footpainintro

The podcast episode discusses foot pain and covers topics such as plantar fasciitis, footwear, gait mechanics, ankle mobility, lower limb swelling, and personal histories of foot injuries. The hosts also talk about their own foot pain experiences and the role of footwear in foot health. They emphasize the importance of addressing foot pain and swelling for overall well-being. Welcome back to the Movement Professional Podcast. In this episode, Corey and I discuss foot pain. Specifically, we touch on the following topics. One, plantar fasciitis. Two, footwear. Three, gait or walking mechanics. Four, ankle, foot, and toe mobility. Five, lower limb swelling. Six, our personal histories of foot, ankle, and toe injuries. Seven, our clinical histories with foot, ankle, and toe injuries. Please make sure to check out the show notes for videos that further clarify the topics covered. If you have questions or suggestions for content, please head over to movementprofessional.com for information on how to contact us, and we'll be happy to get back to you. Thank you, and enjoy the episode. All right, good morning, Dr. Richards. Good morning, Dr. Love. Good to be back. Yeah, a couple weeks off. Had vacation. You were out on the beach this past week. Yeah, yeah. Yeah, it was good. I saw, I meant to mention this earlier. How was the jiu-jitsu competition? It was good as it could have gone. I mean, I only had to face one person, which is sort of part of my plan, in a way. Like, I'm in the 40-plus division, so there's not a lot of people that sign up for the 40-plus division. And I also did no-gi only. I just wanted to integrate myself in. Like, if you're not familiar with the jiu-jitsu terms, the gi are like the pajamas that you kind of wear and I find that harder because people can really hold on to the gi and get grips. And you have to work a lot harder to break things, where with the no-gi, you're slippery. So I won both of my matches. I didn't give up any points, so I was happy. I got, like, a gold medal, which doesn't mean a whole lot because there's just a ton of different divisions. But for my first experience, it was definitely a good one. I was very nervous. You know, I went early to watch some teammates. And I don't know if that was a good idea or not because it's an intense environment. There's like 15 matches or so going on, like a bunch of matches. And it's kind of hot in there and it's an aggressive atmosphere, really. So when you're training, sometimes, you know, when you spar, it gets pretty aggressive, but a lot of times it can be, you know, you're going against somebody that's a different level than you, so you're drilling. You know, it's not always as aggressive, but every match seemed pretty aggressive. So I'm looking at the different people that I might compete against, and just a lot of thoughts are going through my mind. So it was actually nice to get out there and, you know, just compete a little bit. And it went well. I'm better than I thought. Are you going to do another one? I think I will. Not right away, you know, because for me, it was more of the training for it. I definitely really got everything I wanted out of it. Like, it put me into more of a focus for jiu-jitsu. I feel like above any other movement practice, like, if I get a little bit better at jiu-jitsu, like, I feel like I've done a lot. Like, I just feel like it's such a big bang for your buck movement practice, but it is complex and it's humbling. And the cardiovascular element for me, it could be, like, really tough depending on who I'm rolling against. But I really felt I got a lot better in the training, but the training also, for me, it's not what I'm going to do for a living. So it's like, I put a lot more effort into the training. So for now, it's nice to kind of sit back and feel like I don't have to have a pressure of a competition, but I'll probably switch gears into something else. I'm just not sure what. Yeah, is that your third competition this year? Or third within the past year, I guess. I think it's just two this year, but then I had done the tactical strength challenge at the end of last year. Yeah, so I know it's definitely useful to put something on the schedule and have a focus goal. I just don't, I don't think I want too much focus right now. The other thing is sort of takes a little bit away from my work-related tasks. Like if I want to create content and stuff like that, I just, I can't be spreading my brain that thin to like focus on like a competition that's coming out and then be as consistent as I want to be with like building content for the business. I think I want to put a little bit of work into actually making my training more tied into like longevity-based training and see if the stuff that I've written about actually is useful as I train myself with it, which I have done this to a certain extent before, but I want to really hone a program that I can then write about and make a program about. Yeah. That's my thought right now, but we'll see how that changes. How about you? What's your training looking like these days? I've been, are you familiar with Alex Blenis? Have you ever heard of him? He's like a tactical kind of strength athlete. He's done a bunch of ultras. I think he set like the Murph World Record and stuff. Oh, wow. But I've been following, he just does like a subscription-based programming, so I've been following that. It's kind of a mix of, like there's some hypertrophy in there, good amount of conditioning, some Metcons thrown in. So it's a good like, Alex Blenis, B-L-E-N-I-S. But he's big on, he has a lot of different kind of programs along that line, but I've been enjoying it. It's a little more well-rounded than what I was doing previously. So yeah, I'm feeling good. I ran a 10K yesterday. Oh, nice. And it felt good with it. So I might try to sign up for something. I'm thinking like a, either like a sprint try, or I don't know what, maybe a 10K or a half or something like that. We'll see, man. All right, a wide ISA entering into the endurance realm. I like it. I know, I know. Good for you. Yeah, some good rotation for the running. Yeah. Yeah, speaking of that, I've been like on a documentary kick, like a sports documentary kick. Since I went away to the shore, I didn't have my normal like Hulu Live to watch, so I had to watch a lot of Netflix. And one of the documentaries I came across was Quarterback on Netflix. Oh, did you see that? Who started that? Who started, yeah. The thing that'll be interesting is when they, Patrick Mahomes is one of the quarterbacks they profile. And his trainer, which is like a childhood friend, but he talks about like, he is better than any like high velocity pitcher he's ever worked with at rotating and separating out his rotation, like from his neck to his spine. He probably uses terminology that we might not use, but I just thought that was like fascinating for some of the work that we've done, at least more recently. And he's definitely a unique guy out there when you see him move. And when they broke down like some of the movement, it made a lot of sense where it's almost like, I don't know how much you've done work with like golfers. Like I know in TPI, when they talk about like the professional golfers, the dissociation from the upper body and lower body is like one of the things that like every professional golfer has that amateur golfers don't. And it was just interesting to hear that with like the best quarterback maybe ever. And that's one of his like superpowers is that he rotates his spine and dissociates his spine, like neck from torso from hips better than anyone in the league. And it's almost like a baseball player. Yeah, you can see it too. Like he like runs, he's so good at kind of throwing back, I guess. Like if he's running to his left and still throwing. And the one thing that they kind of profiled and they slowed it down is that he, his gaze is always able to like stay fixed, but he can have his body turned the other way. So it's like, you think of it as though he makes it look so easy when he's able to like be facing one way and throw like a bullet the other way. But the reason he can do that is because he can actually turn his whole body to face where he wants to throw it. But like half of his eyes at least are looking the other way or vice versa, right? So it's that separation of like the neck from the torso. But what that often looks like is like no look passes where he's like throwing a bullet, but his body looks like it's facing the other way, but it's really maybe just his head. So, and that's, you know how tricky that could be from a coordination standpoint, but he just seems to have that down. Yeah, it's insane. He's insane. I mean, I like, I mean, obviously I like Jalen Hurts more as a quarterback, but from like a talent throwing perspective, he does some absolutely ridiculous things. Yeah, I like that you get a little bit of behind the scenes with the guys and you get to see some of their personalities. He comes off well, he's a competitor, but he comes off well. So I've been getting a little obsessed with that, but I thought that was fascinating and it makes sense when you hear it, but I didn't necessarily put it together less than a blip. Yeah. All right, so today I think we're gonna touch on foot pain. We're gonna be pretty broad with this. We'll talk about a couple of different diagnoses there. We had a request from a listener, and to be honest, this is something that's been important to me of late as I've gotten into more jujitsu. I feel like, you know, it's a different type of training for my body, especially when we go close to 100%, but where I tend to feel it the most is in my feet because there's a lot of times where I have to be on the tops of my feet, on the mat or on the balls of my feet. And that's especially when I'm on the balls of my feet. I don't have the best toe and ankle mobility, but I have to be strong there. And you don't necessarily feel it during, but the aftermath of it definitely brings that on for me. But I also think for a lot of people that are recreational athletes, you know, they might be working in a job that's not as active, but still playing basketball, still playing lacrosse, still playing tennis, like sports where you have to be planning and cutting a lot, right? Feet start to take a pounding and we hear about knees. We hear about backs all the time, but I don't know that the feet are talked about as much because I think a lot of times you could play through or, you know, work through the foot stuff, but it's just like a chronic pain that you're dealing with. So I figured that would be a good topic to touch on. I know you're a bit younger than me, but I'm sure, you know, you're an athlete. You played longer than me in sports. So have you had your share of foot and ankle issues in your playing career of late? In my playing career, less so, but as of late, yeah, probably because my actual preparedness isn't as good as it was before, but I've been playing a good amount of pickleball, actually, and my feet are like crushed by the end of that. And then, yeah, I get out on the field once a week or so with some guys and do some sprints. And that's something too, where like if I increase my volume a little bit, then my feet just hurt the next few days. Dogs are barking at me a little bit. And I think it is something where it's kind of not talked about as much and people often just kind of work through it, but there's something that we inherently all need. And if you kind of lose the tolerance to work through it or it kind of gets past the tolerable point, then you're kind of at a loss. So I think this is a good topic to touch on for sure. Where do you feel your foot pain the most when you get it? I get it mostly like just right in the arch. What about you? Sometimes there, I mean, in the past, I've had some plantar fascia type issues, but it's less so there. I've had a long history of ankle sprains, not in a while, but I would say two or three a year when I was playing basketball. So I've always been limited with ankle mobility and that's been like a lifetime goal of just trying to continually improve that. So I'll even get some like inner, like tarsal tunnel, inner ankle pain sometimes, but it's my left big toe, I would say is like the biggest issue. And sometimes it'll go to the right foot, the left big toe, for a long time, there's been a lack of mobility there. And I'm certainly been working on it as much as I could, but there's just seems to be a limitation left versus right. And that will tend to light up a lot quicker than the other side. So I find that that's to be the thing that's the bigger issue. And one of the things I think I started to associate with more of that pain is also swelling in the feet, right? And depending on nutritional things, depending on even just temperature in the atmosphere is after training, a lot of times we'll recover in a way that we're not always elevating our feet, we're not always thinking about, how much fluid and how much pressure is moving down into the feet. That seems to play a huge role in how much discomfort I'm starting with in the feet. And then vice versa, if I do some things that are like, I have the Normatec gear, which is the intermittent compression to kind of try to push some fluid out of there. I'll use some of the intermittent compression bands to try to move some pressure from the foot up into circulation. That seems to help a ton, but at my starting point, especially in the mornings, more and more seems to be more pressure down low into the feet. And I need to do a lot more work to get some of that swelling or edema out of there and back into circulation. So I feel like that's a part of it outside of any specific joint or tissue is just that may change over time, but I do think that's something that's a little bit underrated and it's sort of a more systemic holistic way that we have to think about the feet is like, how much swelling is there and what can we do to make that better in any moment, but also appreciate that it's dynamic. There's never gonna be a time where you don't have swelling move down into your feet. It's gravity dependent, but it's also dependent on a lot of other things that might be limiting circulation at any moment. Is that like a newer thing for you? Have you dealt with that for a while since you're playing career? No, I mean, when I was playing basketball, I mean, I was quite a bit younger. I didn't pay attention to any of that stuff, you know what I mean? But I certainly didn't have the same toe issues or foot issues. I think I've done a lot more cardio in the last like five years, which has made me feel much better in many ways. But I do think one of the side effects of that is even being on a bike, in order to get my heart rate up a lot of times, I'm not a high level cyclist, but I'll just stand up on the bike because it's just easier to get my heart rate up and sit down on the bike than when I have at home. And sometimes I'll do that for like 90 minutes while I'm watching TV or something like that. And stuff like that starts to bother me. I used to do a lot of like running in place while I was watching TV. And I like being barefoot, like I feel comfortable being barefoot. But I think after a while, one thing I was underestimating was the effect on like the ball of the foot because when you're running in place, there's a little bit less load. You can control your landings a little bit better, but at the same time, you're not going through the same type of foot motion. A lot of times it's more targeted to just the ball of the foot when you're moving. So I've had to be a little bit more careful and vary up my movement. You know, just especially the movement that I would usually do is almost like extra, like non-exercise activity while I was watching TV. I think I thought I was being kinder on my joints, but I was forgetting about my feet a little bit. And then, you know, with that, it's just, there's a stiffness that I feel like comes with my initiation of trying to get movement to the foot that seems to be worse if it's, you know, earlier in the morning, or if I haven't done some things to get just my whole body circulating better. So I'm attributing that somewhat to just, you know, circulation things, swelling staying low. And just as we both know, like the gravity dependent nature of swelling is really, really important. And I think it's not as appreciated by people that aren't in the field and thinking of the body as like a pressure system more than just like a bunch of isolated joints. How much do you think footwear kind of plays a role in some of that stuff? Because I'm thinking like when you were playing basketball, you were wearing probably basketball shoes, I would assume. I was obsessed with them. Loved the basketball shoes. Jordan's? Oh yeah, huge Jordan. My daughter is named Jordan just for reference. Versus like a, now I know you're, you go barefoot a fair amount more, like you're competing barefoot with jujitsu and been doing some different types of cardio and more barefoot shoes. Like how much do you think that plays a role? Or do you think that more is just dependent on like kind of coming back what your body is ready for at a certain time? Like, does it matter that much? Or is it as long as you're ready for it from a physical standpoint, it's okay to go one way or the other? Yeah, I mean, I think it always can fall into, like if you're ready for it, you can wear whatever. But with that being said, we can't get too extreme. And I certainly have been in that camp of really getting extreme with footwear. And it's almost just because like my body felt a different way with something. And I think we talked about this when we were talking about nutrition, where you make a change to something and it feels better. And now you feel like you were missing this your whole life type of thing, as opposed to appreciating that it might just be within a certain context that this is appropriate. Right, and I think with footwear, there's no doubt that that is something that we can all fall into. Whereas like you have a pain in your foot, it's common to go to a doctor and they just tell you to like, get the biggest orthotic you can, never take that orthotic off, but protect, protect, protect. But then what are you doing on the other side of that? You're atrophying, atrophying, atrophying, right? So like there's always that balance of being able to tolerate, but also knowing like what's the context in which you're in. So I'll tell you like just a history of like my thought process with footwear. So I used to wear basketball shoes all the time. And I didn't really think about my footwear as like a way to improve my function. I just sort of like rolled with what, you know, like basketball players wear basketball shoes. And then I, it was more of a fashion thing, like my footwear. And then I got into, for a very short period of time, Muay Thai kickboxing. And I always jumped rope, you know, playing basketball. And I, you know, had to do drills where I was wider on my feet. But doing Muay Thai, we were jumping barefoot, jumping rope for about 15 minutes, just as a warmup before we got into, you know, all of the striking and kicking. And when you're throwing kicks in Muay Thai, you have to roll over the ball of foot. So you're gonna be very much on the ball of foot. But there was a sense of doing that for just a couple of weeks where I just felt like a cat. I felt very light on my feet. And as soon as I put shoes on, I felt heavier. And it was very obvious. And it was obvious when I was working. So like I would be wearing like Skechers or something. I tried to dress up a little bit nicer than what I do now. I just wear like the movement professional T-shirts and shorts. But I got to, you know, I tried to dress up with khakis and I had like sort of dressier shoes. And I would just feel heavier. And so the contrast there for me, it was like, all right, I have to explore this a little bit more. And it happened to coincide with the Born to Run book and the Vibram five-finger shoes. So of course I went all in. I got the Vibram five-finger shoes. And I did feel really good wearing them to work. You know, and of course I got made fun of and everything like that. But I really didn't care at that moment. I think it was like kind of coinciding to when I gave up drinking and I was vegan. So I was like, I was embracing all of that, you know what I mean? Just like, whatever, you know, I'll be different. But I did feel like quite a bit lighter on my feet. But then I also was like training for the Broad Street Run and I started running in them. And they're like, that's two different things. I was not a good runner to begin with, but for some reason I decided to go like all in in the like barefoot running. And I, yeah, I broke the top of my foot. All right, so I ended up healing that just by like wearing a more supportive shoe. You know, I don't wanna use the word healing, but like I was able to run the Broad Street like a couple of weeks later just by wearing a more supportive shoe. And I never really felt that pain again. So that was like a good kind of eye-opening experience for me where it's like, it really depends on the task. And it's a long-winded story there. And then I had another type of experience where I did indoor rock climbing. And I don't know if you've ever done that before, but I'm again, not good at it. It was an experience where like I was being tied and I went with my five-finger shoes because I was wearing them all the time. And, you know, I sucked really bad because you need to have like a little point. And there's like shoes that actually give you like a little point that you can have more foot contact on these like smaller holes. That if I have like bare feet, then one, my like toes are bending, I have no strength there, right? So for the function of that, there's a reason that people that are really good at it wear a certain type of shoe. It's like, it's not like I'm going to train my feet to be better than people that are really good at it. And I found that out really quickly because then I put the shoes on and I was quite a bit better with the shoes on and quite a bit better from nothing is still terrible, but it was a stark, you know, contrast. And again, it was just another experience where it's like, okay, it depends on what you're doing from just a performance standpoint. We're not even talking about like our injury prevention and things like that, but I'm sure it would be for that too. If I did that over and over again, my toes are going to take quite a bit more of a beating if they're getting bent as opposed to having a nice firm rock climbing shoe that's built for that task. And then another example is like you got into CrossFit and started doing Olympic lifting where it's like the Olympic lifting shoes make you Olympic lift a lot better than if you try to do that barefoot, right? Like, because one of the values of being barefoot or wearing less support is that you tend to be a little bit lighter on your feet, because it hurts to be not lighter on your feet. So that I believe is a good thing, right? So you want to think of it from a perspective of like how much support do I need right now? Like if I'm standing and walking around, it's a good thing if I could tolerate this on the undersurface of my foot to have sensation that tells me don't be so heavy on your feet, right? So for up the chain, like that makes sense that that's going to actually be useful. But if I'm standing on concrete all day or asphalt versus if I'm standing on, I have indoor turf, I can be on that, right? Like the surface you're standing on matters, right? And how long you're doing it matters. Like, so there's always context to footwear and that really, really doesn't get talked about, right? And especially from, you know, in the orthopedic world, it tends to be just, you know, usually don't have enough time, but like I get patients that come in and their physicians have just told them orthotics, this is how you're going to solve this problem. And it's just, that's really, really short-sighted. And then what ends up happening is it's like you're dependent on the new footwear. And then you're, I see this time and time again, I'm sure you see it too, where as soon as somebody needs to get a new pair of shoes, they blame the whole like company that they can't find a shoe. They got rid of the shoe that was, you know, the only shoe I could wear. Well, no, it's just because it's probably the exact same shoe made in the factory, but like you had broken it in exactly the way that you were used to. So any change is going to throw you off and that becomes the problem. You don't want to be in that scenario where you can't change your footwear at all. So we've talked about variability many times, like that definitely plays a role in my opinion in the footwear discussion, but it's not, it's never going to be a simple answer. It's going to be sort of an N is one, assess yourself type of situation. Let's take it back to the Broad Street. You ran that with a broken foot? I mean, I had an x-ray that showed I had a broken foot, right, and this was like maybe two weeks before the race. I wore a boot for like a week. The podiatrist told me to wear it for, like I was going to need to wear it for a lot longer. And I just, I just didn't, you know, I guess I was like a bad patient. Like I wore it for a week. I started training with it on and then I took it off a little bit and I wore a more supportive shoe. And I was just like, yeah, it doesn't hurt that bad. And I did a little run on like a treadmill with a more supportive shoe. And I'm like, I feel actually okay. Like I have been walking with a little bit of a limp periodically. I felt like there was something that just changed just by like going in and trying to run and saying like, oh, it's not as bad as I thought it was going to be. And then I just like, I just ran it. And, you know, there's a piece of that. I'm not necessarily advising anyone to do that, but there's sort of a piece of, you have to really test things out a little bit. Like my plan, and I wasn't like, I was just going to go run 10 miles. I was going to run like a half, a quarter mile or something like that. And just see like, how does it feel? And as I started doing that, I was like, oh, it actually feels better than not running weirdly. So then I just kind of kept going with that. I trained for another week or so, gradually building up the distance. And I'm like, you know, why the hell not? And I thought it felt fine. And afterwards I didn't really feel it again. Yeah. Yeah. That's awesome. What was it? You said that was kind of in like your, when you were vegan, you were coming into five, like was that kind of tough to go into work without those shoes on, without the five finger shoes on? Well, I like it. You go hit or like. Yeah. Yeah, it was. And there was a lot of people that were like, it was a weird time, like telling me to sue. You know. Really? Yeah. Like I had, and I was in a, Ballot King when I was in the main line. So there was people that like were attorneys or everybody knew it. At least everyone knew an attorney, had a family member that was an attorney. So it was just, that's the last thing I was thinking about, but it was, yeah, there was a discussion about it at least. Yeah. And definitely like, I cringe looking back in some ways at my mentality towards like certainty when I was younger, right? Like, cause whenever I would make a change and I'm glad I definitely, I'm glad I experimented and went through all these things. The stuff that makes me cringe is I remember my mentality in certain times were like, this is the thing to do. No doubt. You know what I mean? Like, this is the thing I've been missing as opposed to just like, let's just see how this plays out. Like, you know, let's have a little more curiosity as opposed to certainty. Yeah. And it's like, everyone else is wrong. I know exactly. Yeah. And I remember being vegan. I was purposely trying not to have that mentality, but I was very much like, I mean, I still kind of am easily swayed by a good argument, but a good book can really make me very passionate about something. I think because I've had these experiences a lot less so now, a good book will make me be curious about something that I wasn't curious and help me stay more consistent. But in the past, I read the China study, which is a pretty popular, it was at that time, about why veganism helps people not get cancer and things like that, which I feel like it's sort of been debunked and I've seen some research to debunk it in some ways. But at that time it was like, oh, well, I'm gonna live longer by doing this. I'm pretty sure of it. But I was trying not to be the guy who was telling other people to do it at all. And it was more of the opposite where I would just be out and it was obvious I wasn't eating animal products and people would come up to me and then they would tell me why it was wrong. It was really more of the opposite from that perspective. And there was a bit of that too with the footwear. I was actually standing at, with my first job, standing at the front desk and some woman didn't address me, just walked right by me. And I'll never forget this. She just goes, I hate people that wear those shoes. Didn't say it as if she was talking to me, but just walked back so I could hear it. I was just like, wow. That's insane. Yeah, it was insane. So it was like, she doesn't hate the shoes. She hates people that wear the shoes. Yeah, shoes are fine. Hates the people. That wear the shoes. She actually directly told me she hated me pretty much. Oh my gosh. Oh, that's insane. We've been talking kind of broadly about footwear, or if not football footwear, but also like foot pain. I think the big thing that comes to mind that I see a lot in patients, and I'm assuming you do the same as people come in with a diagnosis of plantar fasciitis. Right. What are you kind of thinking when you hear that? What are your conversations like with people? Because I know that's kind of a, it's just meaning that that area is really irritated. Right. But it can sound like scary. It's another thing where sometimes I almost feel like it's over-medicalizing kind of a just general pain in the foot can sound a little more scary than it is. But what are your conversations like with people? How are you kind of going about looking at from a broad perspective? Yeah, first I would agree with you that, we had a conversation a couple of weeks ago about osteoarthritis. And to just break down, again, the term plantar fasciitis, the plantar fascia is a structure on the undersurface of the foot, and itis means inflammation. So at any moment in time, if there's inflammation that leads to a patient complaint in the bottom of the foot, it's gonna be called plantar fasciitis. So sometimes there can be imaging or things like that, that show like tearing and fraying within the plantar fascia too. But I do think that sort of like falls into the same idea of no image is gonna tell you like how somebody's presenting. And when we're thinking about that, like you ultimately have to think that the foot is the thing that takes contact with the ground the most. So there's really two things that I look for, or sort of like two archetypes I'll look for when somebody's complaining of foot pain, is one I wanna see like, is their foot biased towards a more rigid sort of supinated position, which would be like a higher arch, or is their foot like more biased towards a pronated position, where more of a flatter foot. And that's just like a start. And then I wanna see how well they can move in and out of that starting position. So it's really, you don't wanna get too biased to just like taking one look at someone and be like, oh, I know exactly like how that person moves just by what their static posture is. But a lot of times if you see like a higher arch and say somebody can't get out of that higher arch position, that tends to correspond to more potential for rigidity, lack of movement of the plantar fascia, right? So if the arch is lifting higher, you can think of it broadly as the plantar fascia is moving more towards tight, more towards rigidity. Where if the foot is actually like pronation or the plantar fascia is actually desirable, it just depends on how much pronation and can someone move out of that pronation? So we've both seen like that navicular drop type of idea where like the actual inside arch is resting on the ground and it can't get off of the ground. That's a problem too, and because, and again, even though that would theoretically be a less rigid plantar fascia, the foot, the arch, the toes, you know, can't really move. So it's just sort of falling inward. And that's not just a foot problem. That is typically a problem up the whole chain. So we have to see like where somebody's starting from and then ultimately it becomes about which direction do we have to move this person? So if somebody has a more rigid foot, one of the things that I find to be the most useful is unstable surface, kind of standing and walking. So just getting somebody to actually take their shoe off and stand on like what would feel like deep sand can be quite useful, or getting like a softer type of massage ball and having the foot slowly smush that massage ball so that there's this sense of the massage balls going into the undersurface of the foot and making the foot wider, the more smush you get into the ball. So trying to widen the foot actually becomes a big part of that process broadly. And I don't think we'll be able to go into like how many ways we can look up the chain to make it happen, but that would be just my general idea. I wanna make typically a foot wider when there's plantar fascia symptoms, unless you're having that kind of really, really pronated foot, then we're gonna have to do some work to try to build a little strength in the foot and typically up the chain. A lot of times I look at really pronated feet, I'm thinking that's a midline stability issue as much as it is a foot strengthening issue. Right, I think the other thing that comes with the unstable surface strain, especially with that high foot, kind of high arch is it's like you're just giving people also a reference to like feel that part of their foot in contact with something when it probably isn't used to it, which I think could be helpful for another mechanism. We don't need to get into mechanisms of how things happen, but potentially another mechanism of why that might be helpful in like letting that foot kind of widen and get a little bit fatter. Are you looking typically at like overall activity level, like are you making activity modifications with people based on that or is it so, it's obviously case by case dependent, but how often is that kind of part of your discussion with people versus just like, okay, let's focus on either getting your foot fatter or whatever it ends up being and there's more nuance to it than just that, but how often are you kind of looking at that activity modification piece with the foot? Yeah, I mean, you really have to, because a lot of times this stuff becomes a volume game, depending on what the task is, right? If somebody is having pain and it's secondary to playing a sport, especially like playing a sport that they're playing recreationally, sometimes that's a difficult conversation because the problem with sports is like when you're actually in a competition, like good luck trying to modify your activity in that moment. I hate telling people like not to do things. Like I think that's as far away from like what I think our job is, but in certain moments, it's gonna be like just trying to have people understand like the difference between in training, doing something less, which I'm always erring on the side of like, never shut the light off, but turn the dimmer switch down. But if you're playing a sport, you may have to just practice or not playing a game. Well, if somebody is just playing like in a men's league once a week, that means they don't play that game. You know what I mean? Like you can practice basketball, but it might be really hard to actually play in a game and still modify this if that becomes the problem. So that's a discussion that I tend to have. And I like to make it a shared decision making process because the other thing I like to discuss with people is like how important is this task for you? Because I get it. Like, I'm talking about my foot issues now. You're not telling me to stop doing jujitsu right now. It's not that bad, right? Like my feet aren't that bad. And the gains I get from jujitsu are way better than waking up with some toe pain that feels better later in the day when I mobilize it. You know what I mean? So I think it's important to have that shared decision making discussion about, okay, if we can find some exercises, if we can sort of like understand this process enough, give you three or four things to do that even when you're in pain, make you feel like you're in less pain, you get a little bit more control over the situation, but you also got to play in your game, right? You get to continue the thing that you're trying to do. And we just have some things to put the fire out. Is that worth it to you? Like, does that make sense? So a lot of times I think that becomes more of the avenue that I would like people to understand at least. And if they say, no, I don't want to have any pain, I'm like, well, you probably can't play right now. You know, like we have to, you know, let's give it a month and see, maybe we can get back into it. But again, their season might be over in a month. You know what I mean? So it becomes a very much case by case basis, but I think it's a discussion about shared decision making. And I like to try to have people think about like, here's the possible scenarios. We might be able to make progress a lot quicker than you think. And depending on the task that has to be modified, that's when I absolutely will talk about footwear and say like, you know, while you're playing, you might want to think about, you know, maybe compressing the foot a little bit more, right? Like see what it feels like to have a little bit more support. And then immediately afterwards, have actually some type of process where now you take your shoes off, you let your feet breathe, you move your feet a little bit, you do some of your exercises, you get some circulation, you do some stuff later at night to create a circulation change that gets some fluid out of there, right? Have a process and be curious, like be in it. So you don't have to take any time off, but see how much better you can make yourself just by doing some of the things we're talking about. Yeah, the footwear piece is interesting because in a way, and like changing biomechanics and things like that a little bit, it's a form of kind of load monitoring in itself, where if you're kind of changing how the foot's working, then different areas are going to take on load, even if externally your activity doesn't change. But I think I love the shared decision-making process, and I think that applies to every real diagnosis, especially like when we're seeing it in an outpatient case-by-case basis of kind of like, okay, this is kind of just shooting people straight. Like, all right, you don't necessarily need to stop this, but this is what you can expect from doing this. Here's how we can kind of modify things or supplement to make sure you're still moving in the right path, versus like you said, like if people, you've had people that just say, I don't want any pain, then that's a little bit of a different game plan. So I think that's really helpful with this discussion and just overall as an overarching theme with therapy as a whole. I think one of the things from a biomechanics standpoint that is really good to get people thinking about and working on right away is gait mechanics, like walking mechanics, right? Because especially with the feet, right? Because that is, to me, this gateway to the discussion about the feet and the whole chain all in one, right? So if you can have a system that you look at how somebody's walking, but make it that you could easily break it down. So you see what somebody is ready for, but you can give them some exercises that are working on integrating the feet with something that looks like it would carry over to walking mechanics. I think that's huge, right? Because what I find to be useful with the understanding that I have about gait is if my feet hurt after doing something that is a little bit more intense, walking actually becomes therapeutic for me. But it wouldn't if I didn't have the awareness of how to put load through my body, how to think about gait. And it's not that I'm walking always in the same exact way, but I have a way of thinking about walking when my foot hurts in a certain area that actually becomes part of the solution, right? Or part of the recovery at any moment. So getting people to understand where the foot would be more optimal from an initial contact standpoint in the heel. How we can think about, or you're getting big toe pain. Big toe is on the inside of the foot. How could we shift not just your foot contact, but your whole body maybe toward the outside of the foot, but do it in a way that's still within the whole process of gait, not so that you're just never touching the big toe of your foot. And you understand the gait mechanics too, but I just think that that's the first thing that I think about as a clinician, where it's like, all right, foot pain, we may have to do some things to widen the foot, to make it less rigid, but we also have to really look at how is this person walking every step they take? And then this is where having an appreciation of maybe like when you're in house, you're doing some drills that are walking oriented, you're doing those barefoot. So you can feel the relationship between what your foot is doing and do it barefoot on a nice carpeted surface, right? So the surface that you're walking on also will have an effect on what footwear you should wear, obviously. But one of the things that like wearing cushions footwear does for you is it gives you, you don't need to have, it takes, it deadens the sensation between you and the ground, but it also in a way can make the foot a little bit wider if it would be a little bit more rigid, because it's like, it's sort of an unstable surface that's moving with you if it's cushioned enough, but it also gives you less ability to move your foot oftentimes, because it's not just that you're standing on a more cushioned surface, you're standing on a more cushioned surface that's boxed in from all angles. So when you walk on a softer surface, like a carpet, but you also don't have the shoe compressing you on the top, to me, that is sort of the best of both worlds where you can get some movement, but you also don't get too much of the sensitivity underneath. And then you can manipulate that surface over time as part of your exercise, right? So most houses have some type of carpeting, you can get a mat that you can walk on, but then you can also go on linoleum, some hardwood and say, all right, I can tolerate this now, at least while I'm doing a slow walking exercise to work on my gait mechanics, right? So it ties in some of the understanding or the ideas of footwear with, what surface can you tolerate it by breaking down the gait cycle? Because oftentimes that's going to become the complaint. It's not necessarily during the competition, it might be, but a lot of times it's just walking and first step you take in the morning, well, attack that, go after that right away, really understand walking, and then you can actually see where you are in the process. And sometimes you got a slow walking down, you got to break it up into drills, but then you can speed it back up over time. I really like that using kind of the surface as just another way of looking at footwear, just in a different way, that's helpful for me. And yeah, I really like that. The other last thing we would touch on is just, which is similar in topic is if there is a, especially like a ball of the foot type of pain, so this is more of like a big toe type of issue, but you can tend to see it with the plantar fascia too, is most of the things that we do in the course of our day are going to be oriented towards like moving forward, because our gaze is forward, our eyes are forward, even when we're sitting at a computer right now, like the tendency is to not sit back into the chair, because we're having a conversation and the more that we're kind of excited about that conversation, we're going to come forward. So when we're doing an activity that is higher intensity, especially stuff that's more like team sports, the body weight tends to be shifted forward more than, it's at least more biased forward, and there becomes an imbalance about where we're putting load through the feet. So a counter to that then becomes what type of exercise is biased more of the back of the foot or a more balanced foot contact? So you think like kettlebell swings, right? You think about like any type of squat work, deadlift work, that the idea is that you're actually supposed to stay grounded through the foot a lot more. That's a good opportunity to start training the foot, barefoot, but not have to make it like only about the foot. So the feet are more planted and the goal and the intention is to be heavier through the heel without losing the ball of the foot, but a lot of times it's, you could call it posterior chain work, things like that, but making the intention, not just about doing a deadlift, but what are your feet doing during the deadlift? Not just doing a squat, but what are your feet doing during the squat? And then vice versa, or going forward with that, like a snatch is a higher velocity thing that I think is really, really useful, or a snatch, sorry, a swing or a snatch, any of those ballistic movements in kettlebell that you actually have to speed up the motion, but still think about, are you staying anchored through your feet? Are you getting knocked off balance? So there could be a whole progression there and I find that to be super useful on top of working with gait. Gait's a little bit more dynamic where you're moving forward and you're actually feeling yourself move through the whole foot outside the end, but with a swing or a squat, you might be more grounded and it could be actually a lot easier for people to start to feel the feet while they're still doing fitness and working up the chain. Yeah, I think too, with that kind of theme of trying to stay back, especially on a lift and things, especially with people that complain of tight ankles, I think sometimes just teaching someone how to kind of stay back and squat down through the midfoot towards their heel a little bit, it enables actually freeing some stuff up at the ankle without actually having to directly do like a traditional stretch or anything along those lines. And then that, the hope is, carries over to gait, managing your center of mass and being able to do that even as you're kind of falling forward continuously, I think changes things at the ankle and at the foot as well. So, 100%. Yeah, I think that's a good place to stop and I think that last piece really speaks to, it connects to what we were talking about with grip, several sessions ago, where there was these four corners of the foot, well, or four corners of the hand and where you are on one of those corners will dictate what you're doing up the chain into the shoulder. Well, the same thing is true with the foot. So, even if you're thinking about like, working on dorsiflexion, which would be typically thought of as a calf stretch or a soleus stretch, the first thing you gotta be able to do is anchor your foot, right? Because you can get a stretch, but you shift all your weight forward and it totally changes the intention. So, it's not about the stretch, it's about keeping an anchor and actually the direction of motion that you're trying to get to when you're trying to mobilize the ankle there. So, yeah, the anchoring aspect and keeping your weight back is typically the thing that you gotta think about because the tendency is to move forward, I think is probably the most important thing to teach people because it's not intuitive. Absolutely. All right, until next week, we'll try to pull the audience again and see if anyone's got questions about specific injuries, we'll do a whole episode about it. So, comment with questions and otherwise we'll see you next week. See you then. Thank you for listening to the Movement Professional Podcast. If you're finding the information useful and would like to support us, please subscribe on Apple Podcasts. If you have questions or suggestions for future content, feel free to send us a direct message on Instagram at movementprof, that's at M-O-V-E M-E-N-T-P-R-O-F. Or you can email us directly at chris.movementprofessional.com. If you're interested in more information regarding health, longevity, fitness and performance, please check out Dr. Lab's books, Longevity Through Movement and Mobilize. Longevity Through Movement lays out an optimal plan for staying fit and healthy as you age, where Mobilize provides a framework for improving joint mobility throughout the body. Both books can be purchased at www.movementprofessional.com backslash book. That's www.movementprofessional.com backslash book. Thanks and see you next time.