Fixing Foot Drop

For someone with "foot drop," the front lower leg muscles are too weak to lift the foot upward at the ankle. The foot hangs downward instead of lifting upward to take each step. Gait is altered and the front of the foot may slap the ground with each step. Fixing foot drop involves fixing three things - stopping the original cause, strengthening the (several) secondary effects of the weakened and tightened muscles, and retraining gait to normal. Common treatment options of braces to hold the foot up, canes or walkers to steady walking, drugs for the pain of whatever is causing it, reductions in activity, and certain surgeries, may all interfere with recovery and create new, and even more serious problems. Healthy treatment can be done without surgery, drugs, inactivity, or bracing.

One common surgery fuses the ankle so that the foot can't hang down. The foot can't move any other way either, causing new gait disturbance, and limitations in moving for health or fun. When foot drop comes from a herniated disc reducing nerve conduction, surgeries may remove the disc. However, discs are needed for healthy spine dynamics. Surgical spine fusion, even more drastically limits healthful movement, and ultimately health itself.

Interchangeably called drop foot, it is not a disease by itself, but the result of something else. Foot drop can follow a herniated disc that presses on nerves that exit the lower spine. It may also come from an injury directly to the peroneal nerve behind the knee. Certain diseases of the nervous system such as multiple sclerosis, Parkinson's, and amyotrophic lateral sclerosis (ALS) may reduce signals to various nerves.

A disturbing and increasing number of foot drop cases come from back and knee surgery. Someone undergoing surgery for a herniated disc or a knee replacement may wake with foot drop when nearby nerves were damaged or accidentally cut during the surgery. Such "side effects" are regularly called unavoidable surgical risks. It is important to change understanding of medical practice so that it is understood that adding new problems is not healthy and so, isn't "health care." Tragically, surgery itself for disc trouble is nearly always unnecessary.

As foot drop continues, lack of stretching in back of the leg that would have naturally come with each step from lifting the foot results in Achilles tendon and other structural tightness. Tightness can increase until that alone restricts lifting the foot.

Reader Sylvia wrote me several notes of her success reversing the components of foot drop. She first wrote in August, after finding the post of Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier. Her photos walking with a cane and needing to ride in a golf cart are above, left.

In Sylvia's case, her physician told her that a herniated disc was preventing the nerve down the leg from conducting enough to the front lower leg muscles (usually the tibialis anterior), which lifts the foot. Sylvia wrote,

"The specialist orthopedic surgeon I was referred to fortunately said he would not operate and my subsequent follow up visit has resulted in him telling me to go away as I am no longer in pain although I still have no dorsiflexion (upward lift of the foot). If in a year I still have drop foot I should discuss again with my doctor. Not very helpful…Thankyou for the wonderful work you have done putting this web-site together Best Wishes from England.

Sylvia"

When a disc is involved, the first thing to do is to stop the reasons for discs pressing outward, such as bad bending and sitting, and use good bending and sitting instead. If it is slouching so that you have too much inward curve of the lower spine, and that is pressing on the nerve, or it pushes the disc which then pushes the nerve, then you stop that habit, so it can heal. Stop the source. Surgery is not necessary. This is explained more in the post Cauda Equina - Result Not Cause. Then you exercise the shin muscles that have weakened, and stretch the calf and Achilles and bottom of the foot, which has tightened. You also need to practice balance and gait.

Reader Ivy began corresponding in the comments of the post to tell Sylvia her specific events to first stop the disc herniation, which was pressing and constricting nerve conduction.

By October, Sylvia has done much to reserve several causes and results. She was walking without a cane (right) and wrote,

"Hi Jolie and Ivy
"I really appreciate your support and enthusiasm. My badly herniated disc obviously impinged on the nerve causing the nerve damage. I know this is from years of bad posture. I have come a long way already but not too far in the lunging and balance areas yet.

"At the weekend I was seen to be dancing at my son's wedding and I realised that non-one would believe I am usually slapping along.

"Instead of wearing my usual flat shoes or bare feet I had some new ankle strap 2 inch heel sandals for the event. The strap helps to keep the shoe on and the height of the heel was just right to keep me on my toes ! So I have decided to find a dance class to supplement my pool and land exercises as I have rediscovered I love dancing !

"I am going to Florida for a couple of months and should be able to find some dance action there. I'm going to try and toe walk on the sandy beach too.

"In the meantime I will keep on trying to change my bad postural habits! Best wishes. Sylvia"

Sylvia and I also corresponded. She send a photo of her happy and healthy at her son's wedding (below, right), with this update:

"Dear Dr Jolie,
"I have received the books today... Now I have no excuse for not stretching and correctly at that !

"I can't wait to get back in the water and see how my ankles are - they are probably quite stiff so will need some work.

"I have printed the Inspirational Ivy page with the pictures of her exercising and keep it in my purse as a constant reminder that my condition will improve. Everyone here whom I haven't seen for two months whilst in the UK, is telling me how much better I'm walking. I tell them what I'm doing and if they have any problems refer them to your web page. Best wishes for now."
Sylvia

We will be hearing more wonderful things from Sylvia.

Posts with specifics to try:

• Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier
• Cauda Equina - Result Not Cause
• Fix Disc Pain Without Surgery
• Studies Say Back Surgery Not Needed
• The Cause of Disc and Back Pain
• Disc Pain - Not a Mystery, Easy to Fix - When you stop bending wrong many times each day, which pushes discs outward many times each day, damaging forces will stop, and can heal.
• Changing Thai Massage to Be Healthier Part I - Avoid Pressuring Lower Back Discs

Labels: disc, fix pain, footdrop/dropfoot, gait, impingement, injury, Parkinson, readers inspiring story, surgery

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Feeling Better Than She Ever Has Part II - Fixing Herniated Disk and Reclaiming Active Life

Barbara lives in a little town of 300 people in Yukon Canada - map at right. Part I of Barbara's story last Wednesday described why it didn't take six weeks to fix Barbara's herniated discs and severe sciatic pain and numbness, but it was six weeks until the "light went on" and she did the things to stop the cause of the injury, so it could stop hurting and start to heal.

Here is an insider's peek behind the scenes week-by-week:

"Dear Dr. Bookspan,
"This is a bit of a long one, and probably reaffirms everything you've ever received in hundred and hundreds of emails and stories, but I wanted to share this with you anyway. I can’t thank you enough for working hard and sharing all your knowledge. I am almost completely pain free!

"After 6 weeks of severe sciatic pain and numbness and weakness of my left leg and foot, something just clicked on Thursday night and I became more determined than ever that I could get rid of the pain. Through your website, the Fitness Fixer, and reading lots of personal stories (on your web site and book), I realized that I had to fix (the) causes. I know this might sound dramatic, but you’ve changed my way of life.

"Pre-sciatica lifestyle:
"A cycle of: 1) a few months, everyday, of "power" exercising with all the unhealthful postures and movement habits you talk about, then sitting at the computer in all the unhealthy ways you talk about and drinking coffee and smoking, feeling like I’d accomplished something in my day; 2) followed by a few months of complete laziness (not even power exercising). Power exercising consisted of running (without stretching at all) with bad form, and Hatha Yoga (forcing myself into the stretches and tons of forward bending).

"Sciatica struck.

"First two weeks:
"I did absolutely nothing about it. I read stuff on the internet and was convinced from the stories that I had some debilitating disease that would affect the rest of my life. I thought the cause was that I didn’t keep up with my "power" exercising. But, I continued to sit bent forward in a chair, hunched over, bending wrong, doing yoga forward bends, smoking and drinking coffee. I know, how sad."

Here are posts and information Barbara used:

• Why bad forward bending is a major mechanism in disc degeneration and eventual bulging and herniation: Disc Pain - Not a Mystery, Easy to Fix
• Avoidable sources of bad bending that go unnoticed in common exercises: Common Exercises Teach Bad Bending
• How to avoid herniating forces on the lower back discs during yoga and fitness stretches for the hamstring:Healthier Hamstring Stretching

"Third week:
"Had to go back to work in the morning, teaching 4 and 5 year olds in a kindergarten class; in the afternoon, teaching reading strategies to Grade 1 and 2's - sitting in a chair all afternoon. No longer could I hobble around the house holding my backside and leg - full on activity - and pain, tingling, numbness in my left foot, and total weakness in my left leg. Felt like I was walking around all day with a Charlie horse going down my entire left side. Amidst all my continued Internet searches, stumbled upon your website when a friend said that slight forward bending doing dishes and getting ready in the morning leaning over the sink might be a cause. Your website made so much sense to me - if a slight forward bend is a bad thing, how much more unhealthy would my Hatha yoga program be, with all its constant forward bends. I might add here that the two people at work who talk about slight forward bending being a bad thing continually hunch forward while sitting and exercise using forward bends. Just something I’ve begun to notice."

Major news stories quote physicians saying that back pain is often a mystery and that no one knows why stretching isn't working. My readers regularly report that once they understand the simple principles, they see the unhealthful positioning that causes pain frequently - at the gym, in fitness magazines, and in exercise videos and classes:

• Fast Fitness - Fix Positioning by Watching Others
• What Does Stretching Do?
• Are You Making Your Exercise Unhealthy?

Barbara continues:

"I started with lying on the floor propped up, upper and lower back extensions, pec and trapezius stretches, isometric abs, being continually aware of my posture and not doing ANY bad forward bending. Tried to do the lunges and squats for daily good bending, but my muscles were so weak and I practiced them half-heartedly. I tried to apply them in daily life but life seemed so fast-paced at work and I was in so much pain constantly, that I would get _ way into it and then just try to lean to the side to pick things up - result, I was contorting my body in very odd ways! I ordered a support brace and special support backrest (now I know why I never needed them) and seat cushion for my chair from other web sites, but also ordered your book Fix Your Own Pain, along with a few of your other books."

These are some techniques used above:

• Lie on floor propped on elbows - Fast Fitness - First Morning Stretch
• Pectoral stretch - Fixing Upper Back and Neck Pain
• Trapezius stretch - Nice Neck Stretch
• Lunge for daily good bending - Strengthen Legs Without Knee Pain - Standing Lunge
• Half squat for daily good bending - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.

"Fourth Week:
"Limping and terrible pain, my boss told me to visit the nurses station -living in a town of 300 in the far north, we have one general store and a health centre, doctor visits once every two weeks - and take every afternoon off during this week to rest up. He still needed me at work in the mornings. Taking my new prescription of Naproxen and trying the lunges and squats and some stretches but not really trying to apply them to the rest of how I was moving and bending and sitting. I would be in quite a bit of pain coming home from my mornings at work. In the afternoons I would basically throw in some stretches, but generally read (sitting badly) and nap for an hour. A lot of the pain would dissipate after my stretches and a good nap - only to be set into full force the next morning at work.

"Your book came in on the Friday and I was very excited. I read through it and practiced the retraining stretches that show how to restore straighter positioning throughout the day. I felt much better by Sunday night with the stretching. Still only half-hearted attempts at lunges and squats."

"Fifth Week:
"Decided to start my morning off by doing my full range of stretches instead of sitting in the computer chair smoking and drinking coffee. I felt pretty good when I left for work. People at work were starting to call me "feisty" saying that I seemed to be walking better (that was probably because of my better posture from applying your method instead of just doing stretches!) Sitting in a chair almost killed me - after 25 minutes in a chair the pain was almost unrecoverable - to be endured for the next hour and a half at work."

Barbara was getting the idea about healthy movement, but was sitting in the same way that causes discs to be pressured. She thought it was "taken care of" because she used a commercial lumbar support she purchased the first week. However she was still sitting in unhealthy ways, right over the support:

• The Cause of Disc and Back Pain
• Does an Exercise Ball Make You Sit Straight?

Barbara continues:

"I could manage the pain better with frequent relaxing on my stomach propped up on arms and stretching, but I never felt complete relief until I got home at night. I still didn't realize it was bad sitting position, so decided to get rid of my chair and stand to teach. This was better, but the pain still kicked in(especially in my left buttock!). Once my left buttock got hit with pain it went downhill - down my whole leg, followed by the numbness and severe tingling. Midway through the week I went to see our visiting doctor - quick visit and the prognosis that I had a herniated disc L5-S1. He said it would heal. I was feeling pretty positive about this, as it seemed to coincide with what you say about herniated discs. Meanwhile, the sciatica was taking it out of me. I felt I was always either in pain, or awaiting a painful episode. I made it through, relieved that the weekend was underway. I decided to trying walking - every couple of hours I'd walk on my treadmill for 20 minutes and then do my stretches. I did this two times in the day, and then went for a walk outside in the evening (-35 degree weather so I bundled up really well). My dog and I headed out for what was to be the most agonizing walk for me. Half hour into the walk I started to get that butt pain but I was only half way home. By the time I got home after an hour walk, I wanted to hit the roof and I although I could alleviate some of the pain through lying on my stomach propped up, and stretches, I could still barely sleep. I was also completely consumed by whether or not I had slacked in my posture somewhere along the line while I was walking, or whether I was too tight or loose (still missing the big picture)."

"Sixth Week:
"Still determined. Began the week at an all-day staff meeting where I lay on a gym mat on my stomach, propped up on my elbows- all day. Stretching at lunch and a couple of other times I walked out of the meeting to stretch. It almost floored me to do a 20 minute standing stint that we had to do during our meeting. Followed by a 2 hour course via video-conferencing where I did the same thing. When I got home the pain was less and I didn’t want to "over-do" it again, so I gently did my stretches throughout the evening- I didn’t try to walk. Next day at work, the pain was pretty bad from the beginning, but it was -60 degrees F outside and not many kids came to school - more time out to stretch when I needed to. Wednesday - more of the same. I tried to walk at night but got discouraged when I couldn’t walk for more than about 10 minutes without pain. Thursday - same thing, but I almost ran out of the school at the end of the morning to go to the nurses station. (We both wrongly assumed that I had overdone walking, not just walked in injurious ways.) She prescribed more Naproxen and told me to make sure that I walked but more frequent intervals. She also told me to keep stretching, but that lunges and squats were simply out - don’t do them. I kept wondering about this advice as I reread Ivy’s story and looked at the pictures of her doing those amazing squats and lunges. I spent most of my evening on the internet reading and rereading stories."

• Walking wasn't Barbara's problem. She was overarching the lower spine while walking, making a hidden problem - Spotting Back Pain During Running and Walking - What Do Abs Have To Do With It?
• Barbara was lying face down propped up on elbows for long periods in a way that hurt instead of help. Instead of letting the entire spine gently extend backward so that the upper back "unrounded," she was "folding" a crease at the lower back, increasing pinching in the lower back.
  
• Posts about how reader Ivy stopped the same sciatica problem: Inspirational Ivy and Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier

"Friday of the Sixth Week: True Awakening!
"I took Friday off work and first thing in the morning while I was doing my usual morning stretch routine, it just hit me! I became so obsessed with my posture, thinking that stretches should magically make my pain disappear, but I wasn’t viewing my body as how I used it during regular activity; I was also very guilty of giving up on certain things when they got "too hard" (lunges, squats). My balance was bad (despite trying to practice it while putting on my socks and shoes), my walking gait was horrible, I wasn’t really trying to do anything that required some effort, and I was continuing my bad habits of resting for hours before I tried to get back up and stretch again. Having reread some of the personal stories, I worked on my walking: feet straight ahead, feet hip-distance apart, heel to ball of foot, using my whole foot to walk - I was so focused on posture that I was holding myself stiff while walking instead of walking naturally with a bit of rotation at the waist). When I thought I was using my muscles, I was really just tensing them right up instead of truly using them. Reading posts and walking also made me realize how tight my Achilles tendon, hamstrings, and hips are. I decided to work on this through my stretches too. Next hour I was back up and walking, and stretching those areas after (using a counter to hold onto while doing a full squat, doorway hamstring stretch, and stretching my hip sitting on a chair rather than lying on the floor). Every hour I walked and stretched, and every walking session was longer, every stretching session I could actually stretch farther! Halfway through the day - now it was time to really engage myself in those lunges and half-squats - just do them and do them properly - no excuses - I need them for everyday life and unless I go beyond what I think I can do, I’ll never get to that point. They’re definitely not just part of an exercise routine, but unless I could do them with strength and stability in my living room, I knew I couldn’t do them in a fast-paced setting when I needed them.

"Time to stop making excuses. I was up and about constantly all day, walking, lunges and squats, stretching. By the end of the day, I can’t even describe my feeling of elation when I went to bed completely pain free, with my left leg hardly stiff at all, and some of the numbness in my left foot gone! Actually having been rather lazy, and in fear of lunges and squats doing more damage, they turned out to be the best stretches and strengtheners...now why wouldn’t I want to use these in all situations to get a beautiful natural stretch during my day! The confidence and calmness that all using your principles, and truly using my muscles to engage in activities is giving me give is fabulous. Not to mention all the energy! This is a new way of life for me. And quitting smoking is not a different story...it’s the same story...and my next step is to look into my eating habits and to quit smoking. It’s my life and my body is a temple...I’m sick of mistreating this temple with lethargy and apathy. No more unhealthy exercises in "power" work-outs and yoga for me...strength, balance and flexibility will is every moment, every day. Now I'm ready for your Healthy Martial Arts book...

"Thank you! Thank you! You (and Ivy) are my inspiration!
Wishing for you all joy and true happiness in life (which I know you already have :) ).
"Fondly, Barbara

"I'm truly thankful for your hard work and great insight into pain and how to live healthy in every day life!!

"PS I was frightened when I was told I had a herniated disk at L5-S1, and this was great news to me as I know I'm healing and I won't need any physiotherapists, etc. to help me through this! Your book Fix Your Own Pain is amazing - I think I've almost memorized it; two people at work have borrowed it already (including my boss) - I think they're seeing how much it has helped me. I'm thinking about giving your book to people for Christmas."

Summary "take-home" message - Barbara found that she doesn't have to "do" any exercises. That is the difference with this method and others. Moving for daily activities using the retrained healthful positioning stops the source of the injury. At the same time, it just happens to give much built in functional healthful movement. That is how exercise is supposed to be - a natural part of your human life.

There is more good news to Barbara's story, but that's enough for now.

Labels: disc, fix pain, gait, hamstring, injury, lunge, readers inspiring story, sciatica, sitting, squat, walking

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Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier

Ivy had serious sciatica with foot drop. She had knee and other injuries. She was in awful pain. In this kind of foot drop, the nerve cannot serve the muscles enough to lift the foot to walk normally. The toes drag. The foot hangs limply and slaps the ground with each step.

Commonly, someone with foot drop is put in a leg brace for life. One surgery done for foot-drop fuses the ankle so the foot is rigid and doesn't hang. Other problems come over years from changes in walking mechanics. For the terrible pain, patients are often directed to drugs and surgery. These are not healthy.

We changed that:

1. Monday's post Inspirational Ivy told the essentials of stopping the cause of the sciatic pain and nerve impingement, rather than treat the results with unhealthy means. Links to specific methods are there.
2. Sciatica, disc damage, facet pain, and impingement are results, not the cause of pain. They are not a diagnosis. When you have them, find what is causing them. Then you can reverse the cause: The Cause of Disc and Back Pain
3. The post How Often Should You Be Healthy? explains when and how to apply it.

Ivy followed my directions exactly and used her brain to understand how to get the intended results, not just "do a bunch of exercises." When she first began, she wrote,

"Over the past few days, I have been very conscious of my movements and, hey presto, I have not experienced any tingling or pain. I have to take total responsibility for every movement I make. I am constantly telling myself 'Think before you go to the fridge or need to pick up something off the floor - think lunges.'"

I gave her simple gait retraining. Ivy quickly discarded the cane she had used for nearly 7 months.

Ivy went on to teach several neighbors in her community how to fix their own pain. One story is posted in Each One Teach One.

In April 2006, Ivy wrote,

"It is nearly 5 months since I started your wonderful programme so I thought it was time that I gave you an update. I am fit and well, the sciatica has disappeared, if I get a little niggle in that area, I ask myself as to what have I done wrong, my left knee (IT Band) is no longer a problem, my balance has improved immensely and the "dropped" foot is great, in fact, when I go for my daily walk, I no longer hear the plop, plop of which I hated. I can also now wear "normal" shoes.

"Without your help and support and putting me on the right road so to speak, I would still be in constant pain plus making the chiropractor richer. Please note, I no longer go to him for treatment - I DON'T NEED HIM."

At age 70, Ivy is steadily improving strength and range of motion using healthy movement for daily life. She is eating healthful vegetarian food. January 2007 brought this note:

"The reason for this e-mail being that I feel somewhat excited re a remark made by the son of one of my fellow villagers. His very words being, "How did you become the woman that you are now. I have watched you over the past couple of years - when I first met you, you were obviously in a lot of pain, what is your secret?"

"I also sent the photos to my son and daughter-in-law who live in the US, they too, could see the improvement - they thought I looked great. Mind you, over that 2 year period, I gradually lost 20 lbs."

What about Ivy's e-mail that I mentioned in the last post about the new hip stretch? I'm out of room again. Watch for the next post - Good Life Works Better Than Bad Ab Exercise.

Labels: disc, facet joints, feet, fix pain, footdrop/dropfoot, gait, iliotibial band, injury, knee, lunge, nutrition, readers inspiring story, sciatica, shoes, spirit, squat

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Why You Need Toe Stretches

When you take your shoes off and stand up, do your toes turn upward by themselves, as in the photo at right? That is usually from tightness in the top of the foot. You can often see the tight, string-like tendons on the top of the foot pulling the toes back. Do your toes face outward (toward the little toes) when your foot is facing straight forward (same photo). A sideways -shift is common, not only from tight shoes, but can be produced from how you walk, step after step, year after year.

Toes deform into unhealthful positions in common ways:

• Shoes: Tight shoes fold and shift toes out of place. Heeled shoes push toes upward. When toes are held in one position too much, the muscles tighten and don't go back to normal length.
• How You Use Foot Muscles: Many people do not use muscles in their feet or toes when they walk. They just clomp. The muscles that normally work to pull toes and forefoot downward during the weight-bearing phase never engage properly. The toes stretch upward during push-off, but not downward.
• Positioning: If you walk with feet facing outward, the "push-off" phase is on the side of the big toe instead of the bottom of the foot. After years of being pushed toward the other toes, the big toe eventually tightens into the new shifted position.

Good reasons to stretch toes:

• Healthy spacing avoids fungus like Athlete's foot, calluses and other injuries from rubbing, and improves needed movement.
• Toes need to move through a full range up and down, and independently from each other, for balance, preventing several causes of foot pain, and for quicker, healthier movement ability. Feet are not just blocks to clomp around on.
• You can avoid toes that curl, hook, hammer, face different directions, or push sideways into bunions.

Try these easy stretches:

• Take your toes in your hands and bend them all downward, to stretch the top of your foot.
• Take your toes in your hands and bend them all upward, enough to feel a nice stretch in the bottom of your foot, not just the toes.
• Pull each toe apart from the next.
• Pull the little and big toes away from each other at once, restoring healthy width to the front of the foot.
• Pull any toes that are bent-up until they are back downward. Pull bent-down areas gently straight, and pull curled toes straight out to restore straight length.
• See the post Healthy Toe Stretches for fun foot stretches.

Stretch deformed, squashed toes with your hands several times every day, or at least at night and in the morning, or when exercising or stretching. Reduce the need to stretch them back to health in the first place. Walk with feet (and knees) facing straight ahead. Wear shoes with room in the toes. Tight shoes are not healthy. Unhealthy shoes are not beautiful.

Labels: feet, fix pain, gait, posture, shoes, stretch, toes

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Are Your Shoes Too Tight?

It is often taught that tight or snug shoes are needed for "support." However, tight shoes are not healthy for many reasons, or even needed. The posts Arch Support Is Not From Shoes and Which Shoes Help Exercise, Fall Prevention, and Ankles? explain more about the myth that support is from shoes.

Shoes worn snugly "for support" cause frequent problems. If your toes fit together like puzzle pieces or do not face straight ahead, as in the photo at left, it is likely that you frequently wear shoes that are too tight.

There should be space between each toe, and each toe should face straight forward, not turned toward either side (photo below right).



If you need toe separators (a soft foam device for separating toes) to paint your toenails, your toes are too tight and bunched together. Toes that are bunched together need regular stretching to separate them. Take your toes in your hands and gently pull them apart. Some of my patients use those toe separators to wear to bed. That is all right to start, but instead of only treating the result of a tightness problem, it is best to correct the problem with simple stretching before deformity progresses to the point where it is difficult to fix:

• Pull your toes away from each other with your hands.
• Straighten each toe gently.
• Make sure all toes separate and can wiggle.
• Practice wiggling your toes.
• Don't wear shoes that push your toes together or keep them from moving.
• Avoid tight socks and stockings - "tight" is anything that presses your toes together.
• When standing, don't tighten or clench your toes against the floor or each other. Don't press toes into the ground to balance so much that they buckle and bend. Keep your weight distributed over your entire foot, including your heel. Notice if you rock forward to the ball of your foot when standing.
• Take off shoes and all hosiery every day and let toes get sunlight and air.
• When you exercise and walk, make sure you do not walk "toe-out." Turning the feet outward, sometimes called "duck-foot" used to be thought the normal direction of the fibers and muscles. Now it is known that both feet should be able to comfortably face straight ahead.

Toes do many wonderful things for balance, walking, ability to jump and move quickly, for the shock absorption important to your hip, and more. See the post Healthy Toe Stretches for foot stretches. The next post will give fun stretches specifically for tight toes.

Labels: feet, fix pain, gait, injury, shoes, stretch, sunlight, toes

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No More Ankle Sprains Part II

The previous post How To Treat Ankle Sprains and Prevent Them promised another effective technique on the missing link in preventing and rehabbing ankle sprains in today's post. It follows below. First, it made news yesterday that a well known name in spine research, Stuart McGill, found what I have been saying for nearly 30 years of my research career - that tightening the abs and "sucking them in" inhibits healthful movement, and using the popular "draw in the abs" technique is making yoga and Pilates classes the sources of more back pain and problems. The post What Abdominal Muscles Don't Do - The Missing Link shows why crunches and Pilates are not the best exercises for core muscles, and the comment replies to Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain give more links on how abs really work. The next post will cover the news from Dr. McGill and my years of research of what works the abdominal muscles in healthier ways instead.

So today you get two breakthrough fitness posts in one. Now the promised second fun thing to do for more stable ankles. Maybe you never sprained your ankle but wear supportive shoes thinking that will keep you from sprains. Maybe you've sprained your ankle in the past, and rested it and keep it braced during activity thinking that will help, and did ankle exercises, usually consisting of "spelling the alphabet" in the air with your foot or using resistance bands. The "exercises" often do not prevent repeat sprains, leading people to think that exercise will not help and only bracing will "support" an ankle. Rest and bracing often make things worse - the numbers show many repeat sprains in people following this method. Why?

The missing link is receptors in your ankle that sense if you are standing straight on your ankle or if your ankle is bending outward, a movement called inversion. In an inversion sprain, the bottom of your foot turns toward the other leg and your ankle bends too much, overstretching or tearing the connective ligaments. Inversion is the most common source of sprains. There are two common beliefs in medicine - that strengthening will help prevent sprains, and that strengthening will not help. Both points of view are missing that preventing sprains requires something else - training the receptors that tell you if you are about to invert. This sense is called proprioception. Without it, the ankle does not send signals to your leg muscles to prevent you from turning it. With proprioception training, you learn how to sense ankle position and balance to keep it from inverting. Allowing inversion when stepping up or down is surprisingly common, even in people who exercise frequently. No wonder they get sprains. The last post showed the interesting proprioception drill of rising to toes while not allowing your ankle to invert. Try that first, then try this next step:

1. Rise to tiptoe and lower to full foot, keeping your ankles straight without allowing your weight to shift over your small toes. Keep weight over your big and second toe. Repeat at least 10 times.
2. Work up to rising to toe and lowering on just one foot (good for balance).
3. Work up to careful jumps, first coming down on both feet, then on one foot. Each time, land with your weight centered over your big and second toe, not turning your ankle outward, then roll gently down until the whole foot is one the floor.
4. Use the above stabilization technique each time you step up or down from anything, including stairs and curbs.
5. With this practice, you can train your ankles to deliberately hold healthy position with each foot-fall, reducing your risk of sprains, instead of letting the ankle turn outward.

Related Fitness Fixer:

Unhealthy Yoga Ankles
and
Better Hip Stretch - Check Your Ankles
show a common way that people predispose themselves to sprains by overstretching ankle ligaments without knowing it, and how to prevent it.

Coming Next:

Why Using Abs Is Not Tightening.

Labels: ankle, balance, feet, gait, injury, sprain, yoga

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Healthy Toe Stretches

Don't forget to stretch your toes. You need mobile toes for balance, healthy walking mechanics, and foot health.

Every day, take your feet in your hands and stretch your toes apart side to side, easily and comfortably. Make sure all your toes can move apart from each other, and that each one moves up and down. It is not healthy for your toes to remain stuck together and not moving.

Sitting in various ways can be a built-in stretch for the toes. If you sit on your heels, as in the photo at left, or kneel on your hands and knees with toes curled under you, or when you are sitting in your chair right now, see if you can bend your foot behind you and still touch all your toes to the floor - even your little toes. Don't force toes to bend, just gently see if they all reach the floor. After stretching your toes back (toward the top of your foot) bend them all down toward the bottom of your foot. Many people, particularly people who wear heeled shoes wind up with toes that are bent upward all the time. The tendons on the top of the foot can shorten from keeping the toes bent up, and the toes can get stuck in a pulled-up position. Future posts will cover more on stretching your feet for mobility, pain control, and health.

When you sit, as in the photo above, see if you can rise to a stand without pushing off the floor with your hands or bracing your hands against your leg or knee. Just use your leg muscles and get a strength and balance exercise while you get a nice stretch on the bottom of your feet.

The photo was taken when I studied a medicine course in Cambodia. Before and after classes you practice respect, concentration, and self-discipline. While you do this, you get a lot of physical exercise - it is commonplace for people of any age to kneel without using hands for anything except to hold the candles, flowers, and incense, and to rise the same way. The photo was taken in the middle of bowing, so I am not fully straightened yet. The nun is laughing. My Cambodian is so bad that I made her laugh. I think that is good exercise and good medicine too.

Photo by Paul

Labels: ankle, arches, balance, feet, fix pain, gait, leg strength, orthotics, pronation, shoes, spirit, squat, strength, stretch, toes

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