410 | Foot Health Q&A | Bunions, Toe Spacers, Plantar Fasciitis and More!

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen and I'm Dr. Dom and we are doctors of physical therapy bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

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[00:02:57] So today we're just answering your questions, mainly based on questions that have come through Instagram on foot related topics. So, um, which there's so many questions and a lot of them are duplicate. So hopefully we get to answer a lot of people. Um, but I mean, foot health is such a complex topic. It can be, but it also is so widely needed because we're always using our feet and we're on our feet. And sometimes we don't pay attention enough to our feet. So I'm excited to answer some of these.

[00:03:27] I know. And as somebody who has had significant amounts of foot problems in my athletics career, I was always dealing with either top of foot pain or heel pain or plantar fasciitis type pain. I tore a bunch of ligaments or really one major ligament in my left foot that resulted in the worst injury I've ever had. Um, I have become very interested in foot health over the last few years. So definitely a topic of passion, I guess.

[00:03:55] Yeah. Well, let's go right into it. So something that people were asking a lot about are, um, toe spacers, toe separators. What do they do? Why are they necessary? Um, how did it help?

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[00:05:33] Passive treatment. That's the first place I'm going to start. It's something that is passive. So it's kind of the low bar and it's a great place to start. If you're somebody who has bunions or bunionettes or notice your big toe and little pinky toe kind of get squeezed in.

[00:05:49] If you aren't able to actively spread your toes or if you try and focus and try to spread your toes and don't feel like anything happens, toe spacers are a great place to start because just putting them in five to 10 minutes at the end of the day or if you're sitting on the couch can give you that passive stretch in what we call the intrinsic foot muscles that are responsible for bringing our toes together and spreading our toes out.

[00:06:16] Everyone has them. We all have these muscles and hopefully can start to reconnect with them and getting that passive stretch is one of the first steps. And there was actually a really cool study. I know we've mentioned in the past that showed how mild to moderate bunions can actually be helped. And one of the treatments that they used within the study were toe spacers. Obviously, there were other exercises that went along with that study, but it showed, you know, it actually helped to change a bit of the bunion angle and just the toe alignment.

[00:06:46] And so really getting your toes back into that natural toe. What is Dr. Emily saying? Natural toe pockets or something is what she calls it. Toe pockets. And kind of realigning how those toes are resting. It will change the effect of your muscles of how you're moving.

[00:07:05] We had a recent guest on who said our foot should be the widest at the tips of our big and pinky toe. Like that should be the widest portion of our foot. And when we look at that, you know, usual footwear or traditional footwear, it's the narrowest at the point that our big toe and pinky toe should be. And that's a whole nother topic is shoes, but toe spacers. Yes, we love them. We use them.

[00:07:31] We'll even just weave socks between our toes if we're too lazy to run up and grab our toe spacers. But there are different brands that I think are specific. Like the Yogi toes are way too aggressive. You guys, I had those when I first started using toe spacers and I was like, oh my God, you can't walk them. You can't move them. They're so thick. It's not necessary. Like, yeah, if you put toe spacers in and it's painful and within a minute you're like, wow, this is aggressive and this hurts my feet.

[00:08:01] Not good because again, any passive treatment or stretch should help us relax and should help relax some of those tight muscles rather than feel like we're aggressively. Trying to put them in a different place. So we use the Neboso toe spay and we'll have a discount code. Well, it's optimal. Yeah, optimal gets you 15% off or something. Anything on their website. And they have lots of cool products for foot health.

[00:08:28] But what's great about Neboso, not only are they squishy and super stretchable, like they're just so comfortable that you can wear them around the house. You can wear them in your Vivo Barefoot shoes. You can wear them in, you know, you can wear them more than just like passively hanging out. So it could be more of an active process when you get when you build up time in them. Right. Within that answer, you brought up bunions. And I don't even need to look because I've read through these already. There was a dozen or more questions about bunions.

[00:08:58] I'm getting bunions. What should I do? The question really that I want to answer, which you kind of kind of already did with the study you put out there, like can we reverse bunions? Can I make a difference? If you've noticed a bunion starting to form. Yes. One, you can get it to calm down. There was a question about can I get this question to call or can I get the pain to calm down or the flare up to calm down? Yes. Like you can get it to calm down. Yes.

[00:09:26] You can get it to stop growing. And there's also been recent research that shows you can actually start to reverse course and reverse the angle in mild to moderate bunions. I don't know the exact point where it becomes a severe bunion. I'll let you give some thoughts on this and then I want to give my last tag on it. Yeah. I mean, something will always get worse if we don't do something about it. Right.

[00:09:54] So if we're just looking at the bunion and like rolling out your foot or just not going to do anything and you're like, well, I have this. So and I know that you can't fix it. So I'm not going to make a change in footwear. I'm not going to make a change in how I exercise as I may or may not be doing for my feet. Yeah. Then, of course, something is going to continue to progress like that is the natural progression. If we don't change it, it's only going to get worse.

[00:10:18] So there's even if it does not make a structural change, even if the angle of the bunion did not move, could our function improve? Could our pain disability improve 100 percent? And so that is like the baseline of why you should be working on improving your bunion health, even if it doesn't change the structure of what it looks like. That's OK. But there's so much that we can do.

[00:10:43] So bunions in general become a result of essentially the laxity or the lack of strength within our foot, because it's not so much that the big toe is moving in. The big toe moves in as a result of what's called our first metatarsal head moving out, moving out and rotating. Right. So there's this rotation component, too. When you have that movement on the midfoot, well, then the big toe is your body always wants to find balance.

[00:11:11] Right. So instead of your big toe just falling out, your big toe comes in. So it ends up being this big bunion at the big toe is what we see. Right. And so it's really the midfoot that we need to focus on then. So, yes, we can use our toe spacers and we can use things to help to realign the toes. But we have to address what's happening in that midfoot stability. So gaining strength of that foot is so incredibly important.

[00:11:34] And we have a ton of exercises that we do in particularly our barefoot mini course that helps to bring not only the mobility, but the stability of the foot and gaining that that strength aspect. That's so usually neglected, mainly because of the shoes that we in the environment we put our foot in that shuts off the access to utilizing those muscles the way that we should be. But there's so much that we can do to help improve that stability and strength.

[00:12:02] Yeah. And now I'll give my little soap, which I hope no one's listening that will take offense to it. But I actually think the message that has been the message for the longest time that, oh, bunions, nope, you can't change them at all. Yeah. I think that's a little dangerous. And I think that can be harmful to people's mindsets where, oh, if I can't change it at all, then like, why do anything? Yeah. Where the provider, yes, you might be talking about the angle and you might consult them like, yes, we can make your foot stronger. We can get rid of the pain. A lot.

[00:12:32] All a lot of people care about is the angle. So if there's no hope on changing how it looks, people will be like, okay, whatever. It is what it is then. And yes, for in some cases in severe bunions or, you know, moderate bunions with specific lifestyle choices that people have, there might be very, very little hope if no hope in them changing it.

[00:12:51] But for a health professional or someone who studied the body to have the mindset that if I take a thousand people under ideal conditions and train them and train their feet and they all have bunions and train them for five months, six months and they do everything I tell them to do. You don't think a single person's bunion would improve? You don't think the angle would improve in one single person? Which we now have a study that shows that. And we do have research that shows that it does and it can happen. So I'm glad that we're starting to have the research that shows that.

[00:13:19] That we're starting to have more research come out. The MyFootFunction guys who did the study in Sri Lanka that shows that environment has a significant impact on how people's feet develop and it's not just a genetic thing. Our environment plays a pretty large role as well. So I just would caution providers and maybe you as the person going to the provider, if they say, nope, there's nothing we can do to change it, challenge them on it.

[00:13:48] Or if they're hard fast and that, then maybe they're not the person that you should be seeing if you actually want to make a difference yourself. And listen, like for severe cases, there may need to be surgery involved and that's okay. Like I've worked with someone post-bunionectomy and we've been able to get her back into really good function. So you might need surgery, but don't neglect the exercise because surgery may fix the look of it again, the structure of it.

[00:14:14] But if you go back to doing exactly what you were doing that led to the bunion, you don't change anything at all. You're going to be back in the same place that you were. Great. Moving on from bunions. And our little soapbox. And we did a whole podcast on bunions specifically as well. That gives you a little bit more like direction on what to do so we can try and make sure that's linked up in the show notes. What next? What question would you like to? Oh, my turn. I chose bunions. You chose bunions. Okay.

[00:14:44] Plantar fasciitis. That's also one that obviously is asked a ton. And the main thing about plantar fasciitis is that postpartum plantar fasciitis. I like that one. So plantar fasciitis in general is we're looking at it more of a plantar fasciopathy is what we're learning. There's not it's not necessarily an acute inflammation of the tissue at this point.

[00:15:08] Once you feel the pain, it's probably that the tendon, the plantar fascia has been used in a way and overused in a way that now is causing the pain. So it's past the point of just icing and resting. And fasciopathy in general just means that the tissues are all like dysregulated. Right. And so and that's what's starting to cause the pain is the dysregulated tissues can't handle the stress. The stress. The amount of stress. Yeah.

[00:15:37] So no longer is the recommendation to ice and rest and just do ultrasound or just do, you know, there are some treatments. I think when we did our plantar fasciitis episode, which we'll have all the episodes specifically linked. So, you know, exactly what, you know, are the specifics to look at. But there were some treatments, I think that, you know, passive treatments that showed like shockwave therapy, I believe.

[00:16:03] And again, I mean, the message around passive therapies in general is like if it helps you feel good in the moment. OK, great. That can be a part of your treatment. Yeah. The next part is how do we start to get that plantar fascia to like remodel itself to be able to handle the to be able to handle the stresses and activities of the day. And yes, if there's a certain shockwave therapy, great. We just interviewed a light therapy guy. And I bet two years ago we would have said stay away from light therapy.

[00:16:33] But if there's certain red light, red laser therapies that can help with tissue healing and help with tissue healing and the speed of tissue healing and that seem and that feels to you like it's super beneficial. Great. Gets you back into the movement. That's the whole journey. It's like we have to get back to exercise. Even Forrest, who we interviewed, was like, no, like movement is a whole part of this puzzle. Like this isn't the magic bullet. And he's the guy who developed the red light and laser therapy technology.

[00:17:02] So and then it comes down to the load. And how do we play that balance of deloading during the time where we calm it down? Because depending on how flared up you are, like you can't jump right into heavy eccentric heel raises, you know, like that's going to you're going to be in excruciating pain.

[00:17:25] So we need to deload, maybe using some of these passive techniques, maybe maybe modifying footwear so that we have a more cushy sole in our shoe that takes away some of that load. If you're wearing barefoot shoes or something that seems pretty aggressive on the heel strike. Like, great. And then once we get it calmed down. Yeah, then we need to address some of the I mean, it's always going back to what were the things that kind of led to this kind of fresh opathy in the first place?

[00:17:54] And that's going to be slightly different. Where where are the mobility restrictions? So a lot of times we can look at even just the angle of your ankle and how tight your calf is. So if you have a lot of calf tightness, that can be a big risk factor in developing plantar fasciitis. So in general, like how tight are your calves? How mobile are your ankles? Like we need to start to address those things. How mobile is your big toe?

[00:18:20] If your big toe is never getting into that full extension or your toes aren't kind of spreading naturally in order for your big toe to move into its natural extension as we're walking, then we're lacking that that load, that natural stretch and pull that should be happening at the bottom of that plantar fascia. So we need to improve the mobility around our ankles, around our toes, around our calf, around our muscles.

[00:18:48] We need to also then strengthen and support the foot. And that's where, you know, we have been able to see the typical exercise is making sure that your big toe or your toes in general are on a slight elevated surface. So like a rolled up towel. And you're eventually getting back to the point where you can do hill raises. You're doing really slow and controlled hill raises. Maybe you're starting in a seated position. You're going to two legs standing. You're going to two legs standing and one leg down.

[00:19:16] You're going to, I mean, we can go through, you know, say all the exercise, but that's been one to show a lot of improvement in plantar fasciopathy because it loads that tissue on such an aggressive level because your big toe is elevated. Yeah. And that's with most tendinopathies, fasciopathies, anything like that is like progressing to that maximal level, slow, eccentric exercise that's going to load the tissue is going to help the most with that remodeling, you know, phase. Right.

[00:19:46] The quickest. And, oh, and I wanted to say when you were talking about that, getting that natural extension in your toes. Some people, we even start walking different. And that's where we start to see differences in like our, our gait over time because we're getting that, you know, fasciitis, plantar fasciitis. So we don't want to roll over the toe. We start walking with our feet out a little more, rolling over the inside of our feet, which can then cause different issues up the chain and the hips and the low back.

[00:20:14] Another thing in our barefoot mini course that, that you cover is the walking and gait analysis and everything else. We just talked about ankle tightness, big toe mobility, big toe strength, because you need to, once you have the mobility, press through that big toe every time you walk and have strong big toes. So let's do one more. Okay. Well, one thing I want to touch on since I'm very pregnant right now myself and someone asked about postpartum plantar fasciitis. Yeah. I just think it relates so much.

[00:20:43] So I've actually experienced, Dom, I have told you, I have felt a little plantar fasciopathy thing. I don't believe it. I think she just says it so she gets foot rubs, but. Yes, I like my foot rubs. What pregnant woman does not? Um, but, um, I have had a couple days now where we did, we went to Universal Studios. We did a lot of access walking. Yeah. Um, in my third trimester, which I do not recommend.

[00:21:09] That is the one decision I will say I regret immensely is going to Universal in my third trimester. Anyways. I regretted not saying anything about it once we were there. I digress. Um, and not because of the walking on my foot, but just because it was 90 degrees and I was in the heat and you can't do anything, anything in Universal Studios when you're pregnant. So don't do that.

[00:21:31] Um, but these different symptoms that we feel at the bottom of the foot, the laxity within our feet, the, the flatness, the, the foot growth, the, um, the plantar fasciitis, fasciopathy. We can start to feel in pregnancy and even into postpartum because of this ligament laxity that we're getting throughout our body. Now, when hormones affect our body, it's not going to just affect one area. So yes, we want this ligament laxity around the pelvis.

[00:22:00] That's what helps and prepares our body for birth. And our ligaments and our foot are also going to feel that, that ligament laxity. So it is even more crucial during this time to work on our foot health. And this is where it goes back to, like, for me, it was like, okay, yes, I want the foot massage because it feels good. And I need to be working on my ankle mobility. I need to be working on my foot strength.

[00:22:27] I need to be working on, um, I mean, and just wearing Vivo Barefoot Shoes alone, which we have code. What is our code? Code Optimal15. And sometimes the code changes because they get leaked on those stupid sites. So if you go to the link, our, our current code will be at the very top of our page. Yes. And you get a discount from our podcast. 15% discount. Yes.

[00:22:48] However, just walking in barefoot shoes alone has been shown to increase your foot strength by, by like 60% within six months. Right. That's what it was. So that's why alone, like that is my one pregnancy treatment that I recommend is walking more barefoot, getting outside, using your feet more. Because if you're always putting it in really cushioned shoes, which at the time, if you're experiencing pain, like Dom said, it's okay to wear more cushioned shoes.

[00:23:17] If that's what's helping to support you. Got to calm it down first. But we need to get our feet strong. So maintaining, there's so many exercises we do within the barefoot mini course that you would be able to utilize all throughout pregnancy that really help to maintain that foot strength. And I highly recommend. Yeah. And I think the last question, cause I was going through there. And one of the questions was first, first shoes for baby. Yeah. First shoes for baby. And I mean, we're vivo barefoot people. I don't think that's any secret.

[00:23:47] I don't want like, yeah, we, they sponsor our podcast, but we use them every day, all day, every occasion. It's the only shoes Dante has known. It's the only shoes. Yeah. Dante wears. And they have an amazing, um, pluma. Is that what it's called? Pluma knit toddlers. The, the pluma knit toddlers is like a first walker shoe that they came out with. That's incredible. It's kind of got like the sock type, um, fit. So it slides right on. But it's wide.

[00:24:14] It's like, you can roll it up, roll it around. And you know that your little one's foot is being treated well in that shoe. Yeah. Um, so that's what we've used for him. And then they have all the different shoes for all the different ages for any parents out there. Um, same code applies optimal 15 or whatever's on our page. Thanks for tuning in for another episode of the optimal body podcast.

[00:24:41] And again, that was all listened, listener questions, listener feedback, because we want to know what you want to know so we can make these episodes more meaningful to our audience. If you have a question or a topic that you don't think we've covered yet, please email us Jen at Jen dot health or reach out to either of us on Instagram. And if you want to get your pelvic floor and check Jen's in her postpartum period, and she's really wanting to do this with the community, we are going through our pelvic floor foundations course, having a pelvic floor challenge.

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