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As runners, we don’t tend to think much about our feet. The only time I give them a second thought is if they’re sore. And even then, that’s about as far as my thinking goes.

And there’s a lot to think about. The foot is one of the most complex structures in the human body. Your feet contain about a quarter of all your bones. Each foot has more than 30 joints and more than 100 muscles, tendons and ligaments. There’s a lot that can go wrong!

I was surprised to hear podiatrist Matt McKean tell the Trail Snails podcast that podiatrists don’t just treat feet, they look holistically at everything from the hip down. On reflection, it should have been obvious. After all, as the old childhood song says “The foot bone’s connected to the shin bone, the shin bone’s connected to the thigh bone, the thigh bone’s connected to the hip bone, I hear the word …” you know the rest.

As runners, our feet are literally where the rubber hits the road. And it makes sense that many issues further up the biomechanical chain would manifest in our feet. So why is it that we spend so little time thinking about them? Apart from chat about blisters, lost toenails or the occasional plantar fasciitis, when was the last time you had a serious discussion with another runner about your actual foot? Or about the systems in your leg that dictate how your foot strikes the ground.

I know I’m definitely guilty of spending more time obsessing over footwear than foot care. The options regarding hi-tech, brightly coloured, heavily-marketed shoes occupy much more of my brain space than the highly complex skin-covered structure of bones, muscles, tendons and blood vessels that we slip into them.

So in the spirit of thinking a bit more about my feet, I sat down with Matt, who is based in the Brisbane suburb of Milton, to talk all things feet.

Three-part harmony

Matt says he believes in taking a holistic approach when treating his patients, with a particular focus on three things:

1. Function - gait patterns and so on

2. Foot position and structure; and

3. Footwear

He says all three need to be working harmoniously to avoid foot trouble. Figuring out how harmonious that relationship is almost always starts with gait analysis - basically asking people to do laps of his treatment room while he watches them walk.

This is not just about staring at a person’s feet looking for obvious issues like a collapsing arch. Often, the telltale signs for foot trouble are most obvious elsewhere - for example if a person’s shoulders are out of kilter when they are walking, that can be symptomatic of a hip-to-foot issue.

“When I’m seeing people, I’m just wanting to see how they move,” he says. “The human body is like a system … every step we take there are hundreds of structures acting in that few seconds - and timing is everything. The foot, knee and hip all communicate and influence one another.

“There are things the foot has to do when it lands in the stance and mid-stance phase of our walking and running. Then the knee has to unlock, it has to soften to allow the foot to plant correctly. And that gets the pelvis and hip into a nicer position.”

Matt says it’s often small adjustments he makes to the way people walk that yield the biggest results. That’s because we all have small things that are “nibbling away” at us. “Some of the common things I see are little things that are happening in our gait that aren’t ideal, but our bodies are such amazing machines that they adapt. We can function imperfectly and not have pain because our body gets used to it.

“But I often find there’s a straw that breaks the camel’s back - like someone goes on holiday or they suddenly walk 5,000 more steps one day or they’re in Europe on cobblestones or they double the run distance they do. And that’s what starts the injury.

“And then all those little suboptimal things that they have managed with fine up until that change are enough to keep that injury around. That’s really common,” Matt says.

Sometimes the upper body is sending a signal about problems down below. “It’s just those little things… A common cue I’m giving people is let’s try to bring your chest forward a few millimetres or weight the centre of your foot… they might look better straight away. So it’s those little things which could be manipulating or changing what’s happening down below,” Matt says.

Of course, running trails is different from walking laps of a treatment room, and the uneven terrain introduces added complexity due to all the variables you have to deal with. But Matt says we should resist the temptation to “overcomplicate things”.

“There are still things our body has to do with each step and we need to apply those same principles. It’s just hard to apply them when you’re also thinking about not slipping and falling and tripping and sliding down a mountain,” he says.

There are a handful of common issues Matt spots in his patients, one of the most prominent being people walking with a “locked knee”. This causes hyper-extension which results in the pelvis tilting or thrusting to the side which can, in turn cause lower back issues.

“The knee has a job description. When you walk, you should soften say up to five or 10 degrees. If you’re not doing that, you start to get these little issues that you might not notice yet, but years down the track the wear and tear comes in,” he says.

Don’t just treat the symptoms

Another common issue is that classic runner’s ailment, ITB Syndrome. Most people who have gotten serious about their running will have either experienced this, or know someone who has. Matt said his job is to find out why the ITB has flared up.

Generally speaking, the prescribed treatment for ITB Syndrome is to stretch and/or use a foam roller. But this is treating the symptoms, not the disease. “Function’s my huge focus. If someone walks or runs in a way that irritates that ITB, no amount of stretching and strengthening is going to remove that,” Matt says.

Instead, Matt goes back to assessing gait, posture and biomechanics to try to find the root cause of the problem and deal with it. Poor knee function is again a common culprit for ITB Syndrome.

Matt says when the knee locks in walking or running it can drift outwards, pushing on the ITB and stretching it. “Whereas when the knee softens and moves forward, there’s no sideways movement. The quads switch on and they take on the load rather than it all being dumped into the ITB,” Matt says.

Loading the outside of the foot is another common cause of ITB Syndrome. This again pushes the knee outwards, loading up the ITB. This is often accentuated in running rather than walking and can be exacerbated by the current trend of very soft daily trainers, Matt says.

Shoes

The third of Matt’s three focuses is footwear - and this subject can be a near obsession for runners.

“As a podiatrist, I’m really interested in function,” Matt says. “I’m looking at how a person moves. There’s an optimal way for each person to move and the job of the shoe is to let that happen and not get in the way of it.”

So shoes are an important part of the puzzle for Matt. But not a straightforward one. “It’s an interesting topic because it’s become a fashion market... It’s endlessly changing so it’s hard to keep up with, even as a podiatrist.

“Things change all the time and not for the better I think sometimes,” he says. While he notes he really only sees people who are in pain, which is only a sample of the market wearing these shoes, Matt is not a huge fan of super-soft, high-stack everyday trainers that are one of the current trends.

“I see its purpose, but when you see people in pain and you’re spotting big deficits in people’s function and you’re seeing this [sole] that you can compress with two fingers. Then you see an 80+ kilogram person running on it and therefore it’s not well aligned - the shoe’s not springing back into position so they’re still out of alignment. I think the foam, being a lot softer, can exacerbate things,” he says.

He says it wasn’t that long ago that “barefoot” shoes were all the rage because they felt more firm and stable. At the end of the day it comes down to personal choice - whether you prefer shoes that are soft, firm, carbon-plated, a particular colour, or the same as someone who’s fast.

But Matt does use a tripod analogy to assess shoes. “When you’re standing on the ground, you should have equal pressure between your heel, your big toe joint and your little toe joint so that the centre of gravity’s in the middle of your foot. So shoes should complement that.

“The way I assess shoes is I put them on the floor and push into the heel. The shoe should just stay level. A lot of shoes fall back and tip up like a rocking chair.” Yet another small thing that can, over time, create big problems.

Matt told me the majority of his patients come to him with chronic pain. They have issues that have been bugging them, and getting progressively worse, for a long time. This includes runners. And invariably he offers them some advice that can help fix those problems.

Which makes me think that, as runners, maybe we should have gait analysis and regular tune-ups with a podiatrist as part of our maintenance schedule - like getting the car serviced. A little early intervention, applied semi-regularly, could prevent a whole lot of tears down the track. Literally and metaphorically.

Upcoming Events

There are way too many events for me to list everything that’s happening around the country, but here is a selection of upcoming races (with a bias towards South East Queensland).

The Running Calendar website is a great source if you want a comprehensive understanding of what’s available around Australia.