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Feet First: Clinical Pearls for the Feet #3 and #4

Let's continue on our journey of all things foot related.

3. Bunions Are Not Fated- a better way to think about them is as a sign of osteoarthritis within your feet (this is also connected to the nature vs nurture argument of musculoskeletal development)

Weakness and stiffness in the feet create poor biomechanics that lead to bunions. As I mentioned above, the foot needs to navigate an incredible amount of forces during its daily function. If you add to that mix: running, high heel use, not training your feet, over reliance on orthotics- you have a recipe for foot dysfunction.

Bunions are one such sign of dysfunction. They represent bone growth along the medial (midline) aspect of your big toe. I have many friends (therapists too) who believe that bunions develop because of genetic predispositions. This has been only marginally established. In fact, how we move is nurtured by our family- it is one facet of the age old nature/ nurture debate. Do I develop bone conditions because of genetic coding (nature)? Or do I develop osteoarthritis because I am socialized to move like my parents- who were in turn socialized to move like their parents (nurture)?

At this point of time in medicine, most of us within the general public do not have access to change genetic factors. And when we do get that chance, I am sure medicine will enroll people with life threatening diseases first (think: Huntington’s Chorea).

But what we do have control over, is how we move. We have access to changing how we move (even in the presence of a disability) until the day we die.

So a better way of thinking of this is: I stand/ walk like my mom and grandma who had bunions, and if I don’t change how I move, I will likely develop them.

Just like you can learn to anticipate and positively influence conditions that create osteoarthritis in the rest of your body, you can change your propensity for bunions through addressing your biomechanics, strength and mobility.

The most important movements you can do to help you stay away from bunions:

  • Perform the two toe and ankle mobility and stability exercises from Clinical Pearl #1

  • Perform your heel lifts from Clinical Pearl #2

  • Wear footwear that allows your big toes to function (no narrow toe box, high heels)

4. Walking Requires Super Strength in Your Calf (gastrocnemius) Muscle- learn how to test yours

In the clinic, a couple of the biggest issues I see with the feet and ankle (put most simply) are a stiff big toe, a stiff ankle, and poor strength of the gastrocnemius. Your gastroc (that’s insider, industry lingo ☺) needs to have a 5/5 muscle grade to be able to meet the demands just for normal, healthful walking. Not to mention what is needed when loaded hiking or running. Let’s explore how to check to see if you have enough strength for healthful walking.

This is perhaps the easiest of all of the explanations. Can you do 15-20 single leg heel lifts on each leg well, without pain, without bending the knee or overusing the arms to push yourself up to your tip toes? If so, you are in pretty good shape my friend! Please continue to practice heel lifts as you age- these are a rest of your lifetime exercise.

In addition to walking, gastroc strength has been associated with improved balance with age. Crucial!

If you check out the above practices, let me know what findings you have.

Happy Moving (your feet)!


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