The Dynamic Balancing Act of the Foot

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NORMAL FOOT ANATOMY

The importance of your feet cannot be overstated. Your foot is a complex structure consisting of 26 bones, 30 joints, and 4 intricate layers of muscles and ligaments to create a strong, elastic foot arch. The dynamic relationship between the arch, bones, ligaments and muscles creates the ability to absorb up to 400 times your body weight and seamlessly translate that force into functional movement (walking, running, jumping). 

MISALIGNMENT AND ITS EFFECTS ON THE FOOT

Given the complexity of the foot’s internal structure, a misalignment locally in the foot, or in a distal body part like the ankle, knees, hips or pelvis have the potential to disrupt optimal foot function and alignment. Misalignment can create excessive load on certain structures of your foot, leading to muscle strains, tendon overuse injuries, bone stress injuries and ligament damage.

CAUSES OF MISALIGNMENT

To categorize the causes of misalignment, we’ll break it down into 2 main categories.

1: Structural Misalignment

This describes feet (or other body parts) that have a misalignment due to the way a person’s skeletal structure has been formed asymmetrically. Examples include Bunions, Hammertoe, Pes Planus/Cavus and Hip Dysplasia. 

Excessive Ligamentous laxity, usually from repeated trauma such as ankle sprains, will also contribute to the development of injuries, as it will not be able to support joints especially during higher impact activities. Secondary injuries due to ligamentous laxity include 

• Early onset joint degeneration – if ligaments aren’t able to support joints during movement, there will be excessive wear and tear, leading to early breakdown of joint surfaces. 
• Soft tissue irritation – repetitive motion strain causing inflammation and pain to the muscles, tendons or connective tissue of the ankle and foot.
• Ankle Joint Impingement – Ligamentous laxity may cause the maintenance of normal volumes of joint space between 2 bones, causing impingement in the ankle joint. 

Other common causes of structural misalignment include Scoliosis (spinal asymmetry), and even in females who generally have wider pelvis widths, creating a larger, acute angle between the pelvis and lower limb (Q Angle).

2: Functional Misalignment

This describes a foot that is structurally ‘normal’ at rest, but during functional tasks such as walking, running or playing sports, it doesn’t have sufficient strength and control of the foot posture to be able to function well. The most common causes of this is weakness in the intrinsic foot muscles, poor hip and leg strength, coupled with poor core activation. Foot posture can also be altered in a deconditioned individual, where their skeletal muscles are unable to maintain the body’s posture against gravity’s force. 

Some of the common foot injuries resulting from Misalignment include

• Medial Tibial Stress Syndrome, also known as ‘Shin Splints’. 
• Tibialis Posterior Tendinopathy 
• Plantar Fasciitis 
• Heel Spurs 
• Achilles Tendinitis 

WHAT CAN YOU DO ABOUT THE MISALIGNMENT?

Clearly, there are many causes of misalignment, and most people have some degree of misalignment in their body. At James Fowler Physical Therapy, our team are experts in assessing your body structure, using a Kinetic Chain Approach. This means we don’t only look at your foot, but we also assess other contributing body parts above the foot and curate a treatment approach that is effective at reducing any pain you may be experiencing, and address the cause of your misalignment. You can find more about that here.