foot arches

Why is it not a routine practice for podiatrists to observe their plantar fasciitis patients’ stance and gait? Let’s consider how a broader approach that considers the way people stand and walk could improve treatment outcomes for plantar fasciitis patients—and also help prevent recurrences.

The main factors in foot health

In my experience, the top three influences on the health and performance of the human foot are the architecture and orientation of the foot and leg, the way a person stands, and the way a person walks. Of course, shoes also play a big role in foot health (you can read more about this here), but while truly healthy posture can do a lot to compensate for poor shoes (extreme styles excepted), the best of shoes cannot make up for poor posture, stance, and gait. 

These African fishermen all show healthy external rotation in their legs and feet. Pexels

Internal leg rotation mechanically disadvantages our structure, and offers poor support to the feet and legs. Pexels

What gives rise to foot problems

We frequently work with people whose foot problems have been created or made worse by poor postural habits. While there can be a genetic predisposition to foot problems, frequently, what appears to be a genetic trait is actually the result of mimicking those closest to us—the person with bunions has replicated their parent’s poor posture or poor shoe choices which, in turn, caused their bunions. 

Let’s consider what can go wrong in the feet when standing. In a common modern stance where the hips are parked forward relative to the feet, the body’s weight lands excessively on the smaller, more delicate structures of the midfoot and forefoot. The ligaments that bind the bones in the feet together may no longer be able to do their job in preserving the shape and healthy function of the foot. 

 
How you stand affects your weight bearing and the forces going through your feet. This man has parked his pelvis forward, shifting his weight off his heels and onto the more delicate forefoot. Pexels

Plantar fasciitis

Plantar fasciitis is one common problem that results from faulty weight distribution overwhelming the foot ligaments. Other problems may include calcium deposits (bone spurs) at points of stress, nerve damage such as in Morton’s neuroma, inflammation such as in sesamoiditis, and stress fractures. 

Plantar fasciitis affects the strong, fibrous attachment that runs from your heel bone to the ball of your foot, supporting the medial and lateral arches. The ligament-like tissue becomes irritated and inflamed, making it painful to bear weight or use the foot, especially on initial standing. 

Plantar fasciitis occurs when the connective tissue on the sole of the foot becomes inflamed. Pexels

Treatment of conditions such as plantar fasciitis is often limited to local solutions. A common treatment for plantar fasciitis is to stretch the plantar fascia with exercise, manual therapy or by wearing night splints. This has some protective merit as it reduces the degree of tearing that can occur under the body's weight. Another measure that can offer relief is foot rolling with iced water bottles. 

After observing the shape of the patient’s foot, a podiatrist might prescribe an orthotic. The most conservative treatment with orthotics simply reflects the shape of the foot and aims to prevent further deterioration of the foot’s structure. Somewhat more sophisticated orthotics are designed to exert corrective forces on the foot, such as lifting a sunken arch. 

A root-cause solution is to learn how to stand and walk well. Instead of band-aid stretching and orthotics to compensate for weak muscles and poor body mechanics, this approach will lead to a strengthening of the foot muscles, an overall shortening of the foot, and appropriate weight-bearing on the foot at all times. When students come to us with orthotics, we encourage them to think of the orthotic as a training device that reminds the foot to practice what it needs to do, as well as being a prop for as long as they need it to do some of the lifting for them. 

Once the foot muscles have learned to grip around the contours of an arch support the foot can go beyond resting passively as shown here.

Learning to activate the feet is especially beneficial for anyone with “flat” feet. It’s also important for women during pregnancy, since both the additional weight of a baby and the hormone relaxin increase any tendency to ligament laxity. 

Key components of Gokhale Method® training in our in-person Foundations course, one-day Pop-up course, and our online Elements course will enable you to make profound and lasting changes for your feet. You can learn how to:

• Place much of your body weight on your heels. These are large, dense bones with a cross-fiber construction that are well suited to load-bearing compared with the comparatively delicate forefoot with its longer, thinner bone structure.
• Kidney-bean shape your foot, keeping its structural integrity. 
• Use your foot muscles to interact with the ground, providing stability and propulsion. 
• Coordinate your foot action with the external rotation of the leg and activation of the glutes.
• Antevert your pelvis, stack your spine, and align your upper body as part of healthy standing and glidewalking.

We pay a lot of attention to the feet in all our courses. Here I am showing a student how to kidney-bean shape their foot.

Is hi-tech the answer to foot problems?

Computer technology has enabled podiatrists to measure foot shape, weight bearing, and biomechanics with a precision that was previously unattainable. There have been exciting advances in clinical 3D scanning and modeling, and the use of sensors to measure real time movement and weight distribution. There is also an increased biomechanical understanding of how gait interacts with foot function. 

However, the medical model of foot and gait health continues to arrive at conclusions based on abstract reasoning instead of tried and true historical and anthropological evidence. It therefore continues to encourage modern distortions like a “straight” foot and “straight ahead” feet. We would love to see a shift in the medical perception of healthy feet and gait that weaves in ancestral wisdom. 

The Gokhale Method has developed two wearables that help refine students’ stance and gait. The five-sensor SpineTracker™ wearable is used by many of our teachers in a classroom setting to allow them and their students to monitor and track real-time changes in spinal shape during gait. The two-sensor PostureTracker™ is a consumer product that enables students to refine their stance and gait at home, work, or leisure. 

  
The PostureTracker setting Piston Walking can tell you if you are successfully straightening your back leg while walking (a) or not (b); this is relevant to the healthy function of your feet. 

Free Online Workshop: “Fix Your Feet”

On Wednesday, May 24, 1pm PT, we will be offering a Free Online Workshop, Fix Your Feet. If you would like to volunteer for a mini-consultation in this workshop, please email teamesther@gokhalemethod with a brief description of your foot condition. If you would like to support friends and family who suffer from foot problems, please feel free to email them.

Best next action steps for newcomers

If you would like insight on your foot issues and posture, consider scheduling an Initial Consultation, online, or in person.

You can sign up below to join one of our upcoming FREE Online Workshops. . .

When it comes to foot position, feet parallel is often regarded as the ideal in our present-day culture. Standing with the feet apart, pointing straight ahead, is also seen as the starting point of a normal and healthy gait. Walking then proceeds along two parallel lines, like being on railway tracks. 

In our culture today, standing with feet pointing straight ahead is regarded as normal, and the best biomechanical option. Unsplash

From a Gokhale Method® perspective, a healthy baseline position for the feet is angled outward 5–15°, or “externally rotated.” Why is there such divergence of opinion—and angle? 

Most people learn and then teach feet straight ahead

Feet straight ahead is the model learned and perpetuated by most professionals who are trained in anatomy, whether they are fitness coaches, yoga teachers, Pilates instructors, physical therapists, podiatrists, family physicians, or surgeons. Training regimens, gait analysis, shoe design, and equipment such as elliptical trainers and step machines are also based on this belief. 

There’s compelling evidence for feet out at an angle 

The Gokhale Method approach to solving back pain and the many other musculoskeletal problems that beset our society is not based on such current assumptions, but on direct observation of biomechanically healthier populations. The Gokhale Method understanding of healthy posture draws on field research among traditional and tribal populations in many parts of the world, where despite differences in culture, age, gender, and occupation, posture remains remarkably consistent—and includes a 5°–15° foot turnout. This same turnout can also be seen in our infants, historical artifacts, and our ancestral images prior to the early twentieth century. 

You can see that the feet of this woman in Odisha, India, angle outward.

Let’s look at some more examples of evidence for feet out. 

Ancestral and antique photographs

This Victorian photograph decorates a table mat at a country hotel in the UK. The group on the right all clearly show significant external rotation in their legs and feet.

These Scottish soldiers from the mid-twentieth century show degrees of foot turnout that would be uncommon today. Pinterest

Contemporary traditional and tribal culture

These women in tribal Odisha, India, habitually stand and bend with externally rotated legs, which orients the feet outward.

This snippet of video from a market in tribal Odisha, India, shows people walking with feet turned out.

The ancient world

As ancient Greek statuary became ever more naturalistic, it captured the outward angle of the feet, even lifting one foot to suggest walking or a relaxed, “contrapposto” standing position. Marble Statue of Serapis, from Amorgos, 2nd Century BCE, National Archaeological Museum of Greece, Athens. Wikimedia

Children

Children naturally externally rotate their legs from the hip joint, angling the feet out.

Being held in poor positions or sitting in furniture which tucks the pelvis will counter healthy external hip rotation and cause an infant's legs and feet to roll inward.

Extreme outward feet angles

Some dance forms, including those based on traditional posture, have evolved an exaggerated degree of external rotation for artistic effect. Several of the base positions of ballet take natural external rotation to an extreme. Such angles also feature in Indian classical dance. These angles work in people who have been raised with them from early childhood but can be impossible or problematic for modern hips which formed while using Western furniture, including seated toilets. Squatting and sitting cross-legged in childhood encourages healthy hip socket development.

The “first position” in ballet requires considerable external rotation in the hips to turn the feet out at 90 degrees. Wikimedia

There are numerous foot gestures in Bharata Natyam, a traditional Indian dance form, which require 90 degrees of outward angle in both feet. Pinterest

Footprints that follow a central line—not parallel tracks

Soft sand is great for capturing footprints, and those of tribal people will clearly show not only the external angle of the feet, but also how the heels touch either side of a central line. John Carter, one of our teachers in the UK, shares a telling tale: 

It was 2010 and I was staying in a beach hotel near a fishing village in southern India. Checking my well-thumbed copy of Esther Gokhale’s book, 8 Steps to a Pain-Free Back, it was instantly obvious who had left their footprints in the sand. Local fisherman left kidney bean shaped footprints, with strong indents from the heel and big toe, and landed with the inside of each heel on either side of a central line. Tourist footprints were wider in the center, indicating lower foot arches, and were usually placed along two parallel lines.

I was traveling with my yoga teacher friends and colleagues. We all admired the grace and poise of the locals, how beautifully they stood, walked, bent from the hips, etc. However, this was strikingly different from the posture that my yoga companions had been taught, in line with conventional yoga ideas. I was eager to discuss the differences, but my colleagues, confused by their received wisdom, continued to repeat what they had learned in training, which included sticking with parallel feet. 

Two sets of footprints from Brazil, showing both feet out and walking on a central line. Unsplash

In modern Western culture it is much more common that footprints are straight ahead and run along parallel tracks. Unsplash

A workman stepped in paint… the prints that his boots left on the sidewalk show a healthy angle of turnout, and that he walked on a central line—this combination is relatively rare in industrialized cultures (UK).

Why do feet point straight ahead?

From our anthropological perspective, having feet straight ahead is actually an inward turn from a healthy norm of “external rotation.” This has come about for several reasons:

• Weakened arches cause the foot to collapse inward (pronation), also rotating the leg inward.
• Concave “bucket” seating, soft sofas, “sling” style footrests, and other poor furniture all lead to poor posture and a lack of healthy external hip rotation.
• “Ergonomic” design and anatomical teaching are both based on the false paradigm that feet should be straight ahead.
• Fashion role models, footwear, clothing, and mistaken ideas about what is healthy perpetuate parallel or even internally rotated feet.

What are the benefits of feet out?

• Encourages kidney-bean shaped feet with strong arches and healthy function.
• Brings optimal alignment to the ankle, knee, and hip joints.
• Facilitates natural pelvic anteversion and a well-supported spine.
• Facilitates healthy deep bending (hip-hinging) as the pelvis can nestle between the thigh bones.

Feet pointing outward adds stability when maneuvering heavy loads, and, with a wider stance, aligns the legs and hips well for hip-hinging. This man is able to bend deeply to the ground.

If your feet are currently straight ahead, or somewhat internally rotated, and you want to move toward external rotation, we recommend you introduce small degrees of change very gradually to allow the tissues and bones of your feet, legs, and hips time to adjust. We strongly recommend you do this in combination with other postural principles taught in 8 Steps to a Pain-Free Back, and our Gokhale Method® in-person Foundations and Pop-up courses, and our online Elements course. 

If you would like guidance on any aspect of your posture, including how best to use your feet, consider scheduling an Initial Consultation, online or in person, with a Gokhale Method teacher.
I’ll also be giving a free online workshop on Thursday September 15, 4:00pm PT, Fix your feet with the Gokhale Method. You can sign up here. I look forward to seeing you there.

We assume in our culture that aging will necessarily be accompanied by a loss of height, increasingly stooped posture, loss of muscle strength, and a precarious inability to balance. But is this really the inevitable trajectory? Here we look at why this occurs and focus on how a healthy gait can help us maintain good balance throughout life, including into old age.

Walking sticks and poles help prevent falls but are poor compensation for loss 
of natural stability and balance from the feet and buttocks. Unsplash

Falls can have fatal consequences for the elderly, potentially resulting in broken bones and a cascade of problems that can ensue from hospitalization, injury, surgery, and immobility. Scientific data followed by the U.S. Department of Health and Human Services (HHS) has linked several known risk factors, attributing most falls to muscle weakness and problems with balance and gait. Conversely, elderly people who maintain their strength and ability to balance have been shown to mostly avoid trips, slips, and falls.

The importance of the glutes

When it comes to balance, there is good evidence to confirm that the role of the gluteal muscles (buttocks) is key. Research¹ has shown that having strong gluteal muscles and hip abductors differentiates non-fallers from fallers. These muscle groups include gluteus medius, a muscle that we pay a good deal of attention to in both our online Elements course and in-person Gokhale Method Foundations Course. 

 
The gluteus medius muscles form the
upper outer quadrants of the buttocks. Wikimedia

 
Healthily developed gluteus medius muscles are clearly visible 
in these Ubong tribesmen. (Borneo, Indonesia)

The attachments of gluteus medius high on the pelvis and wide at the hip joint position it to play an important role in steadying us when we walk. With a little coaching, it is easy to monitor its degree of engagement with the fingertips. This is also a good way of ensuring that other important muscles in the area are performing their function.

People who walk well use their back leg and glute strongly 
to propel themselves forward and maintain their balance.

Should I do glute exercises?

Well-targeted exercises are an effective intervention for jump-starting weak and sleepy glutes, and are therefore included in our courses. But your glutes would like around 5000 reps a day to maintain a good baseline tone—enough to drive most of us crazy. Fortunately, Nature has a saner solution—walking. Rather than dedicating a large percentage of your disposable time to doing exercises, if you walk well, squeezing your glutes, each step becomes a rep.  

Note the bean-shaped contours of this woman’s feet. (Odisha, India, 2017) 
She has strong, even inner and transverse arches 
giving the foot convexity rather than a collapsed shape.

Feet

At the other end of our walking gear are our feet. We treat our feet somewhat like prostheses to be shoved into shoes, with little regard for their function. But healthy feet are critical in gripping and grabbing the contours of the ground, even through shoes, as part of maintaining our balance. 

Natural gait includes a grabbing action by the foot as the glute contracts, with the back heel staying down
on the ground well into the step.

Glidewalking

A natural gait that makes good use of the glutes and feet is so rare these days that Gokhale Method teachers call it “glidewalking” to distinguish it from the various poor gait habits and compensations that most people develop in industrialized societies. 

Walking distortions

Monty Python’s “Ministry of Silly Walks” comedy sketch, starring John Cleese. 

The Monty Python “Ministry of Silly Walks” sketch shot to fame in 1970 and is still absurdly comic. Its silly walks are hilarious and clearly extreme, but some of their genius lies in their exaggeration of truth as they magnify the distortions and quirks that can be observed in our individual walking patterns.

A common walking distortion occurs when the pelvis is tucked under. Tucking the pelvis disadvantages the muscles of the glutes and feet which are designed to propel us forward. Without this propulsion from behind, muscles in the front of the body such as the psoas and quadriceps are obliged to take their place and pull us along. These muscles cannot give us the same stability however, and our ability to balance or catch ourselves from falling is reduced. 

Non-industrialized populations the world over, despite their varied environments and cultural habits, share a common gait pattern. This photograph (Laurence K. Marshall) reveals no appreciable differences in walking between individuals, male or female, child or adult. 

By contrast, if you observe a tribe or family of Kalahari Bushmen you might detect slight nuances, but each individual shares the same essential gait pattern. This is also observable in our young children and is preserved in the art and film of our ancestors prior to the 1920s.

All of the upside, none of the downside

While it’s true that any type of walking may bring benefits such as cardiovascular fitness, interaction with others, connection with Nature, and a low carbon footprint, there will be downsides for your balance if you have a poor gait pattern. A habit such as landing heavily means that your weight is committed forward too early in your step, removing the ability to side-step a loose tile or slippery floor. Many people lean backwards slightly as they walk, making them more prone to their heels slipping underneath them. By contrast, glidewalking is well balanced and stable, which lends it an innately peaceful and dignified quality. 

Gokhale Fitness teacher Eric Fernandez and Gokhale Moving Meditation teacher Kathleen O’Donohue take online participants through balance exercises and movements.

It’s not just an age thing

Many younger people with poorly developed walking muscles and a “flat butt” find themselves prone to falls and injury but are likely to put it down to poor coordination and clumsiness. Whatever your age, if you often feel unstable, trip frequently, notice that you struggle to stand on one leg in yoga classes, or cannot shift your weight smoothly in Tai Chi/Qigong, it is definitely worth looking at ways to improve your balance and movement.

Strengthening the gluteus medius muscles prepares you for glidewalking.

Learning to glidewalk

The best and safest starting point for learning glidewalking is to strengthen and become very familiar with using your gluteus medius muscles. You can find our favorite glute strengthening exercise, “leg raise,” in the exercise appendix of my book (pg. 213), “8 Steps to a Pain-Free Back”.

Or watch our Online University video clip here.

For those who are willing and able to follow detailed instructions, Lesson 8 in “8 Steps to a Pain-Free Back” takes you through the phases of glidewalking step-by-step. 

If you have the resources, I recommend contacting a Gokhale Method teacher who can coach you and tailor lessons to your needs. 

You are also invited to join me for the Free Online Workshop, Sturdy, Upright, and Tall: Posture for Aging, on June 29 (5 p.m. PT). Best foot forward!

          1. Mario Inacio et al., “Gluteal Muscle Composition Differentiates Fallers from Non-fallers in Community Dwelling Older Adults,” BMC Geriatrics 14, no. 37 (March 2014), https://doi.org/10.1186/1471-2318-14-37.