Building Foot Abs, an Unconventional Approach to Foot Injury

Move over abdominal muscles, you are not the only core muscles in our body that need strengthening. At the recent American College of Sports Medicine annual meeting in Denver, Colorado, Irene S. Davis, Ph.D., PT, FACSM, FAPTA, FASB, professor in the department of physical medicine and rehabilitation at Harvard Medical School and director of the Spaulding National Running Center shared her unconventional approach to treating plantar fasciitis and Achilles tendinitis which includes strengthening the foot core and spending more time barefoot.

“Our feet are amazing with their 26 bones, 33 joints, 20+ muscles and 4 layers of arch muscles and they play an important role in both static posture and dynamic activities,” she said during her presentation.

Davis who is also known as the “Barefoot Running Professor” referred to a 2004 Nature article by Dennis M. Bramble, Ph.D., University of Utah and Daniel E. Lieberman, Ph.D., Harvard University, which described how humans evolved into endurance runners about 2 million years ago, but said that today we are not living the lives our bodies are evolved for.

“The environment is changing faster than our bodies can adapt and what we eat, the air we breathe and our activity level are the cause of many illnesses today including diabetes, obesity, cardiovascular disease as well as musculoskeletal injuries,” she said.

Davis argued that most running injuries are related to faulty mechanics and not necessarily overtraining and that the best chance runners have to be injury-free is to run barefoot or at the very least in minimal footwear in order to strengthen the foot and ankle.

Plantar fasciitis, a degenerative condition of the fascia overlying the plantar is one of the most common running injuries and according to Davis results from the excessive deformation of the arch. Current rehabilitation guidelines however just focus on supporting the foot with orthotic devices instead of training the muscles to perform the way they are supposed to. And in the case of Achilles tendinitis, which is caused by repetitive or intense strain on the Achilles tendon, she said, we need to focus on strengthening the tendon.

At the Spaulding National Running Center, Davis’ approach to plantar fasciitis is to slowly wean the patient off of orthotics and into minimal footwear. Research has shown that the more cushion between the foot and the ground actually translates to a harder impact when your foot hits the ground. Patients also engage in a foot core strengthening program which includes foot shortening exercises like “doming” where you keep your toes flat on the ground while squeezing your arch and drawing the ball of your foot towards your heel.

She said you need to be careful of doming errors though and to “avoid toe flexion and over activity of the tibialis anterior as well as excessive supination.”

She said they have found success improving foot function with a progressive 8 week foot core program.

For Achilles tendinitis, she recommends switching to a forestrike running pattern and strengthening the tendon by spending more time barefoot and running either barefoot or in minimal footwear.

In one of her recent studies published in the December 2016 issue of Medicine & Science in Sports and Exercise, Davis and her colleagues compared loading rates in runners who were rearfoot striker or forefoot strikers in traditional running shoes to forefoot strikers in minimal shoes and found that runners with a forefoot strike pattern who wore minimal shoes had lower loading rates than both strike patterns in traditional running shoes.

“Footwear really matters. Walking and running in minimal shoes strengthens your foot,” she said during her presentation at ACSM.