Developing Strong Feet: The Overlooked Performance Enhancer

Developing Strong Feet: The Overlooked Performance Enhancer

From the most elite sportsperson to the everyday punter, hours are spent in the gym each week trying to develop the body into a performance machine capable of accomplishing any goal, be it big or small. Composite exercises covering multiple joints and muscles, raising the heart rate to higher levels and producing natural HGH within the body to grow and hopefully get the upper hand on our opponents, whether that be another competitor or ourselves. But in many cases one of the most important structures of the body is so often overlooked. The only part of the body directly in contact with the ground, which can act as a shock attenuation device and mechanical lever capable of producing powerful force reactions. In this article we look at how foot strength is developed. Then in a follow up post we will look at the small everyday things you can do to help improve yours.

shutterstock_314849579Strength Overview
Strength is the underlying principle of all performance training. It is the ability to
generate a functional contraction force through movements of the body. Strength training can be used to form the basis of muscular hypertrophy, endurance and power. Hypertrophy is the most obvious
physical adaption to strength training, however, inability to receive adequate rest post training can actually have a negative effect on performance. Muscular endurance, is the body’s ability to perform repetitive actions and cope with those stressors which are placed upon the body. Muscular power, is the rate at which a functional contraction can be performed at speed.
For all of these physical qualities to be properly trained a specific strength and conditioning program must be designed and followed. The physiological changes within the body which are responsible for physical adaptions are both neurological and musculoskeletal in nature.

Neural Adaption
Neuromuscular facilitation or muscle memory as it is commonly known, is the way in which the neuromuscular system memorizes motor skills to perform a semi-automated action in response to stimuli, likely to be a long term adaption. Motor neurons are nerve cells which originate within the CNS and terminate in the neuromuscular junction. Increases in an individual’s strength within a short duration of training are largely due to neurological adaptions. These adaptions take place in the form of synchronized recruitment of firing motor units to allow for maximal force production. Neurological strength adaption occurs when a high resistance is moved through few repetitions with a full recovery allowed before beginning a new set.

Soft Tissue Adaptionshutterstock_195157721
As discussed above, hypertrophy is the most obvious physical adaption to strength training. Resistance training has been shown to promote a shift in the ratio for fast to slow muscle fibres, with the conversion of Type II-b fibres to Type II-a fibres the most common alteration. In response to resistance training skeletal muscle will typically increase in size, produce faster contraction speeds, increase strength and increase anaerobic capacity. Similarly, increases in ligament and tendon strength may be seen; as well as collagen and bone density increases.

Benefits (prevention and performance)
Developing strong feet and ankles can have a great effect on the performance of an individual and reduce the possibilities of injury. Developing the extrinsic muscles of the foot creates a more intrinsically supported ankle joint and an influential adjunct to the lever system which helps to create a commanding spring within the lower limb. By strengthening the intrinsic muscle of the foot, we are able to better utilize the stretch return energy of the plantar fascia and foster a tight posterior sling capable of generating fast and powerful contractions.
Strong feet which are able to be controlled and activated efficiently will have higher neural innovation than that of a foot which cannot. Proprioceptive input and balance will benefit from feet which are trained specifically, creating better body awareness and a reduction in falls.
Any body part can be improved through training whether it is the brain, heart or musculoskeletal system. Why not try to improve something that can be improved or at least maintained?
It is a disservice to yourself or your patients if you are not using these techniques to constantly push for improvement.

Orthotics and Strong Feet
Orthotics do have a place in the management of the feet, lower limb and lower back pain or discomfort. Those who rubbish orthotics completely are usually making anecdotal arguments against a medical device which although may not be a perfect science, has strong evidence to support its use in symptomatic patients. However, the use of orthotics should never be the be all and end all in treatment of the foot. They should be a part of the management of a condition for a short to medium duration with the goal of being out of theshutterstock_201691886m within a specific amount of time (whether that is 6months or 2years). You do not get placed in a sling for the rest of your life if you hurt your arm, neither should you be when you are placed in orthotics – unless you have an underlying medical condition or complaint which can be addressed directly through strength and conditioning
Arguments which have been put forward to belittle the use of orthotics include; reduction in muscle activity, increased muscle activity, reduced proprioception, increases in pain, discomfort associated with the device and a restriction on the available shoes which are appropriate for you use. Let’s answer these now.
1. Reduction in muscle activity – FALSE – in many research articles orthotics orthotics have been shown to increase muscle activity in associated structures.

  1. Increase in muscle activity – TRUE – however, as long as a balance is found between increased muscle activity and not overloading the tissues, there is no negative issue. If you see this as a potential issue, ask your podiatrist for clarification.
  2. Reduced proprioception – TRUE and FALSE – this is a complicated issue that research fails to really grasp. Although orthotics does not specifically reduce proprioception in respect to foot being aware of what is directly beneath it. The combination of both orthotic and thick soled footwear can dampen the input to the foot from the surface on which the individual is standing or moving upon.
  3. Increases in pain and discomfort – NEUTRAL – the use of orthotic devices should not increase pain nor should is cause discomfort if gradually worn in properly, with the tissues adapting to the change in support. If discomfort is felt, then it usually will come to down to poor prescription or orthotic design and will be practitioner based issue more than anything else.
  4. Footwear restrictions – orthotics have come a long way in the last decade with shell material being able to supply the same amount of support at half the thickness. But take this into consideration, if you have been instructed to wear orthotics it is clear that something you are doing in your life is not working. In most cases it will be the footwear you have chosen to squeeze your foot into day in and day out. If you have the choice of being pain free and wearing slightly less than fashionable options or have pain and wear your pointed toe box Julius Marlows – vanity may win in the short term but pain will win in the end.

The muscles of the feet are very similar to any other group of muscles within the body. They can be trained and improved to increase performance and prepare the feet to deal with the on-going stressors which they are being placed under on a regular basis. The principles of developing strength in the feet in no different to that to developing strength in any other muscle system. Neurological adaption and innovation to improve muscle contraction and recruitment is necessary to increase activation, control and strength. Additionally, the proprioception associated with completing single leg stance exercises and walking barefoot to feel different surface below the feet helps with the CNS input and interpretation of environmental information.

Until Next Time,

Jackson McCosker
Director/Chief Editor



Australian Strength and Conditioning Resource Manual. (2014). Helensvale: Australian Strength and Conditioning Association.

Bompa, T., & Buzzichelli, C. (2001). Neuromuscular Adaptions to Strength Training. Human Kinetics.

Brandson, T. (2016). The StrongFeet Manual. Wollongong: The Running Lab.

Fischer-Colbrie, M. (2015). Brain to Body: Your Neural Adaptions to Resistance Training. BridgeAthletic.

Powers, H. &. (2008). Neuromuscular Adaptions to Training. Chicago.


I’ve Got an Itch to Scratch: Athletes Foot (Tinea Pedis)

I’ve Got an Itch to Scratch: Athletes Foot (Tinea Pedis)
It’s not a pleasant thought to have, although the presence of foot fungus, athlete’s foot, tinea or whatever you choose to call it is something which affects us all. It is one of the most common skin conditions which affect the feet and has no bias to who it may infect. Although, those who tend to use indoor swimming pools, public showers and the same pair of socks a couple of days in a row are more at risk.shutterstock_37715113.jpg

Fungal infections require warm, moist environments to develop and this is why the feet are one of the most prone areas to infection. Symptoms of tinea pedis are commonly reported as; itchy and stinging areas of red, scaly rash which results in splitting and peeling of the skin.

The best treatment for tinea pedis is the use of an antifungal cream. Of course it is suggested to use as directed by the brand and label you choose to buy but in many cases it is suggested that the product be used for a number of days after the tinea signs and symptoms have completely disappeared.

When trying to reduce the chances of infection it is suggested that you wash and thoroughly dry the area on a regular basis and expose the skin to air as much as possible. Antiperspirant can be used to reduce sweating at the area and thongs should be worn when at public swimming pools, showers, gyms and other communal areas.

To limit the spread of the infective bug both hands and feet should be washed thoroughly after touching the infected area, towels should not be shared and bare foot walking should be limited. Additionally, cleaning the shower, bath and bathroom with a mild bleach wash will reduce the chances of tertiary infection.
The faster you to diagnose and treat this condition the faster it is going to disappear.


Summer Footwear and the Feet

Summer Footwear and the Feet

Nothing beats waking up in the early hours of Spring and Summer to find the windows and grass frosted over as the sun beams down, reflecting through the crystalized water and creating a breath taking glare which screams that today is going to be a pearler. The singlet and shorts are donned to reveal a contrasting tan line from the months past as your look in the wardrobe and try to decide which shoes you will be wearing today…or if any are actually necessary for the activities are planned for the day. Summer fashion, particularly footwear is a major reason for people attending a podiatry clinic over the warmer months. Your activity levels increase, the shoes you wear majority of the time, not just while on your 30min run are questionable and those on-going stressors build until the body cannot take any more – ending in pain or injury just before the colder months start, your routine suffers and you invariably end up putting back on those 10kg you had managed to lose. So today we look at summer footwear and the impact it has on the feet and what you can do to limit the impact.

So let’s begin with those who choose to walk around barefoot. Let me point out, there is absolutely nothing wrong with this at all, in fact I whole heartedly encourage this whenever possible, be it summer or winter. The important thing to be aware of is how much your body can tolerate and either working on increasing its tolerance or getting back into shoes at the appropriate time.
A number of exercises can be complete to increase the strength within the intrinsic muscles of the foot. Examples of these exercises can be seen below, primary focus when being barefoot is being aware of the surfaces you are walking upon and while increasing your tolerance making sure you stick to softer surfaces when possible.

Towel Scrunch: Fast gripping of the towel with toes for an extended period of time – aim for 2min.

Big Toe Adduction: Control movement of the 1st toe toward the midline of the body.

Isometric Calf Raises: Place a towel under the 1st toe as shown and raise the heel approx. 2/3 of max height from the ground and hold.

Most people are aware there are two kinds of thongs available commercially these days. The first is the traditional flat 15mm blown rubber with double or single plugs. The second is the slightly elevated mid foot arch creating a supportive structure for those who choose to wear them.
There is no right or wrong when it comes to these products. Those with feet which are in a more pronated or flat position often find the arch support in these thongs too aggressive and tend to cause irritation to the plantar aspect of the foot. However, those with flexible flat feet or a higher arch can find these to be more comfortable than the traditional flat thongs.
Both products have a common issue – their fixation method. The strap of the thong which covers the forefoot and slips between the 1st and 2nd is often a cause for increased forefoot pain, especially at the 1st MTP joint as the big toe abducts and flexes to form a grip on the footwear to hold it in place.
This can lead to hastened fatigue of the intrinsic muscle of the foot and subsequent lower leg as the duration or frequency of these actions increase. This can lead to the development of conditions such as plantarfasciosis, insertional achillies tendinopathy, FHL tendinopathy and the many diagnosis associated with metatarsalgia. An open shoe with more appropriate fixation is commonly suggested as a better option.

Sandals offer much better fixation than the average flip flop. At the very least, a full length forefoot strap is in place to help reduce the need for clawing of the toes to keep the footwear on; at the very best you have an 8 strap leather shoe with holes in it, where you find yourself asking “why didn’t they just fill the rest in?”
The more intricate design of these products is what helps when it comes to open toed footwear. The decrease in soft tissue fatigue has the potential to significantly reduce the chances of pain or injury. For the dads out there who are looking to embarrass the kids a good pair of white socks always goes quite well with this type of footwear and can be worn at any occasion.

High Heels and Wedges
In any weather the high heel can be a disaster to the feet, ankles, knees and hips. The acute angle which even a “small” 3-inch heel places the foot in, can lead to ankle injuries, forefoot trauma and affect balance directly causing falls. The tight, pointed and low profile toe box increases pressures on the toes and forefoot while the increase in heel height shortens the achillies tendon and tips the centre of gravity forward.

The important message in this situation is to play it safe. In this day and age, or any day and age for that matter, very little consideration has been taken in regards to health when something is considered to be fashionable – heels, smoking, drinking are just some examples.
A thought when deciding on what to wear is how long will you be in these shoes? What surfaces will you walking on? Do you have the option to sit or remove your shoes? Do these colours actually go together?


Until Next Time


Jackson McCosker
Director/Chief Editor

Tennis and Achillies Tendinopathy

Tennis and Achillies Tendinopathy

Tennis is a non-contact sport which can be enjoyed by people of all ages in both a social and competitive manner. Due to the need for fast foot work and change of direction, ankle injuries; both serious and mild are very common within the tennis community. Continuous mild injuries and stress placed upon the achillies tendon, which crosses the ankle joint, can lead to overuse or chronic disability within the structure.

shutterstock_59311696.jpgAchillies tendinopathy is a common degenerative injury among athletes who are involved in a lot of running. Development of the condition can occur due to a number of issues including; muscle power and tendon elasticity imbalance, a sudden increase in training intensity or duration and inadequate warm up or stretching before the completion of an explosive activity. Achillies tendinopathy in middle-long distance runners compared to both white collar and blue collar workers has been found to be statistically significant.

Diagnosing a suspected achillies tendinopathy, requires a full history covering past treatment, medication, medical conditions, training patterns, past training patterns and footwear use. Palpation of the achillies tendon at insertion mid portion, origin and surrounding tissues should be complete and in many circumstances the use of US or MRI may be appropriate to confirm the diagnosis.
It is suspected that tendon degeneration begins long before symptoms begin and may even remain asymptomatic in some cases. Early diagnosis is of practical relevance particularly in high performance sport. Despite popular belief found there to be no significant link between gender and achillies tendinopathy development.
It has been described tendinopathy to be on a continuum which incorporates 3 inter-weaving stages and suggests that each may be required to be managed differently depending where on the continuum the pathology resides.
Reactive Tendinopathy: Is a non-inflammatory response to compressive or acute tensile forces which develops a thickening and therefore increased cross section of the tendon, usually due a sudden increase in activity which an individual may not be used too. There is no change in the vascularity of the tendon matrix and collagen is mostly maintained at this point.
Tendon Disrepair: Is seen as a tendon which will make an attempt to repair, as seen in the reactive tendon but suffers from increase matrix breakdown and collagen separation. The placement of this within the spectrum will generally be associated with high intensity or repetitive load over a long duration. It is still somewhat possible to reverse anatomical and physiological changes at this point.
Tendon Degeneration: Is clearly identified by changes to the matrix and cells within the tendon. The ability of the tendon to reverse any possible pathology has diminished and some cell apoptosis has occurred. Through imaging these is visualization of extensive changes around the area of concern.

Over the Counter Foot Products: The Good, The Bad and The Ugly

Over the Counter Foot Products: The Good, The Bad and The Ugly

Google and other search engine technologies has moved us from the information age, into the knowledge age and how that knowledge is used can land anywhere on the spectrum from brilliant to disastrous. How this easy access information affects the feet may seem insignificant to the most of the population, compared to other happenings in the world. But the impact on the quality of life of individuals can be incredible, with some basic over the counter products being an absolute no-go for diabetic patients and the warnings in tiny writing it can be easily missed. So today, we look at the most commonly purchased over the counter podiatry products.

Anti-fungal Agents
Antifungal agents are a commonly bought, quick grab product when a cutaneous issue like tinea pedis presents itself. Tinea pedis thrives in warm, damp areas such as in between the toes. However, left untreated the condition can spread across a more diffuse area of the foot, leading to increased dry flaky skin – this is known as moccasin type tinea pedis, sometimes this will require more aggressive treatment in the form of systemic antifungal therapy.
The most widely available topical antifungal creams include:shutterstock_89663761
Caneistin (Clotrimazole)
Moni-stat-Derm (Miconazole)
Lamisil (Terbinafine)
Tinactin (tolnaftate)
Desenex (undecylenic acid)
A number of controlled studies have shown that all of these substances have a high rate of mycologic cure and symptom relief. However strong argument still stands that terbinafine remains the most effective. Additionally, improved hygiene practices are essential for reduced chance of re-infection post symptom relief. Tea tree oil has been found to reduce symptoms associated with tinea pedis, however, its mycologic cure properties have been found to be no more beneficial than a placebo.

Wart Treatments
A number of wart resolving treatments are available to the public, prescription free, through supermarkets and chemist outlets. The evidence for any and all wart treatment is quite poor, with many treatments being shown to be no more effective than the other and spontaneous resolution also being a contributor to a cure.
The primary mechanism behind wart resolution is the sparking off an immune response from the body to remove the pathology.
Whether cryotherapy, salicylic acid or lactic acid is the primary treatment product it should be made quite clear that those with an impaired vascular system, diabetes or neurological conditions should seek medical advice prior to purchase of any products which may cause cutaneous damage to the body.

Corns, Blisters and Excess Skin
Excess skin is commonly referred to in the podiatric community as hyperkeratosis. A corn is a hyperkeratotic lesion usually as the result of increased pressure specific to the area in which it is situated. Corn pads are an item readily available to the public, they typically use a sal acid compound designed to blister the area of skin where the corn lays with the aim of having the area resolve by falling off. Unfortunately, something we see far too often in the podiatric community is the disasters that grow from the use of these items. Quite often macerated tissues, some which have developed into full blown wounds are presented which require conservative treatment multiple times a week until completely healed.
Similar stories occur with the use of abrasive rollers and dry skin removing products which can cause further damage when used either incorrectly or too aggressively in the hope of developing silky smooth tooties.
In some circumstances the use of padding to offload areas of increased pressure may be absolutely appropriate, however, ensuring that the padding is placed in the correct area of the foot is a difficult task that some professionals will even have trouble with every now and then. Your best option is to see a podiatrist and give your feet a proper clean up and health assessment.

Insoles, Arch Supports and Orthotics
One of the most pressing and misunderstood products on the market and a regular question proposed to podiatrist on arrival to a consult – “ I have already tried orthotics from the chemist, what makes these any different?” …cue active sigh – let’s get some definitions out in the open to reduce the possibility of confusion.
Sock liner: the removable product in most athletic shoes designed to give mild cushioning while protecting the midsole stitching of the shoe.
Offloading Devices: products sold which often can be used individually or in conjunction with an orthotic device to achieve a desired outcome. These are inclusive of but not limited too; Metatarsal Domes, Heel Lifts, Rearfoot Wedging, Varus/Valgus bars and Tri-planar wedging.
Insole/Arch support:  a generic over the counter product with varying arch heights and cushioning properties, which supplies very little rearfoot or forefoot support.
Semi-Custom Device: a product available to podiatrist which can be heat moulded or adjusted in a way to partially customize the device for the individual. It is often a cheaper product than a custom device and is used for post-op care or if the offloading is only seen to be necessary for a short period of time.
Customized Orthotic Device: A 100% customized device made by an allied health professional for the purpose of offloading an area of concern, increasing function or increasing performance.

As described in all my articles, an offloading device is not the be all and end all for any biomechanical related condition. A program designed specifically for the improvement of strengthening and mobility is always a must. A multi-faceted approach will always produce better clinical results than a one-size fits all management plan.
In relation to the over the counter topical and cutaneous treatment products – please, always seek medical advice before purchasing that which you saw on a search engine produced website.

Until Next Time,

Jackson McCosker
Director/Chief Editor