What is a Bunion?

A bunion is a deformity that forms at the joint of the big toe. A bunion develops when the first metatarsal bone turns toward the inside of the foot and the big toe angles toward the other toes.

This deviations causes the joint to protrude out from the side of the foot.

Most bunions occur in adulthood. Rarely, children may be born with bunions or develop them during childhood. Bunions are more common in women than in men.

A bunion can also form on the little toe side of the foot. This is called a bunionette or tailor’s bunion.

What Causes Bunions?

Bunions are though to be caused by a combination of several factors. These factors include:

• abnormal foot mechanics affecting the big toe
• flat feet
• shoe wearing
• abnormal anatomy or shape of the bones that form the big toe
• joint hypermobility
• genetic influences
• inflammatory joint diseases

Tight-fitting shoes that have narrow toe boxes and raised heals are often blamed for the condition. Footwear can not be solely to blame as bunions are found, though rarely, in populations that don’t wear shoes.

As the bunion progresses, there is a change in the structure and function of the muscles and connective tissue in the foot that makes the condition difficult to reverse.

Improving Bunions

There is a lack of high-quality research evidence on the non-surgical options for caring for bunions.

However, based on the limited evidence available and anecdotal reports, there are some promising options for improving the appearance of bunions as well as reducing the pain associated with the condition.

Choosing Appropriate Footwear

Since narrow shoes are known to exacerbate the problem, it makes since that the first step in tackling the problem would be selecting shoes that have a wide toe-box.

Not too long ago it was difficult to find shoes that were shaped like feet. Now, a number of brands make shoes that accommodate the normal, anatomical position of the toes.

Though it’s not clear how much of an influence heel height has on bunions, it seems reasonable to avoid high-heeled shoes that force the foot forward and cram the toes into the toe box.

Foot and Toe Strengthening

It’s common to see a muscular imbalance with bunions. The muscle that pulls the big toe in towards the second toe end up overpowering the muscle that pulls in the opposite direction.

One exercise that has been shown in studies to improve the alignment of the big toe in mild and moderate bunion cases is the Toe Spread Out.

Toe Separators, Orthoses, and Night Splints

There are a number of products available that aim to return the big toe to its previous position. These include toe separators or toe spacers that go between the toes to create space, and splints that pull the big toe out away from the other toes.

Taping can also be used as a method to hold the toe in a better alignment.

Adjusting Walking Mechanics

How the foot contacts the ground directly relates to the stress of the big toe joint. Reducing the force pushing the big toe sideways can be achieved by stabilizing the big toe on the ground with each step and limiting the amount the foot pronates or rolls inward.

Massage, Mobilization, and Stretching

Massaging the foot, particularly the spaces between the toes, and stretching the toes by hand may provide pain relief and reduce joint stiffness.

Conclusion

Given the lack of high-quality research, it’s difficult to conclude to what extent bunions can be prevented or reversed without surgery.

There are a lot of anecdotal reports of people who have improved their bunions. Several studies have shown that the angle of the toe can be improved with non-surgical measures.

It’s likely that there are some cases where the angle of the toe cannot be changed without surgery. This might depend on the severity of the bone or soft-tissue deformity and other underlying or hereditary factors like bone shape and the strength of the ligaments holding the bones together.

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Plantar fasciitis is a common cause of heel pain. The common presentation is a sharp, localized pain in the bottom inside part of the heel.

Plantar Fasciitis Is Probably Not Inflammation

Plantar fasciitis was previously believed to be inflammation of the fascia near its insertion on the heel bone. The suffix (-itis) means inflammation. Studies, however, reveal that changes in the tissue associated with the injury are degenerative and not related to inflammation, at least not in the way inflammation is typically viewed 

A sudden onset of heel pain may be related to acute inflammation. For persistent heel pain, the condition more closely resembles long-standing degeneration of the plantar fascia near its attachment than inflammation. This could explain why anti-inflammatory medications and injections have relatively low success rates.

But there is more to heel pain than just the plantar fascia.

Not Just Fascia

The pain associated with plantar fasciitis is typically localized to the underside of the heel towards this inside of the foot. Often overlooked when talking about this injury are the muscles that share an insertion with the plantar fascia. Looking at the muscles in the sole of the foot you can see that the flexor digitorum brevis muscle runs directly above the plantar fascia. On the inside part of the heel the abductor hallucis, an important arch stabilizer muscle, attaches.

It’s not certain that the pain associated with this condition originates in the plantar fascia. Many of the diagnostic features seen with this condition (e.g. bone spurs, thickened fascia) are also found in people without heel pain, and likewise may be absent in people presenting with the injury.

There’s a chance, in my opinion, the pain is the result of a tendon problem of the muscles deep to the fascia, rather than the fascia itself. The role the foot muscles play in this condition will be discussed later in the article.

Overuse Injury?

A common theory on how plantar fasciitis develops is that repeated strain on the fascia causes small tears to develop that eventually lead to pain. Excessive pronation (collapse of the arch) is often cited as the cause of increased mechanical loading of the fascia.

Despite how frequently pronation is blamed, there is not much evidence that arch mechanics play a role in the condition. This may be partly due to the researchers have accurately measuring pronation, especially movement of the arch inside of a shoe. This might also mean though that tensile stress on the fascia from arch movement, at least in itself, is not a cause of plantar fasciitis.

Role of Compression

Animal studies suggest repeated mechanical loading alone may not be enough to cause degeneration of connective tissue. Tissue degeneration is more likely to occur in areas that receive a poor blood supply, or at locations in the connective tissue where the blood supply is cut off.

Another interesting finding is the presence of fibrocartilage near the attachment of the plantar fascia. Fibrocartilage insertions are more common in structures that undergo bending or compressive forces. It may be that bending and compression are a bigger problem than tensile or stretching forces.

Heel spurs were also once thought to be a feature of this condition, with the thinking that they were caused by the fascia pulling away from the bone. New evidence strongly suggests that spurs are unlikely to be a cause of fasciitis, and that they may develop due to compression rather than tensile force on the fascia.

Risk Factors

Currently, no single factor has been reliably identified as contributing to the development of plantar fasciitis.

Two risk factors that have support from current research:

• Decreased ankle dorsiflexion
• Increased Body Mass Index (BMI) in non-athletic populations

When dorsiflexion range of motion (ankle flexibility) is lacking, the body often compensates by increasing movement of the arch. In this way, decreased ankle dorsiflexion influences pronation and places strain on the underside of the foot.

Similarly, having a high BMI causes strain because it places a load on the foot that may be in excess of what the foot can support.

As I mentioned earlier, overpronation is thought to be a contributing factor, but studies on this have so far produced mixed findings.

A lack of ankle flexibility and a high BMI can also both cause increased pressure on the heel in standing. Keeping weight on the heels causes compression under the heel. But it also means the muscles and ligaments in the arch are not being used to balance your body weight.

Looking beyond these potential contributors to heel pain, though, there is another factor that I think is often looked–the way footwear alters the function of the foot.

Can Shoes be a Factor?

There are several features in the design of shoes that can cause abnormal stress on the plantar fascia and potentially affect the muscles in the foot.

Toe Spring

Most shoes curve up in the front in the area of the toes. This upward curve of the sole is called a toe spring. This is engineered into footwear because shoes are crudely made compared to the complexity of the structure and function of the foot.

The curve allows for a rocking motion to occur as a person transfers their weight from their heel to the front of their foot. This rocking motion is a substitute for the bending the foot does when walking barefoot–a motion shoes are unable to replicate.

Having this toe spring means that, for the majority of the time when a person is standing or walking in a shoe, their toes are held elevated off the ground. The curvature of the sole places the toes in an extended position. Because of this, the toes can only make contact with the ground when the heel lifts up.

Keeping the toes splinted in this extended position can hypothetically do several things:

• Holds the plantar fascia and other structures in the sole of the foot in an unnaturally elongated position
• Prevents the toes from gripping the ground
• Prevents the intrinsic foot muscles from contracting to support the arch
• Prevents the muscles and plantar fascia from assisting with shock absorption
• Possibly cuts off circulation on the underside of the foot

When walking barefoot the toes make contact with the ground much sooner in the stance phase of gait than they do inside a shoe. These foot muscles are needed to assist with gripping the ground and stabilizing the arch.

Without support from these intrinsic foot muscles, extra strain may be placed on the plantar fascia. This extra stress can be doubly bad because the toe spring also places the plantar fascia in a stretched position. Toe extension (upward movement) stretches the plantar fascia via the windlass mechanism. With the plantar fascia already stretched by the toe spring at the time the foot contacts the ground, its ability to lengthen farther to absorb forces is limited.

Increased strain on the fascia is not the only problem related to the restricted movement of the toes though. As mentioned earlier, deep to the plantar fascia are those foot intrinsic muscles with tendon attachments to the heel.

Stress Shielding

Stress-shielding is one theory on how connective tissue injuries happen. Stress-shielding suggests that the part of a tendon exposed to a low amount of strain is where problems develop. This contrasts sharply with the conventional theory that excessive strain is the cause of heel pain.

It’s possible that the restricted movement of the toes leads to degeneration of either the plantar fascia or the tendons of the intrinsic muscles because while wearing a shoe those structures are not put under enough tensile stress!

Not only do shoes restrict the ability of the toes to contact the ground, they also limit their ability to fully extend. When going barefoot extension of the big toe is somewhere around 48 degrees. The toe only extends to about 28 degrees when wearing a standard shoe with an orthotic. Because of this, the tissue on the underside of the foot is prevented from moving through a full range of motion. Its reasonable to think that keeping the foot in a fixed position for long periods of time in combination with some of the other factors mentioned could lead to issues.

Built-in Support

The foot arch not only supports the weight of the body, it also provides a space underneath the foot for nerves and blood vessels to pass. A structural arch is supported at its ends, not in the middle. Many shoes have a built-in arch support which takes up space under the arch. This could possible add compressive force near the attachment of the plantar fascia.

Inflexible Sole

Similar to the toe spring, a shoe with a rigid sole also alters the natural movements of the foot. All individuals are built differently. It’s very likely that the few spots where a shoe with a rigid sole bends aren’t matched perfectly with where the foot can bend and twist.

Raised Heel

Most traditional shoes typically are by at least 10mm. This might not directly affect the plantar fascia, but the raised heel does a couple of undesirable things.

• It places the ankle in a plantar flexed (downward pointed) position which can lead to adaptive shortening of the calf muscles. As noted early, calf inflexibility is suspected as major risk factor for developing plantar fasciitis.
• It alters the way a person distributes their weight on the foot.
• Lastly, the extra cushioning under the heel can cause a person to strike the ground harder with the heel! 

My History With Plantar Heel Pain

Around 15 years ago I developed plantar fasciitis in my left foot. A few months earlier I started wearing running shoes and inserts recommended to me by a specialty running store. The “expert” from the store said the shoes and insoles would help with my pronation. I wasn’t running much at the time. My BMI was in the normal range. But I was wearing the shoes for work, standing and walking around in them for eight or nine hours every day.

I tried stretching, ice, taping–all the common recommendations for plantar fasciitis–and none seemed to provide lasting relief. The pain lasted for several months.

What treatment finally worked?

Getting different shoes. A short time after I stopped wearing those particular shoes and insoles the pain went away. Coincidence? Maybe. At the very least that experience made me think that supportive shoes and orthotics are not a great treatment for plantar fasciitis.

Are shoes enough to cause plantar fasciitis by themselves? Maybe.

But I can see how combining a shoe that restricts motion and muscle activity in the foot with increased stress, especially compressive stress, could.

Sources:

1. Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med. 2006;36(7):585-611.
2. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain–plantar fasciitis: clinical practice guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008 Apr;38(4):A1-A18.
3. Orchard J. Plantar fasciitis. BMJ. 2012 Oct 10;345:e6603.

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Flat feet is a condition where the normal arches on the inside of the feet are low or missing. This condition gives the foot a flat appearance with the entire sole of the foot contacting the ground. Also called pes planus or fallen arches, flat feet may be present from birth or develop over time.

Exercise plays an important role in the health and functioning of our feet. The use of exercises for flat feet is not a new concept.

Over a century ago, programs of stretching and foot muscle strengthening proved to be remarkably successful. Recent studies have also shown that exercise can often improve the shape of the arch and reduce pain in people with flat feet.

Exercises for Flat Feet: Basic Routine

Below are four targeted exercises for flat feet designed to raise the height of the arch.

1. Short Foot

The short foot exercise targets the small muscles that support the arch on the inside of the foot.

The exercise is performed by sliding the front of the foot along the ground toward the heel without curling the toes.

• Sit in a chair with the foot on the floor and the toes pointed forward.
• Slide the front of the foot back along the floor toward the heel, keeping the toes flat on the floor.
• Hold the short foot position for 5-10 seconds.
• Relax and repeat 10 times on each foot.

It is important to keep the heel in a neutral position and not let the toes curl or lift off the ground. When done correctly, the ball of the foot and the heel stay in contact with the ground while the arch lifts.

2. Calf Stretch

The calf is a group of muscles in the back of the lower leg. Flat feet and overpronation can be the result of the foot compensating for limited ankle flexibility caused by tightness in the calf.

An example of a calf stretching exercise is the lunging straight leg calf stretch.

• Stand facing a wall with both hands on the wall for balance.
• Extend the leg to be stretched behind with the knee straight and toes pointed forward.
• Keeping the back leg straight and heel firmly on the ground, gently lean forward until feeling a stretch in the calf of the back leg.
• Hold the stretch for 30 to 60 seconds.
• Repeat 4 times on each leg.

To make the stretch effective, it’s important to not let the foot pronate or roll inward during the stretch.

3. Heel Raises

Heel raises strengthen several of the lower leg and foot muscles that support the arch. This exercise has many possible variations. Shown here is the double leg heel raise.

This exercise is done standing on both legs with the hands placed on a wall for balance.

• Stand with feet about shoulder width apart.
• Raise heels off the ground as high as possible keeping even pressure across the front of the foot.
• Hold for 1-2 seconds at the top of the movement then return slowly to the starting position.
• Do 2 sets of 10-20 repetitions.

4. Toe Yoga

The muscles that control the toes are frequently underused and often lack strength and control.

Working on toe dexterity helps develop the strength needed to stabilize the front of the foot against the ground.

• Lift the big toe up while pressing the other 4 toes down. Hold 5 seconds.
• Press the big toe down while lifting the other 4 toes up. Hold 5 seconds.
• Repeat the sequence 10 times on each foot.

Basic Routine Video

The video below demonstrates the exercises in this routine.

Flat Feet Correction Program

This basic routine is a sample of some of the exercises that helped me reverse flat feet and develop strong arches.

The full program that is available to members has a variety of exercises designed to target specific muscles and movements.

In addition to doing exercises, another part of this process was learning how to stand and walk correctly. A lot of my success, especially for fixing overpronation, came from changing the way that I walked.

My feet were extremely flat before I started training my arches. It took around 12 weeks to see improvement in my arches to the point that they were no longer considered flat.

The post Best Exercises for Flat Feet appeared first on Somastruct.

Several years ago I created this site as part of a project to see if I could fix my flat feet with exercise. After several months of training, I developed normal arches in my feet.

The following guide provides an overview of the flat foot correction process.

What are Flat Feet?

Before getting into the details of the program, let’s first review some basic information about flat feet.

Flat feet, also known as pes planus or fallen arches, is a condition characterized by the absence of an arch on the inside of the foot. 

The condition has been associated with genetics, early shoe-wearing in childhood, obesity, and several other factors.

There are two main types of flat feet: flexible and rigid.

Flexible Flat Feet

Flexible flat feet are the most common type. A flexible flat foot is a foot that has the ability to form an arch but the arch flattens when weight is put on the leg.

Rigid Flat Feet

A rigid flat foot cannot form an arch. This is usually the result of how the bones are shaped or formed in the foot. This condition is uncommon and is unlikely to change with exercise.

And even though many cases of flexible flat feet can improve (and research supports this), all individuals are different. So the program I followed may not be effective or even appropriate for some cases.

Fundamental Concepts for Correcting Flat Feet

Developing the foot arch is similar to learning a new skill. The process requires strengthening weak muscles and stretching tight muscles. But it also requires an ability to control the muscles and movements of the foot.

Two key concepts that are helpful for improving awareness of foot posture are the neutral heel position and the foot tripod.

Neutral Heel

People with flat feet often stand with their heels in an everted or angled out position. This position shifts weight to the inside of the foot when standing, putting pressure onto the arch on the inside of the foot.

The heel normally moves into this position when walking, but if it happens to a large degree this results in excessive pronation (rolling in) of the foot.

The neutral heel position is what I call the straight up and down position of the heel.

Being mindful of holding a neutral heel position can improve foot posture by strengthening the muscles that invert the heel (e.g. posterior tibialis muscle). Also, many of the flat foot correction exercises are performed with the heel in the neutral position.

Foot Tripod

The foot tripod is a useful way of thinking about how the bottom of the foot contacts the ground.

The three points of the tripod are the:

1. Center of the heel
2. Base of the little toe
3. Base of the big toe

A balance between these points gives the foot stability.

Learning to feel how these tripod points contact the ground is another key to making many of the exercises in the program effective.

Factors Contributing to Flat Feet

Learning how to fix flat feet requires an understanding of why the arches are collapsing. The factors contributing to flat feet can extend well beyond the foot.

Lack of Ankle Flexibility

A tight calf muscle or Achilles tendon can force the foot to collapse inward. This was evident in my case because whenever I went into a squat my already flat feet would collapse even farther.

A tight calf muscle restricts ankle dorsiflexion motion. Ankle dorsiflexion is the bending movement of the ankle that brings the top of the foot closer to the shin.

If the foot is on the ground, this motion happens when the lower leg travels over the foot.

Flexibility improves with regular stretching. An example of a stretching exercise for the calf is the standing wall stretch.

See also: Better Calf Stretching for Flat Feet

Foot Muscle Weakness

The arch is like a bridge and the muscles inside the foot tie the two ends of the bridge together. These muscles are part of the system that keeps the arch from flattening when weight is put on the foot.

Besides supporting the arch, the muscles inside the foot (known as the foot intrinsic muscles) stabilize the many joints of the foot. Doing so assists the larger muscles of the lower leg in raising the height of the arch.

These muscle also allow the toes to separate, or create splay.

For a person with flat feet, the muscles inside the foot may be weak or functioning poorly. One of the core exercises for flat feet to target these muscles is the short foot.

Short Foot Exercise for Arch Muscle Strengthening

1. Sit in a chair with the foot on the floor and the toes pointed forward.
2. Keeping the toes flat on the ground slide the front of the foot back along the floor toward the heel.
3. Hold the short foot position for 5-10 seconds.
4. Relax and repeat.

Repeat 10 times on each side.

The foot intrinsic muscles also control toe movement. So exercises for toe dexterity play a role in strengthening these muscles. An example would be spreading the toes apart.

Lower Leg Muscle Weakness

There are several muscles in the lower leg that cross the ankle joint to attach onto the foot. These muscles are larger and stronger than the muscles inside the foot.

The posterior tibialis is one of these muscles commonly suspected of being weak in people with flat feet. But all the lower leg muscles work together to give the foot stability. One of the best exercises for strengthening these muscles are heel raises.

Pelvic Tilt

Anterior pelvic tilt posture is when the front of the pelvis tilts forward creating a large curve in the lower back.

This posture is sometimes associated with changes in the angle of the joints in the hip, knee, and ankle. This change in alignment can place increased stress on the arch.

Getting into Better Alignment

To maintain a good arch shape, I found it necessary to improve my posture. A big part of this in my case was reducing anterior pelvic tilt and maintaining a more neutral position of the pelvis when standing and walking.

In addition to reducing pelvic tilt, bringing the whole system, from head to toe, into better alignment also made a noticeable difference in arch height and stability.

Some general cues I like for posture are:

• stand tall with ears over shoulders,
• keep a neutral pelvis, and
• maintain hips over ankles.

There are many exercises the can help with reducing anterior pelvic tilt and improving posture. I found these exercises were most effective when combined with the practice of being mindful of good posture.

Walking Mechanics

Walking is one of the best exercises for training the foot. Just think, if you take 5,000 steps a day — that’s 5,000 chances to work on arch strengthening.

On the other hand, if the feet are overpronating or rolling inward excessively with each step, then this can negatively affect the arch.

In order to permanently raise my arches, I needed to change the way I was walking to stop my feet from overpronating. Walking mechanics are very complex so it’s difficult to briefly describe all the changes. But I’ll mention three rules that helped a lot.

Three simple rules for walking:

• Keep feet pointed straight ahead (or close to it).
• Keep weight towards the outside edge of the foot.
• Walk with a springy step.

In combination with the exercises and improving posture, I was able to stop my arches from collapsing while walking. At first, I had to frequently think about it. But over time everything became automatic.

Hip Weakness

Some of the largest muscles in the body are around the hips. The hip muscles need strength to control the alignment of the leg.

A lack of hip strength can alter the alignment of the leg and increase pressure on the arch.

I don’t find isolated hip strengthening exercises very useful for improving the foot arches. What worked best for me were exercises that combined hip activity with arch strengthening.

Some examples would be balancing on one leg or squatting while trying to maintain an arch in the foot.

Forefoot Supinatus

Forefoot supinatus is the angling or inverted position of the bones in the front of the foot in relation to the heel. This causes the foot to roll inward (pronate) in order to bring the big toe side of the foot down to the ground.

Supinatus is thought to be a way the foot adapts over time to overpronating. I had this only on my right foot and it was hard to reverse. Working on pressing the big toe down while preventing the heel from everting was one way I went about correcting this.

Footwear and Orthotics

There is a lot of debate about what types of shoes are best for people who have flat feet or overpronate. In the past, I wore stability shoes and used arch support insoles.

Part of what inspired me to start working on my arches was the barefoot-running movement. So during this project, I started spending more time barefoot and began wearing thinner, more flexible shoes with less support.

There is some evidence that going with less support strengthens foot muscles and I believe this helped in my case.

Additional Notes

Before starting this project, I never paid much attention to the strength and flexibility of my feet. I felt dependent on shoes and thought my feet needed external support to function properly.

When I began working on this in 2012 there was very little information available on correcting flat feet. I wasn’t sure if building arches was even possible.

My goal was to perform around 10 minutes of foot exercises everyday. The most dramatic changes happened in the first few months.

I continued to adapt the program as I found new things to work on. It took close to a full year until I was completely satisfied with the results.

I’ve maintained this site over the years since a resource like wasn’t available when I started out on my journey. If you’re interested in learning more about the process, consider signing up for membership for a more in-depth look at the flat foot correction process.

The post How to Fix Flat Feet appeared first on Somastruct.

Rather, this is about my own experience of how flat feet affected my squatting.

Learning to squat the wrong way

When I started squatting with a barbell as a teenager, I did the exercise with my heels either on a wooden board or iron plates.

This was the way other people a the gym were doing them, though I didn’t know the reason why.  I learned later that squatting with the heels elevated allows you to to keep a more upright posture, and this is advantageous for certain lifts. In fact, weightlifting shoes are designed with large, elevated heels for this purpose.

But doing squats this way was hiding something. Squatting with the heels elevated allowed me to get around the fact that my ankles weren’t very flexible.

Effect on body mechanics

When doing a body weight squat barefoot, I could see that my already flat arches were collapsing even farther. Consequently, this was making my knees and hips rotate awkwardly.

My ankles lacked flexibility so my body was compensating. Some of the motion that should have come from my ankles was coming from my arches collapsing.

So when I tried squatting barefoot without something under the heels my form fell apart. I had difficulty keeping my chest up, my back rounded, and my knees collapsed inward.

Also, because my right ankle was less flexible than the left, and I pronated more on the right side, my whole body twisted as I lowered down into the squat.

I worried what might happen to my joints years down the road unless I made a change.

One goal I set for myself was to be able to do a full body weight squat without my arches collapsing.

Achieving a full body weight squat

The full squat refers to a position where the knees are flexed to the point that the back of the thighs rest against the calves. Young children instinctively go into a deep squat when they want to reach for something low, and often hold themselves in a stable squatting position to engage in play.

In some Asian cultures, squatting often replaces sitting. In fact, many people throughout history relied on a full squatting posture to perform work, eat meals, or rest.

Modern society has mostly eliminated the need to squat in our daily lives.

I suspect it was a lack of activity requiring ankle mobility along with habitual shoe wearing that contributed to my difficulty with barefoot squats.

This may also be the reason for the phenomenon called the Western squat, where the heels remain propped up in the air.

To improve my squatting mechanics, it was clear that I needed better ankle flexibility. And this can obviously be achieved with calf stretching exercises and ankle mobility drills.

However, having flexible flat feet creates an obstacle to improving ankle flexibility.

Just like how my arches collapsed when going into a squat, they would also collapse when doing calf stretching exercises!

So first I needed to learn how to create and hold a stable arch in the foot. This involved a lot of foot intrinsic muscle strengthening and motor control exercises, like learning how to stabilize the foot tripod.

I held off on doing squats with weights for a while, and focused on body weight squats, going down only as far as a I could while maintaining the foot arch.

Everyday activities like standing up and sitting down in chair even became opportunities to work on my squat mechanics.

It took several months until I had enough ankle flexibility and foot strength to do a proper full depth squat. You can read about the entire process I went through for building arches in this guide to fix flat feet.

When I returned to squatting with weights, I did it wearing minimalist shoes. Before, I would usually work out in traditional running shoes. These not only have a raised heel, but I find the cushioning in most athletic shoes makes it difficult to feel what my feet are doing.

Now, I’m able to keep a more upright posture with squats and I feel a better connection with the ground. Hopefully, I’ve reduced some of the wear and tear on my hips and knees as well.

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What is Morton’s Toe?

Morton’s toe is the name given to a condition where the second toe looks longer than the big toe.

I didn’t think much about my second toe until I started working to strengthen my arches. As I began learning more about flat feet, I came across a lot of information about Morton’s Toe and the various problems it is thought to cause.

What Causes Morton’s Toe?

The cause of the second toe appearing longer is not actually due to the length of the toes themselves, but rather a shorter first metatarsal bone inside the foot in relation to the second metatarsal.

This foot shape is fairly common, with estimates of up to around 25% of people sharing the trait.

History of Morton’s Toe

The name Morton’s Toe is attributed to Dr. Dudley Morton, and orthopaedic surgeon, who described the condition in an article published in 1927. He apparently argued that many foot problems can be traced back to the length of one’s toes.

Dr. Morton considered this a medical condition, particularly when the short first metatarsal was present alongside other findings, like a hypermobile first metatarsal segment (which I have also).

But well before Morton’s time, ancient artists saw the long second toe as an ideal form of beauty. A long second toe was commonly referred to as a ‘Greek foot’. This name comes from how often this foot shape appears in ancient Greek paintings and sculptures.

It can be found on Michelangelo’s David, the Venus de Milo, and the Statue of Liberty.

Is Morton’s Toe a Problem?

There are a lot of theories about the problems Morton’s toe might cause, but there is research to back up these ideas.

One study found that a long second metatarsal was a risk factor for tears in the plantar plate (a ligament that runs underneath the toes).

However, several resources state that having the first metatarsal shorter than the second is normal, and may be even preferred, from a biomechanical standpoint. It’s thought that the parabola shape formed by the ends of the metatarsal bones as a whole allows provides balance and stability, and allows for optimal functioning of the big toe.

Going back to the question of whether Morton’s toe contributed to my flat feet and pronation issues — I tend to think it didn’t, but I can’t be completely sure.

It’s thought that a long second toe will take on more pressure than the big toe. My “lazy big toe” definitely contributed to my pronation issues. Getting my big toe to better engage the ground was an important part of stabilizing my arches.

I also noticed that if I didn’t work on maintaining a solid foot tripod, the second toe would drift toward the big toe — like it was trying to take over some of the work.

But I’m not sure the Morton’s toe was the reason for the poor functioning of the first toe. I say that because my feet were able to improve despite the long second toe.

It didn’t seem to impede my progress in fixing my arches. But there’s always the possibility that it was a factor in my arches not developing when I was young.

I imagine in extreme cases, where the length difference between the metatarsal bones is substantial, this may create issues. Or maybe it’s the way that this foot shape interacts with certain types of footwear that creates problems.

But, ultimately, I view my long second toe as a pretty normal anatomical variation.

I only take it into consideration during shoe fitting to make sure I size shoes to the length of the second toe instead of the big toe.

The post Morton’s Toe: A Long Second Toe appeared first on Somastruct.

To give you a brief summary of my story, I was able to build arches in my previously flat feet after several months with a program of stretches and strengthening exercises.

You’ll notice that the site deals almost exclusively with my experience and that I’m not promoting a universal cure for flat feet.

I certainly think it’s possible for many cases of flexible flat feet to improve with exercise, and there is research that supports this which I’ll get into later.

However, I limit the scope of this site mainly to my experience because every individual is different, with their own unique factors and circumstances to consider.

It wouldn’t be possible to recommend a program that would work in all cases.

With that being said, I share my experience to show what is possible and to provide quality information on this topic.

In this post I’m going to go over some of the available evidence and historical context on correcting flat feet with exercise.

What Evidence Is There That Flat Feet Can Be Corrected?

When I first started searching for exercises to improve my arches it was difficult to know what information to trust. Many sources that I assumed were reputable said that flat feet couldn’t change.

There were some blog posts and videos showing exercises to supposedly fix flat feet, but without much proof that what they were presenting actually worked.

Historical Treatment of Flat Feet

Some of the best information I’ve come across to date is from over 100 years ago. In the early part of the 20th century, the use of exercise to correct flat feet was apparently a common practice.

Dr. Royal Whitman, a prominent orthopedic surgeon of that time, is quoted as saying “flat-foot is an acquired weakness and is understood to be preventable and curable”.

In a book originally published in 1909, physician and sculptor Robert Tait McKenzie wrote about the treatment of flat feet with exercise.¹ He included before and after pictures of footprints showing the improvement from following an exercise program.

The exercises in the book are similar to some of the exercises I used in my program — like calf stretching, heel raises, and walking on the outside edges of the feet.

He wrote that exercises were often combined with the use of supports, like metal plates or bandages, but emphasized that these should only be used temporarily.

Here is another set of comparison footprints from McKenzie’s book:

I didn’t become aware of McKenzie’s work until after I started this site, but we had similar thoughts about using footprints to measure changes in the arch. Here are my before and after footprints:

For anyone looking for more information on the historical view of flat feet, this excellent essay delves into how flat feet became seen as a societal problem and the development of flat foot camps used to to improve soldiers’ feet during the First World War.

Recent Evidence

During the second half of the 20th century, there doesn’t seem to be much attention paid to exercises for flat feet. It’s as if some of the lessons from history were forgotten.

At the time I started this project, the only study I found was from 1987, showing that the shape of the arch can be improved by increasing barefoot activity.²

However, in the last few years, several new studies have been published showing that foot strengthening exercises can improve the arch.^3,4,5,6,7

One thing to note about these studies is that they are usually done with young, healthy adults and exclude people with foot problems or injuries.

And even then, the amount of improvement varies among the participants.

However, studies are not necessarily designed to produce the best outcome. And typically a study will only look at the effects of one or two exercises.

What worked best for me was a comprehensive program of stretching, strengthening, and being mindful of the way I stood and walked.

Some Exceptions

It’s important to note that when I refer to correcting flat feet, I’m only talking about the flexible type that I had. There are many conditions or injuries that alter the normal anatomy and function of the foot that make it unlikely for the arch shape to change.

One example would be a rigid flat foot which is often the result of how the bones are shaped or formed in the foot.

These differences don’t necessarily mean that the foot can’t function well, only that a lot of this information would not apply in those situations.

Current State of Information

Today, there seems to be quite a few articles and videos claiming to have the solution to flat feet. The quality of the information in these sources varies.

Obviously, there is no one solution that will work in every case, and there are many different types of flat feet.

I tend to be a skeptical person by nature, and that’s what led me to start questioning the common belief that my flat feet were a permanent condition.

It took me a while to realize I could improve my aches partly because of the widely promoted notion that feet need support to function properly.

So with this site I’m committed to providing quality information on the topic.

I can show what worked well for me but can’t say for certain what results anyone else can expect from the same program.

The Takeaway

The use of exercises to correct flat feet is a practice that goes back at least a century. Recent research has shown that exercises are effective at improving the arches in some people with flexible flat feet who are otherwise without foot problems or injuries.

Since every individual is different, there cannot be a one-size-fits-all solution. The best approach is likely one that is tailored to meet each person’s unique needs.

The post Can Anyone with Flat Feet Improve Their Arches? appeared first on Somastruct.

There is good evidence that what happens at the level of the foot affects segments higher up in the body — like the knees, hips, and pelvis. I’ve even seen it suggested that the effects extend all the way to the head.

How the Effects of Flat Feet Effects Extend Above the Foot

Studies show that when the foot pronates (collapses in) the lower leg rotates inward. This then causes the thigh and hip to turn inward.

Going up another segment, this inward rotation of the leg causes the front of the pelvis to lower. This forward rotation of the pelvis is known as anterior pelvic tilt.

Anterior pelvic tilt is typically associated with an increased curvature of the low back.

So because of this relationship between the separate areas of the body an argument can be made for how flat feet could contribute to an issue like back pain.

Even though the potential is there for a connection between flat feet and problems in other areas, the jury is still out on if this actually happens. I haven’t seen a lot of research establishing a clear link between flat feet and injuries or pain in other areas.

There is some evidence of an association between flat feet and knee pain and arthritis, although the research doesn’t show if this is a cause and effect relationship.

How This Relates to Fixing Flat Feet

In my case, aside from temporary issues with plantar fasciitis and pain on the tops of the feet, my flat feet never really hurt.

As I got into my thirties, I became somewhat concerned that my weak arches and overpronation could lead to ankle or tendon problems.

But what really concerned me was the effect all of this was having on the joints higher up. It was clear that the way my arches collapsed was having an impact on my knees and hips.

It was during the process of learning how to strengthen my arches that this concept of how the segments of the body link together became very useful.

Heel position is usually a good indicator for how much the foot is pronating or rolling inward. So I started training myself to get into and maintain a neutral heel position.

Initially, I was thinking only in terms of fixing the problem from the ground up. Then I discovered that I could get a greater effect by also paying attention to the segments higher up.

So in standing I worked on reducing anterior pelvic tilt. For walking, I worked on controlling the position of the pelvis and hips.

The exercises for flat feet that I worked on helped with improving the strength of the muscles that support the arch and my flexibility. But I don’t think I would have seen the same amount of progress if I only worked on those things in isolation. It was this focus on the body as a whole that helped me get the results I wanted.

The post Effects of Flat Feet on the Body appeared first on Somastruct.

I thought it would be interesting to remake the video to show how things have changed since then. So in the video below, I combined the old and the updated clips of me doing the short foot exercise.

A few things stand out when watching these clips. First is that the base of the big toe lifts off the ground during the first short foot attempt. I do a better job keeping the big toe down on the second attempt, but I remember how difficult that was to do back then.

Keeping the ball of the foot on the ground was a key component of many of the exercises I worked on to correct my flat feet.

Another thing that stands out is how flat my foot was before. I’m always a little shocked when I look at old photos or videos from when I started this project.

But the most interesting thing to me is the comparison of the starting and end positions of the short foot exercise.

When making a collage of the before and after screenshots, I noticed the end position from before looks almost the same as the starting position now.

When I started training for my arches, seeing that I could form an arch in my foot with the short foot exercise gave me hope that my feet could improve. Now, even when I try to collapse my arches, I can’t get them to look like they did in the starting picture.

The post My Before and After Progress with the Short Foot Exercise appeared first on Somastruct.

In this post, I’m going to go over some tips on stretching these muscles.

Tight Calf Muscles Limit Ankle Dorsiflexion

Ankle dorsiflexion is the motion that brings the top of the foot closer to the shin. This motion is also seen whenever the knee travels over the foot when the foot is on the ground. Between 5 and 10 degrees of doriflexion is needed for normal walking.

When this motion is limited the body can compensate by flattening the arch. Improving ankle flexibility was one of the keys to fixing my flat feet. I needed to improve my ankle flexibility to lessen the forces causing the foot to pronate and collapse.

But because my feet were so used to pronating and going flat, there were a few adjustments I needed to make in the way I performed calf stretching.

Key Points for Better Calf Stretching

There are many different exercises for calf stretching. The one pictured here is called the standing wall stretch or runner’s stretch.

Stretching involves placing the target muscle or muscles into a lengthened position and holding for some length of time. The key ingredient here is keeping the muscles under tension.

For someone with flexible flat feet, it can be difficult to keep the calf muscles under tension because of the compensations mentioned earlier.

Two important points for making calf stretching effective are:

1. keeping the heel in a neutral position, and
2. keeping the heel pressed down on the ground.

Keeping a Neutral Heel

It’s common for the foot to pronate during calf stretching for people with flat feet. This puts the heel in an everted position. One study found that having people stretch while standing on an orthotic made the stretch more effective because it kept the heel in a more neutral position.¹

A similar effect can be achieved by placing a rolled up sock underneath the arch of the foot.

For me, I didn’t find it necessary to use anything to hold my heel in a neutral position. Instead, I focused on keeping weight toward the outside edge of the foot and stabilize the arch by maintaining a good foot tripod position. 

Performing the stretch while trying to hold the heel in neutral also had the benefit of training the foot to hold an arch.

Don’t Let the Heel Lift Up

The second key point, keeping the heel pressed down, is fairly straight-forward. I find there is a tendency for the heel to lift up while doing calf stretches. This makes it seem like you’re going farther with the stretch but really it’s just taking tension off of the muscles.

To prevent this, I like to focus on pressing the heel into the floor during the stretch.

There is another point I’d like to make about this though, and that pertains to stretching with shoes. I did almost all the stretching in my program barefoot. The main reason I stretched without shoes is that I wanted to be able to see if I was holding a good foot position.

But an equally important reason is that most shoes have a raised heel. This includes many athletic and running shoes. As you can see from the picture, the elevated heel of the shoes lifts the back of the foot up higher than the front of the foot.

This is opposite the direction needed to stretch the calf muscles and consequently makes it harder to get to a position where there is tension on the calf muscles.

The post Better Calf Stretching for Flat Feet appeared first on Somastruct.