Saturday, June 7, 2008

If the Foundation is Off?



The Leaning Tower of Pisa is unstable and tilted. Why? It's foundation wasn't solid. Engineers have put in all sorts of support so it won't tip over and can remain standing for many more years. What happens to a runner when his foundation is unstable? I am looking again at my feet. My left foot does not function correctly, so as I run, walk, and even stand it pronates and seems to push my foot over on the arch side, then the ankle rolls in as the foot twists out, then knee goes knock-kneed, and so the leg is unstable causing the hip to not support and drive the leg correctly. I get hip and back problems and things have been this way for years!

I can't tell if it is a hip problem forcing the chain of events down the leg, or a foot problem forcing the imbalances up the leg. No doctor or specialist has ever given me a solution or even addressed my questions.



Last year I attempted to do something about it and today I decided to go back and try it again. I started playing around with old insoles from all the retired running shoes I had lying around. I cut sections off under the left foot's little toe's metatarsal bone. There is a point there that stays grounded on the ground and doesn't flex or roll the foot like the bone on my right foot. In fact as I walk or run and start rolling forward on the foot it pushes my foot over to the arch and does not allow a proper foot function. I am unstable even as I stand and walk. My wife tells me often to stop bumping into her as we walk as I tend to walk over to my right side or self correct and bump over to the other side.

I cut the insole under that bone last year so that it did not come into contact with the shoe. I then had one of my best track workouts of the year. It was a very hot humid night and I did 3 X 2 miles all at 12:00 flat. My teammate Jerry and I just ran shoulder to shoulder for each of them. Battling the heat, the elevated heart rate and pure "give it your all" on each interval made for a very satisfying workout. The best part was the "cut out" insoles let me feet roll so much better than normal. My hips and stride felt great and I remember feeling that I had solved the "problem". I was seeing a physical therapist for my hip problems and I showed her what I did and how I felt good for a few days (my hips no longer were hurting like they had) that she marveled a bit and sent me on my way canceling the rest of my appointments.

I remember training runs feeling better and having a better stride, but I could never get the cutout just right. I went through all my old insoles. Some the cutout was too big, some too small. The right foot didn't feel correct so I cut out a small piece on those insoles too. Somewhere down the line, I can't remember when and why, I stopped using them. Did I run out of insoles? Was my foot working a little better without them? Was a knee or something starting to hurt? I can't remember exactly why but I went back to running without them and forgot about the experiment.



Today I went back to a box of old insoles and found one pair. It must have been my best cut outs because they were the only ones left and so I wore them on my run. I felt the return of a more stable run and stide. The left leg and hip seemed to be working better. My left hip wasn't jamming up and instead I could feel the muscle under the sit-bone working. It was a good (and hot humid run). I also felt, like I remembered last fall how the bottom of the left foot was rolling forward. Without that bone, sticking and pushing my foot off to the side, I could feel the foot land properly but then it rolled forward to the big toe side and I could push off at the toe (instead of from the side of my foot). I think I will keep up with the experiment and with all the flexibility and mobility work I am doing maybe the transition will be smoother.

Here are some really unglamorous photos of my feet to try to explain their function. The first photo shows me trying to hold my knee and leg straight. All my weight is on the outside of my left foot and the inside of that foot is rotated up and off the ground.



The next photo tries to show how that looks closer up. Not a comfortable way to stand and I definitely can't run on the foot like that!



The next photo shows what happens when I put the left foot flat down on the ground. The left knee then rotates in (creating instability throughout that leg, hip, and back). This is how my knee tends to turn as I run, but the foot does not stay straight like this!



The last photo (haven't you seen enough!) shows what the leg and foot tends to do as I run. The knee goes in a bit but I try to keep it straight so the foot rolls in on the arch and everts out to the side, putting my foot, leg, knee, hip, and back through all sorts of rotations and compensations so that I get into the mess that I am always in as a runner but also in my daily life.



I will say that with all the work I have been trying that I am doing so much better in my daily life then I was 20 years ago or even five years ago. I was so tight and twisted that I found it hard to sit and move throughout the day. I have learned to strengthen and relax the right muscles so that I can sit and move more freely. However the running part continues to fall apart (aging, habits, or years of misalignments?).

Maybe someone reading this has more experience and can comment on this. I have yet to find a doctor or therapist who can give me the information to figure out the root cause of my alignment issues, but I am sure there is someone out there who can. Are there chiropractors for the feet?

You can go to these entries to see how my leg looks as I run:
runner-heel-thyself-can-it-be-done and
running-form-dissection.


Anyhow talking about the feet here are some drills I am going to try now that barefoot weather is here. They are explained a little more here. Finally, this one is called, Yoga for the Feet.

9 comments:

Anonymous said...

Jim,

You seem to have similar issues to what I had. A cascade of problems, thats why it's so difficult to treat. Here is the rundown.

1. Left foot turns in. Probably caused by the muscle on the left outer calf being deactivated from past injury/stress, whilst inner calf muscle still active and pulling inwards. Therefore left foot pulled inwards. Need to get that fixed by trigger point therapy to reactivate the outer calf muscle (not sure the name of the actual muscle) and therefore even pulling from both sides. Foot will realign. Worked for me.

2. Shorter leg. probably a result of twisted hip due to years of imbalanced walk/hyperpronated foot. Get trigger point therapy to work on the hip flexor muscle (next to groin) and reactivate that muscle and loosen it up - hip will feel great. Trigger point may hurt when released.

3. You probably have a lower shoulder too, maybe a cascade of all the above. Get trigger point therapy to reactivate muscles around and behind the shoulder to balance them up again.

4. To prevent all this happening again, check your foot for Mortons Foot condition and possibly get a Posture Control Insole (PCI) fitted to both shoes. A hyperpronated walk can cause rolling in/out and all the above compensation problems.

5. Finally, get your jaw/TMJ checked by a dentist who knows about TMJ problems, as these muscles may be misaligned and causing downward misalignment, all the way to the feet (descending pattern).

Goodluck

Jim Hansen said...

Interesting thoughts and thanks for offering them;

Just last night I was thinking about trigger points and starting up again the use of my TPMassage products. I was even on their site checking out the videos to make sure I do it correctly. I think some muscles in my left leg may pull the tibia and fibula out of alignment over the ankle (if they can do that or at least do as you suggest-overuse on one side).

I have had ART work in the past on my left hip flexor (repaired years of damage, but it did not do much after that when the Psoas felt weakened. My inner thigh is constantly tight up there. Maybe it need reactivation.

How do you find trigger point specialists and how much treatment is involved? I will search later. I have a few books on this. I have stuck almost solely with Feldenkrias movement therapy since August and I am relearning movement patterns, but had been thinking about going back to other practices I have tried to work in conjunction with this (strength training, foam rolling, stretching).

Yeah, my shoulders are off. I did Rolfing a few years ago and loved the realignment that was sadly only temporary.

I have used the Posture Control Insoles a few years ago. They started out great and then did nothing for me. Some of my messages are even on their testimonial page. I did buy the newer version last month to try out again. I did not like the insole and only used them for less than a week.

The jaw thing is interesting. The rolfer described something similar, I think about connected fascia. Strangely enough, I notice photos of me running in the past few years and the left side of my face seems to fall downward like the hip and shoulder. Someone close to me even asked me once if I had a medical condition like Bell's Palsy. I have done some joint therapy for the jaw with Z-Health drills and sometimes get a clicking. I used to get a tightness up there that I had to push on to relieve, so maybe there is something to think about too.

Lots to think about. Thanks for offering advice, and it sounds like it has worked for you! Good for you!

Anonymous said...

Jim,

Glad you think it's helpful. As a layman I had to learn all this myself speaking to different practitioners and working out how things all fitted together.

None of them had a holistic view of the whole system and how it affects each other, they concentrate on their own modality, suspecting that theirs is the solution to your problem. You have to connect the dots.

For example, releasing the shoulder trigger points will balance the shoulders out, but it may also fix the TMJ problem as a consequence - did with me.

The hip trigger point may fix leg length difference and inwards turn of leg. The calf trigger point may help with your walk by balancing the feet during impact - did for me.

However, I firmly believe that the cause is either ascending (feet/walk/pronation) or descending (jaw/tmj) or both. The rest in the middle such as the hip,knee, shoulder & back are probably as a result of these 2 critical areas being out of balance. Just a laymans view.

Trigger point therapist are hard to find, try looking for myofascial and deep tissue massage therapists who specialist in sports injuries or maybe accupressure therapists (slighlty difference concept).

Please, dont subscribe to stretching, strengthening and balance exercises from some physical therapist, as these will probably make things worse until you fix the underlying imbalances.

PS - I never stretch my muscles before running or sports, this is a surefire way to cause injury and damage, as muscles are unnaturally expanded and become weak and prone to injury - that's why you feel stiffness after stretching exercises and it may take hours for it to repair. Best warm up is simply cardio activities to get the blood pumping and moving around the body for a natural warm up. You WILL notices the difference it makes.

Again, goodluck and hope I've helped.

Jim Hansen said...

I have been thinking about your comments the past week and was already back to exploring some of these ideas. So now I am continuing on with them.

About Morton's Foot. I tried the Posture Control Insoles before with limited success. I think they are base on proprioception. I think they are technically for a similar condition called Rothbart't foot. I seem to have a longer 2nd metatarsal, but not a longer 2nd toe.

I took out the newer Prokinetics version that I tried last month and did not like: http://www.prokinetics.com/index.html and used just the wedge glued to my shoe normal insole. I liked the feel and did an experiment Sunday. I ran my second marathon in 8 days (this time with the glued in wedges). I am suprised I didn't realy stress or hurt something like I expected. The pro-kinetic wedge is wider than the PCI and goes under the toe and metatarsal. It's angled slightly but I don't think that the proprioception feel is the same. it isi more of a lift.

I was reading more about Morton's Foot and found this book and site:
http://whyyoureallyhurt.com/. I ordered the book Sunday from Amazon and got it today. It is an easy read and I read most of it quickly. The key cheap remedy that the book describes is found here: http://www.bottomlinesecrets.com/article.html?article_id=49341 . I also ordered the Spenco Moleskin.

Then difference between the two insoles and this remedy is that this remedy only goes under the head of the first metatarsal (not the toe). I fixed up one insole and am walking around and it feels good and more natural than the two other insoles. I haven't run yet but will continue this experiment. The book also points out where the trigger points you can get from Mortan's Foot are and mentions the link to TMJ.

And yes I am learning not to stretch (static stretching kills me). I do like resistance stretching but have backed away from it for the past few months.

Thanks again for you thoughts and direction!
Jim

mark said...

Is there such a thing as a chiropractor for the feet? No. The best thing you can do is use your feet as nature intended. The rest will take care of itself. Check out Vibram Five Fingers.

Enjoy!

Mark

www.markwalleschiropractic.co.uk

mark said...

I have one thing to say.
Vibram Five Fingers.
Use your feet naturally, and the rest of the body will take care of itself (that is assuming your primary problem is related to the biomechanics of your feet. Using shoes inhibits the neuromuscular system of the feet and weakens the ligaments. This results in muscular inhibition higher up the chain. I used to suffer plantar fasciitis in my left foot, left knee and hip and right shoulder problems. I tried everything (I am a chiropractor). Now I live barefoot, work in my five fingers and regularly stetch the fascia in the sloes of my feet with a golf ball and have no pain. Good luck !

Mark

www.markwalleschiropractic.co.uk

Jim Hansen said...

Hi Mark,
Thanks for your comments. This was an older post and I am still struggling somewhat with the feet. However some of that is due to labral tear surgery last summer. I am currently working on the glutes and other muscles that put my hip and leg into unnatural positions. I am personally not a fan of the five-fingers for running except for strides, although I do use minimalistic shoes for everything else. I am doing somatic and feldenkrais exercises for the feet and just ditched the orthotics that I had for 2 years, but have stopped running for now while I get the rest of my body strong from my bad patterns. The orthotics are for functional hallux-limitus.

Professor Rothbart said...

Interesting. Your history is very and failed interventions is fairly consistent with a PreClinical Clubfoot Deformity.
For more information on this foot structure, go to http://rothbartsfoot.es/PreClinCFD.html
Professor Rothbart

Jim Hansen said...

Thanks...but I hope not. The pictures on your website don't look similar to my feet. I do have your ebook.