The foot is a complex structure with many articulations and multiple degrees of freedom that play an important role in static posture and dynamic activities. It is made up of 26 bones and 30 major synovial joints all very significant. During standing this is what provides our base of support. The average person takes between 10/15 thousand steps per day so what we put on our feet and how we take care of them are all very significant.
When we walk, the foot must be stable at foot strike and push off. However during mid support, the foot must become a mobile adaptor and attenuate the loads. It has the ability to store and release elastic energy with each foot strike. This is accomplished through the deformation of the arch and controlled by the intrinsic and extrinsic muscles (1).
When these key factors are not functioning properly, the foundation becomes unstable and maligned that leads to abnormal movements of the foot and perhaps other detrimental consequences further up the chain.
Over the years people have come to see me for various problems such as persistent knee pain when skiing and constant back pain when sitting at work. I used to feel that this should not be a reoccurring problem if they have had regular treatments and doing their specific knee and back exercises. Therefore I began to consider what the rest of the chain is doing when they are performing their meaningful task.
This is where I felt that ‘the old ankle injury’ that they sustained in their teens has come back to haunt them. Although they returned to sport quite quickly, the years of continual playing and running around on a unstable base has resulted in altered movement patterns elsewhere in the body. Hence the persistent pain in their knee and back.
A study by Anandacoomarasamy and Barnsley (2) reported that a significant proportion of patients with ankle sprains still had persistent problems for months and years post injury and emphasised the need for more functional testing in order to provide more information to the clinician.
Our feet are important as they are our stable base that has to absorb shock and then use this to push off again. Our ankles are torque convertors as is our hip, thorax, and neck. If one of the cogs on the wheel is broken or catching then this will have an impact up or down the chain; i.e. If our foot does not attenuate the shock as we walk then the hip, knee or spine will have to. This will lead to excess pressure and movements within those joints that could lead to further injury and pain.
What we need to do once we are out of the acute phase of injury is to ensure that our foot regains full mobility and strength so that it can function adequately. Bio mechanical factors and more functional assessment are necessary post foot injury in order to ensure that normal or near to normal function is regained.
I encourage the readers to be mindful of how you walk. So watch your STEP!
Josie Mitchell BSc (Hons), MSST, is a Sports Therapist specialising in the holistic approach to assessing your injury. She works with people from all walks for life and helps Release, Rebalance and Revive.
(1). "The foot core system: a new paradigm for understanding intrinsic foot muscle function”; O Mckeon et al Br J Sports Med 2015 49: 290
(2). "long term outcomes of inversion ankle injuries" A Anandacoomarasamy, LBarnsley - Br J Sports Med 2005;39:e14 (http//www.bjsportmed.com/cgi/content/full/39/3/e14)