Video Transcript
Hey, this is Dr. Gangemi, and today’s Sock Doc video is going to be about the foot. I’m going to basically describe and talk about some easy treatment options that you can use for some common foot ailments that I haven’t discussed in other videos. And we’re going to talk about top of foot pain, Morton’s toe, Morton’s neuroma–type issues, and peroneal problems, as well as your big toe. And a little more about pronation and supination.
So let’s get right to it, pronation will kind of pick up a little bit more where I left off on a plantar fasciitis video. If you want to know about plantar fasciitis, check out that video. We’re not going to talk about that here, even though obviously it’s a foot/heel problem. But your plantar fascia, that sheath on the bottom of your foot, is made up by, or supported by I’ll say, the tibialis posterior muscle. And that attaches to your medial arch. This muscle has an important role in natural pronation, shock absorption, natural rolling inward of your foot. And we’re going to relate that today to supination, which is the rigidity of your foot as you push off when you walk and run.
And that has to do with the peroneal muscles, which I described a little bit in the knee videos, and we’re going to talk about more now as they relate to the foot. So you have three peroneal muscles, and they start up here: Your peroneus longus comes down the outside of your leg and then wraps around the bottom of your foot and attaches to your first metatarsal and your first cuneiform. Pretty much right underneath the arch of your foot.
So if you’re having a problem anywhere on the outside of your lower leg, and especially if you do this with your foot—if you push it, if you plantar flex it, push down and kind of turn out like that—that would be more of a peroneus longus or maybe peroneus brevis type of problem. Very similar motion, the longus kind of scoops a little bit more, where the brevis just kind of pushes out. But, the longus again comes down, wraps around the bottom of your foot, and goes to that area. So look for trigger points in the bottom of your foot, right around here, right around underneath your arch, just to the inside of your big toe, where the metatarsal is.
And then your brevis muscle starts a little bit lower, here. So, you want to start looking in here, and that attaches to the bottom of your fifth ray. Your fifth toe, right about here. So, feel around there for any trigger points. The third one there is your peroneus tertius, which is a little muscle that has to do with bringing your foot out and kind of dorsiflexing it like this, which is up and out.
It’s not very often found—I don’t see that I have to treat it that often. But it starts way down here. It’s mostly tendon and then attaches to the top of your fifth metatarsal there. So it’s pretty much that motion like that. So if you feel any pain when you bring your foot out like that, think peroneus muscles—they have a lot to do with supination as I said earlier. And the balance between supination and pronation with your tibialis posterior that I talk a lot about in the plantar fasciitis video. Because it has so much to do with your arch and plantar fasciitis problems.
Now, your big toe is the next muscle we’re going to talk about. Your big toe muscles, your flexor hallucis longus, is this type of motion—if you have problems curling your big toe or even plantar flexing your foot. That muscle, believe it or not, that helps to curl your big toe like that, starts all the way out behind your fibula. Way up here. So, look for trigger points behind here now, not on the side where you were looking for the peroneus muscles. But in the back, again all the way up here for the big toe. And then, on the bottom of the big toe, right around here.
And the next one would be your peroneus brevis, which is more of this motion—if I’m pushing down, like that, rather than this. So this is longus and this is more brevis. And this muscle splays out and attaches to your cuneiform bones, which are underneath the arch here, like this. So any big toe issues start digging around in there.
I’ll tell you—even though I find these muscles to be weak and I have to help people with their big toe muscles functioning more and more efficiently—a lot of times it’s because of improper pronation, and they are not naturally rolling in on their foot because of a tibialis posterior dysfunction. Again, real quick, that would be on the inside, where the tendon sheath is of the tibialis posterior. But if you feel like you’re having that sort of problem, check out the shin splints video—that’s where I really talk about your tibialis posterior.
Let’s go right into Morton’s toe and Morton’s neuroma. Morton’s toe is actually when the first metatarsal is shorter than the second. A lot of people think that you have to have a second toe longer than your first to have a Morton’s toe, but that’s not necessarily the case.
They could actually be very similar in length, but it’s about where this one ends, your big toe. If it ends before the one on the second, your second toe, then you would actually be known to have a Morton’s toe. It really doesn’t mean you’re going to have pain like a lot of people think they do. They say, I have Morton’s toe, even if their toe is obviously much longer, could be a good centimeter or so longer than their big toe.
It means that you’re going to be more susceptible to a problem if you have Morton’s toe because you’re not going to pronate as efficiently as you would if you didn’t have that. Where your big toe is the biggest, and you can naturally roll in and not hit the longer of the bones before you hit the shorter one. So, if you have a Morton’s toe, it just means if your pronation/supination balance is out of harmony with one another, you’re going to be more susceptible to a problem than if you didn’t have a Morton’s toe.
But again, it doesn’t mean you’re going to have a problem. A lot of foot problems, and I talk about this on the Sock Doc site, are from too much stress in your life. That can be poor diet, emotional issues, overtraining is a big deal, improper footwear—any of these problems that relate to too much stress in your life will result in foot problems and cause pronation, tibialis posterior and supination problems, peroneus muscle problems, and result in other foot issues too. Such as arch pain, such as a big toe problem, and that sort of thing.
And likewise, someone can get what’s called a Morton’s neuroma, which is when one of the plantar nerves, typically the one between your third and your fourth toe, becomes inflamed. Painful, tender, red-hot type of pain right in the joint that some people call a fibro, abnormal growth, or, if it’s around the nerve, then a neuroma. An inflammation of that nerve. And that again is from muscle imbalances of the foot that have been there for a long time.
Although many conventional methods like to treat these things locally with corticosteroid shots and orthotics and that sort of stuff, they’re really not addressing the problem if they do that. It’s about the balance of your foot and correcting these natural pronation/supination imbalances that you may have, resulting in any other problem. Which also includes top of foot pain. A lot of people have pain on the top of their foot. They think it’s because their shoes are too tight—they tie them too tight.
But it’s really because their arch is being pulled up. The arch is not naturally flexing and extending when they are walking and running. And the bones are starting to become irritated at the top of the foot. And again, often this is from the bottom of the foot. It’s from the plantar fascia; it’s from the tibialis posterior, attaching to the arch here and the bones in the bottom of your foot. It’s from tibialis posterior problems way up here on the inside of the tibia. It’s from peroneus problems, supination problems on the outside of the leg. So, it’s about the balance there. I think the best way to rehab your foot—once you find the trigger points and are hopefully starting to feel better, or you address the reason for those trigger points, also on the Sock Doc site—is to go barefoot as much as possible or wear, as you know, firm, flat, flexible shoes. Shoes with not much of a drop.
This is a zero-drop–type shoe, meaning there’s no drop from your heel to your forefoot—just as if you were barefoot. They’re very flexible, just as your foot should be, no support. And they’re letting your foot feel the ground and feel where you are. Develop proper proprioception. Develop proper, what is known as kinesthetic sense, feeling the ground, so your foot knows how to walk, run, jump, and play naturally to help rehab these muscles rather than isolate them one at a time through some therapy and exercises or that sort of thing.
The more you are in over-supportive shoes, the more you wear orthotics, again, all this is on the Sock Doc site, the more you’re going to cause dysfunction in these lower leg and foot muscles, and the longer you’ll end up with pain and with discomfort. Maybe not while you’re in them, but as soon as you get out of them. You end up basically being devoted to them forever.
In this video, I discuss how to identify, treat, and prevent common foot ailments. Learn about various types of foot pain and injuries from “top of foot pain” to peroneal tendonitis, as well as Morton’s toe and Morton’s neuroma. Normal pronation and supination are also discussed. Learn and enjoy!
