Yoga is a great activity to defeat the evil forces of gravity. Every step you take produces 2-4 times your body weight on your feet and there are 1,100 steps per mile. Do the math and you will appreciate how much work your feet do.
You don’t have to have the power of levitation to defy gravity. A perfect foot is designed and intended to take this punishment, but the problem is very few of us have biomechanically “good” feet. A foot that rolls in (pronates) too much allows soft tissue and tendons to stretch—and not in a good yoga way. Foot and ankle position can be controlled in slow movements with yoga with minimal impact. There is no way that we can voluntarily control the foot’s position from the rapidly changing and excessive force produced with walking or running.
Another great advantage yoga provides is an awareness of body and space relationship called proprioception. Proprioception provides balance but also protects the body by warning the tendons and muscles when they are rapidly stretched to a point of damage. This type of injury goes down to the cellular level through tiny stretch gauges called Golgi apparatus. When these stretch fibers are damaged in a rapid and ballistic movement, such as an ankle sprain, their stretch monitoring function is impaired and they cannot provide adequate warning from additional injury.
With slow movement and maintained position, stretch fibers can be reeducated to provide better body awareness as well as protection from reoccurring injuries. This is not an overnight process and may take weeks or months to repair. This is the exact type of motion that is addressed in yoga and emphasized in a restorative or rehab yoga class.
Although you may notice a particular injury during yoga, it is most likely a result of non-yoga activity and falls into the category of an overuse injury. The number of steps you take every day, the type of shoes you wear, and body mass are a part of the injury equation but the major contributor is the way the foot works (biomechanics) that create muscles that are either too tight or too weak to perform their function.
One of the most common foot problems is plantar fasciitis, which involves a thick band of connective tissue that attaches at the bottom of the heel and passes through the arch to the base of the toes. If you pull upward on the toes, this band is easily found in the arch area.
The plantar fascia is secondary in strength to the Achilles tendon, so it is not a frail structure and takes a lot of damage to produce symptoms. Damage occurs during walking or running, but may not be noticeable until it cools down after activity. Some discomfort can be experienced during activit, but the tenderness will amplify after you drive home. The location of discomfort is specific to the inside bottom of the heel but can extend the entire length of the band when it becomes chronic.
The clear majority of plantar fasciitis sufferers are pronators, but this problem can also show up in cavus/high arch feet. A tight Achilles tendon is the common thread and is present in a sizable portion of the population. Again, yoga is not the cause of the heel pain but a result of other activities such as running, treadmill, and hiking.
Everyone, except maybe your Yogi, has a tight Achilles tendon. This is the price we pay for wearing shoes with any elevation in the heel. Tenderness in the body of the Achilles tendon is a true tendonitis, but if discomfort occurs at the attachment point on the heel bone it is called insertional Achilles tendonitis and is associated with a bump or bony enlargement. The latter is a potential showstopper and if ignored will lead you toward the path of surgery. This enlargement is also called a “Pump Bump” or Haglund’s deformity and is reactive bone that grows around and into the Achilles tendon.
If the bump appears to grow larger with activity, a bursa has developed in addition to the bone changes. The longer inflammation lingers around the Achilles tendon, the greater the likelihood the injured portion of the tendon will change to resemble a bruise of a banana. This chronic change will make it very difficult to convert back to normal tissue. Beware of localized swelling in the mid portion of the tendon that can be a warning of a partial tear. Plantar fasciitis is a nuisance and will make your life unhappy but Achilles problems can be a “Yoga Stopper”.
Hallux Limitus – the Yoga Killer
When the great toe joint loses motion, there will be pain with specific poses. Typically, this joint has 70-80 degrees of upward motion (30 degrees is needed for walking). You can get by if the joint allows 45 degrees for most yoga poses. The deformity produces a bony enlargement or “bump” on the top of the great toe joint. This is different than the typical bunion where the big toe angles toward the second toe and the bump is directly on the inside portion of the joint.
When the joint reaches the end range of motion with enough force, reactive bone develops that eventually grows larger. It looks like a speed bump on x-ray. The larger this lump gets, the greater the collision which makes the bone larger. See the cycle? Eventually, the joint will stop moving. Unfortunately, no amount of stretching or therapy will return normal motion to an enlarged and damage joint.
If you are mindful and modifying poses to help protect the joint you will have greater comfort in class. Protecting the motion will also extend the life of the joint. A stiff soled rocker bottom shoe is my conservative option. This type of shoe includes the Hoka One One Stinson III, found at REI (www.rei.com/stores/castleton.html) or Blue Mile (https://www.jackrabbit.com/info/locations/store/blue-mile-indianapolis-broad-ripple), MBT found at Goodman shoes (www.goodmansshoes.com) and the Skecher rocker shoes. Disclosure: Dr. Leibovitz is not a sponsor or investor in these companies or stores.
If protection does not provide adequate relief, the other option would be correction. This may involve a simple joint cleanup procedure or more aggressive joint fusion. At this time I am not a strong advocate for joint implants due to the limitations and complications of man-made material. There are several implants on the horizon that do show promise – just don’t be the first one in line to get this.
Posterior Tibial Tendinitis
Bulging, swelling and pain in the inside portion the foot between the arch and ankle may prove to be a significant problem. This tendon is responsible for holding up the arch and when it stretches or tears, the foot will collapse inward. The typical scenario is a chronic flat foot that develops swelling and pain in the arch that may extend behind the ankle and into the leg. A simple test to see how much damage has occurred is called a “single heel raise” test. Stand on one foot and rise up as if you are looking for grunge on top of the refrigerator. If this is painful or difficult to perform, there is significant damage to the posterior tibial tendon. This is another injury in the “Yoga Stopper” category.
This is in the nuisance category of injuries. Isolated pain under one of the joints where the toes meet the foot (metatarsal phalangeal joints) is noticed when posing on a hard surface with weight on the forefoot area. The cause is not related to yoga but from high heel shoes, thin soled shoe, and toe deformities. Use a mat and keep going, but this can lead to a stress fracture with running activity.
Foot injuries are not commonly from yoga but if you experience one, do not fret. You should be safe from foot injuries during yoga, it’s the rest of the time you should worried about. If you are experiencing problems interfering with your yoga classes contact my office at 317-545-0505 or contact us online by simply clicking “Contact Us.” My staff and I would love to assist you in getting back on the yoga mats and getting you back to 100%.