Ask The Doc: Are Your Feet Healthy?

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by THERESA LARSON, DPT, Marine Corps Veteran, CrossFit Coach

Ask The Doc: Are Your Feet Healthy?
At Movement Rx, the majority of our clients are tactical, adaptive, CrossFit, and higher level athletes. Some of our patients’ normal days are to walk 10-15 miles, run miles in the sand, or carry awkward objects and bodies. But it doesn’t take these crazy lifestyles to wear your feet down. Whether you’re a mother of three, a gym owner, an adaptive athlete, an office worker, or a Navy SEAL, your feet are a huge deal. In my parlance, keeping your feet healthy means having good foot mobility. Specifically you want the capsule, sliding surfaces of the muscle, connective tissue, nerves, arteries, and veins as mobile as possible.

How Do You Know if You Have Good Foot Mobility or Not?

Immobile feet mean worse balance and reaction time, lower speed, and less load, amongst other things.
You can see it in your own movement, and you can probably feel it as well. Perhaps you are already feeling the lagging factors of pain such as shin splints, a tight or tender Achilles tendon, plantar fasciitis, bone spurs, or tingling/numbness in your toes. If you have ever experienced any of these, you should probably check your foot mobility.

Important note: If you are having nervy symptoms in your feet, such as numbness and tingling, it may or may not be coming from your spine, so that is something you would want to get checked out if it remains after trying the tests below.

Five Easy Tests

1. Test your squat! Can you squat — feet forward — butt to feet without having your feet turn out?

  • This shows you which side might be more limited. It’s not uncommon for one foot to turn out the lower you go in the squat.

2. Can you sit at the bottom of a pistol with your foot forward and hang out for at least 30 seconds without falling over?

  • This indicates whether you have full ankle range of motion on a single leg

3. How quickly does blood flow back into the toes when you pinch them? 

  • This is a quick test for capillary refill of your feet to show the rate at which blood refills empty capillaries. To measure, place your foot above your heart — which prevents venous reflux — and press the soft pad of the toe until it turns white. What is important is the time it takes for the color to return. If it takes longer than 3 seconds to refill with color, it may be an indication you are dehydrated, so drink some water, give it 10-15 minutes, and retest. If it still takes longer than 2-3 seconds, then see your primary care physician.

4. Can you jump rope for a minute without any discomfort in your feet, knees or hips?

  • This stresses the dynamic nature of your feet and the elastic ability of your connective tissue – such as collagen, muscles, and tendons – that work together around your leg and foot.

5. If you perform the fight club stance (dome your feet or lift your arches to let feet flatten), does one move more than the other?

  • This tests whether you get full pronation and full supination.

Reduced Range of Motion Means Poor Performance (and Potential for Injury)

Here’s why:

Proprioception

Neuromuscularly, you have nerve endings in your joints and soft tissue that relay all information about the muscles, bones, and ligaments to the central nervous system (your spinal cord). These are called proprioceptors or mechanoreceptors, and your feet and ankles are full of them. Proprioception is your body’s ability to understand your own position and movement.

Your feet are the one area of proprioception that is in contact with the ground, meaning they are crucial in detecting any changes in physical displacement (movement or position) and any changes in tension or force within the body.
Immobile feet mean worse balance and reaction time, lower speed, and less load, amongst other things.

Pain
[Y]ou need to heal the tissue through performing movements under appropriate loads, over an appropriate time, with appropriate mechanics…
Pain is a lagging factor, and usually what we see in the gym or on the field are more chronic conditions of immobility or lack of stability and motor control that can lead to acute sprains, strains, dislocations, and tears. The most common chronic inefficiency is limited range of motion (immobility). Even if the pain goes away, you still need to help the tissue heal properly and improve the underlying immobility. Whether it is capsule, muscle, or ligament, you need to heal the tissue through performing movements under appropriate loads, over an appropriate time, with appropriate mechanics, or that pain will come back. If you are diligent you can make gains quickly and improve, but that does not mean jumping back into the same loads prior to injury. You need to work up to it!

What Steps Should You Take for Better Feet?

Step 1: Go after your foot’s joints first, hours before your workout, and/or often during the day. There are 33 joints in the foot, so you do not have to tackle them all at once. Just go after positioning following KStarr’s lead.

Step 2: Go after the soft tissue that impacts the foot. You want to do this after your WOD/exercise or after a hot shower or soak in the hot tub. Here are some examples:

Step 3: Perform proprioceptive neuromuscular facilitation (PNF) techniques throughout the day.

[D]on’t expect that your immobile tissue will change quickly if you sit at a desk every day or have moved with poor form for a long time.
Contract and relax of the calves. Activate the front of your shin (anterior tibialis) by pulling your foot up towards your shin for 5 seconds, then relax and physically pull/push your ankle further into this position (dorsiflexion).

It takes time for tissues to change, folks. Most people will see immediate short-term improvements with the above, but don’t expect that your immobile tissue will change quickly if you sit at a desk every day or have moved with poor form for a long time. On the other hand, the more you get out and work on yourself, your positioning, your form, the better.

So enjoy running, walking, and lifting and remember: take care of your immobilities before they become the chronic pains in your heel, foot, shin, and knee.

References

1. Adler S, et el. PNF in Practice. PNF Book. 3rd ed. Chicago. Springer 2008

2. MIT Website: http://web.mit.edu/tkd/stretch/stretching_2.html

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