Massage and Bodywork Magazine for the Visually Impaired - Working with the Shoe-Bound Arch

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March/April 2013 Issue

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Working with the Shoe-Bound Arch

By By Til Luchau
[Myofascial Techniques]

Michelangelo said, “What spirit is so empty and blind, that it cannot recognize that the foot is more noble than the shoe?” Some 500 years later, we are still squeezing our feet into shoes; shoes that, in the name of beauty, are often too small.

But compressed feet are rarely happy feet. As an extreme example, consider foot-binding, which was practiced in some parts of China until modern times, despite being outlawed in 1912 and again in 1949. Done in the name of beauty, the foot bones were broken and distorted to allow the wearing of a miniature shoe (Images 1 and 2). Women with bound feet suffered pain and lifelong disabilities.1

The space and movement between the foot bones are as important as the bones themselves. Without enough space and movement, feet lose the supple mobility needed for adapting to the constantly changing angles, forces, and surfaces that standing, walking, and running entail. When the feet aren’t able to make the ultrafine adjustments that provide stability, larger muscles and connective tissue structures elsewhere in the body compensate by gripping, tightening, and holding. 

Try this: walk barefoot around the room, but stiffen one of your big toe joints—don’t allow it to move. Obviously, this will change the way you walk; but more to our point, feel where else in your body you sense the effects of this toe restriction. If you had to walk like this for a long time, where would you need some bodywork? Many will notice a change in knee function, stiffer hips, or back or neck discomfort. When the feet aren’t happy, the body isn’t happy. 

Barefoot and minimalist running has been popular for several years now, and the trend shows few signs of fading. Despite its faddish aspects (minimalist shoes, in spite of having less to them, often cost more), barefoot running has spurred a thought-provoking debate into the definition of foot health, and offers ideas that we can adopt for our hands-on work with clients and patients. Barefoot runners claim that since humans have been running barefoot for longer than they have been running with shoes, our bodies do better when the feet are not overcushioned or immobilized. I’ll describe two techniques from Advanced-Trainings.com’s Advanced Myofascial Techniques seminar and DVD series that can help anyone’s feet regain a higher degree of natural mobility and adaptability, whether they run barefoot or not.

Are Flat Feet Bad Feet?

Looking at the issue of arch height, a quick overview of arch anatomy is in order. Skeletally, the foot bones function as sets of longitudinal rays, each comprised of a toe, its metatarsal, and an associated tarsal bone. These foot rays are further grouped into two structural divisions: the medial and lateral arches (Image 4). The bones of the medial arch include the phalanges of toes one, two, and three; their metatarsals; plus the cuneiforms, navicular, and talus. The lateral arch is made up of toe rays four and five, which share the cuboid as their associated tarsal. The cuboid in turn articulates with the calcaneus (the heel bone) via a unique locking joint, which adds stability. The connective tissues, muscles, tendons, and ligaments of the foot and lower leg contribute either spring or fixity to the arches, depending on the tissues’ own elasticity and resilience.

Conventionally, low arches or “flat feet” have been thought to be problematic, though some proponents of barefoot running question this assumption. While overpronation (Image 5) has clearly been linked to foot, ankle, and leg problems, the relationship of arch height to pronation and overall foot health is not as clear. 

The generally accepted view links low arches with overpronation of the calcaneus. Because the talus (medial arch) rests on top of the calcaneus (lateral arch), pronation or eversion of the calcaneus and lateral arch is conventionally thought to dump the talus medially, lowering the medial arch and giving rise to flat feet. However, there is credible research that contradicts this view, correlating pronation with higher arches rather than lower ones,2 and multiple studies suggest that barefoot running can reduce overpronation.3 There is also evidence that shoe use accentuates foot narrowing and arch height. One study (comparing indigenous non-shoe users with habitual shoe-wearers) correlated shoe use with higher arches and narrowed feet, and with less-even weight distribution in the sole when compared to non-shoe users.4 Other studies question the reliability and usefulness of arch-height measurements in general.5  

Where does this leave us? Rather than assuming problems based solely on arch height, we can take the pragmatic approach of assessing and releasing articular immobility and connective-tissue restrictions wherever we find them, working toward the structural differentiation that brings adaptability. In addition to more balanced foot mobility, it is also important to include symptom improvement (less pain in the feet or elsewhere) and our clients’ subjective experience (do the feet simply feel better?) as indicators of success. Using adaptability, symptom improvement, and subjective experience as our criteria is often more effective, and probably more universally relevant, than looking for change in foot shape or arch height alone.

Anterior/Posterior Arch Mobility Technique 

The metatarsals are lined up side by side in the midfoot, much like sardines in a can. This side-by-side arrangement helps the metatarsals resist excessive lateral movement, while allowing them to spring up and down in the sagittal plane. The controlled dorsal/plantar mobility of the metatarsus allows the connective tissues of the foot (such as the tendons, plantar fascia, and spring ligaments) to absorb shock and store energy for release into the next step. When the metatarsals are fixed, undifferentiated, and immobile, the foot lacks both the spring and adaptability necessary for efficient and comfortable function.

Begin the Anterior/Posterior Arch Mobility Technique by assessing the mobility of individual metatarsal bones. Using a firm grip, move two rays of the foot against each other in the sagittal plane (Image 6). This does not involve squeezing and releasing, nor is it kneading the soft tissue of the foot. With a constant amount of grip pressure, isolate the up/down (dorsal/plantar) motion of each metatarsal bone in turn, moving it back and forth against its neighbor in a slow but full scrubbing motion. 

Feel for mobility restrictions in either direction. When you find a direction that is less free, use the same full anterior/posterior motion to increase mobility. Make sure the distal ends of the metatarsal are mobile, as this will lay the groundwork for individual toe adaptability and range. Check and release the proximal ends of the metatarsals, too, along with each accompanying tarsal bone. Be thorough, scrubbing each pair of metatarsal rays against one another in turn. 

Especially important is the division between the rays of toes three and four, since it is here that the medial arch meets the lateral arch (Image 4). This division extends proximally between the third cuneiform and the cuboid, and then between the talus and the calcaneus, and is often the first intermetatarsal space to lose adaptability. When this division is not mobile, the arches become fixed in relation to one another, negatively affecting pronation/supination balance, arch spring, and overall adaptability of the foot and ankle. 

Intermetatarsal Space Technique

It bears repeating: the spaces between the bones are just as important as the bones themselves. Without the differentiation that gives adaptability, strength turns to rigidity, both in the feet and in the rest of the body. The Intermetatarsal Space Technique is a straightforward way to regain lost lateral differentiation and adaptability in the forefoot.

Using your thumb and fingers, feel into the space between each metatarsal from above and below the foot. Staying well within your client’s range of comfort, use enough pressure to feel all the way through the foot, as if touching the thumb and fingers together between the bones (Images 7 and 8). As always, avoid pressure that elicits sharp, electric, or other uncomfortable sensations, since there are sensitive nerves in the intermetatarsal spaces. Once your fingers and thumbs are in position, wait for the foot to yield. In the time it takes the tissues to respond, you can typically take two or three slow breaths of your own. 

After you feel the initial release, you can facilitate a deeper response by asking for slow, focused, active movement. Have your client gradually flex and extend the toes, and then the ankle, as you maintain the space between the metatarsals with your fingers and thumb. There is almost no movement of your touch; any sliding that occurs results from your client’s active movements. In addition to helping the tissues release, holding the bones apart as your client moves adds an element of movement reeducation, as your client’s nervous system learns what it feels like to move the foot while maintaining width across the foot. Repeat this cycle of static-touch release, followed by active movement, in several places along each metatarsal space, and then between all other pairs of foot rays, for both feet.

In some people, the narrowing of the metatarsals can irritate and enlarge the perineurium (the outer connective tissue layer) of the intermetatarsal branches of the plantar nerve (Image 9), causing foot pain or numbness. This condition, known as Morton’s neuroma, most commonly occurs between the third and fourth metatarsals, right where the medial arch meets the lateral arch. If your client complains of numbness or a sharp pain between the distal ends of the metatarsals, especially when standing or wearing shoes, work to separate and decompress the intermetatarsal spaces. As long as it is within your client’s comfort range, gentle but deep work here can help ease the effects of midfoot narrowing and compression, as well as address the connective tissue fibrosity of the perineurium and surrounding tissues. Use your client’s active toe flexion and extension to glide the tissues under your fingertips; feel for an increase in boney mobility and openness of the intermetatarsal space. Your client may experience rapid relief, but don’t be discouraged if it takes several sessions before the irritation subsides. Stubborn cases merit a change of footwear and/or evaluation by a medical professional. Conventional nonsurgical treatments include orthotics, orthopedic pads, or sclerosing or other injections. 

Just like people, not all feet are the same. Barefoot running isn’t for everyone, and what works for one client may need to be adapted or avoided for another. We’ll be most effective as practitioners if we bring the desired qualities of adaptability and flexibility to our own strategizing as well. After all, as psychiatrist Carl Jung said, “The shoe that fits one person pinches another; there is no recipe for living that suits all cases.” 

Notes 

1. For more images and information about foot-binding, see www.environmentalgraffiti.com/news-foot-binding.

2. M. Boozer et al., “Investigation of the Relationship Between Arch Height and Maximum Pronation Angle During Running,” Biomedical Sciences Instrumentation 38 (2002): 203–7.

3. A. Stacoff et al., “The Effects of Shoes on the Torsion and Rearfoot Motion in Running,” Medicine and Science in Sports and Exercise 23, no. 4 (1991): 482–90.

4. K. D’aout et al., “The Effects of Habitual Footwear Use: Foot Shape and Function in Native Barefoot Walkers,” Footwear Science 1 (2009): 81–94.

5. H. Menz, “Alternative Techniques for the Clinical Assessment of Foot Pronation,” Journal of the American Podiatric Medical Association 88, no. 3 (1998): 119–129.

  Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and has taught for the Rolf Institute of Structural Integration for 22 years. Contact him via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.

 


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