Author: Katy Bowman

Topics: Rehabilitation, foot and ankle health

All information is attributed to the author. Except in the case where we may have misunderstood a concept and summarized incorrectly. These notes are only for reference and we always suggest reading from the original source.

Forward

Movement is a biological necessity, and the bedrock of high levels of health, energy, well-being, resiliency, and also happiness and creativity. Most of us cannot climb a tree, run skillfully over challenging terrain, carry a heavy load long distances, or jump over a large gap. Most gym training is too restrictive, isolated, and impractical.

Erwan LeCorre created MovNat, a school of physical competency, based on natural movement. Walking, running, balancing, crawling, jumping, throwing, and catching and striking and grappling.

The act of caging our feet has restricted our access to foot proprioception, strength, and flexibility. The artificial ground we walk on is also flat, predictable, and unchallenging.

INTRODUCTION

Minimal shoes are dangerous if you aren’t ready for them. Walk before you run. Literally and figuratively.

A flip-flop alters the way you walk, so shouldn’t be considered a minimalist shoe.

Minimal shoes have:

• a sole that is thin and flexible enough for the tissues in the foot (and not just the ankle) to feel the ground below the foot and respond by articulating, innervating, contracting, releasing, etc.
• a heel that is neutral, or “zero-drop,” allowing all joints to work from a neutral baseline and enabling the full range of motion for all joints in the body
• an upper that fully connects the foot to the shoe, so there’s no need to grip the toes or the front of the shin to keep the shoe on while walking
• a spacious toe-box that allows enough room for the toes to extend and spread as necessary while walking, hiking, or climbing.

In many cultures, wearing shoes was a way to distance the haves and have-nots. A way of establishing being civilized.

33 joints in each foot, and the muscle groups of the feet make up 25% of the body’s total number of muscles. The complex machinery of the feet are responsible for gait patterns and ankle stabilization, whole-body balance, nerve conduction, and cardiovascular circulation.

When we discuss foot conditions or other injuries, we tend to look for a specific remedy or prescription to alleviate the ailments. Rather than addressing the underlying cultural problem causing the dysfunction in the first place. By dealing with basic needs, our huge list of health issues go away without targeted remedies. This book will not target bunions or plantar fasciitis. Just do the exercises and find your own pathway.

Shoes have been great for protection from the cold, avoiding wounds, long distance travel, etc. Like all technology, we end up paying a biological tax.

SECTION 1: THINK

The Problem with Shoes (is not just about shoes or feet)

If you ate a diet entirely of candy, you would manage to get your caloric intake. Then you would probably get scurvy unless it was vitamin C enhanced. Then you’d eventually run low on B12; you’d become weak and tired and your digestion would begin to fall apart. You’d become iron deficient, perhaps develop a swollen tongue and brittle fingernails. Your diet would be devoid of good fats, your pancreas would struggle with all the sugar intake, etc. Long story short, you can’t just keep on adding new things and expecting to deal with deficiencies. You need to get the source or what we evolved to eat/do. Without the correct input, the body will fail over time. Given the right context, a junk food diet may save you, but it is not conducive to longevity.

Conventional footwear has a small toe box, elevated heel, and is stiff and thick soled. Shoes can push toes together, weakening foot musculature, and affect nerve health. Elevated heels make full joint range of motion impossible, limiting hip and knee capacity. Creating adaptation to the deficit.

If you’ve got achy, grippy toes, consider ditching clogs, mules, or flip-flops for shoes with a more attached upper part. If you’ve never worn positive-heeled shoes but still have weak feet, or ankles that pronate, you should benefit from strengthening and habitual positioning exercises in Section 2.

Heels and “Body Neutral” (and that diagram that everyone uses to explain the need for minimal shoes)

In order to bring your head upright, while wearing heels, you have to move your body backward relative to your standing surface. The shin stays forward, with a backward motion from the knees and ribcage, creating an angle at the legs and spine.

The higher the heel, the shorter the foot, and the taller the body, the more forward a body is projected. Meaning kid’s shoes magnify the detrimental effects as their heel is the same size of an adult’s shoe. Men’s heels are usually lower, feet are longer, but they are generally taller. Distorting their bodies more than a women’s.

A change in position requires bones to move, but also requires muscles to shorten and lengthen. Cells within bones become compressed (or not), resulting in a particular bone-mass distribution. We’ve adapted to bodies that are constantly stacked downhill.

There Are More “Parts” to Your Body Than You Realize

Heeled shoes provide slack to the posterior muscle line that runs from the pelvis to the heel of the foot. Sitting and wearing heeled shoes causes the calf muscle running from the thigh to the Achilles to adapt by shortening. Taking pressure off the posterior leg muscles and the lower back when standing. Creating gradual atrophy. Each degree of motion lost creates muscle atrophy, which then affects the next part of the chain. Other joints compensate to make up for the deficit in another. Each step we take tends to be on an unnaturally flat surface, with a constantly elevated heel. Each step further engraining that expectation of environment.

Shoes suck, biomechanically speaking, due to a too-tight shoe box that prevents toe spreadage, the upper not connecting to the foot (flip-flops), or the sole being stiff and unyielding. Forcing the work of walking to come form the ankle rather than distributed across the foot.

Transitioning Out of a Heel

Spend at least a month doing the corrective exercises before throwing heeled shoes away. It will take a while for a life-time of bodily adaptation to go back to normal and reawaken lost foot movement. You can always slowly lower your normal heel size as you adapt. Once you can go deeper in the calf stretch series, the pelvis won’t jut forward as much, and pain will be reduced with lower heels.

Reduce sitting time and the amount of time with knees bent, as it shortens posterior chain muscles.

The Flip-Flop Flaw

They allow greater sensory input in the form of air pressure and temperature, they are flat, and flexible. Unfortunately, they don’t connect to our feet. The toe-gripping action leads to shorter toe muscles, which can affect balance and foot arch strength, and lead to toe contractures (hammertoes).

Trying to grip while walking will affect how the toes bend and which parts of the foot connect with the ground. Curling some toe bones up and some down, creating higher than normal tension. Greek sandals are marginally better.

Ankle Schmear

Sitting and wearing shoes can lead to tight hamstrings and calves, or bunions and hammertoes, not to mention the more serious effect of our bodies collapsing at the hips and taking the ankle with them (ankle schmear). The difference between ankle pronation and the schmear is: pronation is a tri-planar motion that moves the shin inward, and the schmear is the effect of this tri-planar distortion on the lower leg as a whole.

The ankle joint is made up of the talocrural and subtalar joint. The talocrural joint is made up of articulations between the tibia, fibula, and talus. The subtalar joint is made up of an anterior, middle, and posterior facet, and is what allows for the tri-planar motion. The talocrural allows dorsiflexion and plantarflexion at the malleoli, but the subtalar acts more like a gyroscope, allowing the body to walk upright even when walking over varied terrain. Meaning, when that terrain is always flat and there is no room for variation, the subtalar potential is reduced.

Sole + traction + external rotation can change the foot skin, the loads to the foot bones, and the axis of the ankle joints.

Let’s Check if Your Schmear is Affecting Your Shoe Size

1. Stand on a piece of paper with your foot pointing straight forward, completely loaded. Keep your muscles relaxed. No need to correct anything yet (we want to see where your foot is most of the time).
2. Trace around your foot.
3. Step off and measure your foot length.
4. Place your foot back into your print and then externally rotate your thigh until your knee pit is in neutral (as described and pictured in Neutral Femurs on page 50).
5. Retrace your foot.
6. Highlight your “rotated thigh” foot with a different color and remeasure your length (or width or just shape in general). Here you can see that not only is my left foot (which always runs about quarter-inch longer than my right) shorter when my thigh and shin are less rotated off their axis, it is also narrower once I’ve undone the tri-planar distortion of my ankle complex.

So, What’s Natural?

The more inclines and declines on a walking surface, the more variation in ankle, knee, and hip use, pelvic positioning, and the greater variance in muscles used throughout the entire body. The more natural debris —twigs, leaves, mushrooms, stones—cluttering the surface, the more your whole-body musculature has to work. And, in both cases, the more of your “parts” you keep.

Since we can’t naturally walk barefoot, we kind of need shoes to buffer the repetitive strain of unnatural hard and flat surfaces. The hip weakness, from repetitive flatness, as well as lack of walking in general, has resulted in our entire legs being off their axes. Which means foot bones, soles of the feet, ankles, knees, and hips are orientated in a position that makes for wonky loads with each step.

Your Mission: Mobilize Your Feet, in the Lab and On the Field

When switching to barefoot or minimal footwear, give underutilized muscle time to develop. Foot exercises before switching shoes, and continue them while doing whole-body training in less supportive shoes. Master shoeless walking before running. Run short distances first, on dirt or grass. Seek out experts on running form.

SECTION 2: MOVE

Stance Habits to Change

The way you stand is based on your movement history and the shoes you’ve worn. Changing the way you stand will also change the weight distribution on joints.

Start Straightening Your Feet

Most of us tend to walk with splayed out feet.

Try to line the feet up by making the outer edges parallel.

Feet Pelvis-Width Apart

The way our feet-knees-hips line up tend to result in a higher than normal load on the medial side on the knee, which is a risk factor for ACL and medial meniscus tears.

Stand in front of a mirror, line up the middle of the front of your ankles with the bony prominences at the front of your pelvis. The better distributes the weight of the body over both knees.

Test by going up and down stairs. Does your knee end up dropping inwards as you transfer weight onto it? Also, the wider the pelvis, the greater the medial knee loads with narrow foot placement (women more at risk of ACL and knee osteoarthritis).

Back Your Hips Up

If you stand sideways in front of a mirror and hang a plumb line from the center of your hip joint, you’ll probably find that the end is dangling over the front of your foot. Increasing psoas tension, lower-back compression, and reduced weight-bearing status of the hips. The bulk of your weight is being carried over the small bones of your feet instead of being distributed throughout the larger, stronger bones in the shins, ankles, and heels. Pelvic thrust also makes it difficult to rotate your thighs, because your quads have to tighten to keep your whole body from pitching forward.

Move your hips back so that they are directly over the knees and ankles. The plumb line should be at the midpoint of the knee and the quarter sized ankle bone over the heel. Reducing pressure on the front of the feet and any nerves, neuromas, or hypermobile toe joints that are in there. Also, releasing the quads, so that the thigh can move, and allowing the feet to be more mobile.

Neutral Femurs

Foot schmear is partially caused by internally rotated femurs.

Externally rotate the femurs, keeping feet pointed ahead, pelvis width apart, and hips backed up, until knee pits are pointing straight back behind you. This will create an immediate arch, even in the flat footed.

As a note: You don’t need to keep the instep down if it rises up. This places too much torsion at the knee. Eventually they’ll be able to stay down when your foot is in neutral after lots of intrinsic foot muscle mobilization had been done.

Stretching the Intrinsic Tissues of the Foot

This includes all musculoskeletal tissues – bone, ligament, tendon, fascia – that reside in the foot. Feet that have been crammed in a shoe box and only been subjected to flat surfaces have probably not given the tiny foot bones a chance to slide around. Leading to deformation as the muscles adapt to their frequently experienced conditions.

With a lack of muscle use comes less circulation to all the tissues of the feet, including bone. Form, level of impact, hardness of ground, distances traveled, and health of the foot tissues can all lead to bone marrow edema (leading to bone fractures) and other foot injuries.

Passive Toe Spreading

Mobilizes the toes bones, muscles, and connective tissues in your feet so you can start achieving better intrinsic muscle strength, circulation, and nerve health.

Start with sitting with one ankle crossed over the opposite knee. Using your hands, gently spread your toes apart for about a minute at a time. Start with smaller distances with each toe for about 15s and build up as you feel more comfortable. Eventually, you should be able to interlace your fingers with your toes.

Use passive time, like while watching movies, to practice. You can also get toe-spacers and toe-spreading socks to help.

Standing Foot Massage

If you have your thighs in neutral, but the balls of your feet aren’t in contact with the ground, it is probably because your feet have lost their mobility from being rammed into shoes. Foot motion now only comes from the ankle.

Starting with a tennis ball, roll it gently across the feet, slowly introducing greater load to different parts of the feet. Get around the 33 different joints. Work the sole with the ball and if you’re feeling brave, use a lacrosse ball.

Top of the Foot Stretch

Great for undoing chronic “gripping” tension in the toes and the front of the ankle. Especially important for chronic flip-flop wearers.

While holding onto something, take one foot back and tuck your toes under and place them on the floor. If your body starts to lean forward, to reduce load, shorten the distance you’ve reached the leg back instead. Or sit on a chair to lessen the load. Once you’re used to the load, bring the pelvis over your standing ankle, and try to bring the upper body over the hips. The goal is one minute each side, but cramping is common. If you cramp, come out of the stretch and wait for it to subside. Then try again or switch feet.

Do this a few times each day to regain dexterity and to eliminate cramping. Developing intrinsic and extrinsic tissues.

Stretching the Extrinsic Tissues of the Foot

Extrinsic foot muscles are those that have one attachment in the foot and one outside of it. Basically anything that passes over the ankle, moving the foot relative to the shin or thigh.

Calf Stretch – Gastrocnemius

Our calf muscles get chronically shortened due to heeled shoes (creating forced plantarflexion) and sitting (forced calf shortening via knee flexion). This is bad because calf muscles are responsible for keeping you upright and mobile, standing and walking for long periods of time, and because the tension in the lower body has a whip like effect on the top. Meaning your upper spine and head can be unduly accelerated by tension in your calves.

The shin is slowed down relative to the whole body, accelerating the upper body over the slowed bottom half. Opposing muscles are then fired to manage that forward motion, resulting in a tense upper back and neck with every step. Chronically tensing back and neck muscles to adapt to your leg tension.

Place the ball of the left foot on a half-foam roller or a bunched-up towel. Lower the heel down to the ground and straighten the knee. Hang out there for a while and then try to step forward with the right foot. If you can’t bring it forward very far, just take a smaller step. Keeping the weight on whatever foot is furthest back. Do it a few times a day.

Calf Stretch – Soleus

Targets the soleus and Achilles tendon, both of which are shorter than they should be in most of us.

Place the ball of the foot on a half-foam roller again and lower the heel. Bring the other foot to about level with the stretched one. Then bend the stretched calf’s knee without lifting the heel. Hold for 30-60s.

Double Calf Stretch

Also targets the hamstrings and fascia that wrap around the foot and leg joints. Tight hamstrings keep the knee buckled, which keeps the calves and Achilles short, or vice versa.

Stand in front of a chair, with your feet pelvis width apart, knees straight, and feet pointing forward, tip the pelvis forward until your palms rest on the chair. If you can’t do this without rounding your back or bending the knees, raise the platform/chair. Once your arms are down, see if you can consciously allow your spine to relax and your tailbone to lift, without forcing the ribs or arching your back.

If your back is curved upward, it means the tension down in the back of the leg is working on your spine, knees, or both. Do this stretch every now and then to alleviate it.

Other pointers include: Keep the weight in your heels, relax the back of your neck, try lowering the top of your head. Once you can hold for 60s comfortably, add your half-foam roller and repeat with the balls of the feet on it and heels down.

Strap Stretch

This stretch focuses on connecting the relationship between tension in the calf and coping mechanisms like bending the knees and pointing the toes.

Lie on your back and loop a strap across the toe box of your foot. Straighten the leg above you and extend the other leg until the hamstring is on the floor. Keep both legs straight and allow your arms to hold the weight of your lifted leg, relaxing it completely. Now pull your foot toward you with the strap, not shin muscles. While keeping your ankle in place, pull the leg higher, without allowing the lying hamstring to leave the ground. Consciously focus on not allowing the knee to bend or the toes to point.

Once you’ve held for a while, keep holding the stretch but take it across the body to add a hip stretch. Do these stretches a lot.

Catsuit Stretch

Imagine you are in a tight catsuit that wrinkles or gathers as your body changes orientation from neutral to sitting in a chair or wearing heeled shoes. When the pelvis thrusts, or the chest lifts, the ankles plantarflex, the knees bend, etc. The imaginary suit “fixing” of the forward projection created by heeled shoes is to shorten areas of the suit’s backside and lengthening at the front.

Sit on the floor with your feet pressed against a wall and your legs straight. If your hamstrings are too tight, your pelvis might get forced to tuck backwards, straining your lower back. Instead, sit your bottom on as many pillows as you need. Fold your body forward, tipping your pelvis towards the wall as you drop your chest towards your legs. Don’t force it. Relax your neck and feel how the motion of your head creates additional pull on your legs.

This is a good exercise for showing how foot placement and neck movement can affect your lower back during sitting. Your head position, the position of your sacrum, and shoe choices can lead to chronic headaches.

Strengthening the Intrinsic Tissues of the Foot

Toe Abduction

While standing with feet straight and pelvis width apart, try to spread you toes as far apart as you can, while keeping all toes on the ground. Keep the weight in the heels. Good for preparing for the transition to minimal shoes, those wanting better balance, foot nerve health, and better functioning knees and hips.

Toe Lifts

See if you can lift each toe, one at a time. The muscle group working to lift your big toe (the extensor hallucis group) is one of the strongest muscles in the foot. Getting them working will go a long way towards restoring strength and motor control in your feet, crucial for stabilizing motions at the ankle, knee, and hip. Try not to let the big toe veer towards the pinky toe. Work your way to the next toes and slowly let them down one by one. Finish by stretching the toes with the Top of the Foot Stretch.

Strengthening the Extrinsic Muscles of the Foot

Single-Leg Balance

Many people operate under the impression that they have good balance, even though they never test it.

Barefoot, standing on a flat surface, stand on one leg with the knee straight (not hyperextended), and bend the other knee to lift the foot slightly. Pay attention to what your ankle, arms, shoulders, or even your face is doing. Is the standing foot still forward or did it point outwards or inwards? Did the standing knee automatically bend to lower your center of mass, reducing work to the hip?

Consider how with every walking step, your body will be adapting to deal with this momentary loss of balance and allowing it to affect your gait, until you become a shuffler.

Try again, except this time keep your ankle still, arms down by your sides, and your foot pointing straight forward (knee pits back if you’re more advanced). This ensures you’re training your leg for level-ground gait, and assists in targeting use of lateral hip muscles, responsible for correcting schmear. One minute each side, three times each.

Single-Leg Towel Balance

Do the previous exercise while standing on a folded towel, to increase variability. Turn your head for extra vestibular challenge. Eyes closed for major challenge.

Pelvis List

This is similar to the previous two but demands isolated work from the lateral hip muscles. Place your standing side hand on the same hip and pull the pelvis down towards the floor. This lifts the opposing side up. Neither knee bends during this exercise. Don’t use lower back muscles to cheat. If you wobble or struggle, or the knee bends, it’s a good sign you don’t usually use these muscles when walking. Try holding for a minute each side, three times each.

Next-Level List

Increase the lateral hip’s range of motion by standing on a book or block to increase ground clearance.

Next-Next-Level List

Stand on an inverted half-foam roller (flat side up) and work on making the foot neutral while listing.

Strengthening Your Walk

Stone Walking

The joints of the foot work when deformed by what’s underfoot. Sand, rocky paths, dirt paths, and root-filled forest floors are all great input to mobilize the feet. However, if your feet have atrophied from heeled shoes, progress slowly. Start with small pebbles so you don’t twist your ankle.

With toe-walking children, their heels started lowering while walking over gravel. Texture may be a novel treatment for idiopathic toe-walking. We should think of toe-walking as a deficiency in ground texture rather than changing texture as a therapy. Scurvy isn’t “cured” by vitamin C. Scurvy is caused by vitamin C deficiency.

Start walking on new surfaces with minimal shoes first, then socks, then barefoot. Listen to your feet and don’t overdo it. Walking on cobblestone or some other uneven surface may feel like torture until you get used to it.

Walk on the Pillow Train

Modern ankles are missing varying slope, squatting, and climbing stimuli. By walking on pillows, you can reintroduce uneven and unstable terrain.

Calf Elevators

When you come onto your toes, do your ankles move away from each other? Maybe they even come together. The wonkier your calves are in a calf raise, the more your feet and shins move this way when you walk.

Standing in front of a mirror, line your feet up, press the front of your feet into the ground, and slowly lift your heels away from the ground without shoving your pelvis forward. Keep your ankles straight, the instep of the feet reaching down, and the balls of the feet on the ground. Not your toes. They should be liftable during the whole exercise. You can start by holding something for balance, but you should be able to do it without using something to prepare for real world change.

Walking Over Varied Terrain

Hilly forest trails and rocky beaches are perfect. Start small.

Un-Duck Your Feet

Turnout One

Comes from the hips. Thighbones turned out and away from each other, as are the shin and foot. Upper and lower leg are neutral to each other. When the knees bend, the thigh moves in the direction of the outward turned feet. Cowboy walk.

Turnout Two

Comes from the lower half of the knee. Lower legs rotate away from the midline but the thighs still flex and extend in the sagittal plane. Makes the knee a “medial maker.” Dodgy for the ACL. When you bend your knees, the thigh bones move in a plane that brings the knees together. Knock-kneed.

Turnout Three

Lower leg turnout is caused by the turn in the bone itself.

Torsion is defined as twisting of an object along its own axis, where one end is moving relative to the opposite end; rotating is the turning of an entire unit about an axis. Populations that have different movement behaviors, like India and Japan, are known to have less tibial torsion than those of European descent. This is believed to be the result of loads on the bone created by squatting and floor sitting. W-sitting can create torsion on bones. Better to sit cross-legged.

W-sitting creates internal rotation of the thigh bone coupled with significant/excessive external rotation of the lower leg bones. If somebody was doing other movements and taking their body through many different ranges, this would be fine. However, if somebody preferentially chooses this way of sitting, there may be issues down the track.

To Un-duck the feet, we need to limit certain bad behaviors that are impeding progress:

• Uncross the ankles.
• Don’t fold the feet out of the way when sitting cross-legged. Use bolsters for the ankle if need be.
• Drive better. Don’t use wonky or curled feet when you drive. Push properly.
• Technically there is nothing wrong with doing the following things, but you just don’t want them to become habitual.

THE PROGRAM

Stance Habits To Change:

• Align your feet
• Feet pelvis-width apart
• Back your hips up
• Neutral femurs

Stretching Intrinsic Tissues of the Foot

• Passive toe spreading, toe spacers
• Standing foot massage
• Top of the foot stretch (one minute but stop for cramping)

Stretching Extrinsic Tissues of the Foot

• Calf stretch – gastrocnemius (one minute each leg x 3)
• Calf stretch – soleus (one minute x as many times as you do the gastroc)
• Double calf stretch (one minute and repeat throughout the day)
• Strap stretch
• Catsuit stretch

Strengthening the Intrinsic Muscles of the Foot

• Toe abduction
• Toe lifts

Strengthen the Extrinsic Muscles of the Foot

• Single-leg balance (one minute x 3 each)
• Single-leg towel balance (one minute each)
• Pelvic list (one minute each)
• Next-level list (work up to six minutes total, alternating after every minute)
• Next-next-level list (work up to six minutes total, alternating after every minute)

Strengthening Your Walk

• Stone walking
• Walk on the pillow train
• Walking on varied terrain
• Calf elevators (twenty times, multiple times a day)