Healthy Feet, Healthy Pelvic Floor

Historically, pelvic floor treatment has focused solely on the pelvic floor muscles. We now know that in order to have an optimally functioning pelvic floor, we have to look at the bigger picture - the entire body starting from the feet up. 

The feet are particularly important because whatever happens at ground level determines the forces and load affecting the body all the way up to your neck. Many women that I have seen for pelvic floor dysfunction also have a foot problem of some kind, the most common being bunions. The two conditions, although not physically close, have some similar contributing factors and continue to feed into one another due to tension patterns running from the feet, the back of the legs and up to the pelvis. The biomechanics that contribute to foot issues, also contribute to changes in positioning and muscle action at the pelvis. 

Bunions
Bones respond to load or pressure. The more pressure applied to a particular part of a bone, the denser it becomes and the more it grows (very important for osteoporosis and low bone mineral density, but that's another post!). A bunion is an increase in bone growth around the base of the big toe, leading to an often painful lump and deformation of the toes, angling toward the outside of your foot. 

(Image from Wikipedia)

Bunions, contrary to popular belief, are not hereditary or genetic. They are the direct result of loading the base of your big toe repetitively due to the way you stand and walk, as well as your choice of footwear. However, they do seem to run in families as we often adopt the same walking patterns as our parents!

Stance
Standing with your pelvis out in front of you not only alters your pelvic alignment, but also increases the weight in the front of your foot. Your heel is the largest bone in your foot and is the one designed to take most of your weight so keep it there. You should be able to lift your toes easily but not feel like you are about to fall over backwards

Aligned Stance with neutral pelvis                     Weight Forward Stance with non-neutral pelvis and increased 
and weight in heels                                                        loading on  front of foot

The way that you walk and stand can also increase the load in the big toe. For example, most people have a noticeable turnout to their feet, especially dancers, to varying degrees. This position not only shortens some of the muscles in the hips and pelvis, it also leads to increased loading of the big toe. The foot moves from outside to inside, rather than from back to front, altering the use of the muscles and joints in the foot, ankle, knee and hip with every step that you take. 

Footwear
Any shoe with a positive heel, that is, a shoe that is higher at the back than it is at the front, is going to increase the pressure on the front of your foot and toes, directly affecting the alignment of the pelvis away from neutral and pelvic floor muscle function (See Too Short, Too Long or Just Right). Remember this is not just referring to stilettos - check out your sneakers and work shoes ladies and gents. Pointy shoes with narrow toe boxes will also cause the big toe to become squished into the other toes, creating muscle tightness that continues to pull the big toe toward the others. 

If you have orthotics and/or are only comfortable wearing shoes with 'support' then your body has become conditioned over time to only be comfortable in such things. If your own feet and muscles are unable to support your body weight and allow you to walk and move through life, then this is a sign that your body is not working as well as it could and should.

Four easy steps for healthier feet and a healthier pelvic floor:

Step 1: Begin to re-introduce flatter, more flexible, non toe-squshing shoes and barefoot time. Be aware that a gradual transition may be necessary for your body to readapt and feel that it is comfortable. Check out this list of great shoe options and how to make informed choices Shoes: The List by Katy Bowman. 

"I don't always wear shoes, but when I do..." (haha) these are my favourites for work and play. 

Step 2: Stop standing and walking like a duck and get your weight in your heels! Being in-toed is not beneficial either. Use the straight edge of a floor tile, wooden floor, yoga mat or block to find the straight line from your lateral malleolus (outside ankle bone) and base of your pinky toe. Back your weight up into your heels and remind yourself to get back there 1200 times per day. 

Step 3: Start doing these stretches every day to undo the calf shortening that happens when you wear positive heeled shoes.

• Calf Stretch: Hold for 60 seconds each side, 2-3 times per day
  • Stand with ball of foot on top of a half dome, rolled yoga mat or towel while keeping the heel on the ground
  • Try to keep feet parallel from the outside edges
  • Step closer with the other leg until you feel a stretch at the back of the knee or lower leg on the dome (Note that this may be behind the level dome when you first start). Over time, you should be able to step the other leg further in front easily
  • Try with knee straight (Gastrocs) and bent (Soleus)

• Hamstring: Hold for 60 seconds, 2-3 times per day
• Stand with feet apart and hands down onto a chair or table
•  Keep your legs straight and weight back into heels
• Untuck the tailbone, lifting it up toward the ceiling to feel the stretch down the back of both legs

If you already have bunions, continuing to do the steps above will help to reduce pain and sometimes decrease the bump as well. This next one is especially if you have a bunion and tightness between your toes:

Step 4: Stretch out your toes using your fingers, particularly between the big toe and the the second toe. You can also use toe spreaders (like the things used for painting your toenails) or My-Happy Feet socks for prolonged stretching. 

Until you can do... this! It's my new party trick. No bunions for me :)