The Ground Connection

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Why You Should Be Aware of Your Foot

by Dr. Matthew Klayman, PT, DPT, SFMA, Barefoot Rehab Specialist


In today’s day and age, it seems like people are always looking for direct A to B type answers. People want immediate results and want to know the exact cause of why something is happening to them or their body. But is anything in our body really that straight forward?

Begin by asking yourself four questions. While you answer these questions, think about if and how they are connected.

One- Have you lost or gained weight in the past year? Chances are, some of us don’t really want to answer that question; but I digress.

Two- Have you ever suffered from back pain and not understood how or why? This is a frustrating one for most of us.

Three- Have you burned yourself on something hot?

And, Four- Do you actively track your steps on a device daily?

Well believe it or not, these four questions all can be related to each other. They can be relevant to one body part and its one you might not think about so much unless it is hurting you or you want a fancy pair of shoes. It’s the foot.

26 bones, 33 joints, and over one hundred small muscles and small tendons; and that’s just one of them. The human foot is one of the more intricate, complex and fascinating parts of the human body. Our feet act as the sole connection from our bodies and the earth below. We rely heavily on our feet to guide us through our day and allow us to participate in all the activities we enjoy.

The foot is almost always active. Every time we make contact with the ground, our feet need to respond to our environment. But does anyone ever think about it? It’s a subconscious bodily function like breathing. Why should we care if they’re not having any problems?

I’d like to take this premise and delve in to my thoughts on the reasons why you need to be aware of your foot.

Reason #1: The Foot is an Intricate Machine

Feet are in essence like shrimp to Bubba in Forrest Gump; there are all kinds: small, large, wide, narrow, fat and skinny…what gives and why do I care?

Well, the foot itself is dynamic and is actually the densest area in our body relative to its size as it makes up a mere 1.5% of our total body weight per foot. But with this, our two feet together make up 25% of our overall bone structure. In one pair of feet we have 52 bones; we have 33 joints in each foot which connect the bones and over 100 small muscles, ligaments and tendons that share a role in multi directional actions; these actions include moving the toes up and down, side to side, splaying in and out, moving the ankle up and down, side to side and rotating in and out.

With all these motions, the foot functions in three different parts. First, we have the rear foot which connects the ankle to the heel. With this, the area creates a mortise or slot which allow the foot to freely move up and down; the rear foot creates the initial stability that we need every time that we take a step. Depending on how the rear foot lands when we step partly determines the next portion of the foot.

The midfoot, which works from the heel to the bases of our toe bones, provides shock absorption, takes the brunt of our weight when walking or standing and rotates inward and outward in three different planes of movement to adapt to even or uneven surfaces

Lastly, we have our forefoot which are essentially our toes; they provide the push off to swing our leg forward and provide the power to step.

To make matters even more complex, we have our arches. Spanning across the foot we have three different arches, one that sits on the inside of our foot, one that sits on the outside of our foot and one that sits across it. The job of the arches is to absorb the weight of our bodies when we stand or walk and provide support. They act as a spring, storing and releasing energy whenever we walk. A theory that exists is that our arch shape is based off our movement in utero; if we don’t have enough movement, we are said to develop a higher arch; the opposite is in effect when we have a low arch when we move a lot.

So, as you can see, the foot is like a well-oiled machine, functioning to produce upright standing and locomotion. But like any machine, over time shifts in the environment or technological advances can make them out of date. They must adapt to new circumstances. Specifically, what has happens when it comes to our bodies?

In the last 40 years, global obesity has risen 7% in females and 8% in males. How has the foot adjusted?

Reason #2: Whole Body Connection

With the steady rise in obesity over the above-mentioned time frame, the foot has grown two sizes bigger on average. Theoretically, this may be due to the need to be able to bare the increase in weight efficiently. With this, the foot has been able to effectively distribute weight. Every time that we take a step on the ground, we get a force exerted by the ground. This force can range from being equal to and up to 7x our body weight. With the rise in step count over the past few years, Americans on average take close to 10,000 steps per day; that means the foot is supporting several hundred tons of force a day! 

Because of this sheer amount of force, we need strength in our foot. But what kind of strength am I talking about here? It is not the bulk that we want when weight lifting in the gym; its strength in input and adaptation to the surfaces that we encounter throughout our daily lives.

Just as our hands get stronger with touch and the more that we grip objects, the foot gets stronger with tactile response and input from the Earth. Whether it be grass, concrete, cobble stone or uneven terrain, the foot improves its versatility and strength with being challenged.

The foot itself is the a highly sensitive area in the human body, housing the most sensory nerves per square inch in the body. There are hundreds of thousands of these receptors in the foot equaling more than the hand and mouth combined. In the foot itself, there exists a feedback loop between sensation outside on the sole of our foot and internally throughout the rest of the body. When the foot has contact with the ground, it senses the environment felt and sends messages to the rest of the body and brain. Judging off what we need to stay balanced and out of danger, our foot will make the necessary adjustments. With this, balance and posture are maintained when we stand and when we walk.

All this is great right? We have this amazing internal to external connection between the ground and our entire body through our foot. But 75% of the world population still encounters a foot injury at one point or another so what gives?

Reason #3: Use it Or Lose It

When your foot hurts you for one reason or another what happens? We stop using it efficiently or we stop using it entirely. Whether it is by limping to avoid its use or immobilizing it, the foot has its inner workings put on a leave of absence. And when this happens, it creates a spiraling effect up and down our lower body.  

I like to compare this idea to when someone’s arm is placed in a cast. When a doctor places your injured arm in a sling or cast it is meant to immobilize the limb to allow for proper healing. That’s great, but what happens to your arm the minute that cast comes off? It feels better and more comfortable then it did before you went to the doctor, but your strength and motion is nowhere to be found. Why does this happen?

The quick and easy answer to this is because we stopped using our arm. The muscles and inner workings of that arm ceased most function when it was immobilized. It took a vacation and although the healing that occurred was 100% necessary, it created problems both above and below the affected area.

The same effects can happen to the foot when we protect it from the outside world with immobilization, over corrective shoes or orthotics. Just like our arm in a cast, our foot can weaken without use or with too much leniency through support. The feedback loops that were discussed earlier weaken due to disuse since the foot is no longer receiving proper signals from outside surfaces. Those hundreds of small muscles and tendons go on their vacation and don’t feel the need to come back. In their minds they’re thinking “Why should I work when all the work is done for me already?”.

Although these muscles aren’t actually having a human like conversation, the concept makes sense, right? All the support or immobilization puts the foot in a resting position for a prolonged period. The foot does not go through the normal rigors of daily life and therefore is in a stagnant position without progressing through necessary strength and flexibility which should occur on a regular basis. This can create a cascade of events leading to injury like a loose screw in an intricate machine that causes the entire system to fail. We need to allow our foot to break free from over protection and allow it to function without restrictions in the outside world.

Reason #4: Injury Will Occur and You Can Probably Blame it on the Foot

No matter what activity you perform, there is an inherent risk involved, and whether you think it or not, the foot probably has something to do with it.

Some of the time, it is not directly the injured body part that is causing the current issue; it may be how the body is reacting to said issue. Statistically the foot and lower back are two of the most commonly injured body parts. The lower back is said to be injured at one point or another in 80% of people while the foot or leg comes in at 75%. Now we ask ourselves, is there a connection between the two?

Of course there is!

The first connection is our arch type in the foot. Like I said before, the arch has a lot to do with how a person is stable when they walk. The human arch will be in the range of high to low and depending on the shape you can be more prone to a certain injury.

With a higher arch, a person is not able to absorb the shock from outside surfaces or create enough movement through a step. The foot does not roll toward the midline of our body enough which leads to an outer fall of the foot. This can create flexibility and strength issues along the outside of the lower leg and hip which can eventually lead to back issues.

On the other hand, a lower arch creates the opposite problem. With this, a person’s foot creates too much movement and will roll inward. This creates a compensatory effort which causes the rest of the leg and pelvis to strain in order to follow the foot.

The other concept I cover is the idea of regional interdependence which is defined as “the connect that seemingly unrelated impairments in a remote anatomical region may contribute to or be associated with a person’s primary complaint”. Although it is not an exact science, this can be illustrated using just the big toe.

The big toe’s job when we walk is to provide the main power for lift off to swing the leg forward. With this, it is supposed to have anywhere from 45-90 degrees in each direction up and down. If we don’t have this, our kinetic chain up to our back muscles must compensate. If the big toe cannot push off, the ankle and knee move inward to create as much contact as possible between the big toe and the ground. Next, the hip will move with an inner rotation causing a sheering force at the pelvis. The pelvis connects to the lower part of our spine so our muscles will lengthen or shorten to make up for the change in force which affect the motion of our joints. If this continues over time, it can lead to joint and disc issues along with weakness of our posterior leg muscles which provide the power when we walk.

Reason #5: The Foot is an Expensive Piece of Equipment

All this injury talk brings me to my last point. When we get hurt, we should seek out medical attention. Chances are that if you go to your primary care doctor they will refer you to a specialist to further diagnose the issue. Regardless of the treatment option, you will probably be spending some money to fix the problem.

The first line of defense for foot injuries may be sneakers. On average today, a supportive pair of sneakers cost anywhere from $100-$175 per pair. Bonus fun fact; women on average spend about $20,000 on shoes with about $4500 of that never even being worn! Along with this, the doctor may recommend orthotics which will usually cost between $30-$60 for over-the-counter inserts or up to $500 for the custom-made kind. You may also be told to get braces or other devices that can cost up to $100. Although this may be in excess, it is the only option that will work for some individuals.

But what happens if this does not work at all? Bad fitting or improperly fitting shoes can cause injury like nerve damage or toe deformities. And what happens to you as the consumer? Where is the justification in all this spending if you’re still left with pain and discomfort?

To counteract the injuries people were getting, the sneaker companies started to operate under a two-model system; neutral and stability shoe offerings. Neutral shoes were developed to provide cushion and support on the outside portion of the shoe. The goal here is to produce more rotational movement for higher arches for individuals who strike on the outside of their foot (supination) or for those whose foot does not produce excess overall motion. Stability shoes on the other hand were made to provide control of motion and support on the inner portion of the shoe to reduce excess inward motion (pronation) and restrict movement of the foot for individuals with lower arches. Although this sounds good written on paper, function will change when we run based on how our foot adapts to the ground.

In 2014, the US Marines, Navy and Airforce conducted a study with 6,000 recruits. They used an experimental group where participants were assigned shoes based on their arch type. The study involved a control group where individuals were given stability shoes with no basis from their arch type. The results were surprising here. They found no link between injury reduction and shoe choice and discovered an increase in injury for those wearing the “correct” shoe. To this day, there has not been an orthopedic study which has demonstrated a true link between injury reduction and choice of sneakers in runners. One reason this may be true is that when we run, it is not solely based off how our foot moves but rather how it adapts to an ever-changing environment.

So, should you just throw away all your shoes and forget about running?

Absolutely not! Although shoes do not fix the entire issue, they can increase comfort. And when we are more comfortable, we tend to run and walk better and more efficient. When it comes to fixing your stride and changing your shoes the bottom line to follow is that if it is not broken, do not fix it!


I realize a great deal of information was covered here. Here are some concluding points to take care of your feet properly.

  1.  Allow your feet to experience the world. Let your feet experience different environments, different textures and new surfaces.
  2. Do something good for them every day. Roll them out with a tennis or lacrosse ball, stretch them in all directions, raise up on your toes, walk on your heels. Test them out in new ways.
  3. Walk around or work out barefoot. This can be a life changing experience for those who exercise regularly. Being able to feel the surfaces below in the purest form possible allows our feet to work solely (no pun intended) with their own strength and sensory input.
  4. Question what others tell you. Question what I am telling you. Our bodies are all different. They respond to things in a way that are alike or completely different to another person. Don’t just blindly trust what one resource says. Question it. Ask why you’re doing it and how it will help you. Be a knowledgeable consumer.



Dr. Matt Klayman is a Senior Physical Therapist at Zarett Rehab and Fitness in Philadelphia, PA. His areas of work include orthopedic injuries of the human body with a specialized interest in the treatment of runners and people dealing with foot, ankle and lower extremity injuries. For more information, contact Matt via email:

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