Flat feet (pronation); in response to a q. from Coach Sommer

[Kit_L]

We have had many students start our classes (stretching and strengthening) with 'flat feet' and most have had the form and function of the feet improved significantly. One young man had ankles that pronated so much that he had developed bunions (painfully enlarged joints of both big toes), and the big toes had deviated over 45 degrees away from the midline of the body. Now, three years later (using Five Fingers and a lot of kettlebell work), he now has perfect arches, the swelling and enlargement of the joints has diminished, and he has run two 10km fun runs on asphalt and concrete in his Five Fingers. His feet are perfectly aligned; his arches are developed and supple, and all his toes separate voluntarily.

An aside: most people who have been identified (or "diagnosed") with "flat feet" really have pronating ankles, and not the medial displacement of any of the bones of the feet (talus and navicular, usually that the term properly applies to). True flat feet are rare. When most people (and too many experts, IMHO) use the term, they mean pronating ankles: the whole leg has internally rotated in the hip joint; as this happens, the arch of any foot will flatten, and some collapse. Speaking generally, the pronated ankle is a lower energy configuration of the foot, and this is why exercising barefoot (or in FFs) on gravel or similar sharp surfaces has such a strong effect on foot placement: the body is doing all it can to unweight the sole of the foot—and creating the arch is part of what happens when the weight is spread from the inside border of the foot (pronation) to the whole of the foot (good alignment.

What follows is the first drill:

If you stand, and close your eyes, ask yourself 'where do I feel the weight going through my feet?' If you are like most people, most of the weight goes through the big toe side of the foot, and the heel.

Now, lift the toes off the floor, and deliberately put a bit more weight on the outside of the front of the foot, and look down at your feet: notice how the ankle and arch are better aligned? And notice how that realignment takes no muscular effort?

Now stand in front of a mirror and repeat the exercise (adding weight to the outside of the foot, and follow that with letting the foot roll in. If you watch, you will see that this is a whole-leg movement, mediated by the external rotators of the hip joint and the movement does not come from the foot itself. In fact, as you externally rotate your thighs, the weight moves to the outside of the foot, and the arch forms.

If you have pronating ankles, somewhere in the past, the body has made a choice about where to position the foot (on the internally–externally rotated axis); and the foot adapts to this. The main reasons for the body to make this positional choice (alignment of the femur in the hip joint) are two: tight hip flexors and insufficient stimulation of the soles of the feet during childhood and adolescence. All babies have flat feet; most adults have some pronation, especially under load; and if the pronation is controlled well by the body, it is part of the shock-absorbing mechanism we need for walking and running, as well as the critical mechanism for weight distribution (and obstacle avoiding!).

So: step two is to stretch the hip flexors—not easy to do on your own. We recommend a partner exercise, to begin with:

And step three, last for today, is to do a foot-strengthening/hip–leg alignment exercise. All you need is bare feet and a set of stairs: put the ball of one foot on the edge of the step, place the other behind this leg, and hold a rail. Straighten the supporting leg's knee. Slowly let the heel move below the level of the stair tread (so, a soleus and gastrocnemius stretch). If your calf muscles are tight, then do small contractions with the calf muscles, and then press the heel lower as you relax and breathe. This is part one.

Part two is the strengthening–realigning part: this time as you lower, deliberately let the ankle pronate. Feel where the weight is going through your foot: all on the inside, and under the joint of the big toe. Now, as you press the ball of the foot into the tread to lift the body, transfer some weight to the the outside of the foot so that as you pass the neutral point (normal standing position for the foot and leg): now the ankle will be perfectly alighted, with weight evenly spread across the front of the foot. Pause. Then, as you rise, transfer slightly more weight to the outside (this activates the peroneal tibialis posterior (thanks to slizzardman from Coach Sommer's forums for the correction) muscles strongly, in addition to the two calf muscles). At the top, plantar flexed, position, hold, and feel where the weight is: more will be on the outside than the inside (but don't exaggerate this); and press harder until the muscles spasm momentarily, then lower the heel to stretch that cramp out.

Just shot the video today:

The suggestion to let the muscles cramp might sound a bit intense, but an involuntary cramp activates the largest numbers of the involved fibres, and the strengthening/realigning effect is maximised. You only need a few repetitions. Once you have done both legs, walk around on a surface that gives you feedback (I like gravel!); you will immediately feel that the feet are contacting the floor differently.

This is enough to go on with, and if there's interest, I will add some intrinsic foot muscle–toe spreading drills, too.

Regards

KL

Edited January 30 by Kit_L
typo; deleting sommer reference

[Kit_L]

Now: adding more to the foot drill: before you begin, stand and look down at your feet—and try to spread your toes. You want both feet to be able to spread all toes, especially the little one. Sometimes parts of the body do not follow orders... so you might have to use a little persuasion.

We have a whole sequence of toe spreading (using the opposite shoulder's hand to interlace with the foot in question, from underneath). Start with the little toe, and interlace the little finger, then repeat for the fourth toe, and so on. Once interlaced, push the hand as deeply in between the toes as you can, so that the thickest part of the fingers are spreading the toes apart (the calluses of the hands abut the ball of the foot). If you can't separate your toes at will, this drill with get them going!

I will try to find if we have video of this sequence, and if we do, I will upload to YT and post here. If not, I will copy the relevant section from Stretching & Flexibility, the book that describes 16 class plans in our system.

Awakening awareness in the soles of the feet, and becoming aware of how one uses one's feet is the key. Even when standing around, ask yourself: "where's the weight on my feet right now?". This sounds absurdly simple, but the fact is that for most people these days their awareness resides mostly in the head, and they are suffering a kind of 'sensory motor amnesia' in the feet, and excessively pronating ankles is one effect. This can be changed quite quickly by bringing awareness to the feet—the drills described do this very efficiently.

Re. kettlebells: for this purpose, the swing is the only movement you need to master, IMHO. As well, the young man I described in the first post is now our KB teacher in the group. It is essential, if you want the effects he experienced, to do your KB work in bare feet, and pay attention to how the body is using the feet, and to the alignment of the knees throughout the movement—do not let the knees come inwards (because pronation follows this like night follows day!).

Assume you are sitting cross-legged, with the foot being worked on sitting on the thigh of the other leg (this exercise can be done on a chair, too). Once you do the toe separation using the fingers from underneath, squeeze the finger together to trap the toes, and gently drive the heel of the palm into the ball of the foot: in addition to stretching the instep, this will traction the toes, too. Then, using the non-involved hand to hold the heel, twist the forefoot in one direction (so that the sole is facing the ceiling; then the other direction (so the top of the forefoot is facing the ceiling); this gently "wrings' the forefoot and toes.

Now remove your fingers and place the heel of the same foot on the floor in front of you. Start with the little and fourth toes. Push the little toe away while pulling the fourth toe to you—feel the fascia stretch (like a tiny, localised burning sensation)? Now do the opposite: pull the little toe towards you and press the fourth toe away. There is no way the brain can spread the toes if the proprioceptors in the fascia and skin of the foot are telling it the end point of all known movement has been reached—this mis-mapping is what we are changing in this exercise, as you will see. Continue with the rest of the toes.

Without images, this next part might be a bit hard to visualise. Put the working foot back on the thigh of the other leg, and (describing the left foot here), grasp the ball of the left foot with a pinch grip, so that the L thumb is under the ball (the main joint of the big toe). Fingers will be on the forefoot; thumb under the joint. Now reach the right hand under the L foot, so that its fingers go on top of the fingers of the L hand, and its thumb on top of the L hand's thumb. Grasp the foot firmly in both hands, and slowly turn the forefoot up to the ceiling: if you have ever sprained your ankle, you will feel this stretch on the outside of the forefoot and the ankle. If movement is reduced, hold the end position very firmly, and try to twist the foot back against the resistance of your grip (but do not let the foot move) for a few seconds; relax (again, don't move) then take a breath in. On a breath out, slowly turn the foot further in the celing-facing direction. See how it goes further? Finish this part of the sequence by letting go of the foot and wriggling the toes, and re-grasp it, and turn the opposite direction this time, and repeat all directions.

That's enough for today; cheers to all, KL

[Kit_L]

Another instalment from BtGB (Building the Gymnastic Body) site; today someone observed that his left foot only pronates when he squats; this was my reply:

For squatting, though, we recommend a band or a strap around the knees, and set at a length that is consistent with your foot placement and foot angle (we want the knees to move forwards over the forefoot), and squatting in front of a mirror. You then deliberately lightly press the outside of your L knee against the band/strap, and keep it lightly pressed there—like magic, the foot will not pronate.

Take care to maintain this light pressure when you ascend from the bottom position: this medial knee movement happens because of insufficient external hip rotation (to counteract the medial knee movement caused by the adductors); pressing the knee against the strap and watching the knee and not letting it move medially will re-pattern this quickly. Not everyone realises this, but the adductors are recruited by the brain as hip extensors in the full squat (their action includes extension after 90 degrees flexion at the hip joint).

One more thing (getting back to drills for the feet): pointing the toes hard in all the prep. exercises (scoop, arch, rocks, fish, etc.) all will help the foot to attain a beautiful arch. In dance studios it is a common saying that many dancers begin their careers with flat feet, but none end them that way. It's all about paying attention to what the feet are doing, at all times. Pliés, for example, provide that opportunity on a daily basis for dancers.

I will be videoing some of these drills over the next two weeks, including one on how to improve foot point.

[Kit_L]

More from the same thread:

I am responding to another poster who wrote:

Quote

Bringing the ankle, toes, and foot pad sensitivity into the equation, while promoting a fluid range of hip movement will help avoid the condition i fell into.

I only read your post now, for some reason; this is excellent. What you call foot pad sensitivity is the key to all this. There has been an explosion in the research into fascia—you know, that stuff that (until about 15 years ago) medicine regarded as "inert ground substance". Well, nothing could be further from the truth—in fact, fascia is more innervated with proprioceptors and mechanoreceptors than any other tissue in the body AND it is innervated with 'type-C nociceptive' structures, as well. What a major revision!

The point is the latest research (personal communication from Dr Robert Schleip) is that the superficial fascial sleeve is the 'fine tuner' of the body's sense of mechanical force application, in addition to all the other neural structures involved. I mention all this because its degree of activity in the body depends crucially on the extent of its exposure: if you wear shoes most of the time, this hugely important sense organ is literally insulated from the environment that 'feeds' it.

So the toe spreading drills you do in bare feet in your yoga classes are essential—as much from an awareness-direction sense as the actions themselves. As I mentioned in the first post, it's the combination of the 'insulation' and tight hip flexors that is the deep cause of pronating ankles in our culture. More later.

[Nolan & Jade Foster]

You could teach an entire class using this stuff just on the feet. I'm looking forward to putting this into my foot routine and taking things to the next level. I've really been 'finding my feet' this last 2 or 3 years and I barely even wear shoes anymore, it's tragic now to me when i think of the stiletoes and crap that I used to torture my feet with (i'm a strict Vibram toes wearer these days). In addition to the above I want to add the benefit of the foot savers that I've been using with Cookie, these have been instrumental so far and I use them daily, they're great. Now with this post I'm ready to go even further.

footyou very much

[Kit_L]

Paul and I shot some video over the last weekend of the Sydney Stretch Therapist workshop; if all goes well, I can post the foot sequence from that in the next few days. Bookmark this post and check back soon.

[Kit_L]

Assuming the upload goes OK, the new Foot Sequence Sydney 2012 can be viewed here:

Please let friends and family know; lots of pronating ankles out there.

[Anthony L]

Hi all,

Kit asked my to put in my two cents into this discussion. I'm the one he mentions who managed to correct pronating feet and mild bunions.

I think it was a combination of several things that helped strengthen and transform my feet, as follows in no particular order:

· Stretching the hip flexors and strengthening the glutes and lower abs – this helps to combat the internal rotation of the legs that accompanies pronation. This for me would have been one Posture & flex class and two Strength & Flex workouts per week

· Correcting my foot position every time I was conscious of pronating (this was partly to stop Kit yelling at me!)

· Doing all my strength training barefoot. Interestingly I found that single kettlebell snatches really worked my feet. Uni-lateral exercises such as weighted lunges also seemed to help.

· Doing single leg balancing exercises (such T-pose etc.) with spread toes and a strong foot position. Again, this would be once per week in Greg's Kitchen Stadium class (Intermediate-Plus P&F that is)

· And probably the most effective – about 12 months of regular running on grass in Five Finger shoes (of course barefoot would have been just as good). This was mostly playing lunchtime frisbee twice a week, so nothing fancy, however it did include forward/sideways/backward movement which might have helped. I think the uneven surface of the grass was important for strengthening the foot through bending and twisting etc. I was doing a little bit of regular running at the time, but not a huge amount, although I did work up to doing two or three 10km fun runs in the Five Fingers.

As Kit said, my big toes straightened out, my bunions settled down, and a strong foot position with spread toes and good arch is now pretty much habitual.

Cheers,

Anthony.

[Kit_L]

We are aware that many people reading the forums do not have training partners. Accordingly, I post here a standing, solo hip flexor stretch that—if you really follow the instructions, will allow a substantial improvement in this chronically tight area:

Enjoy (is that the right word, I wonder?) and please report back. Cheers, KL

[Kit_L]

And another piece of the puzzle and that will be it for now; I have decided to make a downloadable product on this problem—it seems so common.

Someone emailed me today wondering if a pronating ankle and tight hip flexors on one side could cause knee pain? Absolutely; in fact if this person was my patient, this would be the first thing that would come to mind. Please let me know how any of this works, or does not work, for you.

[Kit_L]

And I shot another solo hip flexor stretch (this latest one uses a heavy band; it is at least twice as effective as the standing solo hip flexor exercise, above; here it is:

http://youtu.be/vPBSTE7Yk8w

Please report in and let us all know if any of these help, or what you have found.

[Admin]

And please see Simon's excellent posts on 'waking up the feet' HERE.

We are collectively really getting somewhere with this, I feel.

[zerohead]

Hello Kit,

This series of videos are so great. Well, I have a question that might not be so related to flat feet but I hope to know how you see the problem in your perspective.

The problem is that the heels of my shoes are always worn on outside (left side of the left heel, right side of the right heel). The uneveness can be as much as ~10 mm. Is there any way to change the way of my walking and fix the problem?

Thank you very much.

[Admin]

Zerohead, what you describe is the effect of heel-strike: if you watch how you walk—in shoes—you will see that the thickness of the heel means that you land heel-first and, most often, with a straight knee; this is what causes the wear on that part of the shoe. This is standard, and no problem in itself. It is a direct consequence of wearing shoes.

You cannot walk that way on hard or rough surfaces in bare feet or Five fingers. I will add some images later, but my FFs wear out on the tips of the little toes. This is because heel striking in bare feet is simply too painful: when you watch someone walk, or run, in bare feet, especially over rough surfaces, every muscle in the body is trying to unweight the soles of the feet. Watch your avatar: forefoot strike on slightly bent knees. There is no effective alternative, if your soles are exposed to the stress of the activity. You will not need to think about this: it is hard-wired into the neural system, and will manifest if you remove the 'insulation' between you and the environment (the shoes).

The wear on your shoes, FFs, or bare feet (where you callous if you examine the soles of your feet) is a precise map of how you use your feet. Most people callous on the inside edge of the big toe, or the joint of the big toe. This is dues to spending more time on the inside of the feet, and usually though pronation under load. Stimulating the soles of the feet is one way of correcting this.

[TomF]

I'm wondering with regards to the anti-pronation excercise referenced at the top post (#1), has anyone seen this correct congenital flat feet?

I've had flexible flat feet since childhood, the feet are strong, but the arch collapses under load. I was recently told by a podiatrist that I have hyper-flexible joints (he used my wrist flexion vs. his as an example) and that this is the cause of my flat feet. I'm now giving serious consideration to a surgery where a titanium stent is place in the empty opening of the sinus tarsi which would correct hyper-pronation by replacing this empty space in the foot with something that would allow the bones of the foot to maintain their arch under load.

This is definitely a good exercise and I've already started to incorporate it into my daily (or nearly daily) routine. But I tend to wonder if it has any long-term potential to fix hyper-pronation in my particular case. It is a variation on the toe raise after all.... and I've never heard of that exercise correcting fallen arches.

Any thoughts?

[Kit_L]

Tom, try the exercise after you have listened to all the instructions: the critical weight shift, if you can achieve it under load, activates muscles in the lower leg that create the arch. And all the other exercises in this thread are necessary, too.

If I owned your feet, I would be researching and practising all potentially relevant exercises, and doing whatever's necessary to avoid surgery. And some people have fully functional, pain-free flat feet (think of some of the African groups).

You wrote:

and I've never heard of that exercise correcting fallen arches.

You may not, but I have, many times (that, and bunions and whole-foot alignment radically improved) but this is not a foot problem, per se: it is a whole-body phenomenon.

Read this post from a workshop attendee (last weekend):

https://www.facebook...rapyKitLaughlin

She is walking differently right now, having done those HF exercises only three times, but very intensely. Her feet have changed shape, as the load on them has changed.

[TomF]

Thanks much for the feedback!

I think I'll hold off on anything like having an implant inserted in my feet and keep this as an option of last resort.

Believe it or not, the real reason I've been considering having this done is not foot pain, rather it's due to low back and, to a lesser degree hip pain, that has plagued me for years. I've been using Pete Egoscue's techniques along with chiropractic for several years now, but can't seem to jump the hurdle, so to speak, with regard to low back issues. Posture and gate have improved tremendously however, you should see the difference in my shoe wear patterns!

I will say that the idea that flat feet can be corrected via physical therapies rather than surgery and orthotics borders on rank heresy in the United States, at least as far as the doctors I've talked to are concerned. ...but then again, heresy is just so much more fun!

[Kit_L]

Tom wrote:

I will say that the idea that flat feet can be corrected via physical therapies rather than surgery and orthotics borders on rank heresy in the United States

Many teachers and practitioners here have seen these major changes with their own eyes, or experienced it in their own bodies. And we have a recently qualified teacher here who worked with the Egoscue Method for a long time with little change in his body; he has radically transformed his body in less than a year using the ST system. I will ask him to comment here (he may not, of course).

What have you got to lose? This is a zero-risk/huge potential reward situation. Start with your hip flexors. And take advice from people who actually do what they teach; most doctors do little or no exercise—so how could they know about our work?

[TomF]

Many teachers and practitioners here have seen these major changes with their own eyes, or experienced it in their own bodies. And we have a recently qualified teacher here who worked with the Egoscue Method for a long time with little change in his body; he has radically transformed his body in less than a year using the ST system. I will ask him to comment here (he may not, of course).

What have you got to lose? This is a zero-risk/huge potential reward situation. Start with your hip flexors. And take advice from people who actually do what they teach; most doctors do little or no exercise—so how cold they know about our work?

Thanks Kit.

Would definitely be interested in the thoughts of a former Egoscue student as related to his or her experience with both methods.

I can say from experience the the Egoscue Method "works" - maybe not as well as ST, I simply don't know - but I have old shoes and a new gate, posture to prove it after two years of working with his methods along with regular chiropractic treatments. I have one pair of old shoes that I'm keeping for posterity where the gate impacts on the exterior aspects of the rear of the both shoes created a sheering effect that almost make them look like portions where cut away (kinda hard to describe in words). My newer shoes have much improved and more neutral where patterns.

Am I "PainFree", as one of Pete's books is titled? NO! But I am "PainImproved" The journey continues and further improvements, gradual as they may be, are hopefully forthcoming.

I'm not intimately aware of ST, its philosophies and techniques; however it does seem to be more group oriented than Egoscue (just a casual observation). I will be picking up a book on ST to find out more and hopefully add some tools to the toolbox. One or two good tips and I'm a happy camper.

Believe me, I'm in no rush whatsoever to have titanium implants shoved in my ankles to create a faux-arch. I've also been doing the recommended anti-pronation exercise and could swear there have been improvement already (maybe just wishful thinking on my part).

As for doctors and exercise - I totally agree! I spoke with a young doctor a few times, very nice guy, who basically confessed to me without my prodding that he barely does any exercise.

[superjet100]

Hi Kit,

I was searching on google for fallen arches treatment and found this thread.

How long does it take to it take to get my arches back? Months or maybe years? Is it even possible, because many doctors say it's not possible to fix fallen arches for adult without surgery. I need to pass physical exam next summer, so I have only 8 months left. Can I improve my arches somehow for that small amount of time?

Do I need to do those exercises everyday? How long should be each workout? How many reps I need to perform for each exercise or how many minutes I should stretch my muscles? Just want to get some kind of routine to follow.

I would really appreciate your answer!

Thanks a ton!

Pics of my feet:

[Craig]

I'm not kit but had the same feet. Without dedicated work its taken about 5 years for my arches to return, but I guess it could be faster if you do dedicated work.

I recommend as much of this work as you can, and also as much barefoot walking and balancing as you can manage. Balancing on narrow poles in particular does good things.

Also here are some other things you can do while standing around or walking during g the day:

Foot Awakening Part 1 - Toe Wiggles:

[Craig]

Foot Awakening Part 2 - The Ministry of Silly Wal…:

Foot Awakening Part 3 - Balancing and Hopping:

[superjet100]

Thanks Craig!

I'll do those exercises as much as I can. Hopefully 40 min a day will be enough, because I have a lot of other things to do

[superjet100]

Just a quick question:

do you think rolling and pressing bare foot into a handle of an iron dumbbell is good exercise? It's pretty painful if you press really hard. Do you think it will help too? I've seen on the internet somebody claimed that this exercise cured his flat feet within 2 years.

[Kit_L]

MH's feet look wonderful now.

To the OP: don't think sets and reps; in the standing eversion exercise, come ups as high as you can, with a very small bias to the outside of the foot, and the essential muscles will cramp—hold this extremely intense sensation just for a fraction of as second when you begin, then increase the cramping part over time. Cramping is the strongest contraction the body can make, so this will leave the feet feeling sore the next day, and will make the muscles extremely strong. Be guided by this to work out your schedule: wait at least one full day after all soreness has gone before repeating. Do a few sets each time you exercise.

Any curved surface will help the feet form. And don't forget the YouTube foot sequence: an essential part of make a good arch is to stretch the top of the feet—and this is essential for a decent toe point too. And MH's device re. balancing on curved surfaces is gold, too; I have been walking along a low metal pole (diameter 2" or 50mm) and this is an intense foot workout by itself (and works the second arch, the metatarsal arch, in addition).