Basics: What Our Foot is Supposed to Be Doing
I approach physical therapy holistically and from an integrative perspective, which means I tend to approach things from a "360" perspective (yes, I do get dizzy sometimes, and yes I do have a hard time with left and right sometimes). From this perspective, nothing is necessarily more important because it is "higher" or "lower" in the body, or because it is larger or smaller.
In many cases, when working with people with low back pain, hip pain, or knee pain in a physical therapy setting, I look above and below the site that's my client's primarily focus. When looking at a river, we know the water is coming from somewhere, and the same is with pain; where's the water coming from?
The feet are the foundation for a lot of ambulating folks (because not everyone does), and those individuals can be deeply impacted by the shape, structure, and health of their feet. The foot provides the first and last contact for the ground, and how well it does its job deeply impacts the rest of our body.
Ideally, our foot can oscillate between a rigid lever that helps us push off (think about pushing off and lifting your heel when you walk), but also a floppy and absorbent sponge that can absorb force and transfer it up our leg with our first step. And we can tell when that's not working to our advantage; ever heard someone stomping down the hall? Those folks don't have very squishy feet, and that loud stomping you hear is indicative of how unhappy their joints are going to be in a few years.
What makes our foot squishy and soft? Ideally, the human foot should be quite a bit like our hand; widely spaced and able to isolate the individual toes. The widest portion of the foot should be the toes. This means that the bones of our feet have plenty of space between them, and plenty of space for muscles and nerves to run through.
Modern Shoes: Interfering with Normal Foot Structure & Function
The modern shoes, while stylish, is not the shape of the human foot. Pointed toed heels, most sneakers dress shoes, ice skates, rollerblades, these ALL have toes that narrow to points. That point is not the normal shape of the human foot, and when we put on these narrow toed shoes, our foot is forced to adapt. The bones and the toes are all crowded into that space.
Which isn't a big deal, right? It's just a little crowding, right?
Wrong. We wear shoes a lot and that low level of pressure from our shoes and socks is enough to start changing the alignment of our bones. This principle is called "Creep." Low load, over a long time, can have big impacts. Impacts big enough to change the shape of our feet.
Here's an amazing X-ray that captures what can happen in our feet when wearing shoes (the L), and a more spacious foot (R).
These narrowing points will compress the bones of our feet, our "metatarsals." The spaces between these bones is filled with muscles, nerves, and arteries. As they're crowded, we can get pinching, pain with walking, have poor balance, and also drive wonky compensations further up the chain.
Thus, not only might your shoes be causing your foot pain, that could be causing pain in your back, your hip, your knee.
Toe Spacers: Their Role, and What they Do
Toe Spacers do exactly what their name suggests. They're going to physically create space between your toes, and the "metatarsals" of the foot. Just as it was low load over a long time that changed the shape of our feet in the first place, we can reverse it with the same principle.
Toe spacers provide a low load, gently spreading the toes, and by wearing them for progressively extended periods,
Toe Spacers: How, or as I call it, "The Protocol."
1) Phase I: Getting Used To Them, the "Chilling Phase"
i) Start with wearing them for 1 minute at a time. See how it is.
ii) Wear them 1x a day for 5 minutes. Turn on your favorite episode, podcast, or read a book. Start walking around your house in them. Go up stairs, downstairs.
iii) Over 2 weeks, progress to wearing them for 30 minutes every day.
2) Phase II: Make it Functional, IE, "Take a Walk"
i) After a week of wearing them or so, you should be able to walk reasonably.
ii) Once you can wear them comfortably and walk around your house for 30 minutes a day, start taking short walks outside. Start with 5 minutes, on flat terrain.
iii) Over the next 4 weeks (so 6 weeks into wearing them), progress to wearing them while taking walks outdoors for 15-30 minutes on mixed terrain. Aim to get your daily wear time up to an hour.
3) Phase III: Take it to the Gym
i) Start wearing your spacers during your warm ups, and your warm up sets and lower weights for squats and deadlifting. (Remember, we're changing your mechanics with them on, so we don't want to lift super heavy loads while still tweaking the mechanics).
ii) Your daily wear time should be 1 hour a minimum including workouts, but feel free to start stretching it past that.
iii) After 4 weeks of wearing them during warm ups and warm up sets, start incorporating them into your daily workouts.
I don't ever tell people to run in their toes spacers. I'm sure you could, but I honestly think it might suck, and I'd rather you focus on other things during your running.
In general, over the program, you'll progress to wearing your toe spacers not at all, to wearing them at least 30 minutes a day and wearing them during your workouts over 10 weeks.
General rule of thumb with toe spacers?
Stop if it hurts. A little discomfort is okay, but don't wear them so much your foot ia great spasming pain. That's why I've designed this ramp up model, so you can wean onto them. Listen to your body, and build up your tolerance.
What toe spacers do I recommend?
1) The Foot Collective is a mission driven group of PTs out of Canada.
2) Correct Toes is one of the original toe spreader groups. They're a bit pricey, but they have spacers that are more adjustable, which can be handy.
3) My Foot Function is affordable and educational
So, hopefully that answers some of your questions about toe spacers; what they are, how to use them, and why.
If you still have questions about how your feet might be driving your symptoms, feel free to contact me at JJ@theembodiedphyzio.com
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