Our humble feet comprise one quarter of the bones in our body: 52 bones, 66 joints, 38 muscles and numerous tendons, ligaments, nerves, fascia, blood vessels and skin, all absorbing and transmitting the full force and load of our body weight as we move around each day; it’s no wonder then that so many things can go wrong! From Plantar fasciitis, to Morton’s neuroma and stress fractures, problems with the feet can seriously impact our day-to-day functioning. And yet, the feet are often overlooked when it comes to massage. People spend a good part of their day on their feet and/or wearing shoes- if those shoes are the wrong type of shoes, or if the surrounding fascia and muscles of the leg are tight, problems in the feet can arise and significantly affect other areas of the body.
Image 1: How shoes can alter the alignment of the body
Shoes and Feet
Right shoes = No shoes
Humans began to wear shoes roughly 40,000 years ago (Trinkaus & Shang, 2008). Overtime, and particularly in western societies, pointed and closed toe shoes have become increasingly popular with functionality increasingly playing second fiddle to aesthetics. My mum didn’t wear shoes to school. Not just because she was poor, but because nobody did; it wasn’t expected. Times and expectations have changed, so much so that you’re considered a dirty hippy if you and/or your children dare to step out of the house barefoot. In the past 10-15 years there has been more interest in returning to our barefoot past, with the negative impacts of tight fitting, often impractical shoes being highlighted, as well as evidence suggesting that those super expensive running shoes that tout their superiority are actually causing more injuries than they are preventing (Ramanathan et al., 2011). This increased interest in the benefits of a barefoot lifestyle should not be dismissed as a fad. The benefits of not wearing shoes and the negative consequences of habitually wearing shoes have been extensively researched. What people often do not appreciate is that walking generates extensive forces throughout our body, and when those forces are excessive or altered, then problems arise within joints and muscles in both the feet and other joints further up on the body, such as the knee and hip, as well as in our lower backs. Research has shown that while walking or jogging, higher forces are generated when wearing shoes particularly dress shoes, negatively impacting on the hip and knee joints, whereas lower forces occur when barefoot (Bergmann, Kniggendorf, Graichen, & Rohlmann, 1995; Kutzner et al., 2013).
Shoes have the potential to misalign our bodies (Image 1.) and restrict the normal foot motion which can contribute to stress fractures and other foot pathologies and deformities (Morio, Lake, Gueguen, Rao, & Baly, 2009). Habitual barefoot walkers have anatomical and functional differences in their feet, including wider feet, compared to habitual shoe wearers; walking barefoot enables increased forefoot spreading under load and may significantly reduce foot problems associated with long-term shoe wearing (Franklin, Grey, Heneghan, Bowen, & Li, 2015). This does not mean it is time to throw out all of your shoes for good. There are some conditions, such as patellofemoral pain syndrome (PFPS), common in runners, which can be eased with the wearing of specifically designed footwear that aim to reduce overpronation that causes knee pain (Cheung, Ng, & Chen, 2006). Orthotics and supports in shoes can be beneficial and help with an array of foot conditions that are best addressed by a podiatrist. It is important to point out that a lot of research goes into sporting and running footwear, particularly in relation to the forces generated throughout the joints and ways to minimise and optimise functional movement (Braunstein, Arampatzis, Eysel, & Brüggemann, 2010; Radzimski, Mündermann, & Sole, 2012). Our beef is predominantly with impractical footwear that we see our clients wear on a daily basis and often for considerable periods of time. It is almost universally acknowledged that there is very little benefit in wearing footwear, such as high heels (Image 2.), for any length of time. In fact, medical professionals have warned us of the health hazards associated with wearing high heel shoes for almost 250 years. These include, and are not limited to:
- changes in posture;
- increased pressure on the bones and joints of the toes;
- increased lumbar lordosis and anterior pelvic tilt;
- muscle fatigue and pain especially in the legs and lower back;
- changes to the muscles and tendons of the ankle and knee
- changes in a person’s gait and;
- an increased risk of ankle sprains (Cronin, 2014; Cronin, Barrett, & Carty, 2012; Lee, Jeong, & Freivalds, 2001; Radzimski et al., 2012)
High heels are: The. Worst.
Image 2: Examples of horrific high heel shoes
At this point it is good to discuss fascia a bit more- what is it and why is it important and how, do we at MOTR, use our knowledge of fascia to massage your feet and create widespread changes in your body. Fascia is the band/sheet of connective tissue, primarily composed of collagen, that lies beneath the skin and encases and separates muscles and other internal organs while attaching and stabilising them. Passive stretching done by your therapist can help release the fascia around your feet, releasing tension around the joints and up the leg. This can help with the transmission of forces and the natural movement of your feet. Think of tight fascia like wearing a sock two sizes too small and trying to move your foot- your range of motion is compromised, pressure on joints and muscles are increased as is the likelihood of injury. Massaging and manipulating the fascia help to decrease the tightness and pressure and create a greater range of motion for your foot.
A sensible approach to good foot health is to ensure a good mix of shoe and shoeless time throughout your day. However, switching (or seriously minimising your time spent in) those narrow, high-heeled fashionable designer shoes that often promote Hallux vulgus, a.k.a. bunions (Image 3.), (which, trust me, are not fashionable) to either wider soled shoes or no shoes will ultimately benefit your overall health.
Image 3: Bunions
Common Problems with feet
Plantar Fasciitis (PF)
PF is inflammation of the fascia of the foot (a.k.a. plantar fascia) and presents as pain in the heel owing usually to overstretching or overuse. Self-treatment can include anti-inflammatory medication, ice massage (use ice or a frozen water-filled plastic cup to rub on the painful area), rest, changing shoes, monitoring weight (excessive weight can place added pressure on the plantar fascia) and stretching of your arches. Your massage therapist can help with passive stretching and manipulation of the fascia.
This is where the longitudinal arch of the foot is too low, consequently the force going through the foot is not transmitted efficiently and can lead not only to foot pain but pain elsewhere in the body, such as the back, owing to the irregular pressure distribution that results from the condition. Arch supports and supportive shoes from a podiatrist can help with this condition if it is causing you pain. Also stretching of the Achilles tendon can help, as this is often short in people experiencing flat foot related pain.
Morton’s neuroma is a thickening of the tissue that surrounds the digital nerve leading to the toes. There are a few approaches to take to treat the pain; rest, anti-inflammatory medication, ice massage, and changing your shoes.
Metatarsalgia presents as pain and inflammation in the ball of the foot and is often considered an overuse injury. Approaches to help relieve the pain include those mentioned for Morton’s neuroma as well as buying over the counter metatarsal pads or seeing a podiatrist who may be able to recommend arch support options.
Elevating, resting and icing the area is your first course of action. Taping and soft-tissue massage by your massage therapist can also help reduce the pain. If particularly severe, you may need to use crutches or a walking boot, which will need to be recommended by a doctor.
General tips for foot care (especially if you are on your feet all day):
- Right shoes- shoes that do not pinch in your toes and put pressure on your joints and are wide enough to accommodate the changes in your foot shape as you walk and stand
- Stretch and movement- calf raises or ankle rotations, pointing toes up and down. Stretching both the muscles and fascia in your feet help to improve circulation and prevent stiffness and tightening up of calf muscles which can influence the natural movement of the components of your feet.
- Posture- poor or asymmetric posture affects the force distribution through your feet. Favouring one leg while standing is common and can create an imbalance in the load that your feet are taking. Ensuring that you move often and stretch at every opportunity
- Legwear- compression stockings can assist with the movement of blood in your feet which can pool when standing for long periods of time
- Cross-training and rest- pounding the pavement every day is not the best way to get fit or improve your times; mixing up your training with swimming or yoga, can give your feet a rest from the load and forces generated with walking/running/standing
- Pamper, including massage or reflexology- particularly for treating yourself after a long day at work. There are systematic benefits of having your feet touched.
- Podiatrist for persistent pain- if massage, stretching and changing shoes aren’t relieving your pain, our therapists at MOTR can refer you to a suitable podiatrist that can assess and diagnose any underlying issues with your feet
Massage Benefits/treatment options/Strengthening exercises
Feet can be a touchy subject for some, with aversion to their smell or aesthetics the predominant causes for people avoiding having their feet massaged. This is a tragedy in no uncertain terms, because the benefit of having your feet massaged and stretched far outweigh any embarrassment that one may feel. At MOTR, our therapists wet-wipe feet clean and/or use gloves or a towel as a barrier if you have any concerns about someone else touching your feet. Our therapists know what to look for: restrictions in the feel of the tissue, range of movement, colour and temperature of the skin and presence of calluses. Combining these observations helps our therapists get a good insight into the condition of your feet and how best to treat them. MOTR therapists believe it is important when working with the feet to use broad, gentle strokes with increasing firmness as the tissue of the feet can be slower to respond. Some of our therapists are qualified in Reflexology which uses a slightly different approach. According to Reflexology the feet provide a map for the body’s organs and treating an area of the foot that corresponds to say the stomach, can have benefits in that particular organ. Some people are sceptical of the connection, but irrespective of whether you believe or not, the benefits of giving your foot extra love and attention through a foot massage are far reaching, with many clients falling into deep sleeps, such is the level of relaxation achieved.
So, whether you have foot problems or just want to give yourself a treat, next time you book a massage ask if the therapist can pay extra attention to your feet- go on, put your best foot forward!
Ready to find out more?
Bergmann, G., Kniggendorf, H., Graichen, F., & Rohlmann, A. (1995). Influence of shoes and heel strike on the loading of the hip joint. Journal of Biomechanics, 28(7), 817–827. https://doi.org/10.1016/0021-9290(94)00129-R
Braunstein, B., Arampatzis, A., Eysel, P., & Brüggemann, G.-P. (2010). Footwear affects the gearing at the ankle and knee joints during running. Journal of Biomechanics, 43(11), 2120–2125. https://doi.org/10.1016/j.jbiomech.2010.04.001
Cheung, R. T. H., Ng, G. Y. F., & Chen, B. F. C. (2006). Association of Footwear with Patellofemoral Pain Syndrome in Runners. Sports Medicine, 36(3), 199–205. https://doi.org/10.2165/00007256-200636030-00002
Cronin, N. J. (2014). The effects of high heeled shoes on female gait: A review. Journal of Electromyography and Kinesiology, 24(2), 258–263. https://doi.org/10.1016/j.jelekin.2014.01.004
Cronin, N. J., Barrett, R. S., & Carty, C. P. (2012). Long-term use of high-heeled shoes alters the neuromechanics of human walking. Journal of Applied Physiology, 112(6), 1054–1058. https://doi.org/10.1152/japplphysiol.01402.2011
Franklin, S., Grey, M. J., Heneghan, N., Bowen, L., & Li, F.-X. (2015). Barefoot vs common footwear: A systematic review of the kinematic, kinetic and muscle activity differences during walking. Gait & Posture, 42(3), 230–239. https://doi.org/10.1016/j.gaitpost.2015.05.019
Kutzner, I., Stephan, D., Dymke, J., Bender, A., Graichen, F., & Bergmann, G. (2013). The influence of footwear on knee joint loading during walking — in vivo load measurements with instrumented knee implants. Journal of Biomechanics, 46(4), 796–800. https://doi.org/10.1016/j.jbiomech.2012.11.020
Lee, C.-M., Jeong, E.-H., & Freivalds, A. (2001). Biomechanical effects of wearing high-heeled shoes. International Journal of Industrial Ergonomics, 28(6), 321–326. https://doi.org/10.1016/S0169-8141(01)00038-5
Morio, C., Lake, M. J., Gueguen, N., Rao, G., & Baly, L. (2009). The influence of footwear on foot motion during walking and running. Journal of Biomechanics, 42(13), 2081–2088. https://doi.org/10.1016/j.jbiomech.2009.06.015
Radzimski, A. O., Mündermann, A., & Sole, G. (2012). Effect of footwear on the external knee adduction moment — A systematic review. The Knee, 19(3), 163–175. https://doi.org/10.1016/j.knee.2011.05.013
Ramanathan, A. K., Parish, E. J., Arnold, G. P., Drew, T. S., Wang, W., & Abboud, R. J. (2011). The influence of shoe sole’s varying thickness on lower limb muscle activity. Foot and Ankle Surgery, 17(4), 218–223. https://doi.org/10.1016/j.fas.2010.07.003
Trinkaus, E., & Shang, H. (2008). Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir. Journal of Archaeological Science, 35(7), 1928–1933. https://doi.org/10.1016/j.jas.2007.12.002