Foot dysfunctions and rehabilitation

Are you doing a lot stretching of the foot, ultrasounding it, massaging but nothing works?

Take a step back and look at the position of the foot. The resting position of the foot often reflects the tone of the muscles along with other implications.

The challenge that most physiotherapists face when dealing with big toe issues is that it’s hard to draw a logical link between the big toe and the muscular chain higher up.

For this particular patient, he was walking with the left leg crossing over into his right. When the left foot lands on the ground, the foot has trouble placing flat on the ground (walk in a straight line and you will find that you will end up putting more weight on the outer foot) and it will be in a more supinated position. This is indicated by the more inclined sloping angle as indicated in (B).

The body is smart. When it loses stability somewhere, it tries to create stability using some other methods. For my patient, the long flexors of the big toe kicked in so as to pull the big toe down just to compensate for the reduced contact of that inner foot onto the ground.

But it fails. This ends up creating more problems at the foot. When the big toe is pulled to the ground by the long flexors, the big toe loses its resting curve. There’s gonna be a jamming effect at the big toe, you lose stability at the arch, lots of irritation at the plantar fascia along with irritation of the inner ankle tendons (think shin splints, posterior tib tendinitis etc).

To correct this issue, there’s only one way. Limit your time on soft tissue work which includes ultrasound, massage, stretching, taping, infrared, theragun etc. These are great and has its place but there’s also so much work needed to be done for specific and active strengthening rehab. And it’s the strength that will eventually change your movement pattern and get you moving correctly.

Observe how the body compensates, because what you see is the compensation and not always the cause. Then confirm it with a gait analysis and muscle testing. Balance with the patient’s opinions and thoughts about his condition and lifestyle goals. Lastly, form a hypothesis, identify the logic and treat it.