Our cultural epidemic of weak and fallen arches provides a sure and
steady income to the orthotics industry. But many of us still suffer
from aches and pains that arch supports and padded insoles can’t quite
eradicate. For instance, when you first hop out of bed in the morning,
do you get a rude awakening from sore feet and tight calves? This is
just one kind of soreness from chronic strain to a muscle whose job is
to help lift the inner arch of your foot. Fallen arches can result in
tendonitis and contribute to the development of bunions, shin splints,
and pains in the knees and hips—and can even affect the lower back,
neck, and shoulders.
Fallen arches can result in tendonitis
and contribute to the development of bunions, shin splints, and pains in
the knees and hips. They can even affect the lower back, neck, and
shoulders.
The strength of your arches depends upon two factors: the tone, or
tightness, of the ligaments that hold the bones of the feet together,
and the strength of supporting muscles. When the ligaments are loose, or
become loosened over time, we must make an extra effort to strengthen
the supporting muscles.
The
muscle most immediately affected by the collapse of the arches due to
loose ligaments is the tibialis posterior, a deep muscle that runs along
the back of the shinbone and down to the inner arch of the foot, which
lifts the inner arch of your foot.
The tendon of this muscle runs behind and underneath a knob of bone at
the inner ankle (the medial malleolus) and inserts into the bones at the
sole of the foot at the inner arch, just in front of the ankle. These
insertions in the sole of the foot are arranged in pinnate
fashion—literally, like a bird’s feather. The form a kind of net that
can be quite strong when acting to lift the inner arch at the medial
malleolus. The muscle is at its strongest over a very limited range of
movement, and lifts the arch only a little. If the arch collapses beyond
the muscle’s zone of strength, the muscle and its tendons—usually the
small tendons inserting into the sole of the foot—are strained. The
result is an achy soreness at the inner edge of your heel, at the back
of your heel, or in the sole of your foot at the inner arch. You may
also feel soreness, tightness, and a sensitivity to touch at the back of
your calf where the belly of the tibialis muscle lies. The tendons of
the tibialis posterior will benefit from exercises that lift the arches;
in addition, the muscle itself will need some stretching. The challenge
of working with the tibialis posterior is to find a way to accomplish
both.
The Tibialis Posterior in Action
The
tibialis posterior not only lifts the instep of the foot at the medial
malleolus, but also inverts the foot (pulling the inner edge of the foot
toward the body) and medially rotates the foot (turning it toward the
midline of the body). If your tibialis posterior is very short and
tight, you may have a pigeon-toed stance, with the weight of your body
resting on the outer edge of your feet. The misalignment of the legs in
this posture—with the knees and feet turned in—tends to increase the
tightness of this muscle by causing it to work overtime.
A short, tight tibialis posterior can also be at play in the opposite
situation, in which the arches are fallen and the feet turn out. In this
case the arches are so structurally weak that the tibialis posterior is
pulled down with them—and the tight tibialis posterior pulls down on
everything above it, affecting the knees and hips, as well as straining
its own tendons in the soles of the feet.
An
excessively lifted instep and an excessively collapsed instep are two
sides of the same coin: the tibialis posterior exerts a strong pull in
both cases—in one case upward, the other downward. And in both cases
you’ll find the knees turned inward, though the appearance of the legs
will be different. The pigeon-toed individual will appear to be more
bowlegged, while someone with flat feet is likely to be more
knock-kneed.
A program aimed at merely strengthening the arches by strengthening the
tibialis posterior will not fix fallen arches or overcome foot pain and
cramping. A proper solution involves maintaining a balanced foundation
in the feet while practicing exercises that bring both strength and
length to the muscles.
Hatha
yoga does just that. Much of what we do in hatha yoga is “eccentric”
(pronounced ee–centric) work with the muscles, which means that we both
contract the muscle and lengthen it at the same time, slowly releasing
the contraction while maintaining some degree of muscular engagement.
This is the kind of strength and suppleness demanded of the tibialis
posterior as it works to maintain the arches.
The key to exercising this muscle correctly is to resist inversion and
medial rotation of the foot by keeping the ball of the big toe and inner
heel grounded while still working to lift the arch. As you reach out
through these two points at the inner edge of the foot, you also keep
the tibialis posterior long and extended, even while it’s hard at work.
Build Strength in Your Arches
Let’s begin by learning some resistance work that strengthens the
muscle without shortening (i.e., tightening) it, working one leg at a
time. If you have a tendency toward flat feet and knock-knees, use an
elastic exercise band to create the resistance, following an exercise
designed by EasyVigour project founder Bruce Thomson. (Although anything
that offers some resistance—and a little give, such as a yoga belt or a
nylon stocking—will do. Even if you don’t have flat feet, this exercise
will help you learn and practice good action in the feet. The essence
of the exercise is to learn how to keep the inner heel and ball of the
big toe grounded while lifting the arch, and not throw all of the weight
to the outer edge of the foot.
The muscular work we do in hatha yoga strengthens and lengthens our muscles at the same time.
Place the band around the outer ankle of one foot. Step on the band
with the other foot and adjust the tension so that it pulls the foot
toward pronation (i.e., toward a fallen arch). We want to restore proper
tone by working the tibialis posterior to lift the arch, against the
helpful resistance of the band. Keep the knees slightly bent to protect
them, because the knee of the working leg is likely to be in a
vulnerable, slightly knock-kneed position. To keep track of what your
knee is doing, place your fingers at the outer knee.
Now
lift the inner arch, contracting the tibialis posterior so that the
ankle presses out against the band. This is more than just shifting your
weight to the outer heel; while the inner heel and ball of the big toe
stay grounded, the lift comes from the inner ankle. If the lift comes
only from the inner ankle rotating the shin out, the knee will get a
damaging twist. You may feel pain in the knee, or just a hardening and
pulling of the muscles at the outer calf and ankle.
To protect the knee as you lift the arch of the foot, engage the
muscles of the inner thigh so that they lift and press out against the
bone. The thighbone will not only shift laterally, but will also rotate
out slightly, keeping up with the outward rotation of the shinbone and
preventing any twisting in the knee. Notice that all of this begins with
the lift of the tibialis posterior; and the inner thigh muscles need to
learn to move with that lift to readjust the alignment and action in
the thighbone, for the benefit and protection of the knees and hips.
Step by Step: Prasarita Padottanasana
Prasarita padottanasana (wide-legged standing forward bend)
offers us an excellent opportunity to strengthen and lengthen the
tibialis posterior, using the action we just explored with the elastic
band. Sometimes people complain of ankle pain in this pose, usually in
the form of pinching or pulling at the outer ankle. Both kinds of pain
are indications of a collapsed ankle (due to a flat foot) or
overstretched ankle (i.e., pigeon-toed); by lifting the tibialis
posterior in coordination with the rest of the leg, this discomfort can
be eliminated.
To
begin, step the feet wide apart and parallel. Avoid the common tendency
to turn your feet out too much, which tightens the lower back and
limits mobility in the pose. With a microbend in your knees (to avoid
locking them), fold forward at the hip joints and, if possible, touch
the floor with your fingers while maintaining a straight spine.
Experienced practitioners can come into the ultimate expression of the
pose, touching the crown of the head to the floor (making the necessary
adjustments to the distance between the feet) with only a slight
rounding of the spine.
Prasarita padottanasana is obviously a stretch to the hamstrings, but a
big part of the stiffness that holds us back from fully expressing the
pose comes from tight adductors. These inner thigh muscles pull the
thighbones toward each other, tightening and even locking the hip
joints. And you will find that what goes hand in hand with tight
adductors is the inability of the tibialis posterior to keep the arches
of the feet lifted. As the arches fall, the outer ankles can begin to
feel pinched. Or if you overcompensate by putting too much weight on the
outer edges of the feet, your outer ankles may feel overstretched.
Take
a moment to look at your feet and knees in prasarita padottanasana. Are
your arches collapsing and your knees turning inward—or are you turning
your feet out to help you bend forward? In either case, reposition your
feet so they point straight ahead, keeping an imaginary line from the
middle of your ankle to your second toe parallel. If your arches are
collapsing, if your knees are turning inward at the kneecaps, or if your
hips feel locked or tight at your inner thighs, bend your knees more.
Draw your inner thighs back so that your sit bones move back and apart
and your lower back arches more, like a football player at the scrimmage
line.
While keeping your inner heels and the balls of your big toes firmly
grounded, begin to lift the instep of both feet just as you did against
the resistance of the elastic exercise band. Your weight will begin to
shift toward your outer heel, but don’t let the inner heel slide forward
or rotate, twisting, inverting or sickling the foot (so that it ends up
in an abnormal crescent shape).
Wide-legged standing forward bend can strengthen and lengthen the tibilais posterior.
Draw the energy all the way from your inner arches through the inner
knees and thighs so that your inner thigh muscles firm, lift, and press
outward. Press your thighs apart as if you were sitting on a balloon
that was inflating. At the same time, keep your upper inner thighs
drawing back, so that your lower back does not round. If you are very
flexible, engage the middle of your gluteal muscles by pressing into the
floor through the center of your heels. This will protect your
hamstrings while helping to engage your quadriceps and inner thighs.
Watch the connection between (a) your arches lifting, and (b) the shins
and thighs (just below and above your knees) rotating slightly out in
harmony with each other. Your kneecaps should be in line with the second
toe of each foot. Straighten your legs slowly and smoothly, maintaining
the actions of these muscles; don’t allow your knees to lock or turn
inward, and don’t let your lower back round. Firm and lift your lower
belly just above the pubic bone, and you will be able to fold more
deeply into the pose.
If you practice this pose with attention to the lift of the arches, you
will strengthen the tibialis posterior and restore proper tone to its
tendons, reducing pain and soreness in the feet from damage caused by
fallen arches. Prasarita padottanasana has the added bonus of realigning
and protecting the knees against damage from rotation of the bones. All
of the standing poses in hatha yoga involve the same work for the
tibialis posterior in both feet: focus on keeping the inner heel
anchored as you work this muscle to lift your arches. As it gets
stronger, you’ll experience less soreness in your feet—and a newfound
lightness in your step.
Need Arch Supports?
In the orthopedic world, what is often offered as a solution for fallen
arches—particularly when they cause a knock-kneed condition—is support
in the form of a lift or orthotics in the shoe. The artificial arch
takes over the job of the tibialis posterior—and certainly the support
is appreciated over the course of a long day as our feet get tired. Yet
when the tibialis posterior is not working properly, a host of postural
misalignments ensue, and some of them are not rectified by arch
supports. With arch supports, changes do happen in the lower leg: the
arch is lifted, and the shinbone of the lower leg (i.e., the tibia)
rotates out from its base at the ankle, as it should.
The solution for fallen arches is this:
Maintain a balanced foundation in the feet while practicing exercises
that bring strength and length to the muscles.
But not much changes in the thighbone: it remains inwardly rotated and,
in the case of knock-knees, adducted. This means that while the shin is
now rotating out, the inner thigh muscles remain tight and pull the
femur in toward the midline of the body, causing a twisting and grinding
in the knee. It’s not enough to shore up the arches. This simply shifts
the problem up the leg to the knee, where the twisting can damage the
knee ligaments and cartilage. The solution, beginning with the tibialis
posterior, has to involve the whole leg.
