One of many nice things about human movement research is that you get to work with some truly brilliant people, like Dr. Patrick McKeon who just published an article, “The foot core system: a new paradigm for understanding intrinsic foot muscle function,” in the British Journal of Sports Medicine. I had the pleasure of mentoring Patrick back when he received his Ph.D. in Athletic Training at the University of Virginia. What’s kind of “small world-ish” is that he happens to be the cousin of another brilliant research colleague I’ve worked with, Dr. J. J. Collins, who is a professor at Boston University and, I like to say, a certified genius, having received at one point in his career, the MacArthur Genius Award.
Patrick is now an assistant professor in Exercise and Sport Science in the School of Health Sciences and Human Performance at Ithaca College, along with his wife, Dr. Jennifer McKeon. When I saw his article, which he co-authored with a couple other colleague friends of mine (Dr. Jay Hertel and Dr. Irene Davis), I was excited to catch up with him.
Through his research, Patrick has always understood certain aspects of foot function that are often not well appreciated by most. In his foot core article, Patrick and his co-authors call attention to what they describe “the foot core.” Pulling together a number of articles and drawing parallels to the well-known “trunk core” in relationship to trunk-hip stability, they describe an essential core specific to the foot that is vital for stability and overall lower extremity health.
Athletic and fitness training professionals already appreciate that in the trunk and hip, small muscles known as the “core” muscles play a critical role in stabilizing bones and joints, accommodating to changing demands that occur with different activities. When the core muscles are weak from disuse, large muscles and bodyweight forces transmit abnormal stresses and strains that lead to injury. To counteract this effect, core strengthening exercises are performed.
While the concept of the trunk “core” and the need to maintain good “core strength” in these small muscles has been broadly accepted in the athletic and fitness community (just google “core strengthening” to see a myriad of exercise programs aimed at improving core strength), the small muscles in the foot have been largely ignored. In fact, there has been a long persistence of an old “truth” that the small foot muscles are not only unimportant, but fragile and in need of constant external support via arch supports.
Patrick commissioned a skilled medical illustrator to draw the four layers of muscles in the arch of the foot along with the deepest layer of muscles on the top of the foot. These are the only anatomy drawings I know of that display just the muscles and bones in each of the layers.
In another post, The Little Arch Muscles That Could, I reviewed a recent study demonstrating that various of these arch muscles play an active role in absorbing forces to the body that occur when standing, walking and running. In their article here, Patrick and his co-authors review a bunch more studies supporting the significance that these muscles have in controlling load distribution under the foot.
While there are four separate layers of muscles in the bottom of the foot, there are also four separate arches in the foot (the medial and lateral longitudinal arch and the anterior and posterior transverse metatarsal arches). Patrick illustrates with the help of his medical illustrator, Tom Dolan, how these arches effectively coalesce into a half dome as shown below. They credit the idea to J. McKenzie who wrote a little known article back in 1955, entitled “The foot as a half-dome” which Patrick found buried in a university library.
Patrick reviews how the muscles in these four layers work synergistically to control this functional half-dome. Moreover, he and his co-authors explain how these small muscles “set the table” so to speak, for the larger structures in the foot and lower leg to work effectively and normally. Specifically, they describe how they provide the core foundation for maintaining and achieving health in commonly unhealthy structures such as the plantar fascia. They also point out that to date, these muscles have been very much under appreciated in the treatment of plantar fasciitis.
While foot and toe exercises such as “picking up marbles” and “rolling a towel under the foot” certainly activate some of the muscles in the foot, they don’t fully activate the small muscles in the way that they’re activated during walking and running. How these small muscles work during standing, walking, and running to achieve optimal healthy function upward from the ground, is actually rather complex.
So, Patrick suggests a much more functional exercise, a “short foot maneuver,” pictured below, that is done with weight being borne through the foot. With the foot on the ground, the foot is actively “shortened” by using the arch muscles to pull the ball of the foot near the great toe toward the heel as the arch is lifted upward. The exercise is done with increasing weight being applied through the foot.
You can start doing the exercise just while sitting, then when standing on two legs, and ultimately while just standing on one leg. Jay has done a number of studies showing that doing these short foot exercises for just four weeks, significantly improves muscle strength, reduces arch collapse and improves balance ability.
Ideally, you do the exercise while barefoot. As I was talking with Patrick, I found that I was quite able to do the exercise while standing in my OESH La Vidas. I then tried the same exercise in various traditional, non-OESH shoes and was unsuccessful. Just about every non-OESH shoe out there has a built-in arch support which makes it virtually impossible to activate those small muscles. The fact that the typical built-in arch support in a shoe suppresses small muscle activity in the arch of the foot has been confirmed with fine-wire electromyographic studies.
Imagine how the typical shoe suppresses this small muscle activity not just during a short foot exercise, but all day long when those small muscles otherwise would be naturally exercised. Over time, those muscles become weak and compromise the normal function of structures in the foot and the lower leg such as the plantar fascia.
Conversely, it’s been shown that switching to a shoe like OESH that has absolutely no built-in arch support, can re-engage those muscles, essentially exercising and strengthening those small muscles just with regular daily activities.
Patrick and his co-authors state “Clearly, a stronger foot is a healthier foot. To this end, we are suggesting a paradigm shift in the way we think about treating the foot….Unfortunately adding permanent support to the foot, as opposed to strengthening the foot core, is the current standard of care. We would like to suggest that perhaps it is time for the Decade of the Foot. This type of attention to a largely ignored, but critical part of our body might help raise awareness of the amazing function of our feet and their under appreciated potential for improvement.”
I’m looking forward to seeing Patrick and Jen in a couple months when Jen will be speaking at the 42nd annual University of Virginia Sports Medicine Conference. I expect we’ll end up at the OESH factory…where on special occasions we’ve been known to allow a drink or two…to celebrate the publication of this wonderful article.