Focus on strengthening your toes, as toe weakness is identified as the single biggest predictor of falls in the elderly. This is a crucial area for fall prevention and overall quality of life.
Measure your anterior fall envelope by leaning forward from the ankles towards a wall; the distance from your umbilicus to the wall should be 4.5 inches or more, indicating sufficient toe strength and balance to prevent falls.
Engage in regular foot exercise to increase circulation to sensory nerves, promoting nerve fiber branching, improved sensation, and reduced pain, which is imperative for walking upright and preventing falls.
Focus on developing control and variability in movement and posture, rather than striving for a single ‘perfect’ posture, to enhance adaptability and prevent being stuck in one position.
Engage in regular foot strengthening exercises to maintain the foot’s natural capacity to handle load, prevent weakness, and ensure optimal function throughout life, as ‘if you don’t use it, you will lose it’.
Choose shoes with a wide toe box that allows your toes to splay naturally, as this is non-negotiable for foot health and comfort. Verify width by standing on the shoe’s factory insert; if your forefoot is wider, the shoe is too narrow.
Opt for ‘zero drop’ footwear, where the heel and toe sit on the same plane, as this aligns with the natural design of the human foot for walking and movement.
Allow children to spend time barefoot on various surfaces like sand and grass, even for short periods, to promote natural foot development and enhance sensory input.
Ensure children wear shoes with a wide toe box that allows their toes to splay naturally, especially if there’s a family history of bunions, to support proper foot development.
Perform isometric exercises when experiencing pain, as they are safe and can decrease cortical inhibition, effectively acting as ‘pain meds’ by allowing the brain to ’let off the brake’ on movement.
Use a toe dynamometer to test big toe strength, aiming to produce 10% of your body weight by pressing the big toe down without lifting the heel or hammering other toes.
Test the strength of toes 2-5 using a toe dynamometer, aiming to produce 7-8% of your body weight by pressing them down without lifting the heel or hammering.
Aim for approximately 35 degrees of ankle dorsiflexion mobility, as 10-15 degrees is the bare minimum for walking, and more is needed for functional movements like sitting or climbing stairs.
To determine if limited mobility is due to a physical restriction or neurological inhibition, test a deep squat both unassisted and while holding onto support; if holding on significantly improves the squat, the primary issue is likely a lack of stability, not stiffness.
Focus on training proximal stability by ensuring you can stack your rib cage over your pelvis and practice 360-degree diaphragmatic breathing, as this directly impacts foot mechanics and overall body control.
For chronic plantar fasciosis, prioritize strengthening and loading the foot tissue, rather than deloading, to promote healing and build the necessary capacity to handle repetitive stress.
In cases of acute plantar fasciitis, orthotics can be temporarily beneficial as a load modifier to offload the heel and reduce strain, but they should not be a long-term solution.
If using orthotics for acute plantar fasciitis, plan to phase them out within two weeks to a year, simultaneously engaging in foot strengthening exercises to prevent long-term reliance and build intrinsic foot capacity.
For mid-tendon Achilles tendinopathy, understand that discomfort may persist for a long time; focus on continued loading and exercise, even with some pain (e.g., up to 5/10), rather than complete rest, to promote healing.
For insertional Achilles tendinopathy, ensure calf exercises emphasize high end-range plantar flexion to appropriately load the tendon, and minimize deep stretching, as this specific type of injury does not respond well to it.
For functional hallux limitus (limited big toe motion due to muscular weakness, not rigid arthritis), focus on strengthening muscles like peroneus longus and actively working on big toe range of motion to restore function and prevent progression.
Do not rely on carbon plates or very stiff shoes for functional hallux limitus, as these prevent big toe movement, leading to further weakness and potentially irreversible loss of function.
If diagnosed with hallux rigidus (arthritic big toe with lost range of motion), focus on training compensatory movements in the ankle, knee, and hip (e.g., knee and hip extension drills) to maintain overall gait function and prevent issues up the kinetic chain.
Incorporate ’toe yoga’ exercises, such as lifting only the big toe, lifting only the four smaller toes, or lifting and spreading all toes, to improve intrinsic foot muscle activation and brain-foot connection.
Begin using toe spacers gradually, starting with just five minutes a day while barefoot in your house, and slowly increase wear time as your feet adapt to prevent discomfort and promote natural toe splay.
For individuals with bunions or specific needs, consider adding cork or a similar material between the first and second toe within toe spacers to provide increased resistance and support for realignment.
For optimal foot health and strength, combine wearing functional footwear (wide toe box, zero drop) with dedicated foot strengthening exercises to maximize benefits.
Be aware that shoes with more stack height (cushion) can alter and speed up the rate of pronation; if wearing such shoes, ensure you have very strong intrinsic foot and extrinsic lower leg muscles to control this movement.
Opt for thinner-soled shoes that allow you to feel the ground, as this sensory feedback helps with natural shock absorption and provides cues to prevent heavy landing, leveraging the foot’s inherent design.
If choosing to wear fashionable but less functional shoes (e.g., high heels, pointy-toed shoes), commit to dedicated foot strengthening and mobility work before and after wear to mitigate potential negative effects and maintain foot health.
Reserve specialized ‘super shoes’ or performance footwear for specific activities like speed workouts, and prioritize foundational foot strengthening and training in more functional shoes for daily use to avoid injury.
When running, focus on landing your foot close to your body’s center of mass and avoid overstriding (landing with your foot far in front), as overstriding increases ground reaction forces on the knee, hip, and low back.
Consider transitioning to a midfoot or forefoot strike when running to shift load from the knee, hip, and back into the foot and calf, but ensure you have adequate foot and calf capacity before making this change.
If wearing shoes with a heel-to-toe drop, actively perform regular ankle mobility exercises and plantar flexion strengthening when out of the shoes to counteract the shortening of the posterior compartment and maintain overall foot and ankle health.
Consider watching the video version of this podcast episode, especially when discussing foot anatomy and pathology, as visual aids make it easier to understand complex biomechanics, such as how bunions develop.
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