Self-Help for Hammertoe Deformity

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Extension at the MPJ; flexion at the PIJ

Hammertoe deformity (sometimes written as hammer toe) is a condition of one or more of the lesser toes, characterized by extension of the metatarsophalangeal joints (MTPJ) and flexion of the proximal interphalangeal joints (PIJ). To find your MTP joints, lift your toes off the ground – it is that junction at the base of the toes. Lifting them off the floor puts them into extension. PIJ is the next joint along the toe, which in hammertoe deformity is often flexed or in the position of making a fist with your toes.  Sometimes the distal or last toe joints are also extended, which I could demonstrate by lifting the tip of the toe of my foot anatomical model.

Not only can hammertoes be painful, many who have them are self-conscious wearing sandals or going barefoot because of how their toes look.  If you have hammertoes or suspect that you developing them, here are some things you can do.

Evaluate and update your footwear

It is widely accepted that hammertoes are made worse by narrow shoes and high heels. I use italics because most of my clients don’t consider their narrow or high. Here is a simple test for narrow. Remove the insert from your shoe, stand on it, and spread your toes. If your toes spill over the sides, your shoe is too narrow. Period. The great majority of shoes have positive heels, which means the heel is at a higher elevation than the toe of the shoe. Technically, this is a high heel that changes your geometry and therefore your gait – thus where/how your land on your feet, when standing, walking, or running. Look for shoes that are zero drop, meaning there is no drop in elevation of the shoe from heel to toe.

Another ubiquitous shoe feature to avoid is toe spring – that perky lift at the toe area of a shoe. Toe spring is a feature meant to facilitate toe extension phase of walking/running. It is a necessary evil in most shoes because their stiffness undermines our natural ability to extend our toes in gait. The problem is that toe spring keeps your toes in constant extension, which is unnatural. You can see how constant extension would be unwanted in a condition like hammertoe deformity, where your toes are already prone to chronic contraction in extension. In the image below, you can see significant toe spring in the Altra  on the right (a shoe that otherwise has good features like a wide toe box and zero drop heel) compared to the shoe on the left from OESH – a woman owned company that makes anatomically- and biomechanically-informed shoes for women. Not only is there no toe spring, they also have zero drop heels and toe boxes wider than your typical shoe – all features to seek in a hammertoe-defying shoe.

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Toes spring in the shoe on the right

Shoes like flip flops, some sandals, clogs, slides, mules – any shoe that has a loosely attached upper and requires flexion through the first or proximal interphalangeal joint in order to keep them on your feet mimics and may reinforces problematic biomechanics of hammertoe deformity. Try walking in a pair clogs without scrunching your toes and you may find that you’ve kicked your shoe halfway across the room. If you are already experiencing hammertoes, you might consider decreasing the amount of time you spend in these types of shoes.

Train your toe flexing muscles

Some studies have shown a strength imbalance between toe extensors and toe flexors with extensors being stronger, pulling the MP joint into extension. It is thought that toe flexion at the first toe joint is in response to this imbalance. Natural Sports Podiatrist Dr. Ray McClanahan has a good video on this, where he shows passive stretching exercises. In addition to passive stretching, I suggest that you also add the following resistance stretching exercises as part of your everyday training.

Since it is thought that the MP joint is overly strong in extension, training greater strength in toe flexion is desired. From a seated position, cup your hand over your toes, curling your fingers over the tips of your toes to rest on the bottom side of your toes. Hold your toes firmly in place while attempting to curl your toes into a fist.

  • Variation 1 – completely resist flexion of your toes for up to 7 breaths.
  • Variation 2 – allow your toes to flex but against firm resistance – repeat up to 10 times.

Drop your toes

Katy Bowman of Nutritious Movement, one of my teachers, is famous for saying “drop your ribs” to get her clients to pay attention to when they are thrusting their ribs forward thus shearing their vertebrae, chronically extending their spinal muscles, and undermining intra-abdominal pressure. I see a similar phenomenon in my clients with hammertoe deformity, where they are chronically lifting their toes. I usually see it in balancing exercises, ankle exercises, and in the wear and tear on the tops of their shoes.

I pay attention to this and remind my clients, ad nauseam,  to “drop your toes.” Eventually, they start noticing how they habitually contract their toe extensors and, problematically, how they use toe extension muscles more dominantly than the more appropriate muscle on the shin (tibialis anterior) when dorsiflexing an ankle.  I work with them to learn to relax their toes and the top of the foot with some specific ball and sensing exercises and to control toe extension in ankle ranges of motion.

Stretch your calves

Research shows that study participants with hammertoes also have less ankle dorsiflexion – the position of your ankle, when walking up a steep hill. In some cases, this could be due to soft tissue limitations in the calves. Thus daily calf stretching and strengthening may be beneficial. From the calf stretch pictured below, I like to slowly rise up onto the ball of my foot to full plantar flexion (standing in tippy toes) and very slowly lower down to eccentrically load my calf, meaning it gets stronger while it is stretching.

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Calf stretch

If your hammertoes reside in the Yakima Valley of Washington, you can find me at the clinic of Dr. Kara Lolley, where I help you move, move more, and move more of you.

Namaste, Michele

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Three things you can do for your feet today

As a yoga and movement teacher, I am concerned with feet and I see a lot of them. One characteristic that most of the feet I observe share is a crammed, congested appearance of the toes. When I witness this, I know that I am in the presence of feet that are shod (in shoes) much of the time and in shoes that are least like the shape of a foot with features intended to “support” their feet. At best, such feet are tired and sore at the end of the day or painful all day for some poor soles. These feet are developing bunions, nerve damage, degenerative changes, and other painful and potentially debilitating conditions. If you want to begin improving your feet today, do these three things.

1) Take off your shoes. The #1 best thing you can do for and with your feet is to walk barefoot outside on natural, non-groomed terrain. Walking barefoot places the parts of your foot – toes, arch, heel  – in an optimal, biomechanically pleasing relationship to each other. Walking and moving around barefooted strengthens the parts of your feet that need to be strong or stiff and improves mobility and flexibility in areas that need it. Walking barefoot affords your feet the best chance of achieving functional, healthy patterns of movement. In contrast,  as soon as you put on a shoe that changes the geometry of your foot, its parts and everything north of them are no longer working as they were designed.

But, before you go running out the door and into the woods naked and unshod, you must understand that if you’ve been wearing shoes most of the time, your feet are not conditioned for the requirements of hiking in the woods without shoes, much less walking out to the mailbox in your jammies & socks. I grew up in Tennessee, where we don’t wear shoes and I have been practicing yoga for over 15 years, thus have spent a lot of time barefoot. Yet, it took me a year of foot exercises and graded exposure to be able to hike outside barefoot as an adult. It could take you longer, but is truly worth the effort.

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Here is a 12 month progressive timeline to prepare your feet for more barefoot time. Adjust as needed for your feet and demands of your environment and season. Each month, start with minimal exposure to the new terrain – a few minutes, a few times per day and gradually increase duration and/or frequency.

Month 1: Start wearing thin soled slippers around your house for a few minutes at a time, a few times a day. Gradually increase duration and/or frequency.

Month 2: Start substituting thick socks for your slippers.

Month 3: Start spending barefoot time on carpeted areas of your home.

Month 4: Start making barefoot forays into your yard.

Month 5: Start spending barefoot time on linoleum in your house.

Month 6: Start spending barefoot time on mulched areas of your yard.

Month 7: Start spending barefoot time on wood floors in your house.

Month 8: Start spending barefoot time on asphalt/concrete.

Month 9: Start spending spending time on tile/stone flooring in your house.

Month 10: Start doing appropriate outdoor tasks barefoot – gardening, raking leaves, playing with the dog…

Month 11: Start taking walks in a park or on a hiking trail with varied terrain.

Month 12:  Start taking walks around your neighborhood, varying time spent on the edges of neighbor’s yards and on the street/sidewalks.

2) Wear these socks. Toe alignment socks are a perfect companion to more barefoot time. These socks position your toes into more natural alignment, providing gentle stretching to toes that have been crammed into shoes all day. They provide light traction (repositioning) for big toes that no longer lie straight and lesser toes that are trying to crawl on top of their mates.

Amazon sells several brands, like this one.

Flesser® Yoga Sports GYM Five Toe Separator Socks Alignment Pain Health Massage Socks (Pink)

Or, if you are in Yakima, you can save yourself the wait and shipping and buy them from me at Dr. Kara Lolley’s office. We are a reseller for the original foot alignment socks from My-Happy feet, pictured below.

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3) Massage with a ball. I have most of my clients use a ball to massage their feet. If you come to see me with a shoulder problem, rest assured that I will craft a movement program that appropriately loads your shoulder and there is a good chance that I’ll have you roll your foot on a ball!   I prefer a racquet ball, although a tennis ball is OK too. I use a specific ball rolling protocol, when giving clients exercises for their feet. Here is one method from my protocol.

Stand with your feet pelvis width distance apart. Place the ball of one of your feet onto the racquet ball, keeping your heel in contact with the floor. Allow your weight to fully rest on the ball. If sensation is too much, shift some of your weight into the other leg. The motion you will make with your foot on the ball resembles the wiping motion that you would make with your hand if you were polishing a car or wiping a mirror. Slowly scrub the racquet ball side to side with the ball of your foot, as if you were trying to clean the floor with it  – a movement of foot abduction and adduction if you want to get technical. Remember to keep your heel down. This is a very slow motion. Eventually you should work the ball forward so that the scrubbing motion separates your toes as your foot moves the ball.

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Scrubbing with a tennis ball

May your feet be well. May your feet be happy. May your feet be free from suffering.

Namaste, Michele

Alphabet Feet

Our feet respond well to varied movements. I talked about this last year in my weird feet post. This is a spirited yogasana foot exercise mash-up that moves your foot and ankle through countless ranges of motion and is probably good for your neurobiology as well.

I taught this dynamic asana/exercise in my yoga class this morning. It’s kind of impossible for this not to devolve into silliness, so you might keep that in mind if you are a teacher using this in your class.

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  1. Sit on the floor (could also be done in a chair) with your legs extended in front of you.
  2. Hand options: either place your hands alongside your hips to support you in sitting upright; or interlace your hands and press your palms away from you.
  3. Bend your knees and place the soles of your feet on the floor in a pre-boat pose position.
  4. Lift your right foot off the floor.
  5. Using your best “handwriting,” slowly trace the letter A (print, cursive, all caps or small – doesn’t matter) in the air with your right foot, using your big toe as a marker. Move mainly at the ankle joint and less so at the knee and hip. Take a breath.
  6. Trace the letter B. Breathe in, breath out.
  7. Trace the letter C. Full breath cycle.
  8. Trace the entire alphabet, pausing a breath cycle between letters.

In my class, we traced A-M with the right foot, took a forward fold and then N-Z with the left foot, which for most of the class was the non-dominant foot and quite a bit more challenging.

I like doing this in boat pose with hand stretches because it allows more of my muscles to participate. Come up with your own variation and share it with me.

Here is my video of A-G.

Learn more exercises for your feet from my teacher renowned biomechanist Katy Bowman with these brilliant exercise videos that you can stream or download to view as often as you like for just $5 each!

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Schoolhouse Series: Toes & Calves

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Schoolhouse Series: Unduck Your Feet

Namaste, Michele

 

A modified raise, point, & curl for your toes

The American Orthopaedic Foot & Ankle Society recommends an exercise called Toe raise, toe point, toe curl, where you hold each position for 5 seconds, for 10 repetitions each foot. It looks like this: toeraisepointflex

It is promoted as an exercise to “strengthen toes and prevent foot discomfort.” While I think it has merit as a foot mobilizer, I’m not convinced that adaptive changes to strength occur because it is a passive exercise, relying on an external force – the floor – rather than an internal force – your muscles – to perform.

So, in addition to performing this exercise against the floor, I think you could move through these same positions, but dangling your foot just above the floor so that you are stretching and generating force in both your intrinsic and extrinsic musculature. In yoga, since we don’t use weights to provide resistance necessary to make strength adaptations to our tissues, we rely on something called maximum voluntary contraction (MVC), which is your maximum ability to contract muscle.

Position 1, when done with your foot on the floor, is actually more like the heel off phase of gait, but in this floor-bound exercise, it passively loads your your toes, which is not enough to strengthen them. Alternately, when you dangle your foot, you can maximally contract your toe extensor muscles, making it more of a toe raise as the name implies.

Position 2, when performed against the external force of the floor,  is almost all concentric calf contractions without much happening in the toes, because the floor is doing the work of keeping them pointing. However, if you dangle your foot, not only are you still working your calf muscles, but now you must engage your plantar flexors (muscles that engage the sole of your foot) to hold the position and can calibrate the force to ~80% of your MVC, which is the ideal amount of contraction for tissue adaptation.

 

As you can now see, position 3 will also be stronger if you are not flexing your toes against the floor. While it would be possible to grind the top of your foot into the floor as a method of resistance, it would be terribly uncomfortable and that sensation would likely detract you from reaching 80% MVC.

I’ve come up with two variations of the more active exercise  – standing on the floor with the knee of my working foot bent; and standing on a yoga block with the knee of my working foot straight. My preference is the latter because it encourages me to pelvic list on the standing leg in order for the working foot to clear the floor. But I think either method would be fine.

Here is a video of the passive and active variations of this exercise.

Learn more exercises for your feet from my teacher renowned biomechanist Katy Bowman with these brilliant 30 minute exercise videos that you can stream or download to view as often as you like for just $5 each!

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Schoolhouse Series: Toes & Calves

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Schoolhouse Series: Unduck Your Feet

 

Namaste, Michele

Move Your Toes Through Their Full Ranges of Motion

Try this exercise to bring greater mobility to your feet. It works their intrinsic musculature, which allows for flexion, extension, and abduction (spreading) of the toes. Because a big chunk of your day may be spent in shoes with toe boxes that are comfortable yet insidiously restrictive to these movements, you end up with achy feet that are also weak and may not move as well as you’d like.

Remember what happened the last time you removed your shoes after many hours of being shod. Did you immediately start flexing, extending, abducting aka wiggling your toes for the relief it brings? These are movements for which our feet have an evolutionary craving.  Unshod (or even minimally shod) on natural terrain, we would be engaging the intrinsic muscles of our feet in this way, whenever we walked.

But, since we are a shod society, we need to find ways to infuse such movements into our day.

Here is a great way to do this:

toelifts on block

Stand on yoga blocks, books, or anything that you can hang your toes over the edge. You want to be able to move your toes from neutral to full flexion to full extension and back. Be mindful that your medial (inner) ankles do not collapse in towards one another. With your toes hanging over the edges of the blocks, flex your toes down towards the floor then extend your toes up towards the ceiling. Alternate between flexing and extending until you have flexed and extended 10 times each.

Here’s a short video of this exercise.

Learn more exercises for your feet from my teacher renowned biomechanist Katy Bowman with these brilliant 30 minute exercise videos that you can stream or download to view as often as you like for just $5 each!

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Schoolhouse Series: Toes & Calves

UnDuck-Your-Feet-Screenshot-300x300

Schoolhouse Series: Unduck Your Feet

Namaste, Michele

 

 

Foot Love Workshop Exercises – October 2015

You can find variations of some of these exercises in world-renowned Biomechanist Katy Bowman’s books & DVD included in her Healthy Foot Kit.

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Standing Exercises

All standing exercises should be done in Tadasana aka mountain pose with your feet pelvis-width distance apart, pointing forward, which means the outside edges of your feet should form a straight line (you can line up the edge of one of your feet on a yoga mat to check that it is actually straight and match the other accordingly); and your hips back so that they are stacked over your knees, ankles, and heels and not drifting or thrusting forward. Keep your weight back in your heels. I call this Smart Tadasana Alignment.

Toe Spreading

Lift your toes (this is called extension), spread them away from each other, and place them down onto the mat. Repeat several times throughout your day. You can improve your ability to actively spread your toes by passively spreading them using toe socks.

Short Foot Exercise

A full explanation is linked, but the short of it is to draw the base of your big toe towards your heel, without flexing or curling your toes. It’s OK if they grip the floor. This action lifts your arch, thereby shortening the length of your foot, and strengthening the arch-supporting muscles. Hold for 5 seconds and repeat 3 times for each foot. Try to do 5 sets of 3 repetitions per day, holding for 5 seconds each rep. You can perform the short foot exercise any time your standing in yoga postures and as you get stronger, you can do it while balancing. The Short Foot Exercise is comparable to the Strong Yoga Foot.

Balancing

Any single leg balance will strengthen your extrinsic and intrinsic foot musculature. Once you are skilled at balancing on a firm surface, you can explore a variety of unique surfaces – a folded up towel or blanket, a yoga block, a half round, a boot tray of rocks, your yard…Hold for up to one minute and repeat several times throughout your day.

Exploratory feet

Move your feet in exploratory, weird, random, bizarre, strange, silly, varied ways. This can be done sitting in Dandasana (with your legs extended in front of you) or lying down. This is a great way to mobilize your feet before you get out of bed in the morning. Repeat throughout your day.

Top of foot stretch

Extend a leg behind you, pressing the top of your foot into the mat. It is important to keep your pelvis back and stacked vertically over the knee & ankle of your front or support leg as the tendency is for it to drift forward. If balance is a challenge, please use a chair so that you can concentrate on the stretch without worrying about the balance.Hold for up to one minute. Repeat several times throughout your day.

Top of foot stretch

Top of foot stretch

Calf Elevator

Lift the heels of both feet, coming up onto your tippy toes. Try to avoid letting your ankles blow out to the sides. If they do, then only raise your heels as high as you can keep your ankles stable. Hold for several seconds. Once you are skilled at balancing on both feet, start working towards one foot at a time. You can do this either by lifting the heels of both feet, but letting the work happen mainly in one foot; or you could do this balancing on one foot! Whichever variation you choose, make sure your hips are back. Hold for up to one minute. Repeat several times throughout your day.

Calf stretch

A half round (or half moon as one of students sweetly miscalled it) is best for this stretch, but you could roll up a couple of yoga mats or blanket or use a book. Place the ball of your foot on the top of the half round with your heel on the ground. Keep your other foot even to and pelvic-width apart from the stretching calf. You can advance in this pose by slowly stepping the non-stretching foot forward. If your pelvis moves forward with you or you lose balance or get rigid, bring the forward stepping foot back and don’t progress until you can do so in a relaxed and balanced stance with your hips back. Hold for up to one minute. Repeat several times throughout your day.

I purchased a SPRI Half Round Foam Roller, 36 x 6-Inch that I cut down to one 18″ length and three 6″ lengths that I use for various purposes as yoga props.

Calf Stretch/Elevator Combination

Stand with one foot on the half-round and elevate both heels to a slow count of three. Hold for 3 counts. Lower for a slow count of three. The lowering is where you train eccentrically, generating force while you are lengthening your muscle tendon units. This is how you get stronger at greater ranges and with more control. At the place that you want to give up and drop your heel is the opportunity to exercise muscle control.

Hamstring stretch

I’ll be posting later this week on hamstring stretching, but for now, start from tadasana, place your hands on your thighs and hinge forward at your hip joints, allowing your hands to slide down your legs, keeping your spine in neutral. As soon as your spine starts to deform ie round, stop, come up a few inches and work instead on lifting your tailbone, which will move the proximal muscle attachments for your hamstrings that are located on your sitting bones away from the distal attachments that are located on your lower legs, thus stretching these muscles. Hold for up to one minute. Repeat several times throughout your day.

Ball rolling massage

Place a new, firm tennis ball on a yoga mat or carpet. Keep your heel down as you drape only your toes over the ball, weighting it as much as you can tolerate. Very, very slowly, roll the ball under your toes, from side to side, allowing your toes to spread as you go. After a while move your foot forward so that the ball of your foot drapes across the ball. Again, move very slowly side to side. Continue to move your foot forward in small sections using a side to side motion. When you are deep into the arch of your foot, you might explore some front to back motions, or invert/evert your foot to get into the lateral and medial arches. The benefit from this massage comes when you slow down, take your time, move forward in tiny increments, hang out in sore spots, and remember to breathe. This can and should be done daily as a meditation practice.

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Floor Exercises

Plantar Fascia Stretch – kneeling/squatting

In this exercise, you kneel with your knees pelvis-width apart on a mat or padded surface. Extend (curl) your toes forward. If you can, reach around and separate your toes from each other and make sure they are all extending forward. You may be able to lower your hips, shifting more of your weight onto your feet, but do this slowly and with ease as the thick band of fascia and four layers of intrinsic muscles on the soles of your feet may never have experienced this type of stretch. Images and detailed instructions are linked above.

Barbie foot

This is the exercise where you press your balls forward (of your feet, people!), all toes forward, all toes back, foot back. You know the one. In the balls forward, toes back position, your feet look like Barbie’s. You can use your arms to support you in an upright seated position, but I suggest you place your hands in your lap from time to time and hold yourself up using your own trunk musculature. Images and detailed instructions are linked above.

Bridge with marble

I know you all remember this bit of love from the workshop – a yoga bridge pose holding a marble with your toes and extending your leg. Yes, that one.  Remember, cramping is good…a good reminder, that it, that you should be moving your feet more. Again, images and detailed instructions are linked above.

Ankle circles, point/flex, invert, evert

This can be done seated with legs extended or on your back. My preference is supine with legs extended 90 degrees and soles of your feet facing the ceiling. Try to keep your legs straight and pelvis-width apart and don’t be in such a hurry. Slow, sweeping circles will assure full range of motion. If you fatigue, bend your knees, but keep moving your ankles & feet.

Exploratory feet

Exploratory feet can be done standing in Tadasana with your feet squirming around on the mat; seated in a chair with them wiggling about on a bolster; seated on the floor with them playing mischievously out in front of you; or lying supine, my favorite, with your feet in the air spazzing all over. The object is to make as many movements as you can. According to my teacher Katy Bowman, a biomechanist and math dork, if you apply a mathematical concept called a factorial, a foot with 33 joints can deform into 8,600,000,000,000, 000, 000, 000, 000, 000, 000, 000, 000 unique ways – or thereabouts. Whatever.

Toe spreaders

These exercises will help to undo the harm that shoes with small toe boxes cause to the muscles between your toes that have so little range of motion or strength that you may not even be able to generate enough of your own force to spread your toes. The third exercise, Toe Lifts, was not included in the workshop because a) I forgot; or b) We ran out of time. Whatever.

Namaste, Michele

Load Your Feet to Improve Plantar Fasciitis

Last month, I wrote about dissonance that occurs, when I perceive discord among yoga teachers and other movement thinkers, whose work I follow. As a yoga teacher, former research librarian, soon to be Restorative Exercise Specialist™, and someone with rebellious tendencies, I am wired to ask a lot of questions about what is being taught in yoga – and why – and whether cues were informed by research or lineage. Often this results in mental compromises (and annoyed teachers & colleagues) as I try to reconcile such teachings with each other and with what I experience in my body or with my students and clients. There comes a time when a clarifying convergence of ideas emerges that confirms I am on the right path and following teachings from which I am meant to learn. This is one of those occasions. 

In previous posts (listed below), I discussed plantar fasciitis (aka plantar fasciosis) and biomechanical and environmental factors that can be addressed conservatively through yogasana, plantar fascia-specific stretching, alignment, and conditioning.

Previous posts on plantar fasciitis and exercises that can help:

https://footloveyoga.com/2015/01/05/plantar-fasciitis-what-we-know-what-we-can-do-about-it-january-5-2015/

https://footloveyoga.com/2015/01/08/what-does-plantar-fasciitis-your-down-comforter-and-your-sleep-position-have-in-common/

https://footloveyoga.com/2015/01/17/simulating-the-toe-off-event-in-walking-to-stretch-your-plantar-fascia/

https://footloveyoga.com/2015/01/13/strong-yoga-foot/

https://footloveyoga.com/2015/03/16/the-strong-yoga-foot-and-your-flat-feet-in-research/

Upon returning yesterday from what has come to be known as the Jules Mitchell Portland Tour, I found the September 1, 2015 issue of my partner’s American Family Physician peer-reviewed journal sitting on my desk with a section circled. The article was titled “Top 20 Research Studies of 2014 for Primary Care Physicians.” Basically, a group of clinicians with expertise in evidenced-based medicine performed monthly surveillance on 110 clinical research journals in 2014 (the 20th year they have been doing such surveillance). They identified 255 studies that had potential to change how family physicians practice, and narrowed that group down to 20 studies with relevance to primary care practice, validity, and likelihood that they could change practice. The section circled for my benefit was from one of these 20 studies titled “High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up,” which addressed the question of whether strength training is more effective than stretching for patients with plantar fasciitis. The bottom line answer was YES. “A regimen of strength training improves pain and function in patients with plantar fasciitis faster than a typical stretching regimen. Over time, though, patients who stretch will continue to improve and have similar improvement.” My take home, after reading the full study, is that high-load strength training, at 3 months out, resulted in quicker reduction in pain and improvement in function, when compared to stretching alone. However, 3 months was the magic time period. Before three months and at 6  and 12 months, strength training was not superior to stretching.

So, how does this research study on plantar fasciitis converge with the Jules Mitchell Portland Tour? Jules is one of the teachers in my dissonance piece. She is a biomechanist and yogi, who wrote her masters thesis on the science of stretching and turned the world of yoga on its head. One of her workshops that I attended this weekend was an impressive attempt to distill  3 years of research on the biomechanics and neuromechanisms of stretching into 8 hours of yoga workshop. The piece that is relevant here, further distilled from 3 years of research to 8 hours of workshop to two minutes of interpretive writing, is that loading connective tissues, which happens in active static stretching and isometric and eccentric training, is how we get stronger, healthier connective tissues. It is all about the load. You must input load. It is so much more complicated and nuanced than that…I challenge you to learn more by reading Jules’ seminal post on tissue mechanics, which begins her blogging journey of her thesis work.

In explaining results of the plantar fascia study, the authors confirm Jules’ findings that large tensile forces (loads) are associated with improvements in symptoms in conditions involving degenerative changes, like plantar fasciosis. Since the plantar fascia is composed of type 1 collagen fibers, it responds to high loads by laying down more collagen, which may help improve the condition. An additional benefit of high-load strength training is increased ankle dorsiflexion strength, as decreased ankle dorsiflexion strength has previously been identified in those with plantar fasciosis.

Applied exercises in your home yoga practice

With a little creativity, you can use yoga props to combine ankle dorsiflexion and controlled loading of the plantar fascia. This exercise can be used by those with or without plantar fasciosis, as it trains active mobility and improves strength at end ranges of motion in your feet and ankles, which is good for everyone. We know that strong, flexible feet are healthy, happy, and mobile.

I use a block, half round, and yoga mat. You can use a stair step or low stool in place of a yoga block and a rolled up towel or yoga mat for the half round/mat combo in the images below.

The first two pictures show my naked set-up, but I actually cover the whole contraption with a yoga mat because the half-round slides on the block without the mat, when I start doing the exercise. You probably won’t get slippage if you are using a towel instead of a half-round.

plantar fasciosis load1 plantarfasciosisload2 plantarfasciosisload3

  1. Place the toes of your right foot on the mat-wrapped half-round (towel), so that they are maximally dorsal flexed, meaning your toes extend back towards you.
  2. Place the ball of your foot on the block (stool or step).
  3. Hold onto a chair/rail for balance and slowly, over a period of 3 seconds, lift your right heel, so that you rise up onto the ball of your foot (concentric phase).
  4. Remain in the raised position for 2 seconds (isometric phase).
  5. Slowly lower your heel, over a period of 3 seconds, to slightly below the level of the block (eccentric phase). The rise, hold, & lower is one rep.
  6. Repeat up to 12 times (reps) for up to 3 sets.
  7. Once you can do 3 sets of 12 reps, play around with increasing the load by wearing a loaded backpack. You might decrease the number of reps at this new load, but increase the number of sets. The idea here is to progressively load the tissues as you get stronger.
  8. Perform this exercise every other day.
  9. If you find you are not strong enough to do unilateral heel raises, try using both feet at the same time until you are stronger.
  10. This protocol is just a suggestion. Modify the load, reps, sets, and props, customizing it to suit your strength, flexibility, and movement history.

plantarfasciosis load5 plantarfasciosis load4

P.S. Look at how in the first picture, both ankles are dorsal flexed; and in the second both are plantar flexed. Not intentional. Just a neural pathway, I guess.

Consider adding this exercise to your foot health protocol of stretching, strengthening, and mobilizing your feet.

Namaste, Michele