“A compromised foot structure is an important factor in chronic musculoskeletal pain throughout the body.” (Janet Travell, 1993)
In the first three parts, you learned:
- Structural deformities of the forefoot (“shoe‑shaped” feet) are widespread (Nix et al., 2010) and result from wearing shoe‑shaped footwear (Munteanu et al., 2017).
- Such feet are unstable and tilt inward or outward under load (Yavuz et al., 2009; Chou et al., 2009; Plank, 1995).
In this final part, we show how a simple footprint—i.e., the pressure pattern under the foot—can reveal both functional problems and the underlying compromised forefoot structure that causes them.
“Decompensated” shoe‑shaped foot
When the foot tilts inward, high pressure develops along the medial edge of the first metatarsal head and on the great toe (Doxey, 1985).
“Compensated” shoe‑shaped foot
When the foot tilts outward, high pressure appears across the lateral and medial metatarsal heads (Doxey, 1985).
What does this mean for symptoms?
- With the first footprint pattern, knee injuries are common.
- With the second pattern, stress fractures and ankle sprains are typical (Williams, McClay, and Hamill, 2001).
In addition, trigger-point pain in the lower legs, thighs, hips, as well as the trunk and neck occurs frequently—the body is compensating for the unstable foot (Travell and Simons, 1993).
The good news: stability can be restored. The same plasticity that led to shoe‑shaped feet also enables the foot to remodel—improving structure and, in turn, function (Knowles, 1953).
The good news: stability can be restored. The same plasticity that led to shoe‑shaped feet also enables the foot to remodel—improving structure and, in turn, function (Knowles, 1953).
Therapy – simple and effective
- Wear foot‑shaped (functional) shoes: your toes have room to splay, and the foot can widen and flatten.
- Load your feet regularly with your body weight: this provides the stimulus needed to restore foot shape and function.
References
- Chou S, Cheng HK, Chen J, Ju Y, Wong MA: The role of the great toe in balance performance. Journal of Orthopaedic Research. 2009; 27:549-54.
- Doxey, GE: Management of metatarsalgia with foot orthotics. The Journal of Orthopaedic and Sports Physical Therapy. 1985; 6(6): 324-333.
- Knowles, FW: Effects of shoes on foot form: An anatomical experiment. Medical Journal of Australia. 1953; 1: 579-581.
- Munteanu SE, Menz HB, Wark JD, Christie JJ, Scurrah KJ, Bui M, Erbas B, Hopper JL, Wluka AE: Hallux valgus, by nature or nurture? A twin study. Arthritis Care & Research. 2017; 69: 1421-1428.
- Nix S, Smith M, Vicenzino B: Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. Journal of Foot & Ankle Research. 2010;3:21.
- Plank M: The pattern of forefoot pressure distribution in hallux valgus. The Foot. 1995; 5(1):8-14.
- Travell JG & Simons DG. Myofascial Pain and Dysfunction:The Trigger Point Manual. Baltimore: Lippincott Williams & Wilkins; 1993.
- Williams, DS, McClay, IS, Hamill, J: Arch structure and injury patterns in runners. Clinical Biomechanics. 2001; 16: 314-347.
- Yavuz M, Hetherington VJ, Botek G, Hirschman GB, Bardsley L, Davis BL: Forefoot plantar shear stress distribution in hallux valgus patients. Gait and Posture. 2009; 30(2):257-9.