Hurty Feet: Plantar Fasciitis [Part 2]

Intrinsic Foot Strength Progressions

**FOOT STRENGTHENING**In my experience, those with bottom of the foot pain often have weak intrinsic foot muscles. Below is a progression beneficial for some people with foot weakness. Top left, the name of the game is to move the big toe independently from toes 2-5, & vice versa. Those that have foot pain tend to have difficulty with this movement. If the toes can't be moved independently, IMO it's because a lack of representation in the somatosensory cortex, which can be improved via neuroplasticity. the objective is to build connections with the brain for this region. Top right, again, the objective is to move the toes independently, this time with resistance. Be sure to not extend from the distal interphalangeal joint when flexing the toes, rather keep them neutral and focus on motion from the proximal interphalangeal joints.Bottom left, integrated toe strengthening. With this movement, the be sure to drive the pelvis forward when plantarflexing. This is exaggerating what the foot, knee and hip would be doing, when they'd be doing it, relative to the 2nd phase of gait. A verbal cue is to hinge from the shoulders, rather than bending the elbows when driving forward in space. Bottom right, integrated foot strengthening progression, using suspension straps. This movement, like the preceding, is more on the integrated spectrum, and requires much more core stability to properly perform. Notice how wobbly my left leg is compared to my right. It's not a coincidence that I also have some bottom of the left foot pain. progressions include performing on a blue airex padAre you strengthening the intrinsic muscles of the foot in isolation and integration? if not, do it! like it or love it then show it!

Posted by Adam Wolf PT on Wednesday, November 16, 2016

In conjunction with my previous post about “hurty feet” and the importance of toe independence, here are four exercise progressions that I enjoy using in my day-to-day practice.

Top left (ISOLATION): Move the big toe independently from toes 2-5, and vice versa

In my opinion, if the toes have difficulty moving independently, it is due to a lack of representation in the somatosensory cortex.
This can be improved via neuroplasticity with the objective being building connections to the brain for this region.

Top right (ISOLATION): Move the toes independently, with resistance

It is important to avoid extending from the distal interphalangeal joint when flexing the toes.
Keep the distal interphalangeal joints neutral and focus on creating motion from the proximal interphalangeal joints.

Bottom left (INTEGRATION): Integrated toe strengthening

Drive the pelvis forward while plantarflexing.
A verbal cue I find helpful when teaching patients how to drive the pelvis forward in space would be to “hinge from the shoulders, rather than bending the elbows”.
This exercise exaggerates the motions that occur at the foot, knee and hip in the 2nd phase of gait.

Bottom right (INTEGRATION): Integrated foot strengthening with suspension straps

Due to the integrated nature of this movement, core stability is required to properly perform.
Notice the difference between my left and right legs as I go through this movement – my left leg is more wobbly. It is no coincidence that I have bottom of the foot pain in this leg!
To take this movement up a notch, perform it on an airex pad.

Strengthening the Flexor Digitorum Brevis

Since a conversation with Tom Michaud about the feet a couple weeks ago on #2movementguysandaguest I've come to appreciate the importance of the flexor digitorum brevis. for those with "hurty feet". Some takeaways include:1. press the toe tips into the ground during exercise & also while walking (during acute issues). This will take the pressure off the metatarsal heads & distribute the weight better throughout the transverse arch. it will also more specifically towards the flexor digitorum brevis (FDB)–this cue has been helpful for me, especially for people that curl their toes when trying to strengthen, which is a reason I don't love towel & marble toe grabs.The FDB is one of those intrinsic 'force producing muscles' that often is important to strengthen with a hurty foot. 2. Tom described the importance of strengthening the FHB at the back phase of gait, particularly as the heel rises. At heel rise, the calcaneus inverts & the forefoot (FF) relatively planter flexes (PF) & everts, assisting in the windlass to provide stability to the midfoot for propulsion. This exercise does just that, as the rearfoot is inverted & PF and the (FF) is relatively everted. a towel is placed under toes 2-5 to extend them, which would occur at this time & also under the heel to invert it, which occurs as the heel lifts. I start w/ isometric holds for 10s and progress to 60s. Do you strengthen the intrinsics? if so how? if you like this please share, comment and like :)#realmovement #integratedmotion #motorcontrol #flexordigitorumbrevis #hurtyfeet #hurtyfoot #plantarfascitis #footpain #physicaltherapy #massagetherapy #chiropractic #footexercises

Posted by Adam Wolf PT on Wednesday, November 8, 2017

Since a conversation with Tom Michaud about the feet a couple weeks ago on 2 Movement Guys and a Guest (Tom’s episode coming soon!). I’ve come to appreciate the importance of the flexor digitorum brevis (FDB) in foot pain. Some takeaways from our conversation include:

“Press the toe tips into the ground during exercise and regular walking.”

This takes pressure off the metatarsal heads and distributes weight better throughout the transverse arch (specifically towards the FDB).
The FDB is one of the intrinsic “force producing” muscles that are important to strengthen in a patient presenting hurty feet.
I find this cue helpful, especially for patients that curl their toes during toe strengthening exercises (which is a reason why I don’t love towel & marble toe grabs).

“Strengthening the FDB in the back phase of gait, particularly as the heel rises.”

At heel rise, the calcaneus inverts and the forefoot relatively plantarflexes & everts, providing stability to the midfoot for propulsion.
The exercise in the video above accomplishes that by inverting and plantarflexing the rearfoot and everting the forefoot.
The towel placed under toes 2-5 mimics extension in the toes and the towel placed under the heel inverts the heel, both of which happens as the heel lifts.
Start with isometric holds for 10 seconds and progress to 60 seconds.

Taping For Plantar Fasciitis