Health Insights column: Each foot has 33 joints, but we mostly ignore them
January 9, 2017
If I asked a dozen people to describe a joint, then I might get a dozen different responses. Though varied in specifics, the answers would have overlapping details. From a rotating shoulder to a flexing spine, most people get the gist of joints. They are where bones connect, and they support movement.
In this active community, we are well aware that joints are subject to injury. Too much movement (i.e., dislocation) or too little (i.e., fusion) is considered to be a problem.
What if you suddenly lost your ability to bend you elbows? Would you passively ignore it? Imagine getting dressed or trying to feed yourself. Or consider getting around if both knees failed to straighten. Picture a trip down the stairs. May sound like a good quad workout for the uber athlete, but unsafe for the rest of us.
We know that in order to stay safe and be mobile and productive we need our joints to work. If we lose options, then we lose function, right? If we have a problem with our hip, shoulder, knee or ankle, then we would eventually look into it. We address our joint problems with one exception: our feet. When it comes to the feet, we are almost universally "meh." Buy an insole and pack out your ski boots, next?
Each foot has 33 joints. To put that into perspective, our entire spine has 33 joints. The feet are a complex architecture of levers and pulleys and arches. Twenty-five percent of the bones in our entire body are in our feet. In each step (less than 1 second), 26 bones in each foot orchestrate the transition from mobile-adaptor to rigid-lever. Being the only contact with the ground, each foot has more sensory nerve endings per square centimeter than any other part of the body. But for the most part, we ignore them.
I'm fairly obsessed with feet. I can comfortably say that 80 percent of my patients' problems can be traced back to the feet. Everything from neck pain to knee pain can stem from problems in the feet. Think of the body as a closed system with a fixed amount of movement. Whatever doesn't happen in the feet is going to have to happen somewhere else up the chain.
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Consider the person who's had four knee surgeries on the same knee. Eventually, he or she has that knee replaced. In time, the pain moves to that hip. Then that sacroiliac joint in the pelvis hurts, followed by the lower back. We can look at each problem in isolation or look at the big picture. That person can't effectively get off that side. I'd bet money he or she has a flat foot. Lacking the ability to form a rigid lever (a supinated foot), the person is unable to successfully propel off that side.
A litany of compensations occurs with every step just to help manage mass. This impacts one structure after another, all the way up the chain. Too much load on the big toe, too much torque at the knee, too much demand on the rotators of the hip and excess shear at the spine. In time, this person may receive surgical treatment for a bunion, a torn meniscus, an arthritic knee, a torn labrum and a herniated disc. Or, we could just teach the foot how to supinate.
I use Anatomy in Motion to do a body interview and get the whole story. What is the body doing, and what can't it do? Where do you "live" on a foot scan? The body can only use its available options. Lost options lead to pain. I use wedges and gate-based exercises to restore what is missing and fill in the gaps. This enables the brain to perceive contact with the ground differently. This impacts sequencing and distribution of load all the way up the chain.
As with any other care, there is no cookie-cutter approach. Look for the root of the problem, and treat that. I like to link together as many problems as possible. Rather than focusing on the bits that hurt, we address why they hurt. Maybe the toes can't flex, an arch won't drop or the heel won't turn. The ultimate goal is to restore lost options. Restoring function in the feet can provide relief from end to end.
Julie Peterson, MPT, is the owner of Concierge Physical Therapy Colorado. She is a certified neurokinetic therapy specialist with a strong background in manual therapy. She can be reached at 970-306-3006 and firstname.lastname@example.org. For more information, visit http://www.conciergeptcolorado.com.
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