Saturday's Exercise of the Week: Metatarsal Doming or Arcing

Metatarsal Doming or Arcing exercises for the foot are perfect for re-strengthening those small intrinsic muscles in our feet. These muscles are not really exercised properly when we stand, walk, or even run. They can slowly weaken with injuries, periods of inactivity, but also shoes and orthotic devices can allow them to stop working. Consider adding Met Doming or Arcing to your daily home or gym workouts and you will feel more power in your feet. A simple set of 10 reps daily can keep these muscles in tone to protect your foot. You can start doing 3 times daily to begin to catch up, then after several months decrease to twice daily, and then in 4 months decrease to once a day. Of course, all exercises are to be done painlessly. 

Fitness Tidbit of the Day from Lisa Tonra

Fitness tidbit of the day:

Gals: are your thirties well behind you? (I'm right there with you!) Have you noticed that your knees seem to be moving a bit more towards each other, perhaps even looking somewhat knock-kneed? You might 'need' to look a bit more south, towards your feet! It's always wise to check with your podiatrist to rule out more serious conditions and those requiring orthotics or other external support, but a few simple exercises performed in bare feet can make all the difference in knee health. Try this simple routine:

1. Warm-up: While standing, lift all ten toes off the ground and lower them. Now lift all ten toes off the ground and spread them as far apart as possible. Finish with lifting one heel off the floor at a time, rolling from one side to the other. Repeat each move for 12 repetitions.

2. Heel Raises: Standing on both feet, raise your right heel and then set it down. Do the same with the left heel. Now holding onto a firm surface, such as a counter top or chair back, rise up onto both heels simultaneously. Do one set of each movement for 12 repetitions.

3. 'Domers': Standing with feet flat on the floor, lengthen toes along the floor as broadly as possible, then pull them inwards towards you while keeping them on the floor. Try to keep your toes straight rather than curling them under your foot. Return toes to starting position and repeat 12 times.

Strengthening these small-but-mighty muscles of the feet will help increase your foot and lower leg strength, enhance your awareness of foot mechanics and give your knees a big positioning boost! Good luck!


About Lisa:

Lisa Tonra, a twenty-year veteran of the fitness/wellness business, holds credentials from ACSM, NASM, and BASI Pilates and is currently a Physical Therapy graduate student. She specializes in injury 'pre-habilitation,' prevention and recovery for all sports-related and overuse conditions. Lisa can also design, implement, coach and monitor fitness routines for all recreational athletes, fitness enthusiasts and beginning exercisers. Her philosophy is a simple one: "There is a (sometimes hidden) fitness enthusiast in all of us! It’s good to set a short-term fitness, health or lifestyle goal to get yourself up and moving, but challenge yourself to take the longer view of 'training for life.' What are Your Body Goals? I can help you achieve and maintain them, and do it injury-free!" 

Visit Lisa's personal website here: http://yourbodygoals.com

Foot Strengthening After Multiple Foot Surgeries: Email Advice

Hi Dr. Blake,

I have had quite a journey that I never expected to deal with in my life time. I would like some advice about physical activity based on the surgical procedures I have had. When I was 20 yrs old, I had a routine bunion surgery on my right foot. Due to an ineffective surgery, the bunion returned and even had a bump on the top of my foot causing pain at the site of the bunion. I decided at the age of 30 to fix the problem so I ended up having another surgery where it was determined I had hypermobility and had the head of the metatarsal joint shaved down to fix the bunion. The surgeon also had two screws placed on the top of my foot to help with the hypermobility. Well, that didn't last long even though I was on non-weight bearing cast for 4 months as the problems returned 10 fold. I was running about 33 miles a week and general cross training. At the age of 40, I went to a Podiatrist and he could see several problems going on with my right foot. He determined that I do have hypermobility, hallux valgus and my sesamoid bones were completely destroyed. He had to go in and replace the greater toe joint with a Hemi toe implant, fuse the second toe joint, remove the sesamoid bones and remove the screws as they were causing extensive pain as they rubbed against my shoes. Ultimately after 3 surgeries, my left foot ended up having a collapsed arch and I had to have surgery to fix that with pins and a cast for 2 months. I have a bunion surgery for the left foot next summer (As a result my left foot is now 3/4" longer than my right foot!). So, I have had some problems with my feet you could say. =) I am a really active person, I use orthotics, hapad metatarsal pads, and I did receive physical therapy. So far, my right foot has been feeling good, however, I did have extensive discomfort while it was healing. My right big toe is stiff with limited mobility and it's difficult to move and PT helped in a limited amount. Due to my biomechanics in my feet have changed how my weight is distributed I do see some calluses on the outer edge of both feet, but is very minimal. I have curtailed my running and now use an elliptical trainer, I do engage in weight training and watch my diet.
What kind of activities do you recommend with all of the surgeries I have had? What other kinds of foot strengthening exercises can I do to continue my healing process and any recommendations do you have for me at this time? I have tried to find your blog on metatarsal doming, but with no luck. My podiatrist is excellent but I would like other opinions as well. I appreciate your time in reading about my extensive surgeries and you providing advice on my case. Thank you!

Dr Blake's comment:

Hey, Thank you so very much for the email. You are right to think about focusing more on non impact sports like elliptical, cycling, swimming, and moderate running. Sounds like your orthotics or changes in biomechanics have gotten you to the outside of your foot. Continue to work with the orthotic maker to try to keep you centered. The better your core, the less collapse into your arch you will have. The better your foot strength, the less stress on your bones and ligaments. You could easily improve your foot strength by a magnitude of 2 or 3 by daily going through 3 exercises each evening. I will place in my labels all the foot strengthening posts in a minute. I will also place under this email that I will officially post within the hour. I hope this helps. Rich

Good Foot Strengthening Video

This is a great exercise to strengthen your feet. You can actually use rubber bands, but some width to the band makes the exercise more comfortable. Please add this to the other foot strengthening exercises I have on this blog. 

Foot and Ankle Strengthening: Email Advice

This is a fun email. You just have to love this gentleman's attitude. It is great!!!



Hi Dr. Blake,

     First, I'm so thrilled to have discovered your blog! It's hands-down the most extensive source of information that I have found on the interwebs.

     I recently started doing crossfit training and I love it, but it's hard on the feet and ankles and that's always been a weak point for me. I've been reading your blog today and I wanted to ask some follow up questions.

     Roughly 15 years ago I had reconstructive ankle surgery on both ankles. The correction in the right ankle was much better than in the left, but I have significantly less pain in both post-surgery. I suffered a hairline fracture in my ankle as well, maybe 12 years ago now.
     After the surgery, I did physical therapy and the therapist focused on strength and range of motion of my ankle. She had one piece of equipment which I didn't think to get the name of but I thought it was really effective and would like to try to buy. This tool consisted of a flat circular plane and a semi-sphere ball that attached to the bottom of the plane. The semi-sphere ball attached with a screw and there were progressively larger balls that could be attached as the ankle grew stronger and more flexible. Does this sound familiar to you, and if so, can you share the name so I can buy one?

Dr Blake's Comment: This is a BAPS board which stands for Biomechanical Ankle Platform System. Our physical therapy staff uses it on all ankle and foot rehabilitation programs.

http://www.activeforever.com/p-1663-baps-board-biomechanical-ankle-platform-system.aspx

    Next question: I can't do metatarsal doming at all, so what can I do to work my way up to that?
Dr Blake's comment: Try do the metatarsal doming with Yoga Toes on. Focus on working on part one of the met doming which is straightening your toes as rigid as possible. 



  I was watching your videos about the four best exercises to do to strengthen the foot muscles and I could not do the metatarsal doming exercise without curling my toes. I suspect this relates to the inflexibility of my foot, hence why I'm trying to find that flexibility tool the therapist had. Thanks so much again for the blog, I feel empowered!

Designing Orthotic Devices from Afar

Hello,

I am  21 years old and i live in Egypt. I suffer from flat feet and i wanted to ask if i can custom a special steel orthotic matches my feet size, and if there are any other types of workout to help curing it.

thank you,

Dr Blake's response:

 I would be happy to work with you. I do not work with Steel but have found 3/16 inch (4.7 mm) polypropylene work great and gives some spring to the arch. The best is to buy a Biofoam box and try to make an impression of your feet. Then mail the box to Dr Rich Blake, 900 Hyde Street, San Francisco, Calif, 94109, and I will try to make something. It will take 2 -3 tries due to the long distance, but based on the feedback you give me on the first set, we should be able to figure out where to make changes. The link to buy the box is below. Probably sending me a video of you walking back and forth in a 15 foot area will give me better idea what you need. Rich Hope it works. 

http://www.mooremedical.com/Index.cfm?Ntk=all&No=0&Search=Search&Ns=Searchorder%7C0%7C&Ntx=mode+matchpartialmax&Ntt=Biofoam&x=48&y=11

Also, it is extremely important to do daily foot and ankle strengthening exercises. Never exercise through pain, but you should be able to gradually strengthen your flat feet. Here is a video to get you started. Rich

Foot Strengthening: Email Response

Maryann (name changed), Here are the 4 specific foot strengthening exercises I recommended a long time ago, and then proceeded not to send you. After you review them, you can ask me more specific information. Remember not to do these exercises if there is any pain involved. 

1. Peroneal Longus Strengthening

http://www.drblakeshealingsole.com/2010/08/video-on-ankle-strengthening-eversion.html

2. Posterior Tibial Strengthening

http://www.drblakeshealingsole.com/2011/06/posterior-tibial-tendon-strengthening.html

3. Intrinsics with Metatarsal Doming 

http://www.drblakeshealingsole.com/2010/11/foot-strengthening-basics-of-metatarsal.html

4. Intrinsics with Theraband (specifically the short flexors)

It is important when doing the met doming and toe theraband not to curl your toes. Start with one set of ten, and over 3 months, gradually increase to 3 sets of ten with 20 second break between. Slowly increase the tension on the theraband, as long as you can avoid curling your toes. 

The final exercise I would do 2 minutes on each foot every evening is the Single Leg Balancing Exercise. Hope these are helpful for you. Rich

http://www.drblakeshealingsole.com/2010/08/video-flatfooted-balancing-exercises.html

Strengthening Ankle and Foot: Isolating A Weaker Muscle

Here is a question from my video on YouTube on Ankle/Foot Strengthening (see the video below).

Why did you ask her to stop when she started to substitute?

When isolating a muscle/tendon while strengthening, it is important to strengthen that one weak muscle and not allow for substitution of the surrounding stronger muscles. Substitution means that the patient will use another group of stronger muscles to do the activity, and not use the weaker muscle (it will go along for the ride). By isolating a muscle/tendon, you can increase its strength rather quickly and correct muscle imbalances produced by strong vs weak muscles. Dr Rich Blake 

A typical example is the marathon runner who comes in knee pain. You test his muscle strength and all muscles in his lower extremities are strong except for some weak quads. You isolate the quads in your strengthening program, gradually build up the strength, and they return to running with no knee pain.

Orthotic Repairs: Fixing An Air Bubble

Hi Dr Blake,

I am generally happy with the new orthotics you recently made me. I still have the issue at the end of the day but I don’t think you can do anything about me getting older!

I do have one small problem that I would like your advice on. On the right orthotic the covering has pulled  away or was not glued down and there is a air bubble between the orthotic and covering. This air bubble moves around when I walk on it. The air bubble is about 2 ½ inches long and about a ½ inch wide. What would you suggest? Pete

Pete, First of all please see my blog regarding the daily foot strengthening exercises which may help the  end of the day soreness.

Secondly, I put the air bubble in on purpose to provide a cushion for being able to jump higher and dunk  the basketball.  If this is something you do not aspire to, please purchase a small tube of super glue or its knockoffs, and place in the areas of where the air bubble occur and the sides of the orthotic, of course on the plastic, and see if you can get it all glued down. Sorry if some of it sticks to your fingers.   Hope this helps, glad you are overall satisfied with the orthotics.  Rich

Posterior Tibial Tendon Strengthening Exercises

Dear Dr. Blake,


Please post the link to the specific exercises that isolate and gradually strengthen the posterior tibial tendon. Any exercises (resisted adduction, e.g.) that I've tried hurt.

Thanks! Yvonne

Dear Yvonne, Thanks for the email. I hope the above video helps you understand the 4 basic forms of strengthening exercises used in the treatment of posterior tibial tendon dysfunction. Gradually the patient is progressed from Active Range of Motion to Isometric to Progressive Resistance to Functional. Heat (in the form of warm water soaks, heat linaments, or heating pads) is used often to loosen up the tendon before exercise for 10 minutes. If walking is not painful, 5 minutes of walking can get the blood pumping. Ice should be used after for 10 minutes, normally an ice pack over the sore area. NO Pain can be experienced during the exercise. If you are still having trouble strengthening without pain, try the numbing effects of ice. Ice the area for 5 minutes, then let the tissue unthaw for 20 minutes, and then try the exercise. Should work until the tendon is significantly damaged. Then ice 20 minutes afterwards. I sure hope this helps. Rich

Foot and Ankle General Strengthening Program

Strengthening exercises for the foot and ankle are numerous with some helpful and some possibly harmful. I hope that these exercises will give anyone looking to strengthen their feet and ankles a good start. After 30 years of being a podiatrist, the word is finally out. People need to strengthen their feet and ankles. The video shows the basic program taught by our physical therapy staff at Saint Francis Memorial Hospital in San Francisco. Patients can monthly increase the number of sets and reps done, and change the exercises to make them more challenging. This is a great 3 to 4 time a week program when you know you should be building up the strength in these poorly often neglected feet of ours.

Foot Exercises: Presented by Elizabeth Larkam

I am so happy to find my colleague and former head our Dance Medicine division at the Center For Sports Medicine Elizabeth Larkam. I am presenting Elizabeth's series on foot exercises. These are extremely helpful, but watch for pain or cramping in some of the metatarsal doming (Elizabeth is very skilled). Go easy when you start doing this series. Try to do them 1 or 2 times per week. This set of exercises is for range of motion and some strength. Elizabeth does them so easy, so don't be frustrated. I have the attached my most recent post on foot exercises which this can couple with. I like her comment on doing 2 per day of the variety of exercises. Your feet will slowly get more flexible and strong. And do not forget your yogatoes or their equivalent.

http://www.drblakeshealingsole.com/2010/12/foot-strengthening-exercises-who-has.html

http://www.drblakeshealingsole.com/2010/07/help-for-bunions-and-hammertoes.html

Foot Strengthening Exercises: Who Has Lost Their Marbles?

This is another of a series of foot strengthening exercises that I am presenting in this blog. Metatarsal Doming/Arcing and Playing The Piano exercises have previously been shown. When you add flatfooted balancing exercise (separate post) and Inversion/Eversion Thera Band exercises, you can develop a good program to strengthen your feet. Remember to do foot strengthening exercises in the evening when tiring your feet will not matter. You can start these exercises daily to make them a habit, but three days per week will gradually give you stronger feet. See the links below to the other posts on foot strengthening.

http://www.drblakeshealingsole.com/2010/11/foot-strengthening-basics-of-metatarsal.html

http://www.drblakeshealingsole.com/2010/08/video-flatfooted-balancing-exercises.html

http://www.drblakeshealingsole.com/2010/08/video-on-ankle-strengthening-eversion.html

http://www.blogger.com/post-edit.g?blogID=673715911736059911&postID=1595303078516839251

Foot Strengthening Exercises: Playing the Piano

Foot strengthening exercises are extremely important for almost everyone. Since we spend our lives in shoes, our feet get weak over time. When you have any injuries, surgery, cast immobilization, or other prolonged health problems, our feet get even weaker. Just when we are trying to get back into shape, the weakest bites us, and some secondary injury develops. We need to stay strong with our feet. We need to develop a home program of 3 or 4 foot exercises that are challenging, somewhat fun, and ones we will do 3 times per week on average. The best time of the day to do foot and ankle strengthening is the last several hours before bed. Therefore, if we fatigue our feet, we have all night to rest them. And by the next morning they will be stronger. I hope you enjoy this challenging exercise.

Foot Strengthening: The Basics of Metatarsal Doming or Metatarsal Arcing

     Foot strengthening has finally hit mainstream. It has been ignored by podiatrists, personal trainors, physical therapists and orthopedists for years. The foot gradually weakens over the years of use. The foot gradually weakens with the use of shoes and orthotic devices. Injuries to the foot and ankle speed the weakening process. Surgeries to the foot add more insult to injury.

     Yet, finally, the process seems to be reversing. Shoes are being made to exercise your feet. Barefoot running is encouraged by some as a way to strengthen your feet. More and more exercises are being introduced to safely strengthen feet. One of our videos which I would encourage you to read is on balancing exercies, a great way of strengthening your feet. This video gets down to the most basic of all foot strengthening exercises called metatarsal arcing or doming. We have taught this fpr 30 years and should be a basic routine exercise for all interested in strengthening their feet.

Foot and Ankle Exercises: Video on Flatfooted Balancing Exercises: The Best Functional Exercise with Variations

Search Amazon.com for balancing disks


   
   The Single Leg Flatfooted Balancing Exercise is one of the most useful exercises invented. I personally use it for my patients over 50 on balancing programs, and it is used in core rehab, knee rehab, ankle rehab, and foot rehab. It is one of the best methods of foot and ankle strengthening. Gradually the patient works up to 2 minutes with the eyes open, then up to 2 minutes with the eyes closed, then eyes open with the soft pillow, then up to 2 minutes soft pillow with the eyes closed. Some patients will purchase the thin rubber disks for greater difficulty and do other variations as seen with the basketball. I must emphasize that the supporting knee (weight bearing) is slightly bent to protect itself from hyperextending and this position adds to the difficulty balancing. The exercise can be initiated at any time of the day, but should be done normally in the last 2 hours of the evening before bed. This is due to the fatigue of the leg produced, as you increase the time, and you need sleep time to recover. You really do not want to do this exercise before other strenuous weight bearing exercises. Gradually, like any good strengthening exercise, you limit the exercise to 3 times per week. There should also be no pain anywhere with this exercise. If pain develops, stop, and if it repeats itself each time you try the exercise, seek advice on what is wrong, or how to modify.