Strengthening weak feet

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Research shows us that just wearing more minimal shoes will see a near 60% increase in toe flexor strength over 6 months but no further increases after the six month point, so does this mean the feet have reached natural, unshod, strength levels after the 60% increase? That is to say, would the 60% stronger foot of the minimal shoe wearer have the same level of toe flexor strength as a habitually unshod individual ?

I would guess not even nearly, and here is why.

Our feet evolved to function with no shoes and so the grip/traction has to come from the foot itself during gait . This grip, the force that stops us rotating on the balls of our unshod feet during gait, comes from the toes. From straight toes moving around the MTPJ and applying force to the ground . Remove the need for this force during movement and the feet will get weaker over time.

Toes don't need to press down if recoil from the sole of stiff shoes does the job for them.

 

I think I have spoken on Pod arena before about gait being a series of rotations . One side is "planted" and the other rotates about this axis, left past right right past left etc . For efficient unshod gait is essential that the planted foot does not rotate away from the midline and when only the ball of the foot is in contact with the ground the toes help prevent this rotation.
But the toes don't really need to do this if a shoes is worn with a "grippy" recoiling sole.

I feel it is likely it this this aspect of footwear ,more than any other, that gives weak intrinsics and I don't see arch support having much of a role to play at all.

A lot of my shoes have springy soles and I can even fire a golf ball across the room using one .

 

Following on from the posts above, more minimal shoes with less spring like soles will act to strengthen feet compared to more modern shoes. But will wearing them get you to habitually unshod levels? Well no, not if the minimal shoes have a rubber like sole designed to aid grip/traction, normally the job of the toes in and unshod condition.

Also, almost any type of shoe will tend to prevent the toes from moving apart during gait lessening the work required of the abductor hallucis.

Here is a piece of text from 2017

"You might be interested in the following .It relates to grip ,torque ,flat rigid surfaces and the unshod condition .

First I found myself a suitable surface such as linoleum . Next I took off my shoes and socks and stood next to a wall for support . Then , taking most of my weight initially on the right foot which was kept flat on the ground ,I put my left foot into toe off position so that only the ball of the foot and the toes were in contact with the ground . Then I carefully transferred some weight onto the left foot and finally, with the ball of the foot and toes under some pressure , rotated the foot outwards producing torque . I found that the toes played an important part in resisting the outward rotation and that they also began to become spaced out from each other possibly engaging the adductors .( please note that I am not suggesting that anyone copy the above exercise sequence or injury may result )
So perhaps the toes can significantly aid grip on a flat rigid surface ? "

 

"I found that the toes played an important part in resisting the outward rotation and that they also began to become spaced out from each other possibly engaging the adductors"

During unshod gait the heads of the adductor hallucis muscle have a key role to play in plantar flexing the toes and acting to pull the metatarsal heads together, resisting the forces that tend to move the metatarsal heads apart . In this way they help to take strain off of the transverse ligament.

In shod gait the mechanics of the forefoot are radically changed and the adductors have a much reduced role probably leading to them becoming very weak.

IMO a weak adductor hallucis is likely to contribute to hallux valgus and, if exercises are to be used to help correct or prevent this condition, then strengthening of the adductor hallucis should be one of the key exercises.

Here is a link to a short clip of the toes and met heads being separated as the toes act to resist rotation of the foot.

https://youtube.com/shorts/SorZTV7CZ9Q?feature=share

 

Below is link to a short video showing foot doming . Note; toe flexion is accompanied by hallux/ 1st met head adduction as the forefoot narrows . This is the adductor hallucis in action.
A strong adductor hallucis is a key component to help prevent or moderate hallux valgus in most instances.

 

Here is a link to a very simple mechanical model of the action of the adductor hallucis oh the 1st met head and the hallux .
In the model the pen in my hand represents the 1st metatarsal. the second pen the hallux ,the elastic the MTPJ, the dental floss the adductor hallucis and the radio the second toe.

Sure, if hallux is free to move laterally, in the direction of the add hallucis force, then a "bunion" like configuration ensues but if the radio or second toe stops lateral hallux motion then a varus type configuration has a tendency to form.

Complex anatomy in this region but I don't see hallux valgus forming due to a " tight adductor hallucis".

Video clip on youtube


So the idea that the pull of the adductor hallucis moves the hallux laterally and that this somehow levers the 1st MTPJ medially is just not correct ,IMO .

 

So equating the hallux valgus shown in this image with the video linked to above, I fail to see how the adductor hallucis can produce a medially placed MTPJ ( worsening of the condition ).

A laterally directed force acting at the base of the 1st phalanx ,such as would be produced by the adductor hallucis will produce the effect seen in the video that is a reduction of the valgus angle .

Please feel free to correct me if you think what I am saying is wrong. I would just like to know why strengthening of the adductor hallucis is not a priority in this patient group esp with a view towards preventing surgical relapse.

 

Here is a short video from " Bounce Podiatry" showing the doming exercise. Note that the met heads are pulled towards each other, narrowing the foot . I my opinion this might be the most effective exercise for preventing hallux valgus from developing or, at the very, least it should be investigated .

I have read that "overtight" adductor hallucis can make hallux valgus worse, but how can a muscle under constant stretch become overtight? My understanding is that stretching muscles allows them to function over longer ranges and so makes them less "tight". A muscle is not a ligament.

 

HAV angle reduces with adductor activity in this example .

 

Of course exercises which strengthen the abductor hallucis are also thought to be useful when it comes to hallux valgus so an exercise which strengthens this muscle should also be included in a conservative, exercised based, treatment plan.

Research has shown that doming against an inelastic leather band, placed across the top of the foot, activates the abductor hallucis to a high degree. So one exercise will strengthen the abductor and adductor hallucis muscles . This is because both contribute to toe flexion.

Here is the rig from the research I am speaking about. The extent to which the two set ups activate the abductor hallucis is illustrated by the red bar in each graph and is far higher for the doming rig than the toe curl rig (right ) .

So one exercise for abductor and adductor muscles to help treat hallux valgus, doming. Patients can be easily taught foot doming and no equipment is necessary for the basic exercise.

 

Some have written that hallux valgus has a genetic component and that is probably true ,however, it is a rare condition in unshod populations. It seems to me then that although the morphology of the bones of the foot have a role to play, the condition does not usually develop without the influence of modern footwear.

Here is a quote from a paper on the subject-

"Hallux valgus (HV) is a common deformity characterized by progressive lateral deviation of the great toe at the first metatarsophalangeal joint (1st MTPJ). It commonly associates with a painful overlying soft-tissue prominence, the “bunion”. A recent systematic review estimated the prevalence of HV to be 23% in adults aged 18 to 65 years. It becomes more frequent with increasing age and is more prevalent in women than men. Several potential risk factors for HV have been identified. Various mechanical factors are thought to associate with HV including metatarsal length and head-shape, first ray hypermobility and foot posture. HV is rare in unshod populations but associates with wearing high-heeled or narrow shoes." E Roddy 2011

I strongly suspect than modern footwear gives an increased HAV angle and also an imbalance between the intrinsic and extrinsic toe flexors. The footwear weakened adductor hallucis, which normally acts to reduce hallux valgus progression, becomes less effective at doing this, and the increased hallux valgus angle, produced by footwear, increases the mechanical advantage of the flexor hallucis longus which then contributes to the progression of hallux valgus and bunion formation.