working with the shoe-bound arch (myofascial techniques)

7/27/2019 Working with the Shoe-Bound Arch (Myofascial Techniques)

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But compressed eet are rarely happy eet. Asan extreme example, consider oot-binding, whichwas pract iced in some parts o China until moderntimes, despite being outlawed in 1912 and again in1949. Done in the name o beauty, the oot boneswere broken and distorted to allow the wearing oa miniature shoe (Images 1 and 2). Women withbound eet suered pain and lielong disabilities.1

The space and movement between the oot

bones are as important as the bones themselves.Without enough space and movement, eet losethe supple mobility needed or adapting to the

constantly changing angles, orces, and suracesthat standing, walking, and running entail.

When the eet arent able to make the ultrane

adjustments that provide stability, larger muscles andconnective tissue structures elsewhere in the bodycompensate by gripping, tightening, and holding.

Try this: walk bareoot around the room, butstien one o your big toe jointsdont allowit to move. Obviously, this will change the wayyou walk; but more to our point, eel where elsein your body you sense the eects o this toe

restriction. I you had to walk like this or a longtime, where would you need some bodywork?Many will not ice a change in knee unct ion,

stier hips, or back or neck discomort. Whenthe eet arent happy, the body isnt happy.

Bareoot and minimalist running has beenpopular or several years now, and the trend showsew signs o ading. Despite its addish aspects(minimalist shoes, in spite o having less to them,oten cost more), bareoot running has spurred athought-provoking debate into the denition o oothealth, and oers ideas that we can adopt or our

hands-on work with clients and patients. Bareootrunners claim that since humans have been running

114 massage & bodywork march/apri l 2013

tClassroom to Client | @work | energy work | Myofascial techniques

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1

An X-ray o bound eet ( Image 1),

and a miniature shoe or a bound

oot, China, 18th century (Image 2) . Images sized to approximately

the same scale, as the shoe was worn only on the big toe.

2

Research

comparing

shoe-users

eet with those

o indigenous

nonshoe wearers

correlates shoe

use with narrower

eet, higher

arches, and

less-even weight

distribution.

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bareoot or longer thanthey have been runningwith shoes, our bodiesdo better when the eetare not overcushioned orimmobilized. Ill describetwo techniques romAdvanced-Trainings.

coms Advanced Myoascial Techniques seminar

and DVD series that can help anyones eetregain a higher degree o natural mobility and

adaptability, whether they run bareoot or not.

Are FlAt Feet BAd Feet?

Looking at the issue o arch height, a quick overviewo arch anatomy is in order. Skeletally, the oot bonesunct ion as sets o longitudinal rays, each comprisedo a toe, its metatarsal, and an associated tarsalbone. These oot rays are urther grouped into two

structural divisions: the medial and lateral arches(Image 4). The bones o the medial arch include

the phalanges o toes one, two, and three; theirmetatarsals; plus the cuneiorms, navicular, and talus.The lateral arch is made up o toe rays our and ve,which share the cuboid as their associated tarsal.The cuboid in turn articulates with the ca lcaneus(the heel bone) via a unique locking joint, which addsstability. The connective tissues, muscles, tendons,and ligaments o the oot and lower leg contributeeither spring or xity to the arches, depending

on the tissues own elasticity and resilience.Conventionally, low arches or fat eet

have been thought to be problematic, thoughsome proponents o bareoot running questionthis assumption. While overpronation (Image5) has clearly been linked to oot, ankle, andleg problems, the relationship o arch height topronation and overall oot health is not as clear.

The generally accepted view links low arches withoverpronation o the calcaneus. Because the talus(medial arch) rests on top o the calcaneus ( lateral

arch), pronation or eversion o the calcaneus andlateral arch is conventionally thought to dump thetalus medially, lowering the medial arch and givingrise to fat eet. However, there is credible research

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ww w.abm p. co m. Se e wh at be ne fi ts aw ait yo u. 115

that contradicts this view, correlating pronation

with h igher arches rather than lower ones,

2

andmultiple studies suggest that bareoot runningcan reduce overpronation.3 There is also ev idencethat shoe use accentuates oot narrowing and archheight. One study (comparing indigenous non-

shoe users with habitual shoe-wearers) correlatedshoe use with h igher arches and narrowed eet,and with less-even weight distribution in thesole when compared to non-shoe users.4 Otherstudies question the reliability and useulnesso arch-height measurements in general.5

Where does this leave us? Rather than assumingproblems based solely on arch height, we can

take the pragmatic approach o assessing andreleasing articular immobility and connective-

tissue restrictions wherever we nd them, workingtoward the structural di erentiation that bringsadaptability. In addition to more balanced ootmobility, it is also important to include symptomimprovement (less pain in the eet or elsewhere)and our clients subjective experience (do the eetsimply eel better?) as indicators o success. Usingadaptability, symptom improvement, and subjectiveexperience as our criteria is oten more eective, andprobably more universally relevant, than looking

or change in oot shape or arch height alone.

Anterior/Posterior Arch

MoBility technique

The metatarsals are lined up side by side in themidoot, much like sardines in a can. This side-by-side arrangement helps the metatarsals resist

excessive lateral movement, while a llowing themto spring up and down in the sagittal plane.The controlled dorsal/plantar mobility o themetatarsus allows the connective tissues o the

The skeletal divisions o the

oot: the medial arch and the

lateral arch (purple). Imagecourtesy Primal Pictures.

Used by permission.

4

Overpronation o the

calcaneus can cause

problems, but may be

linked to high arches,

not low arches,

as conventionally

assumed. Image

courtesy Lo

Washburn. Used

by permission.


3/4116 massage & bodywork march/apri l 2013

division is not mobile,the arches becomexed in relation to oneanother, negativelyaecting pronation/supination balance,arch spring, and

overall adaptability othe oot and ankle.

interMetAtArsAl

sPAce technique

It bears repeating:the spaces betweenthe bones are just as

important as the bonesthemselves. Without

the dierentiation that gives adaptability, strengthturns to r igidity, both in the eet and in the rest othe body. The Intermetatarsal Space Techniqueis a straightorward way to regain lost lateraldierentiation and adaptability in the oreoot.

Using your thumb and ngers, eel into thespace between each metatarsal rom above andbelow the oot. Staying well within your clientsrange o comort, use enough pressure to eel al lthe way through the oot, as i touching the thumb

and ngers together between the bones (Images 7and 8). As always, avoid pressure that elicits sharp,electric, or other uncomortable sensations, sincethere are sensitive nerves in the intermetatarsalspaces. Once your ngers and thumbs are inposition, wait or the oot to yield. In the t imeit takes the tissues to respond, you can typicallytake two or three slow breaths o your own.

Ater you eel the init ial release, you can acilitatea deeper response by asking or slow, ocused, activemovement. Have your client gradually fex and

extend the toes, and then the ankle, as you maintainthe space between the metatarsals with your ngersand thumb. There is almost no movement o yourtouch; any sliding that occurs results rom yourclients active movements. In addition to helpingthe tissues release, holding the bones apart asyour client moves adds an element o movementreeducation, as your clients nervous system learnswhat it eels like to move the oot while maintainingwidth across the oot. Repeat this cycle o static-

oot (such as the tendons, plantar ascia, and spring

ligaments) to absorb shock and store energy orrelease into the next step. When the metatarsalsare xed, undierentiated, and immobile, the ootlacks both the spring and adaptability necessaryor ecient and comortable unction.

Begin the A nterior/Posterior Arch MobilityTechnique by assessing the mobility o individualmetatarsal bones. Using a rm grip, move two rayso the oot against each other in the sagittal plane(Image 6). This does not involve squeezing and

releasing, nor is it kneading the sot tissue o the oot.With a constant amount o grip pressure, isolate theup/down (dorsal/plantar) motion o each metatarsalbone in turn, moving it back and orth against itsneighbor in a slow but ull scrubbing motion.

Feel or mobility restrictions in eitherdirection. When you nd a direction that is lessree, use the same ul l anterior/posterior motionto increase mobility. Make sure the distal endso the metatarsal are mobile, as this will lay thegroundwork or individual toe adaptability andrange. Check and release the proximal ends o the

metatarsals, too, along with each accompanyingtarsal bone. Be thorough, scrubbing each pair ometatarsal rays against one another in turn.

Especially important is the division betweenthe rays o toes three and our, since it is here thatthe medial arch meets the lateral arch (Image 4).This division extends proximally between thethird cuneiorm and the cuboid, and then betweenthe talus and the calcaneus, and is oten the rstintermetatarsal space to lose adaptability. When this

The Anterior/Posterior

Arch Mobility Technique.Dorsal/plantar mobility

o the metatarsals allows

or arch spring and oot

adaptability. Use an up /

down shearing motion,

in both directions, to

assess and release each

metatarsal ray o the

oot. Image courtesy

Advanced-Trainings.com.

Used by permission.

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The Intermetatarsal Space Technique. With a

static touch, work between each pair o bones

rom both above and below, as i touching

the fngers and thumb together through the

oot. Once tissue has responded, ask or slow

toe and ankle movement. Images courtesy

Advanced-Trainings.com. Used by permission.

7touch release, ollowed by active movement, inseveral places along each metatarsal space, and then

between all other pairs o oot rays, or both eet.In some people, the narrowing o the metatarsalscan irritate and enlarge the perineurium (the outerconnective tissue layer) o the intermetatarsalbranches o the plantar nerve (Image 9), causingoot pain or numbness. This condition, known

as Mortons neuroma, most commonly occursbetween the third and ourth metatarsals, rightwhere the medial arch meets the lateral arch. Iyour client complains o numbness or a sharppain between the distal ends o the metatarsals,especially when standing or wearing shoes, workto separate and decompress the intermetatarsal

spaces. As long as it is within your clients comortrange, gentle but deep work here can help ease theeects o midoot narrowing and compression,as well as address the connective tissue brosity

o the perineurium and surrounding tissues. Useyour clients active toe fexion and extension toglide the tissues under your ngertips; eel or anincrease in boney mobility and openness o theintermetatarsal space. Your client may experiencerapid relie, but dont be discouraged i it takesseveral sessions beore the irritation subsides.Stubborn cases merit a change o ootwear and/or

evaluation by a medical proessional. Conventionalnonsurgical treatments include orthotics,orthopedic pads, or sclerosing or other injections.

Just like people, not all eet are the same.

Bareoot running isnt or everyone, and whatworks or one cl ient may need to be adapted oravoided or another. Well be most eective aspractitioners i we bring the desired qualities oadaptability and fexibility to our own strategizing aswell. Ater all, as psychiatrist Carl Jung said, Theshoe that ts one person pinches another; thereis no recipe or living that suits all cases.

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a Du ru, Biomedical Sciences

Instrumentation 38 (2002): 2037.

3. a. sc ., th ec sh

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ru, Medicine and Science in Sports

and Exercise 23, . 4 (1991): 48290.

4. k. Du ., th ec Hbu F

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w, Footwear Science 1 (2009): 8194.

5. H. mz, av tchqu h

Cc a F P,

Journal of the American Podiatric Med ical

Association 88, . 3 (1998): 119129.

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Mortons neuroma, a painul

fbrotic enlargement o the nerves

connective tissue sheath, is

one symptom associated with

crowding o the metatarsals. Image

courtesy Primal Pictures. Used bypermission.

working with the shoe-bound arch (myofascial techniques)

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