From the Ground up!
Feet biomechanics are incredibly complex, and the daily workload put on our feet is epic. When the system works well, our feet are perfectly resilient — but when it breaks down…. Injury. There are a lot of different ways this system can start to fall apart: congenital abnormalities are common, developmental problems arise from many different directions, injuries of course, and then the enduring wear and tear we subject our feet to. Often this manifests as foot, ankle, knee or leg pain, but as we follow the kinetic chain up, there is a direct effect into our hips, low back and even to the mid back and shoulders in some cases (walk around with one shoe on for an hour and you will understand).
Take for example a high arch (instep) which is typically missing the spring of a ‘normal’ foot — the impact from each step translates directly into the cartilage in the knee and then the hip and low back. Or the flat foot, where the heel rolls inward with each step. This doesn’t just stretch the plantar fascia — it causes the Achilles tendon to bow and twist rather than pull in a straight line, concentrating abnormal stress at its attachment and setting the stage for Achilles tendinopathy. At the same time, that inward rolling of the heel drives the shin and thigh into internal rotation with every single step. The gluteal muscles — responsible for controlling that rotation and stabilizing the pelvis — are forced to work in a mechanically disadvantaged position, overloaded repetitively until they break down into tendinopathy and lateral hip pain. It’s a long way from your arch to your hip, but the connection is direct.
Often our approach is to treat the painful and injured area. Add some rehab and things should be good? But sometimes the foot is going to do what it has been doing all along and the injury resurfaces. From there we need to not only rehab the injury, but address the root cause. Orthotics can be used to this end — restoring better alignment from the ground up, reducing the abnormal loads travelling up the kinetic chain, and giving the injured tissues a real chance to heal and stay healed.
