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Tuesday, January 6, 2015

Yoga for Foot Pain

by Baxter

Study of Hands and Feet for the Golden Age by Ingres
As I was preparing for an upcoming workshop on Yoga for Healthy Feet at Mountain Yoga in Oakland, California, I happened to review our recent communications from you, our readers (thanks for all of these questions, by the way, and keep them coming!), and came across this timely inquiry:

I am a 67-year-old female in good physical condition. About 10 years ago, I slipped down a steep hill and came to a stop half way down the hill, using my foot to stop. I immediately had severe pain in the arch of my foot to which I applied ice. Every since then, I have had pain in the arch of my foot, to varying degrees. I now have that pain wrapping around from the arch to the top of my foot and pain that wraps around my ankle. Even the bone on the medial side of my foot, above the arch, becomes sore at times. I frequently wake up in the middle of the night with arch pain. When I walk fast at all, I get shooting pain in my arch. I have been to the orthopedic doctor and they have injected steroids into the tendon sheath in the bottom of my foot and also by the ankle. These injections have helped for a short time. I don’t want any more steroids. Are there any yoga exercises that I could be doing to strengthen this area and to decrease the inflammation that is there? Any suggestions would be very much appreciated.

I’d like to start by acknowledging how challenging traumatic injuries can be to our bodies, and how they sometimes don’t easily heal and allow us to feel like our old selves again, at least not on the timetable we would prefer! Our reader’s situation appears complicated in the sense that the pain she experiences moves around, is aggravated by certain activities, has been around a long time, and even wakes her up at night. And despite seeing an orthopedic specialist and getting some steroid injections to decrease inflammation in the tissues of her foot, her pain persists. Although I cannot make specific recommendations for this person without a more thorough history and physical, I can provide some general recommendations on approaching foot pain and working toward stronger and more supple feet and greater pain-free movement.

Non-Weight Bearing Mobilization

It turns out the feet are quite complex parts of the body. There are 52 bones in the feet, and each foot has approximately 33 joints, each of which can move in multiple directions. The possible number of distortions of the foot is a huge number, something on the order of 8x10 to the 36th power. In contrast to the foot’s huge variety of possible shapes and movements, we usually wake up, are in bare feet for just a few minutes in the morning and then jam our feet into shoes all day, which protect the feet for sure, but limit movement dramatically. So the first wonderful thing about practicing yoga is that you liberate your feet from shoes for however long your home practice is each day. In the context of painful feet, it may be a great starting place to do yoga practices that are non-weight bearing, since things like brisk walking, as in our reader’s case, might be influencing the persistence of pain.

A good place to start would be with any “warm-up” practices that involve lying on your back or belly and moving your limbs and feet around. An example would be Legs up the Wall pose (Viparita Karani), in which you could add in movements of your feet and ankles to promote mobility of the joints and soft tissues of your feet. Other examples of poses where there is no or very little pressure on your feet include Thread the Needle pose, Locust pose (Salabasana), and Reclining Twist pose (Jathara Parivartanasana). In all these poses, you can deliberately choose how you want to position your feet and ankles—whether you want to spread or curl your toes or vary other foot movements and positions—to bring greater awareness to how your feet are doing moment to moment. Once you are comfortable in these poses and your foot pain doesn’t flare, you are ready to move on.
Locust with One Leg Up
Mild Weight-Bearing Poses


There are several basic yoga poses that begin to require more of your feet in terms of dealing with forces to the soles, the tops, and the edges of your feet. As you introduce this new group of poses, you will again be monitoring how your feet respond during the practice, as well as after the practice, such as overnight. Some of my initial choices include:
  1. Reclined Leg Stretch pose (Supta Padangustasana)
  2. Bridge Pose (Setubanda Sarvangasana)
  3. Seated Crossed-Legs Pose (Sukasana)
  4. Cobblers Pose (Baddha Konasana)
With Reclined Leg Stretch, you are still not bearing weight but you are bringing pressure onto the sole of your foot with the strap. You can vary the location of the strap; I like the heel pad, the mid-foot, or the ball of the foot. And you can vary the intensity of the pull of the strap to gauge how much your foot can handle.
Reclined Leg Stretch Pose
With Bridge Pose, you are beginning to bear weight on your feet, but not your entire body weight, so this pose provides is good way to test the waters to see what your feet are ready to handle. The other seated poses put a bit of pressure on different parts of your feet and can help reveal areas of ongoing tenderness that might need a slower approach towards full function.

Full Weight-Bearing Poses

When you are feeling ready to stand up and see how your feet handle more challenging situations, you can begin to explore the basic two-legged standing poses. Mountain pose and all of its variations—arms overhead, side bending, and so on—are the starting place and a good home base to return to for this group of poses. 
Arms Overhead Pose
From there, move on to the classic two-legged standing poses, such as Triangle pose (Trikonasana), Warrior 1 and 2 (Virabrdrasana 1 and 2), Extended Side Angle pose (Utthita Parsvakonasana), Pyramid pose (Parsvottansanas), and Widespread Standing Forward Bend (Prasarita Padottanasana). Each of these poses will bring slightly different challenges and forces to your feet and ankles. You might add them gradually over time and assess how each one affects the feet.
Triangle Pose
Once poses on two feet are becoming easier, add more challenge by working on one-legged poses, such as Tree pose (Vrksasana), Half Moon pose (Arda Chandrasana), Eagle pose (Garudasana), Warrior 3 (Virabradrasana 3), and Dancer pose (Natarajasana). Be willing to go more slowly with these pose, however, as they will focus more force and pressure onto your feet and ankles, and may require more time and attention to get better at. 
Warrior 3 Pose
Dynamic Movements

In real life, we are moving around on our feet quite a bit, walking, occasionally squatting, and periodically dancing, cycling, or running. You can ready and train your feet for these variable movements by practicing dynamic yoga sequences. The most obvious choices are Sun Salutations and Moon Salutations, but I suggest that you can also allow yourself some creative license to invent your own dynamic movement using yoga poses. Keep a playful, yet focused attention as you move in and out of various yoga poses with clear awareness of your feet. 

See Agility Practice and  Want to Improve Your Balance? Take Off Your Shoes! for more ideas.


Finally…

Hopefully these suggestions can assist in the healing process from a variety of painful foot issues. There are certainly many other non-yoga practices and therapies we cannot cover here, but you have a starting place with yoga to begin your healing journey.

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