Strengthening exercises for barefoot running

I'm a physio and have recently, after years of running-related injuries, started running barefoot. It hasn't been without problems but I'm not going to throw the towel in just yet as I do think that there's something in the whole barefoot thing.

I'm suffering with left foot dorsal pain in the soft tissue around metatarsals 1-3 and, to cut a long story short, am attempting to strengthen up the peroneals and tibiali's to provide better forefoot support (current "mid-forefoot hypermobility" issues due to foot muscle weakness, tight gastroc/achilles, excessive lumbar lordosis and tight hip flexors IMO, podiatrist has advised x-ray to rule out stress fracture and Frieberg's).

I am a physio and my current protocol is:

1. cut running time to almost nothing (5 mins x 3 per week) on level grass surfaces only, barefoot (I own some Vibram 5fingers but am sticking with barefoot currently)
2. Calf raises on step to stretch achilles and strengthen calf muscles)
3. Peroneal and tib strengthening seated using theraband
4. Stuff to sort out my tight lumbar and hip flexor issues
5. Ice to settle slight inflammation around metatarsals

Does anyone have any other suggestions or indeed thoughts on my rehab and the whole barefoot thing generally????? I'm fascinated by this area so any thoughts, advice, opinions and facts would be very welcome.

Hi Jools987,
I agree that barefoot running and the newer style of deconstructed footwear to ease people into this style of running is very interesting and makes a lot of sense.

It is difficult to discuss specifics regarding ideas to assist you without knowing more details about the specifics of your self treatment. Do you work in musculo-skeletal or Sports areas of physiotherapy?

To take a wild guess I suspect that the core stability biomechanics require close attention to reduce lumbar lordosis / correct pelvic tilt and assess any side to side imbalances in muscle lengths affecting posture. It is assumed that you have not had any serious lower limb bone injuries or congenital shortening. An examination of the types of previous injuries may provide a hint to the conditions that may be common to injury causation eg Do you have other hypermobile joints (classified as the true genetic expression or part thereof) and if so a strengthening program without stretching would be necessary.
If your symptoms are suggestive of stress fracture behaviour and have been present for more than three weeks a bone scan or x-ray may be worthwhile. If the problem came on over a few days post barefoot run you may have twisted / strained some interosseous ligaments, which can present as described. Foot taping during a run may help reduce the pain, or just wait until the soft tissue heals, providing mobilisation to the structures during the process.You may benefit from a colleague or yourself providing axial traction through the affected toes whilst mobilising the joints. This technique takes a little practice but you can use yourself as a guinea pig. The area can be painful on compression forces but ease with traction mobilisation - sometimes a click is obtained at the metatarso-phalangeal head and relief follows.

Another method is to use a frozen plastic bottle to roll under your foot (across the arch) with about a third of your body weight placed on the bottle in standing. Roll the bottle back and forth for up to two minutes. The mobilisation effect of the bottle can assist both the dorsal and plantar surfaces.

As stated, I would require more detailed background and injury behaviour to be more specific. The problem may have an entirely different causation from my postulations eg neural pain via nerve entrapment or even a variant of sciatica.

Let me know if I can fine tune anything for you.

Cheers,
MrPhysio+

Obviously, if you strongly suspect a fracture, get this eliminated from your possibilities first.

Hi Jools987,

I think the initial issues here are that the foot intrinsics are not used to working under such loads. It's one thing to work peroneals etc but that's not really their job. You need to take things very slowly and progressively to give the muscles that originate and insert within the foot time to build up strength and endurance. One simple way is to wear masseur sandals around the clinic and house. The little raised pillars that you stand on when wearing those causes the foot intrinsics to contract to avoid the pain of to much pressure in any one part of the foot. After a few weeks this really can give the intrinsics a wake up.

Also the old trick of placing a slightly damp towel on the floor and using the toes to grab it and gather it under the foot (arch) is a good one to get the supportive muscles working.

Thanks for the suggestions. I've so far gone with the further investigation into the problems in the lumbar area and went to see a personal trainer/anatomist who is known locally to be pretty switched on with posture-related issues. She's helped me to see that my pelvis is rotated and upwardly tilted to the right and my lumbar spine is "locked solid" quote unquote - that's the very simplified version as there's a host of other things going on too, obviously.

I've been recommended a physio/osteopath who may be able to help with the jammed up lumbar spine, to be followed by some specific core work, a look at glute firing which is reduced on my left, stretching the ITB, quads and deep hip flexors and internal rotators, and a detailed look at my gait when running, which is currently right side driven. I'll also be doing some strengthening of the intrinsic muscles of my foot, along with the ant & post tibs. All of this before doing any running again.

It's been suggested that barefoot running may load the lumbar spine more than conventional heel strike running, due to with heel strike the shock being absorbed by all three foot arches, whereas with barefoot, due to the ball of the foot landing, the shock is possibly only absorbed by 1 or 2 arches(?) I'll be keeping an eye on this when I get back to running.

So thanks for the advice to date on core and foot related issues, if anyone's interested I'll let you know how it goes, it's going to make an interesting case study if nothing else :)

Hi Jools987,
Your case will be interesting to follow so any flow on information will be appreciated. The shock absorption information regarding barefoot running is new to me and does not follow the usual
biomechanical arguments that I have read to date. It is a developing area so I will keep up to date on further information in this area as well.
All the best for your eventual return to running.
Cheers,
MrPhysio+

A quick update, in case anyone's interested, and this is also a fish for more information.

For my back: I've been to see a recommended craniosacral therapist who's also a physio - I was sceptical but open-minded - and my lumbar/sacral/pelvis area is now significantly improved - no sharp pain or spasms, a reduced and more localised ache and nothing that I'd call pain anymore.

Soft-tissue injury to foot: Now completely healed with rest and ice bottle as advised above. X-ray showed no fractures or bone abnormalities. I'm currently not running at all.

Re strengthening foot: I'm currently doing 1) anterior and posterior tib strengthening exercises 2) calf raises with toes forwards and turned inwards and 3) intrinsic muscle strengthening via towel gathering under foot, with weight through ball of foot, particularly 1st met, toes relaxed and non-weightbearing through.

Here's the query: I've noticed with the last exercise that on the problem foot only, I have difficulty in not 'toe-curling' and effectively engaging the intrinsics and muscles under the arch. I think extensor digitorum longus is short or overactive - apparently when the intrinsics are not working properly this is often the muscle that can become more dominant? I'm persevering with the exercises at the moment in the hope that things will improve as the muscles get stronger but I wondered if anyone had any experience/knowledge of this area/exercise etc etc???

Hi Pflexxsports,
I did not think that this site was for advertising products, but for advice to forum members without barrow pushing.

Hi Pflexxsports,
I did not think that this site was for advertising products, but for advice to forum members without barrow pushing.

Hi Jools987,
Not sure I understand the way the last exercise for the intrinsics is being performed. I would have no problem with the toes curling and assisting the gripping of the towel. Adds to the intrinsic muscle movement.
Or are you concerned that the toes are lifting upwards away from the floor when you are gripping the towel? It is true that any muscle not opposed by its opposite mover may tighten up, but more so when muscle tone
such as in stroke affected limbs comes into play. If you can provide some more descriptive info I will try to help.

Re craniosacral therapy - the pure form of this technique has been described (paraphrasing here) by the British Osteopathic organisation as a scam and any Osteopath practicing it should be deregistered. Big words indeed.
Some therapists mix techniques but include non craniosacral therapy treatment modes under the banner. I cannot argue with your perceptions, but can say that craniosacral therapists claims of moving skull plates after sutures have ossified as well as sacral fused bones, plus feeling 'brain pulses' have been thoroughly discredited. See Quackwatch with a search within the site. Interesting articles.

Sorry for the double post re the advertiser - I received a message that the message pane had timed out so I reposted and doubled up. I wasn't being insistent!.

By the way, I echo the Moderators words re the link to Masai Barefoot Technology. These shoes and others with curved rocker soles claim to increase muscle action and promote strength or weight loss. The rocker sole shoes were independently assessed by a US biomechanical lab - no benefit found. The initial muscle soreness felt by some people was attributed to the fact that sedentary people started walking more after purchasing the shoes. Had these people walked the increased distance anyway, regardless of shoes, they would have felt some post exercise induced soreness. A triumph of marketing over science.

Hope to hear from you with further info.
MrPhysio+