A Few question (and answers) about Foot Problems, from our Blog.
Dr. Ivo Waerlop and Dr. Shawn Allen,
I have had the pleasure of reading much of the content of your website and I have gained many valuable insights into the fascinating world of gait. I have a number of questions that I would love to get your perspective on though. First question: What exercises or techniques do you use to strengthen the intrinsic foot musculature? I gleaned that you are not particularly fond of flexor dominant exercises like towel scrunches so how do you functionally improve the strength, muscular balance and neuromuscular control over those little muscles? Second question: What strategies do you use when treating runners with plantar fasciitis? Would you move them into a less supportive or minimalist shoe or would you bump them up temporarily into a stiffer shoe or use a rigid orthotic?
I would like to also take the time to thank you guys for posting volumes of valuable information on your website. I have found that your website has a remarkable amount of solid, scientifically based information on topics that typically are rife with misinformation when discussed on other websites. Keep up the excellent work and I greatly look forwards to hearing your response to my questions.
The Gait Guys Response:
Thanks for the support and the kudos. In answer to your inquiries:
“First question: What exercises or techniques do you use to strengthen the intrinsic foot musculature? I gleaned that you are not particularly fond of flexor dominant exercises like towel scrunches so how do you functionally improve the strength, muscular balance and neuromuscular control over those little muscles?”
Exercises are prescribed very specific to muscle weakness. There are no “swiss army knife” exercises. Each case is on an individual basis, based on physical exam and muscle testing. For the most part, there are really no bad exercises just bad choices for a specific case and poor execution (although one can easily find on YouTube a plethora of ridiculous examples of foolishness worthy of only The Darwin Award).
The small, intrinsic muscles of the foot have many functions, but flexion of the distal toes is not one of them (this is all afforded via the long flexors, FDL). Proprioception from the feet is very important and information from these muscles, as well as the articulations they traverse, provide the brain with much information about the environment, as well as the landscape they are traversing. Increasing proprioception from the feet (through gradual introduction of more minimalistic footwear and going barefoot) is as paramount, if not more important, as increasing strength. Skill, endurance, strength (S.E.S.) in that order (larger diameter, medium diameter and smaller diameter neurons respectively) is the rule for progressing exercise. S.E.S. is an abbreviation we coined, but it is based purely on neurophysiology principles … all of our information is science based. You will find no ‘internet forum’ assumptions here, as you have so accurately gleaned. As for an example of some of our exercises, we are currently trying to find time to create some new videos of our current exercise protocols. As we mentioned however, it is a difficult projected since each case has different needs and differing orders of protocol. None the less, here is an “oldie but a goodie” from two years ago. Click here.
“Second question: What strategies do you use when treating runners with plantar fasciitis? Would you move them into a less supportive or minimalist shoe or would you bump them up temporarily into a stiffer shoe or use a rigid orthotic?”
A: The causes of plantar fascitis are multifactorial, but I think we all agree that overpronation of the rearfoot, midfoot, forefoot (or a combination) all play a frequent role. Following that assumption as a possible cause, the question is, What is causing the overpronation? Is it due to muscular incompetence? Is it due to loss of ankle rocker? Is it due to a loss of hip extension? Is it due to….. (fill in the blank).
The treatment depends on the etiology. As we just eluded, the cause is not always a foot issue, there can be top-down kinetic chain causes. Progressing them to more minimalistic footwear is a great idea (provided they have earned their right to be in it and have muscular competency and appropriate foot structure). The problem is that not everyone does have the necessary structure to drop into minimalism, some never and some need help with a logical progression. Modalities like acupuncture, ultrasound and EMS, to reduce inflammation certainly help in pain management and can expedite the healing process. At times, if the case calls for it, using an orthotic to temporarily give them the mechanics they do not have, and relieve some of the tension of the fascia is appropriate. Sometimes the orthotic makes things worse (too much support, not enough support). Sometimes, albeit rare, the orthotic is suspect as the causal mechanism. The root cause needs to be identified and then the appropriate therapy can be initiated.
We get questions like these all the time. They are great questions but they are often fraught with so many open ended subsequent questions and parameters that we often feel our answers are never good enough. But, if solving things like plantar fascitis were easy in every case, we would not see clients in our practices who arrive with a bag of orthotics, a long history of therapy, and multiple failed interventions. There are no easy answers or magic bullets. If there were, there would be no need for The Gait Guys.
Providing answers to difficult questions.
Ivo and Shawn