March 26, 2025 • 18 mins
Your feet are the foundation of your movement, yet they're often the most neglected part of athletic training. In this deep dive into foot and ankle mechanics, we uncover how seemingly small issues in foot function can create ripple effects throughout your entire body.
At the heart of many athletic injuries lies a surprisingly common problem: limited ankle dorsiflexion. This restriction forces your body to find creative ways to compensate during squats, running, and everyday movements. The result? A cascade of compensations that can manifest as pain anywhere from your ankle to your lower back.
We explore the critical differences between pronated feet (those that collapse inward with flat arches) and supinated feet (rigid feet with high arches). Each presents unique challenges and requires specific approaches. For pronated feet, we discuss how foot arch collapse leads to lateral column compression syndrome and potential bunion development. With supinated feet, we examine why big toe mobility becomes crucial and how its restriction can lead to stress fractures in runners.
The most eye-opening insight might be that the site of your pain is rarely the actual problem—it's usually just the area that's being forced to overcompensate the most. This explains why treating only where it hurts often provides only temporary relief. By understanding the interconnected nature of the kinetic chain, from hip function down to toe mechanics, we can address the true sources of dysfunction rather than just chasing symptoms.
Whether you're battling persistent ankle pain, developing bunions, or noticing uneven wear on your running shoes, this discussion provides practical insights that could change your approach to movement and potentially save you from unnecessary surgery. Give it a listen and discover what your feet have been trying to tell you all along.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
So the foot and ankle commonthing we see active individuals
with issues right, pain anddysfunction in the foot and
(00:21):
ankle, and I've talked with alot of experts on this and
collaborated with people andit's an enjoyable thing to help
people get better and I enjoyworking on the ankle with people
and the foot.
It's a cool joint region ofjoints that we can work on to
(00:41):
improve their functionality anddecrease pain.
A little bit of insights on theankle, all right.
So the number one thing that wefind with active individuals is
just lacking pure ankledorsiflexion, range of motion,
all right.
Ankle dorsiflexion is when youbend your toes up towards the
ceiling, right, if you'restanding and you lift your toes
(01:02):
up to the sky.
Bending your ankle backwards inthat position is called
dorsiflexion.
When somebody points their toesdown like hitting a gas pedal,
that direction is calledplantarflexion, plantar being
like the bottom of your foot,but ankle dorsiflexion is one of
the most common.
A lack thereof of ankledorsiflexion, pure range of
motion is one of the most commonthings that we find in people
(01:25):
that are battling ankle issues,knee issues, hip issues and
relationship to back issues.
We just can't leave thatneglected to look at, even with
back pain, hip pain, knee pain,whatever for functional activity
like squats and lunges and stepups and running and stuff, or
even the normal gait pattern.
The reason is because upstreamand downstream of the kinetic
chain there are influences fromthe foot and ankle.
(01:48):
As it relates to your back,things will compensate naturally
above, upstream in the kineticchain and just overcompensate
for because of impairedmechanics and lacking range of
motion, lacking stability,whatever.
And that's where the puzzlepiece comes in for us.
It's like what's really theproblem that we need to work on?
And ankle dorsiflexion is asuper common one.
(02:08):
All right, the talocrural jointis the talus sitting over top
of the calcaneus.
Sorry, the talocrural joint isthe talus bone sitting in the
ankle mortis, which is thedistal part of the tibia, the
shin bone and the fibula, justlateral, and the talus sits in
there and it moves backwards andforwards, it rolls forwards and
(02:28):
backwards and if it doesn'troll backwards or shift
posteriorly enough, then theankle dorsiflexion range of
motion is going to be a littlebit impaired and limited.
So with that, if somebody doessquats or lunges or step ups and
running and walking, if thepure ankle dorsiflexion is
limited, then the foot and ankleis going to move a different
(02:49):
direction to make up for that,what we would call a
compensation, and usually theankle that we find will roll
into eversion.
Eversion is when the foot rollsoutwards.
Inversion is when the anklerolls inwards.
So an inversion ankle sprain isone of the most common ankle
sprain injuries for athletes.
(03:09):
Just like if they rolled theirankle, they're usually rolling
their ankle into inversion.
Rolling into eversion is theopposite direction, where the
inside of the ankle is gettingstretched and the outside of the
ankle is getting compressed orapproximated All right, so
people will roll.
Athletes, active people willroll into eversion to
overcompensate for a lack ofpure ankle dorsiflexion.
(03:30):
All right, so the ankles willkind of roll outwards and with
that we have foot arch collapse.
So the arch of the foot is anecessary thing for foot
stability.
Against what most people mightthink, we can improve functional
arch stability.
Some people naturally have flatfeet and some people have
(03:53):
naturally huge arches, right.
Of course there's a ceilingwith how much we can influence
the arch capacity in eitherdirection.
But we can definitely stillwork on functional arch
stability with movement control,with movement activities let's
just say Running, walking,squats and lunges and stuff like
that.
If somebody's just slamming intoeversion and their foot arch
(04:14):
collapse, longitudinal foot archcollapse, that sets the stage
for things to compensate again,right.
So we see people that come invery frequently that are
demonstrating a lack of ankledorsiflexion.
They roll into eversion.
When they bend their anklebackwards, like when they
descend in a squat, their footarch collapses and they also
(04:37):
will like roll their feetoutwards into external rotation.
Their toes will point out asthey go down and then they'll
stand back up again and the feetwill roll in.
That external rotation is aclassic compensation pattern for
a lack of pure ankledorsiflexion and usually what
accommodates that with that iseversion and foot arch collapse.
So somebody could have amoderate arch that just
(05:02):
collapses when they go intosquats and running and walking
and stuff.
That would be a stability issue.
So what's the course of actionthen to treat that?
Stability training, anklestability and foot arch
stability?
Part of that is the footintrinsics, the plantar
intrinsic muscles and some ofthe arch stability muscles the
(05:22):
posterior tibialis is one of themain ones that influences the
foot arch.
All right, the posteriortibialis is one of the main ones
that influences the foot arch.
All right, the posteriortibialis is a muscle that comes
off of the shin bone, the tibia.
All right, the back part,underneath your calf muscle,
deep to the calf, sits theposterior tib, the posterior
tibialis muscle, and it runsdown the back of the shin
towards the inside of the ankleand it inserts on the bottom of
(05:44):
the shin towards the inside ofthe ankle and it inserts on the
bottom of the foot underneaththe arch.
And the navicular bone is atarsal bone that has a big
influence with that, all right.
So if we're checking out likenavicular drop foot,
longitudinal foot arch collapse,rolling into eversion and
rolling into external rotation,that's a classic pronation sign
of ankle foot pronation wherestability plays a huge role with
(06:07):
that.
But if they're lacking anklemobility and a pure ankle
dorsiflexion mobility and thenfoot ankle stability exercises
(06:29):
to maintain a better foot ankleposture and position, with
functional activity, things thatthen will progress and
translate into running, sportsagility, plyometrics, stuff like
that, and, as they naturallyare enabled to have maybe more
of a foot arch, a stable footarch and stable foot and ankle,
(06:51):
it'll translate better tomaintaining that, better
stability with those functionalactivities like sports related
stuff.
This is stuff we work on withpeople very often.
All right, conversely to that,all right, oh, one more thing
about All right.
Conversely to that, all right,oh, one more thing about sorry.
What that also does is this isa common thing People will have
anterior lateral ankle pain.
(07:11):
Anterior means forward, thefront and lateral means the
outside.
So the outside front part ofthe ankle will get injured, uh,
impinged.
Impingement, we would call thatlateral column compression
syndrome.
All right, so the outside ofthe ankle and foot and ankle
tarsal bones will get compressedand approximated in a butt into
each other.
If somebody consistently rollsinto E version under load with
(07:35):
like squats and lunges and stepups and jumps and stuff like
that and they're just slammingtheir arches collapsing, rolling
into external rotation, andthey're just slamming their
arches collapsing, rolling intoexternal rotation, rolling into
eversion, the outsidearticulations, joints and the
tarsal bones are gettingapproximated with force, right,
they're getting abutted intoconsistently.
We would call that lateralcolumn compression syndrome and
(07:56):
that's ultimately a pure ankledorsiflexion mobility problem
and a foot and ankle stabilityarch problem.
That's what we can work.
So, with that being said, thatcould be problem.
We could solve that.
There's a course of action towork on those things and that's
what we do.
We just have to figure out isthat really your problem?
What is like the actual problem?
Where are you compensating andwhat things do we need to work
(08:17):
on Right?
That's part of theinvestigation and evaluation
process.
Conversely with that, let's saysomebody has a very high arch
and a stiff foot.
These feet are usually morestiff right.
They're stiffer, they're morerigid and they have a super high
foot arch.
Pes cavus is what that would becalled.
Pes planus.
Is arch collapse or a flat arch, a flat foot, pes cavus, super
(08:41):
high arch, very stiff.
We would call that a supinatedfoot, whereas the other one
would be a pronated foot.
This supinated foot hasdifferent compensation patterns
still lacking.
Pure ankle dorsiflexion, allright, but a big component with
this one too, I think a key isthe big toe.
(09:02):
The big toe is more rigid aswell and it doesn't bend
backwards into extension, whichwould be like the same direction
as dorsiflexion.
It doesn't bend backwards intoextension as well.
It's more rigid.
So we can't neglect working onthe big toe extension mobility
the hallux is what it's called.
So hallux extension.
(09:34):
Mobility is a big issue.
With very stiff and rigidsupinated feet, toe doesn't
extend backwards well enough.
They're going to roll laterallyand they're going to invert a
little bit as they advance withthe running gait pattern or
walking gait.
As they advance into toe offand terminal stance of their
gait pattern, they're going toroll laterally over their foot.
(09:56):
So that's a classic sign orindication and a thing that we
find with super high arch,supinated feet and anterior
impingement is very commonsymptom and big toe tightness is
also a big common symptom.
And considering that, let's sayyou have an athlete that runs a
(10:18):
lot and they have a high archthat's very stiff, lacking pure
ankle dorsiflexion, bendingbackwards and their big toe,
their hallux extension mobilityis limited and poor as well and
they're going to roll on theoutside of their ankle and roll
the outside of their foot and ifthey're a runner, they're
putting undue consistent stressand load and pressure on the
outside of their foot.
(10:40):
One of the most common sites fora stress fracture is the fifth
metacarpal.
The fifth metacarpal will getit's not a big, heavy, thick
bone, right, but it gets a lotof pressure and stress from the
consistent pressure rolling intoinversion or on the outside of
your foot, the lateral part ofthe foot, with every step and
every toe off and terminalstance of the running gait
(11:03):
pattern, all right, so they'rerunning on the outside of their
foot.
It's an indication.
Check that out.
If you look at your shoes andwhere the sole is worn out and
it shows kind of like within,where you're putting a lot of
pressure and stress through yourfeet, is where the rubber on
your shoes are getting worn out.
So it's just an indication tocheck it out.
Like oh like, the outside of myfoot of my shoe is definitely
(11:24):
worn out whereas the insideisn't.
Or the inside of my foot isworn out and the outside isn't,
maybe pronated versus supinated.
It just indicates maybe some ofthe limited movement
dysfunctions and impairmentsthat are setting them up for
failure at some point where it'sgoing to start hurting.
And then they come see us andthey're like that doesn't make
any sense.
I've been an athlete my wholelife.
(11:45):
All of a sudden now I didn't doanything different, but my
foot's been killing me.
We have to investigate what istheir problem and figure out the
best course of action to treatit.
So once we have a betterunderstanding of what's going on
and why we can have a bettertreatment process and direction
of how we can fix the problemright and ultimately that over
(12:07):
enough time leads to success andimprovements of symptoms and
maybe even learning some newthings, where their functional
performance is going to bebetter than it was prior to the
injury because they learned somestuff and were working on some
things.
The other thing we can'tneglect is there's a strong
correlation with hip and glutestrength and stability as it
(12:31):
relates to ankle issues down thechain.
So again, like we wouldn't bedoing our job if we didn't
investigate upstream some otherstuff that contributes to the
kinetic chain down to the foot,with functional things like
sports, agility, plyometrics,running, exercise, stuff like
that.
And there seems to be a strongcorrelation with hip mobility
(12:55):
issues or hip and glute strengthstability issues that aren't
stabilizing approximatelyApproximately means like up
towards the center, up towardsthe attachment site, as best
they could.
So the foot and ankle is goingto compensate again.
So there's multiple things kindof contributing to the foot and
(13:15):
ankle setting up for failure.
So wherever somebody has pain,the site of pain is usually the
area that's overcompensating themost.
We would call that the morehypermobile area or the area
that's just overcompensating themost.
All right, one of the two.
So, that being said, thepainful site usually isn't the
(13:36):
problem, it's usually the victimand we have to figure out why
is it overcompensating and whatare the things that aren't
helping enough.
So we definitely need to fixthe mobility impairments and
dysfunctions and then also workon the joint strength, stability
, muscle recruitment strategiesthat are setting up for failure
(13:58):
and making something else thepainful site chronically
overcompensate.
So, with that lens, that's howwe usually solve problems the
best and get the long lastingresults.
For people as in like yeah,I've been doing my exercise,
I've been doing stuff and ithasn't hurt for a long, for many
, many months, for a year I'vebeen, I haven't ran so much as
best as I have right.
(14:19):
That's amazing High five.
If we're able to actually solvethe underlying root cause of
the problem, we get better,longer lasting results.
And usually people that we seeare motivated to like get better
.
So that means they're going tobe more um compliant with like
doing these interventions ontheir own, versus just like one
and done when they come see usand never do it again and they
(14:40):
come see us again and that's it.
But usually people followthrough when they come see us.
Um, so it's just interestinglens, Like if we apply that lens
and that that's the diagnosticlens that we go through.
It's just more fulfilling forus because we get people better
and then people are able to getback to their functional life.
You know.
(15:02):
So with the foot and ankle,that's a very common thing.
Oh, one more thing I wanted tosay, so with I forgot to mention
this pronated feet.
We mentioned the big toe withsupinated feet, but with
pronated feet we would call thatsubtalar hypermobile and
they're more hypermobile, moreloose, less stable midfoot, like
(15:24):
their feet.
What is the big toes role inthat?
Usually people walk in anexternally rotated position and
they push off of the medial partof their foot, whereas the
supinated foot, they're rollingon the outside of their foot.
Well, pronated feet, they andthe hypermobile foot, they roll
on the inside of their foot,which consistently pushes the
big toe in a lateral direction,and that's over a long period of
(15:48):
time.
What's been found to suggest?
Suggested that that canincrease the likelihood of risk
of hallux valgus, which is thebig toe, when it points outwards
right and you get a bunion onthe inside of the big toe
towards the middle of the foot.
So like a medial hallux bunionfrom repetitive pronated foot
(16:10):
postures and functional movementpatterns through a pronated
foot rolling on the inside ofthe foot and pushing off from
the medial side of the big toe,chronically pushes the big toe,
the hallux, in a lateraldirection and that, over time,
has been found to increaselikelihood risk of hallux valgus
and the bunion and thatdeformity I just forgot to
(16:31):
mention that but in thecorrelation with the big toe, in
contrast to the supinated foot.
So, anyway, that's stuff thatwe we'd like to educate people
on and bring up, bring to lightso that, um, they can buy in and
they can like, they could like,dive in and be like.
I believe you, I trust you,let's do this together and I'm
going to do everything you say,um, and the education department
(16:53):
component is very important, um, and then, uh, with a clear,
let's do this together and I'mgoing to do everything you say,
an education component is veryimportant, and then, with a
clear diagnosis, we can make abetter judgment call on what
course of action do we take toactually solve the underlying
root cause of the problem.
So, with all that being said,to solving these problems,
unless there's a majorstructural issue, these problems
(17:17):
.
Unless there's a majorstructural issue, I didn't
mention surgery.
I don't do surgery, we don't dosurgery.
But we've had great successwith people where they maybe can
avoid surgery.
That's amazing, right.
Would you want to avoid?
Do you want to have surgery?
I would hope people say no,right, but sometimes you need it
.
I don't hate surgery and unlessthere's some kind of systemic
issue or a severe structuralabnormality that needs to be
(17:37):
resolved structurally, thensurgery isn't going to fix the
problems we just described hipstability, recruitment, foot
arch stability, recruitment,foot intrinsic strength,
posterior tibialis activationstrength, big toe extension,
(17:59):
mobility and just dynamic hip,knee, ankle, foot stability as
it relates to plyometrics andrunning and exercise and stuff.
Surgery isn't going to fix that.
It only fixes structuralabnormalities.
It's just something to consider.
I don't hate surgery.
There's a time and place for it, for sure.
I'm just suggesting there mightbe a different path and please
call us if you have anyquestions, because we can shed
(18:20):
light on this stuff and maybechange a whole life trajectory
for somebody that's beenbattling stuff like that.
So don't hesitate to reach outand I'm always open to questions
, comments, concerns andconflicting opinions.
If you want to be a guest.
You know somebody might be agood guest.
Please reach out we.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
So the foot and ankle commonthing we see active individuals
with issues right, pain anddysfunction in the foot and
(00:21):
ankle, and I've talked with alot of experts on this and
collaborated with people andit's an enjoyable thing to help
people get better and I enjoyworking on the ankle with people
and the foot.
It's a cool joint region ofjoints that we can work on to
(00:41):
improve their functionality anddecrease pain.
A little bit of insights on theankle, all right.
So the number one thing that wefind with active individuals is
just lacking pure ankledorsiflexion, range of motion,
all right.
Ankle dorsiflexion is when youbend your toes up towards the
ceiling, right, if you'restanding and you lift your toes
(01:02):
up to the sky.
Bending your ankle backwards inthat position is called
dorsiflexion.
When somebody points their toesdown like hitting a gas pedal,
that direction is calledplantarflexion, plantar being
like the bottom of your foot,but ankle dorsiflexion is one of
the most common.
A lack thereof of ankledorsiflexion, pure range of
motion is one of the most commonthings that we find in people
(01:25):
that are battling ankle issues,knee issues, hip issues and
relationship to back issues.
We just can't leave thatneglected to look at, even with
back pain, hip pain, knee pain,whatever for functional activity
like squats and lunges and stepups and running and stuff, or
even the normal gait pattern.
The reason is because upstreamand downstream of the kinetic
chain there are influences fromthe foot and ankle.
(01:48):
As it relates to your back,things will compensate naturally
above, upstream in the kineticchain and just overcompensate
for because of impairedmechanics and lacking range of
motion, lacking stability,whatever.
And that's where the puzzlepiece comes in for us.
It's like what's really theproblem that we need to work on?
And ankle dorsiflexion is asuper common one.
(02:08):
All right, the talocrural jointis the talus sitting over top
of the calcaneus.
Sorry, the talocrural joint isthe talus bone sitting in the
ankle mortis, which is thedistal part of the tibia, the
shin bone and the fibula, justlateral, and the talus sits in
there and it moves backwards andforwards, it rolls forwards and
(02:28):
backwards and if it doesn'troll backwards or shift
posteriorly enough, then theankle dorsiflexion range of
motion is going to be a littlebit impaired and limited.
So with that, if somebody doessquats or lunges or step ups and
running and walking, if thepure ankle dorsiflexion is
limited, then the foot and ankleis going to move a different
(02:49):
direction to make up for that,what we would call a
compensation, and usually theankle that we find will roll
into eversion.
Eversion is when the foot rollsoutwards.
Inversion is when the anklerolls inwards.
So an inversion ankle sprain isone of the most common ankle
sprain injuries for athletes.
(03:09):
Just like if they rolled theirankle, they're usually rolling
their ankle into inversion.
Rolling into eversion is theopposite direction, where the
inside of the ankle is gettingstretched and the outside of the
ankle is getting compressed orapproximated All right, so
people will roll.
Athletes, active people willroll into eversion to
overcompensate for a lack ofpure ankle dorsiflexion.
(03:30):
All right, so the ankles willkind of roll outwards and with
that we have foot arch collapse.
So the arch of the foot is anecessary thing for foot
stability.
Against what most people mightthink, we can improve functional
arch stability.
Some people naturally have flatfeet and some people have
(03:53):
naturally huge arches, right.
Of course there's a ceilingwith how much we can influence
the arch capacity in eitherdirection.
But we can definitely stillwork on functional arch
stability with movement control,with movement activities let's
just say Running, walking,squats and lunges and stuff like
that.
If somebody's just slamming intoeversion and their foot arch
(04:14):
collapse, longitudinal foot archcollapse, that sets the stage
for things to compensate again,right.
So we see people that come invery frequently that are
demonstrating a lack of ankledorsiflexion.
They roll into eversion.
When they bend their anklebackwards, like when they
descend in a squat, their footarch collapses and they also
(04:37):
will like roll their feetoutwards into external rotation.
Their toes will point out asthey go down and then they'll
stand back up again and the feetwill roll in.
That external rotation is aclassic compensation pattern for
a lack of pure ankledorsiflexion and usually what
accommodates that with that iseversion and foot arch collapse.
So somebody could have amoderate arch that just
(05:02):
collapses when they go intosquats and running and walking
and stuff.
That would be a stability issue.
So what's the course of actionthen to treat that?
Stability training, anklestability and foot arch
stability?
Part of that is the footintrinsics, the plantar
intrinsic muscles and some ofthe arch stability muscles the
(05:22):
posterior tibialis is one of themain ones that influences the
foot arch.
All right, the posteriortibialis is one of the main ones
that influences the foot arch.
All right, the posteriortibialis is a muscle that comes
off of the shin bone, the tibia.
All right, the back part,underneath your calf muscle,
deep to the calf, sits theposterior tib, the posterior
tibialis muscle, and it runsdown the back of the shin
towards the inside of the ankleand it inserts on the bottom of
(05:44):
the shin towards the inside ofthe ankle and it inserts on the
bottom of the foot underneaththe arch.
And the navicular bone is atarsal bone that has a big
influence with that, all right.
So if we're checking out likenavicular drop foot,
longitudinal foot arch collapse,rolling into eversion and
rolling into external rotation,that's a classic pronation sign
of ankle foot pronation wherestability plays a huge role with
(06:07):
that.
But if they're lacking anklemobility and a pure ankle
dorsiflexion mobility and thenfoot ankle stability exercises
(06:29):
to maintain a better foot ankleposture and position, with
functional activity, things thatthen will progress and
translate into running, sportsagility, plyometrics, stuff like
that, and, as they naturallyare enabled to have maybe more
of a foot arch, a stable footarch and stable foot and ankle,
(06:51):
it'll translate better tomaintaining that, better
stability with those functionalactivities like sports related
stuff.
This is stuff we work on withpeople very often.
All right, conversely to that,all right, oh, one more thing
about All right.
Conversely to that, all right,oh, one more thing about sorry.
What that also does is this isa common thing People will have
anterior lateral ankle pain.
(07:11):
Anterior means forward, thefront and lateral means the
outside.
So the outside front part ofthe ankle will get injured, uh,
impinged.
Impingement, we would call thatlateral column compression
syndrome.
All right, so the outside ofthe ankle and foot and ankle
tarsal bones will get compressedand approximated in a butt into
each other.
If somebody consistently rollsinto E version under load with
(07:35):
like squats and lunges and stepups and jumps and stuff like
that and they're just slammingtheir arches collapsing, rolling
into external rotation, andthey're just slamming their
arches collapsing, rolling intoexternal rotation, rolling into
eversion, the outsidearticulations, joints and the
tarsal bones are gettingapproximated with force, right,
they're getting abutted intoconsistently.
We would call that lateralcolumn compression syndrome and
(07:56):
that's ultimately a pure ankledorsiflexion mobility problem
and a foot and ankle stabilityarch problem.
That's what we can work.
So, with that being said, thatcould be problem.
We could solve that.
There's a course of action towork on those things and that's
what we do.
We just have to figure out isthat really your problem?
What is like the actual problem?
Where are you compensating andwhat things do we need to work
(08:17):
on Right?
That's part of theinvestigation and evaluation
process.
Conversely with that, let's saysomebody has a very high arch
and a stiff foot.
These feet are usually morestiff right.
They're stiffer, they're morerigid and they have a super high
foot arch.
Pes cavus is what that would becalled.
Pes planus.
Is arch collapse or a flat arch, a flat foot, pes cavus, super
(08:41):
high arch, very stiff.
We would call that a supinatedfoot, whereas the other one
would be a pronated foot.
This supinated foot hasdifferent compensation patterns
still lacking.
Pure ankle dorsiflexion, allright, but a big component with
this one too, I think a key isthe big toe.
(09:02):
The big toe is more rigid aswell and it doesn't bend
backwards into extension, whichwould be like the same direction
as dorsiflexion.
It doesn't bend backwards intoextension as well.
It's more rigid.
So we can't neglect working onthe big toe extension mobility
the hallux is what it's called.
So hallux extension.
(09:34):
Mobility is a big issue.
With very stiff and rigidsupinated feet, toe doesn't
extend backwards well enough.
They're going to roll laterallyand they're going to invert a
little bit as they advance withthe running gait pattern or
walking gait.
As they advance into toe offand terminal stance of their
gait pattern, they're going toroll laterally over their foot.
(09:56):
So that's a classic sign orindication and a thing that we
find with super high arch,supinated feet and anterior
impingement is very commonsymptom and big toe tightness is
also a big common symptom.
And considering that, let's sayyou have an athlete that runs a
(10:18):
lot and they have a high archthat's very stiff, lacking pure
ankle dorsiflexion, bendingbackwards and their big toe,
their hallux extension mobilityis limited and poor as well and
they're going to roll on theoutside of their ankle and roll
the outside of their foot and ifthey're a runner, they're
putting undue consistent stressand load and pressure on the
outside of their foot.
(10:40):
One of the most common sites fora stress fracture is the fifth
metacarpal.
The fifth metacarpal will getit's not a big, heavy, thick
bone, right, but it gets a lotof pressure and stress from the
consistent pressure rolling intoinversion or on the outside of
your foot, the lateral part ofthe foot, with every step and
every toe off and terminalstance of the running gait
(11:03):
pattern, all right, so they'rerunning on the outside of their
foot.
It's an indication.
Check that out.
If you look at your shoes andwhere the sole is worn out and
it shows kind of like within,where you're putting a lot of
pressure and stress through yourfeet, is where the rubber on
your shoes are getting worn out.
So it's just an indication tocheck it out.
Like oh like, the outside of myfoot of my shoe is definitely
(11:24):
worn out whereas the insideisn't.
Or the inside of my foot isworn out and the outside isn't,
maybe pronated versus supinated.
It just indicates maybe some ofthe limited movement
dysfunctions and impairmentsthat are setting them up for
failure at some point where it'sgoing to start hurting.
And then they come see us andthey're like that doesn't make
any sense.
I've been an athlete my wholelife.
(11:45):
All of a sudden now I didn't doanything different, but my
foot's been killing me.
We have to investigate what istheir problem and figure out the
best course of action to treatit.
So once we have a betterunderstanding of what's going on
and why we can have a bettertreatment process and direction
of how we can fix the problemright and ultimately that over
(12:07):
enough time leads to success andimprovements of symptoms and
maybe even learning some newthings, where their functional
performance is going to bebetter than it was prior to the
injury because they learned somestuff and were working on some
things.
The other thing we can'tneglect is there's a strong
correlation with hip and glutestrength and stability as it
(12:31):
relates to ankle issues down thechain.
So again, like we wouldn't bedoing our job if we didn't
investigate upstream some otherstuff that contributes to the
kinetic chain down to the foot,with functional things like
sports, agility, plyometrics,running, exercise, stuff like
that.
And there seems to be a strongcorrelation with hip mobility
(12:55):
issues or hip and glute strengthstability issues that aren't
stabilizing approximatelyApproximately means like up
towards the center, up towardsthe attachment site, as best
they could.
So the foot and ankle is goingto compensate again.
So there's multiple things kindof contributing to the foot and
(13:15):
ankle setting up for failure.
So wherever somebody has pain,the site of pain is usually the
area that's overcompensating themost.
We would call that the morehypermobile area or the area
that's just overcompensating themost.
All right, one of the two.
So, that being said, thepainful site usually isn't the
(13:36):
problem, it's usually the victimand we have to figure out why
is it overcompensating and whatare the things that aren't
helping enough.
So we definitely need to fixthe mobility impairments and
dysfunctions and then also workon the joint strength, stability
, muscle recruitment strategiesthat are setting up for failure
(13:58):
and making something else thepainful site chronically
overcompensate.
So, with that lens, that's howwe usually solve problems the
best and get the long lastingresults.
For people as in like yeah,I've been doing my exercise,
I've been doing stuff and ithasn't hurt for a long, for many
, many months, for a year I'vebeen, I haven't ran so much as
best as I have right.
(14:19):
That's amazing High five.
If we're able to actually solvethe underlying root cause of
the problem, we get better,longer lasting results.
And usually people that we seeare motivated to like get better
.
So that means they're going tobe more um compliant with like
doing these interventions ontheir own, versus just like one
and done when they come see usand never do it again and they
(14:40):
come see us again and that's it.
But usually people followthrough when they come see us.
Um, so it's just interestinglens, Like if we apply that lens
and that that's the diagnosticlens that we go through.
It's just more fulfilling forus because we get people better
and then people are able to getback to their functional life.
You know.
(15:02):
So with the foot and ankle,that's a very common thing.
Oh, one more thing I wanted tosay, so with I forgot to mention
this pronated feet.
We mentioned the big toe withsupinated feet, but with
pronated feet we would call thatsubtalar hypermobile and
they're more hypermobile, moreloose, less stable midfoot, like
(15:24):
their feet.
What is the big toes role inthat?
Usually people walk in anexternally rotated position and
they push off of the medial partof their foot, whereas the
supinated foot, they're rollingon the outside of their foot.
Well, pronated feet, they andthe hypermobile foot, they roll
on the inside of their foot,which consistently pushes the
big toe in a lateral direction,and that's over a long period of
(15:48):
time.
What's been found to suggest?
Suggested that that canincrease the likelihood of risk
of hallux valgus, which is thebig toe, when it points outwards
right and you get a bunion onthe inside of the big toe
towards the middle of the foot.
So like a medial hallux bunionfrom repetitive pronated foot
(16:10):
postures and functional movementpatterns through a pronated
foot rolling on the inside ofthe foot and pushing off from
the medial side of the big toe,chronically pushes the big toe,
the hallux, in a lateraldirection and that, over time,
has been found to increaselikelihood risk of hallux valgus
and the bunion and thatdeformity I just forgot to
(16:31):
mention that but in thecorrelation with the big toe, in
contrast to the supinated foot.
So, anyway, that's stuff thatwe we'd like to educate people
on and bring up, bring to lightso that, um, they can buy in and
they can like, they could like,dive in and be like.
I believe you, I trust you,let's do this together and I'm
going to do everything you say,um, and the education department
(16:53):
component is very important, um, and then, uh, with a clear,
let's do this together and I'mgoing to do everything you say,
an education component is veryimportant, and then, with a
clear diagnosis, we can make abetter judgment call on what
course of action do we take toactually solve the underlying
root cause of the problem.
So, with all that being said,to solving these problems,
unless there's a majorstructural issue, these problems
(17:17):
.
Unless there's a majorstructural issue, I didn't
mention surgery.
I don't do surgery, we don't dosurgery.
But we've had great successwith people where they maybe can
avoid surgery.
That's amazing, right.
Would you want to avoid?
Do you want to have surgery?
I would hope people say no,right, but sometimes you need it
.
I don't hate surgery and unlessthere's some kind of systemic
issue or a severe structuralabnormality that needs to be
(17:37):
resolved structurally, thensurgery isn't going to fix the
problems we just described hipstability, recruitment, foot
arch stability, recruitment,foot intrinsic strength,
posterior tibialis activationstrength, big toe extension,
(17:59):
mobility and just dynamic hip,knee, ankle, foot stability as
it relates to plyometrics andrunning and exercise and stuff.
Surgery isn't going to fix that.
It only fixes structuralabnormalities.
It's just something to consider.
I don't hate surgery.
There's a time and place for it, for sure.
I'm just suggesting there mightbe a different path and please
call us if you have anyquestions, because we can shed
(18:20):
light on this stuff and maybechange a whole life trajectory
for somebody that's beenbattling stuff like that.
So don't hesitate to reach outand I'm always open to questions
, comments, concerns andconflicting opinions.
If you want to be a guest.
You know somebody might be agood guest.
Please reach out we.
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