barefoot

We have long ago ditched any Victorian shyness around showing our ankles, thank goodness. In fact, they have become a fashionable part of the body to celebrate with short pants and an ornamental tattoo. But unfortunately for our ankles, the picture is often not so rosy as the years go by…

Healthy ankles can serve both fashion and function! Image from Pickpik.com

You might be surprised to learn that some of the fastest growing orthopedic surgeries are for ankle fusions, and partial and full ankle replacements. Though still less common than the 790,000 knee replacements and 544,000 hip replacements¹ done every year in the U.S., the number of total ankle replacement surgeries has grown to over 10,000² per year, and these are expected to overtake fusion surgeries.

Surgeries have pros and cons

When ankle damage is beyond the reach of physical therapy, ankle surgery is an option. Various procedures are used for treating post-traumatic, osteoarthritic, and inflammatory arthritic ankle conditions. While we recognize that continual improvement is being made in these surgeries, and welcome the mobility life-line they offer to many, ankle surgery can also leave patients with a relatively small range of motion in the joint, wound complications, and residual pain.

Maintaining quality of Life

Good ankle function is clearly important for enjoying life’s pleasures, such as dance, sports, and being in nature—but it is also about being pain-free, being able to keep a job, avoiding fall injuries, and maintaining independence. 

       
Being able to walk with ease and pain free ankles (left) makes life more doable and enjoyable. Image from Pexels(left img, right img)

What causes ankle pain and degeneration?

Ankles become problematic for a number of reasons. Some of our students trace their issues back to old injuries, such as broken bones or “rolling the ankle” and tearing ligaments. And it is true that less than optimal healing or poor rehab can have ongoing consequences, or issues that surface in later years. 

The muscle spindles within and the bands of ligamentous tissue that bind the ankle are especially rich in sensory organs called proprioceptors. These are important for sensing our balance and how we perceive the location and movement of our body parts. Thus, incomplete recovery from ankle injuries can leave us more prone to poor coordination and falls.  The long tendons running from the various lower leg muscles through the ankle to move the bones of the feet want to be strong, as do the connective tissues, giving our legs power and stability. 

The tendons of long muscles such as the tibialis anterior (shown in red) cross the ankle, inserting to work the toes and forefoot. The ankle is bound by strong ligaments. Wikimedia

People sometimes tell me that they have inherently weak ankles, like one of their parents. While our DNA clearly shapes our structural inheritance, a more likely cause for the actual manifestation of ankle problems is poor use of the joint due to problematic posture. A poor gait pattern is often learned from our parents, or role models, influencers, or well-intentioned but misguided coaches. 

Motion is lotion—plus strength and flexibility

From a Gokhale Method® perspective, the root cause of ankle problems in our society is varying combinations of poor posture and insufficient use. Even on flat terrain, walking as we were designed to involves a considerable range of motion—the back of the ankle and Achilles tendon gets stretched as the back heel stays toward the ground, and then the front of the ankle is opened wide as we push off using the toes.  

As we came to work ever more sedentary jobs, walking shorter distances along flatter surfaces in our offices and malls, our ankles do less and less. In centuries past our feet would work hard to grab the textured surfaces of rough earth or cobblestoned streets on which we walked barefoot, or in lighter-soled shoes. Going uphill and downhill makes even more demands on our ankle structure, as do naturally challenging surfaces such as tussock grasses and scree-covered hills. 

Traditional dance forms as diverse as the Indian Bharata Natyam, classical ballet, Irish dancing, and Samburu tribal dance from Kenya, all employ considerable ankle strength and flexibility. Image from Pixabay and Wikimedia

Let’s strengthen our ankles 

Consider your starting point. Don’t go straight into a new or strenuous activity if your ankles have been used to taking things easy! At best you could feel very sore, at worst you risk an injury—the very opposite of what you want. If you are recovering from injury or surgery, we advise you to check with your preferred health practitioner.

If we are lucky, we will gain healthy ankle strength and flexibility as we grow, and maintain it throughout life. But many of us in our society need help to do that. Image from Pexels

Rather than rotating your ankles, which is a commonly given exercise, we recommend you take a look at our free Inchworm and Toe Tap videos (below). Start each exercise gently with a minute’s work on each foot daily, and build up from there.

These are highly functional exercises that can immediately benefit your walking. Although you focus on moving your feet, you will feel your ankles and lower leg muscles working hard as well.

In time, these movements, and others we teach on our in-person Foundations course, one-day Pop-up course, online Elements course, and Gokhale Exercise program, will help to make your walking more balanced, smooth, and powerful. After all, walking well is nature’s way of maintaining your foot and ankle health, giving you the thousands of reps per day that your feet were designed for. 

For our Alumni, we are pleased to announce the return of our popular Advanced Glidewalking course, starting Monday, October 7, 12 p.m. (PST).  You can book your place here.

Best next action steps 

If you would like to improve your ankle function and comfort, get started by booking a consultation, online or in person, with one of our teachers. 

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

References:

¹ “Joint Replacement Surgery.” n.d. Rheumatology.org. https://rheumatology.org/patients/joint-replacement-surgery#.

² Penner, Murray J., Gregory C. Berlet, Ricardo Calvo, Eric Molina, David Reynolds, Paul Stemniski, and W. Hodges Davis. 2020. “The Demographics of Total Ankle Replacement the USA: A Study of 21,222 Cases Undergoing Pre- Operative CT Scan-Based Planning.” Foot & Ankle Orthopaedics 5 (4): 2473011420S0038. https://doi.org/10.1177/2473011420s00381.

Welcome to the third blog post in our series on running. My name is Michelle Ball, and I am a Gokhale Method® teacher in Tasmania. I am a lifelong runner and am passionate about sharing my experience with beginners as well as seasoned runners and everyone in between. Even if you don’t run, but do wear shoes, this blog post is for you!

Active feet come first

When it comes to advice about running, our feet often get sidelined by the subject of shoes. If you missed Part 2, which is about how to build healthy, active feet, we recommend you catch up here. 

The job of a good running shoe—performance and protection

At the level of elite sport, running shoes are designed with increasingly sophisticated technologies to enhance performance. Time will tell what long-term effect these may have on athletes. From the Gokhale Method® point of view the primary purpose of all shoes is to protect our feet and our weight-bearing joints while still allowing us to move as Nature intended. 

A lightweight, barefoot-style shoe gives my feet sufficient protection and lets them be active on a soft, forgiving surface like this sandy coastal trail.

Cushioning the joints

Over the last 50 years, the increase in urban running on hard surfaces, combined with a reduction in healthy posture and biomechanics, has made for a perfect storm of running injuries. These include runner’s knee (patellofemoral syndrome), Achilles tendonitis, shin splints (stress involving microfractures of the tibia), and plantar fasciitis (inflammation of the bottom of the foot). The design of modern running shoes has seen many innovations, twists, and turns, but one clear trend has been to increase the amount of protective padding in the form of thicker, spongier soles, air bladders, and gel at chambers. Whilst some degree of cushioning for the joints is desirable when running on unnaturally hard surfaces, it is now thought that overly thick soles reduce proprioceptive sensitivity and actually encourage runners to hit the ground harder. 

This contemporary road running shoe is heavily padded. From the Gokhale Method perspective, such bulk interferes with our ability to feel the ground and make softer landings and can encourage ankle turnover. Run4it

Strong, responsive feet combined with the natural gait pattern that arises from healthy posture can enable you to land more softly and avoid injury. Building in extreme cushioning cannot compensate for excessive heel strike and its damaging impact on poorly aligned joints. 

Healthy alignment of the ankle

The first time I experienced a running injury was in my twenties. I had bought a new pair of shoes. The salesman measured me and recommended shoes that were designed to prevent overpronation (inward turn) of the foot. They felt good in the store, but after rolling my ankles more than once, I realized the shoes recommended were predisposing me to injury. I found out later that I tended to supinate my feet very slightly and not pronate them. Having shoes that were heavily padded on the inside edge to keep my foot from rolling in, increased the chance of my foot rolling out. The result for me was torn lateral ligaments and crutches on several occasions for six weeks at a time. Once I even had a hairline fracture on the ankle coming down off a boulder. I learned the hard way how important it is to have your ankles well aligned. After buying shoes for normal ankle alignment, I didn’t roll my ankles anymore.

Your weight should align centrally and distribute evenly (left). In overpronation (center) weight bears down more on the inner foot and the ankle veers inward, and in supination (right) weight is carried on the outer foot as the ankle veers outward.

You can do a simple check on your ankle alignment using a mirror or have someone take a photograph. You want to be able to see your heel and ankle from behind.

An overpronated foot may show distortion of the Achilles tendon (right). Wikimedia

Poor ankle alignment may also show up as an ankle bone protruding markedly over the edge of the heel. Here my inner ankle bone shows I am overpronating my foot.

Kidney-bean shaping my foot has now aligned my ankle well. The Achilles tendon is straight, and each ankle bone is better aligned on either side of the heel. 

You can also get useful information by examining the soles of your shoes, which may show more wear and tear along the inner (overpronation) or outer (supination) edge. Check several pairs to ensure that what you see is not peculiar to just one pair of shoes. Compare the left and right shoe.

Learning to correct flat feet

The postural techniques that we teach in our in-person Foundations Course, online Elements, and Pop-up courses, will often be sufficient to correct overpronation, or “flat feet” as it’s commonly known. Here you can learn the detail of, for example, kidney-bean shaping your feet and externally rotating your legs, with a teacher to guide you.

If, after putting some time and effort into solving the problem, it persists, we recommend that you get advice from a good running shop and use your Gokhale Method knowledge to help choose a shoe appropriate for you. They can advise you on which particular shoes can best support you while you continue to work on your posture, remodeling your feet, and realigning your ankles. As you can see in the diagram below, both these measures can support a healthier structure.

This diagram shows how overpronation of the foot can misalign the ankle, knee, hip and spinal joints further up the chain.

Insoles and orthotics as training devices

An insole can add the necessary padding and support to help you transition from a padded shoe to a thinner or barefoot style running shoe. It is important to make this transition alongside learning protective and strengthening posture and foot work. Take your time—start with occasional short training runs in your new shoes, build up the proportion of your running in them gradually, and be very attentive to your form. 

In the Gokhale Method, we teach students to use the contours of an insole as a training device, gripping it to actively strengthen the arches of the feet, rather than just to prop them up. If it is best for you to use a more padded shoe, perhaps because you run on hard surfaces and/or have some degree of joint degeneration, then it will likely have a molded footbed that you can use in this way. 

If you have prescription orthotic insoles to correct overpronation or supination, don’t stop using them abruptly. Try using them less often as your feet gain the strength to support themselves better.

Healthy shoes need to be foot-shaped!

One of the most common faults with modern shoes—including running shoes—is the shape of the toe area, or toe box. The toe box of most shoes is tapered to some degree, which distorts the natural kidney-bean foot shape that the Gokhale Method encourages. We are all familiar with the pointed toe in many women’s fashion shoes, men’s winklepickers, and even cowboy boots—yet it surprises me how this tapering persists in sports and activity footwear. Even some shoes marketed as “barefoot” or “natural” reflect the conventional wisdom of a straight foot, rather than a healthy bean-shaped one. 

             
Most running shoes assume the feet to be straight and tapered at the toes (left). Nature’s blueprint for our feet maintains the external rotation and kidney-bean shape that we all have as infants (right). This is preserved throughout adulthood in traditional societies and explained in Esther Gokhale’s book, 8 Steps to a Pain-Free Back.

Note the bean-shaped contours and wide toes of this Indian woman’s feet. (Odisha, India, 2017) 
This strong, active foot would be constrained and deformed by a tapered running shoe.

Tipping forward/curve in modern shoes

Shoes with an upward toe curve have become increasingly popular. People like the feeling of forward momentum that they give, and they can encourage the glutes to work. Better to learn to use your glutes anyway, then this feature isn’t necessary, and you avoid the downside—the upward toe curve encourages your foot to peel off the ground passively, rather than grab and propel you forward. 

An upward toe curve depresses the transverse arch at the base of the toes. This concavity directs excessive weight through the ball of the foot and contributes to weaker plantar muscles and push-off. Run4it

I hope this blog post has helped you with your choice of running shoes. If you are in the market for a new pair, enjoy shopping with new confidence and purpose.

Spring is in the air! As the temperature rises, we go for lighter footwear, exchanging our shoes for sandals, or going barefoot. It may have been a while since our feet had so much exposure - what can we do to benefit our feet and put a little spring into them?

Babies and Toddlers

For babies, the question about ideal footwear is easily answered - a baby is best off barefoot so she can feel the stimuli of different contours and surfaces. These induce her to engage and strengthen her arch muscles as she learns to crawl and then walk. Minimize putting shoes on infants, as this inhibits the natural development of their feet and affects their learning to move and walk well.

Toddlers and older children, as they venture into unfamiliar or less friendly terrain, may need protection for their feet. For any age group, choose a shoe that allows the foot to retain its natural kidney-bean shape.

Choosing Healthy Footwear

Avoid shoes that point or curve the big toe away from the inside edge of the foot. Heels that are higher than 1-2 inches pitch your weight forward onto the ball of the foot – avoid shoes with very high heels.

Well-designed shoes have a kidney-bean shaped footprint, pronounced arch supports (unless your feet are super strong and/or you're paying attention to your gait), and shock-absorbent soles
 

Healthy Foot Practices

Adults sometimes develop foot problems like bunions despite wearing well-shaped shoes. They may even see this as something that runs in the family – “my mom’s feet are exactly the same”. While it is true that our genes predispose us to certain problems, often it is poor postural habits that actually allow structural problems to develop. For example, if we have copied how our parents stand and now also park our pelvis forward and lock out our knees, then an excessive amount of our weight will fall on the front of the foot.

A pelvis thrust forward displaces body weight forward and puts excessive pressure on the delicate structures in the front of the foot

This is problematic because it flattens the transverse arch and causes distortion through the delicate joints of the forefoot – result: bunions, hammer toes, sesamoiditis, metatarsalgia, etc. It is the sturdy heel bone with its dense, cross-fiber construction that is perfectly adapted to take most of our weight. In Lesson 3 of the Gokhale Method Foundation course, when we teach this shift in tallstanding, most people feel somewhat odd, and have to reassure themselves that they don't look odd by looking at their reflection in a mirror!

The heel bone in our species is a sturdy bone adapted for weight-bearing. The bones in the front of the foot, by contrast, are delicate and not constructed to bear the weight of the body.

Bear in mind that our ancestors continually exercised their feet by walking on softer, more contoured surfaces than we encounter today. Compared with a hunter gatherer's foot, the modern urban foot tends to be underused and weak. Flat, or pronated feet misalign our ankles, which results in misaligned knees and hips, wear-and-tear, and arthritic change in the lower body.

Walking barefoot on the beach - depending on how you do it, this can be great foot exercise or destructive for the ligaments of your feet.

Supportive foot-beds, orthotic insoles, and arch supports can be a real help in correcting this sort of distortion. However, while shoe inserts do help to reshape the arches and restore mechanical advantage to the foot muscles, they are no substitute for learning to actively reshape, exercise and engage the feet. The inchworm exercise below is a great way to begin strengthening important muscles in your feet. After you master this exercise, integrate it into every step you take - grip the ground ahead of you, "pull" the ground towards you and then "push" it behind you. This builds the kind of strength and spring you want from your feet, and an elegant glidewalk will result from it!

Click here to watch.

Best,
Esther