Your Feet. An Enginering Masterpiece

I love feet! 

No, not in the foot fetish kind of way but from an engineering perspective.
Looking at the foot helps confirm my faith in an intelligent designer.
Call it God, nature whatever.
It's very clear the foot is a miracle of architecture and function.

You have 26 bones, 33 joints, and over 100 muscles, tendons and ligaments in your foot.
Your feet absorb 8 times your body weight when you walk and 11 times that when you run.

Let's look at what happens when you walk.

And where I'm going with this is that most of us because of modern day shoes are walking and running all wrong.

When you walk barefooted, the way you were meant to, your toes should splay outward in order to process that force transferring through them.
In modern shoes your toes can't do that. Shoes are basically like having a cast on your feet.
Imagine if you wore a pair of tight mittens on your hands all your life. You should not be surprised that you would lose the ability to move your fingers very well. Same thing happens with your toes.
Over time they stay essentially glued together, (adhesions) which creates instability and does not allow for proper distribution of force through the foot.
Have you ever seen someone who has either lost their hands or was born without them?
They can usually do all the things with their toes we can do with our fingers.

The second thing shoes do which create problems for us is the padding in your shoes.
Comfortable shoes are actually not good.
You were meant to "feel" the ground when you walk. The more cushioning your shoes have the less you feel the ground.
As a result, we tend to strike the ground too hard with the calcaneus bone, your heel bone.
We were meant to graze the heel as we walk.
I often have my patients take their shoes off and walk on the concrete. They usually stop landing so much on their heels real quick because it hurts.
We now know most of the common structural problems long distance runners have are the result of excessive heel strike. Again, the only reason we can run or walk like that are because of modern comfey shoes.

The other thing that happens with soft comfey shoes is that the process of pronation which is the arch of your foot flattening out when you walk and then going back into supination, (the arch reforming) is speeded up which throws your gait cycle off.

The third thing wrong with modern shoes is the arch support most shoes have.
The arch in your feet, of which you actually have three, is made by the muscles and fascia of your feet.
With arch supports in your shoes your giving the muscles in your feet no reason to work.
So they eventually just go by-by. Called disuse atrophy.....Use it or lose it!
This also applies to the strength hence stability of all the muscles in your feet.

The best predictor of fall risk as we age is lack of strength in your toes.
Practically everything that can go wrong with your feet, be it hammer toes, bunions, neuromas are a result of weak foot muscles. 

Another issue with modern shoes is the heel of the shoe being elevated.
This throws your weight forward and without you noticing it all the muscles in your posterior chain now have to work overtime to keep you from falling on your face.

And lastly but not leastly is the material your shoes soles are made out of.
If you read my last article one of the causes of chronic pain I talked about is the lack of grounding we need to make with the negatively charged earth.
Remember that some of the insulators to that vital electron flow is rubber and plastic.
The stuff most shoes are made of.

So.....How do we fix this?

1. Ditch your shoes.  Try to walk barefooted as much as possible. Walking in the sand or grass not only exercises the muscles in your feet but allows that necessary exchange of electrons we all need to stay healthy. 
2. When you do wear shoes, this is mandatory if you want healthy feet, wear what are called minimalist shoes.  I call mine my platypus shoes. The difference is one,  the toe box is wide so your toes can splay out as you walk. That is very different than a typical "wide shoe". If you want to see if your shoes are not wide enough, simply take out the insert and stand on it. If your foot hangs over the side of the insert your shoe is too narrow.  Another is minimal padding between your foot and the ground so you can feel the ground as you walk. There is also zero inclination, (slope between the heel of the shoe and the toe). The other difference is no arch support. (I'll cover orthotics in a second).  If you do buy a new pair of these shoes break them in. I guarantee that at first they will not be comfortable. That's fine, again I know it sounds counterintuitive but your shoes should not be that comfortable. So just start out by wearing them for maybe an hour a day until you get used to them. Once you get used to them you will find them comfortable and a sense of freedom of movement like walking barefooted.
3. Break up the adhesions we all have between our toes. You can buy toe spacers which are valuable, but a better solution is to spend about 3 minutes a day putting your fingers between your toes and pulling down on them. This will also initially not feel good but you really need to spend some time getting your feet to function the way they were meant to. Otherwise I can promise you a future of structural problems later if not sooner.
4. Do some toe yoga.  You should spend some time trying to independently raise and lower just your big toe without moving the other toes, then reverse that. Raise and lower just the other 4 or how ever many other toes you have without moving the big toe.
5. Exercise your feet.  It's interesting to me that we work out every other muscle in our body but who spends any time and energy exercising their feet? Stand barefooted on your toes and shift the weight from your first ray, (big toe) to your other toes. A great workout for your feet muscles is something I call the towel rumba.  Stand on a towel and with your toes try to scrunch up the towel toward your feet. If you don't want to be a fall risk as you get older I suggest you spend some time doing this.
6. Exercise the lower leg muscles These muscles attach to the foot and are a big player in proper foot function. The calf muscle is actually 2 separate muscles. The gastrocnemius and the soleus.  The soleus is the only one that crosses the foot joint so actually plays more of a role with foot movement, but you need to work both. Seated calf raises work primarily the soleus while standing calf raises work the gastrocnemius.  You also should spend a little time working the anterior tibialis. That involves foot dorsiflexion. Google that muscle to see some different ways to work it as most gyms don't have a dedicated ant. tib machine. 
7. Do your own myofascia work. Take your shoes off, get a ball. (I would start with a tennis ball and then try to work your way down to a golf ball and roll the bottom of your feet. Most people will notice a spot or two that really light you up.  Those are the areas you want to focus on.
8. If you do have any foot issues, there's a lot chiropractic can do. Keep in mind, foot surgery has a horrible success rate and often creates more problems down the line.  Getting the bones in the feet in proper alignment and working the myofascia  with active release technique and shock wave therapy and lasers can make a huge difference.
9. A great video to watch on YouTube is, Zuzka exercises for healthy feet.....

The issue of foot orthotic's is complicated.  

I believe as therapists we need to always meet the patient where they are in life.
Say for instance if I do a digital scan of a kids feet and they show a loss of arch, I would be very reluctant depending on the individual case to prescribe orthotics.
I would rather work the muscles and address the proper alignment of feet first to see if we could avoid the inserts.
Now if I'm dealing with a patient who is older or I just know their not going to follow through with the exercises and soft tissue work I recommend then again depending on how bad their scan is I might prescribe orthotics because at some point in life no matter what you do your just not going to be able to get your arches back again. ( Doesn't mean you shouldn't try because even with orthotic's you need to strengthen your feet ).
And remember, your feet are your foundation. If your foundation is unstable the whole structure will be unstable.
So in some cases orthotics are necessary for proper function.
As always, watching your back.........Dr. Steve