Today I had an old friend contact me about a foot pain problem. What can a massage therapist do for someone who lives 800 miles away? If I can help her understand why she has foot pain to begin with, maybe we can figure out what she can do to help herself. Have you ever had “a pain in the foot”?
One fact that may surprise you is that most foot pain problems do not actually begin in the foot. Positional problems with the hips and/or pelvis change the way the rest of your major weight bearing structures (i.e. low back, knees, ankles and feet) are positioned and therefore also change how they function. For example, if your pelvis is rotated forward beyond the normal range your knees will be forced into extension (straightening) and your ankles into plantarflexion (pointing your toes). This will tend to cause shortening of the muscles in the front of your hips and thighs and the also in the muscles of the low back, calves and soles of the feet. This position will also tend to change how/where you bear weight in your feet.
In my experience, however, this combination of issues doesn’t usually cause your foot pain, it only sets the stage for you to have some kind of pain problem in your lower body. Usually there is a straw that breaks the camel’s back. That straw is typically one or both of the following: either the hips are/become hyperextended and/or the pelvis is/becomes higher on one side than the other. Stay with me here, despite the complicated verbiage the story isn’t that complicated.
Let’s do an experiment. Stand up tall with your feet parallel and shoulder width apart. Close your eyes. What happens to your hips if you tighten your glutes forcefully? Where do your hips go? Try it again. If you are like most people, your hips extend forward. Some people stand like that, with their hips hyperextended all the time. Similar to having your pelvis rotated too far forward, this postural problem also changes how you bear weight through your low back, hips, knees, ankles and feet. In fact, some unfortunate people have a pelvis rotated too far forward AND have their hips hyperextended! This combination of malalignment creates huge structural stress throughout your body and arguably the two areas most dramatically affected are your low back and your feet.
So, we have a situation where your feet are under a huge amount of stress. What could we do to crank that demand up one notch to the breaking point? How about tilt your body over to one side so that you are bearing more weight on one foot than the other? Yes, that would do it. If your pelvis is tilted over to one side because of a crooked pelvis, leg length differential, or related asymmetry, not only do you have all of the structures of the foot and lower leg placed in a compromised position, but you are also asking them to do more work than they would normally have to do. This is a recipe for a painful foot or two.
There are bands of connective tissue that go from the bottom of your heel to the base of your toes. This tissue is called your plantar fascia. It acts very much like the guy wires of a suspension bridge. If the architecture of the foot is placed in a compromised position that plantar fascia can only hold up for so long. If subjected to enough prolonged overload it can literally start to tear away from the base of the heel, resulting in pain and inflammation. This condition is called “plantar fasciitis”. If unresolved, this condition can also lead to what are called “heel spurs”. A heel spur results when the chronic inflammation results in calcium being deposited where the plantar fascia is tearing away from the heel.
Patients with plantar fasciitis and/or heel spurs usually have severe pain when they first stand up in the morning (irritated tissues in the foot have been shortening all night!). This pain usually eases somewhat with mild activity, only to worsen later in the day as the accumulated stresses on the foot begin to take their toll. Some people mistakenly assume that surgery is the only solution for heel spurs. What I can tell you for certain is that unless you straighten out the offending alignment problems higher in the body your feet will never fully recover, surgery or no surgery.
In any foot pain case where dysfunctional structural alignment is a contributing factor, the first step is to get the pelvis into as neutral a position as possible in order to normalize the stresses on the feet. Only then will any localized treatment of the painful foot result in any degree of lasting relief. Using my hypothetical example (pelvis is rotated too far forward and tilted laterally), a combination of stretching (quadriceps, hip flexors, adductors and low back) and strengthening (abdominals, glutes and hamstrings) exercises should result in a much more neutral pelvic position. If successful, you are then ready to use specific techniques to directly address the lower leg and foot.
Most people will instinctively feel that their foot/calf needs to be stretched out. Be very careful how you respond to that impulse. Remember that a fundamental characteristic of the original problem has been that the tissues of the sole of the foot have under a tremendous amount of load, tightening to the point of tearing. Aggressive stretching of these tissues will often make the problem worse, not better. Yes, exploring gentle range of motion movements in the ankles and feet is advisable and healthy, but be very careful with how hard you go at it.
Massage and gentle stretching of the tissues of the calf and sole of the irritated foot are useful to eliminate painful localized spasms and trigger points within the overstretched tissues. Almost certainly you will need to also stretch and massage the soft tissues in the front of the lower leg.
Plantar Fasciitis is just one painful problem from a huge list of musculoskeletal disorders that are common secondary effects of muscle imbalance and malalignment. Don’t wait until pain forces you to take action! Spend a little bit of time every day training your body to be straight, mobile and strong and you’ll be glad you did!
Yours in health,
Geoff Dakin BPE RMT
Calgary Registered Massage Therapist
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