Massage for Common Foot Conditions

There are many foot conditions that can wreak havoc within the body. Misalignments and injuries to the physical structures within the pes region can create challenges of gait, postural support and stabilization.

This article will focus on five foot conditions: flat feet, plantar fasciitis, bunions, heel spurs and Morton’s neuroma. These common conditions afflicting the feet will alter the body’s ability to walk and move efficiently causing additional stress upon the sacro-iliac joint, hip joints and knees.

Anatomy of the Region

There are 26 bones and over 50 ligaments in each foot-and-ankle region. These structures provide a solid foundation of support for our body weight and movement capabilities. Many massage therapists employ gait assessment (analyzing the manner in which one walks) to assess dysfunctional movement patterns and determine massage treatment plans.

The main bones one can feel when palpating within their medial foot arch is the navicular bone and within their lateral arch is the cuboid bone. The talus directly bears weight of the tibia bone.

The calcaneus, commonly called the heel bone, anchors the Achilles tendon to the foot.

Just as pollex refers to the thumb, hallux refers to the big toe. Metatarsals comprise five slender bones just as the metacarpals mirror the same design within the hands. The phalanges of the feet mirror those of the hands with separate smaller bone units comprising each digit.

Locomotion is made possible by the design of the foot bones. If we simply had one giant block of bone as a foot, it would be highly unlikely we could propel ourselves forward as bipedal beings. The differing bone shapes and articulations allow these bones to provide the means to propel our bodies forward with a spring-like force.

One can think of the mechanisms of feet movement akin to those of suspension bridges. Placing tension upon one aspect (side, corner, articulation) of the feet will allow for one portion to mobilize, molding the shape of the entire foot to match that of its direct environment just as pulling on one rope of a suspension bridge causes the entire bridge to deviate in shape and mobility.

Dorsal flexion (toes and foot upward) and plantar flexion (standing on tip-toes) take place at the talo-tibial hinge, the articulation of the tibia and talus bones. Restrictions at this joint will result in inadequate gait translating into future structural deviations of posture. Inversion (medial arches facing towards midline)and eversion (lateral arches facing away from midline) take place amongst the joints between the metatarsals and other foot bones.

These arches are formed when a toddler is learning to walk and grips their toes to keep balance. This is why the phrase “it’s important to crawl before you walk” is true for children’s development. Crawling allows leg and core muscles to strengthen before the feat of walking is accomplished.

• Medial arch is designed to bear weight

• Lateral arch Provides stability and balance

• Transverse arch creates lift in the feet (allows feet to walk on uneven surfaces)

Two Most Prevalent Conditions

Flat Feet (pes planus): A collapse of the medial foot arch leading to a flattened appearance of the foot. Often, a visible bulge is present on the lateral foot and the “ceiling”-like curve of the dorsal foot is also lost. Normal weight-bearing support of the medial arch is lacking, thereby increasing this burden upon other areas of the foot.3.3% of females over 40, 9% of females over 65.

Postural distortions causing the lower limbs unable to bear body weight appropriately is the leading contributing factor. These can occur due to many factors:

Damaged posterior tibial tendon, injured foot bones, rheumatoid arthritis, gout, nerve impingement, hip deviation, crus bone injury (tibia and fibular), obesity, pregnancy, diabetes mellitus, congenital or common aging processes including osteopenia (loss of bone mass) and sarcopenia (loss of muscle mass).

With flat feet, feet tire easily, swelling on medial side, pain, achiness, paresthesia, difficulty standing and walking, back and leg pain.

There are two varieties of flat feet: flexible and rigid.

With flexible flat feet, there is no remarkable pain, and the arch may be restored with plantar flexion.

With rigid flat feet, pain can be intense, and the arch will not restore with plantar flexion.

Plantar Fasciitis: Inflammation of the fascia that lies superficial to the plantar foot musculature. Pain, heat, redness and swelling may all be present. Also, patient presents with an inability to place weight upon affected foot.

Damage to the connective tissue band that connects the toes to the heel. Excessive walking and running are the leading contributing factors. Other factors may include: Excessive pronation of ankle joint, flat feet, high arches, walking on hard surfaces, obesity, worn out or ill-fitting shoes or tight achilles tendon.

This condition most commonly occurs in middle-aged adults (40 to 54 years old). Individuals younger than 40 are usually competitive athletes or individuals who stand / walk for the majority of their occupational tasks.

Typically, clients with plantar fasciitis experience pain which increases in intensity when climbing stairs, standing for a long time, stiffness decreases after initial steps after waking, classic inflammation signs (heat, redness, swelling, pain and lack of function).

Common medical corrective treatments include:

• Arthrodesis: fusing foot or ankle bones for better stability.

• Excision: Removing bones or spurs which grow in areas of extreme tension and tenderness.

• Osteotomy: shaving or changing the shapes of foot bones.

• Tendon transfer: adding a tendon from another body region to balance the tendon at medial arch

• Lateral column lengthening: grafting bone to the foot to lift the arch.

Therapist Recommendations

The world-renowned practitioner and creator of Rolfing Bodywork Ida Rolf, PhD, described the feet as the “tattle tales of the body.” This smart observation provides a sound basis of understanding how common foot conditions afflict the body as a whole.

Massage schools traditionally taught the mnemonic PRICE (Protect, Rest, Ice, Compression, Elevation) for alleviating musculoskeletal conditions. Many teachers added a P to the term, standing for Protect, to add an element of stabilizing such injuries to heal better. RICE or PRICE may still be applicable for serious acute injuries to help control inflammation levels within the injury site.

An updated mnemonic presented for such injuries is the MEAT—movement, exercise, analgesics, treatments—method of musculoskeletal injury management. As these injuries progress from acute to chronic stages of recovery, the MEAT method may provide for effective and efficient treatment.

Many therapists employ the strategy of rolling the foot plantar surface with a ball or roller of some type. Golf balls, tennis balls, water bottles and hard rollers are commonly used.

Employing stretching for the feet is also utilized to ease tension of the feet. The triceps surae musculature, gastrocnemius and soleus muscles in union, will need to be lengthened to create relief. Consistency in stretching matters to maintain gains. It is encouraged clients stretch daily in between treatment sessions to maximize benefits.

Exercises to maintain foot musculoskeletal integrity include picking up marbles or other small items with their toes, raising one’s heels off the ground while standing and varying which parts of the feet carry body weight while walking. A physical therapist can be referred in these instances to provide more detailed strengthening exercises.

Splints may be worn at night to stabilize musculoskeletal tissue involved with the injuries. Orthotic devices to restore alignment of foot architecture may aid healing efforts. Patients will benefit from changing footwear for better fit.

Other Common Conditions

Morton’s Neuroma: Compression of the sural nerve between the 3^rd and 4^th metatarsals. Patients may feel either a burning sensation from the ball of foot radiating towards the toes or numbness sensations into the third and fourth toes. (Note: This condition is not Morton’s foot, which is simply a term describing the second toe longer than the hallicus (first) toe.)

The best remedy for this condition is to acquire better-fitting shoes to relieve constant nerve impingment. Mobilizing the metatarsal bones may assist in creating space within the affected region. Addressing excessive plantar flexion of the ankle may aid some clients as the push-off position may exacerabte this condition.