My passion for this article comes from seeing the souls and soles that have come through my office that have faced some kind of loss in the quality of everyday living from foot surgery. Each client and surgery had its own special reason with the common thread that they were each told the surgery would correct their foot.

On Your Feet

Our fully erected posture, a feature we share with no other animals, rests on two feet. Just like the article previous to this one, “New Replacement—New Problem” this one is equally as troublesome for the client whose architecture of their foot has now been changed. The surgery is a promise of fixing their chief complaint of pain which is really a system failure somewhere in the body. However, surgical correction is done without the thought of how this will change the entire kinetic chain response for the patient.  This modification in foot structure will affect the fascial system and alignment for mobility, stability, flexibility and central nervous system control. One alteration in your foot tripod and your knee or hip will be sending signals to your brain trying to recruit help from other places such as your low back or thoracic spine. It really is a recipe for disaster.

We have to ask ourselves is the foot loading and unloading appropriately and if it isn’t, why? Is the foot doing what it needs to do to make the rest of the body successful? And is the rest of the body such as core, hips, and knees helping to maintain the pelvic pyramid over the femoral heads and maintain the alignment during movement? The deep rotators of the hip and the coccygeal fibers of the gluteus maximus are responsible for assisting a leveled pelvis. These muscles help draw the femur posterior within the Acetabulum and fascially help pull the pelvis up over the femur. This position is vital to optimal alignment and performance of all lower extremity patterns. As a personal trainer and massage therapist, I find it so interesting that the medical surgical community specializes mostly in post rehabilitation instead of pre-habilitation. Not enough information is ever given to our clients that a few months of simple exercises combined with massage therapy would save years of post-surgical remorse. Alignment is everything.

A Case Study

I want to share with you the consequences that one of my clients experienced from a single foot surgery. This female client was born with what they called flat feet. She didn’t start experiencing pain until she turned 70. Doesn’t that mean her feet worked pretty well until then? She had left foot surgery to correct the pronation or flat foot and help with the pain. One year post surgery she had a tear in her right gluteal muscle with no apparent reason. They surgically repaired the hip. Two years later she started experiencing right foot pain which was attributed to the flat foot again. The right foot was surgically repaired which resulted in a five degree turn out. She did post-surgery physical therapy and was released with a cane, pain, limp and no further solutions for her present condition. Because of the inactivity she put on 30lbs.  She presented to my office because she wanted to walk normally and return to the golf course.

As people age, they increasingly choose Podiatric Physicians. Medicare data verifies that Podiatric Physicians are the physicians of choice for 83 percent of hammertoe surgery, 67 percent of metatarsal surgery, 77 percent of bunionectomies and 47 percent of rear foot surgery. Medical Economics magazine reported 56 percent of all older patients have seen a Podiatric Physician. What is not told is how these replacement joints aren’t as hard-wearing or long-lasting or act the same as natural joints. Some of the operations restrict joint movement. None of my clients were ever prepared for the amount of time they needed to be non-weight bearing and had to deal with crutches. They also were not prepared for the swelling and stiffness. Sadly many clients have had to have multiple surgeries because of complications that the bones did not fuse together as expected. 

The problem is not the foot. The problem are the shoes and not allowing the foot to touch the ground for sensory input combined with loosening the spring to our natural arches to help the foot work as a mobile adaptor. Ultimately the obstacle is lack of education to the public in their choices for foot care. Honestly, hang out a sign that says “Care of the Sole” and I think you could be permanently busy for the rest of your entire career. It takes a combination of massage and rehabilitation exercises to restore their health but all things are possible before surgical intervention has to occur.

The following is how we worked together to regain her lifestyle:

1.     Worked with a spiky ball under the foot seated in a chair. Pressing into the ball of the foot, mid-foot, and rear foot holding 10-20 seconds.

2.     Followed this with slow deliberate rolling dividing the foot between the medial arch and lateral arch with opening the toes out and then toes curling over the ball.

3.     Towel curls for transverse arch.

4.     Massage therapy to release the fascia around the ankle and to restore the foot mobility. Addressed all muscles of inversion and eversion control.  Electric cupping to help release the fascia and hot towels.

5.     Vibration roller to the bottom of the foot.

6.     Adduction with small ball in chair. Abduction with a band and my assistance of isometrics in chair. Quad tightening sets.

7.     Floor exercises, lying on her side, hold the leg up 5-10 seconds. On her back, bridges with the ball between the knees 5 seconds initially. On all fours, tummy vacuum. All fours remove a hand then leg one at a time for increased core control. Nothing bilateral yet because of her instability.

8.     Standing at the wall with two fingers touching, close the eyes for 10 seconds and then open for 10 seconds to increase proprioception of the feet progress to no contact points. 

9.     Staggered stance at the wall with a 5 finger contact, eventually going down to 2 fingers.

10. Treadmill, very low speed, practiced retraining gait. The use of the treadmill for support helps with core input. Started with only enough time that she could control the gait. Once gait was lost we stopped.

11. Her homework was to go to her gym for 15 minutes, do the bike 10 minutes, 5 minutes of treadmill and all of the above exercises daily. Use warm Epson salt soaks to the foot before and after the exercise sessions.

12. We increased the standing exercises and wall support as tolerated.

The end result was absolutely inspiring. After just two months of twice a week therapy with me and her physically working on the intrinsic muscles of the foot, knee, hip at home she was able to walk better and play a couple holes of golf.  Unfortunately with her gait she had one more hurdle to overcome and that was her leg inequality that was left over from all of her surgeries.  I suggested that when she went back north to seek help from a doctor, they would prescribe a shoe lift built to the outside of her shoe. She was optimistic after feeling defeated for several years.