focusing on the symptoms of the mechanical dysfunction causing the increase in tissue stress. If we dial in and examine the ability of the foot to support itself, as well as weakness in the lower leg, hip and core, then we are truly looking at the cause of the problem rather than the symptoms.
David Butler, DPT, OCS
Owner, Clinic Director
Utah Physical Therapy – Lehi