Ask the physio: Splayed feet

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The issue: The foot can sit naturally in a degree of external rotation – when the toes of each foot are further apart than the heels. But it can go too far, causing form issues. If the piriformis – the smaller glute muscle deep in your buttocks – is too tight it can cause you to turn the foot outward. The muscle is partly responsible in part for external rotation of the hip, so if yours is tight it follows that it will sit in a rotated position at rest.

The big toe can also become stiff and misshapen through bunion growth and this can lead to a loss of flexibility. By rotating the foot outward, there is less dorsiflexion (upward bend) of the big toe as your foot rolls onto its medial (inside) edge during the gait cycle, and this means that you come to rely on an overpronated stance for push-off. (In contrast, a foot that points forward during footstrike will toe-off from a flexed big toe.)

How it affects your form: The position of the foot means you are running like Charlie Chaplin walked, which is neither fast or economical. Your foot will overpronate, your arches will start to lose height, your shinbone is more stressed and your knee will lose alignment. Your hip bursa will start to feel sore as your iliotibial band causes friction at its origin and down the side of the knee. You lose efficiency because your biomechanics are being used more to maintain alignment than to propel you forwards. Over time it can lead to injuries such as plantar fasciitis, shin splints, runner’s knee, hip bursitis, hamstring tendinopathy and lower back pain.

The test: Sit on the floor barefoot with your legs outstretched and take a look at both your foot position and the position of your big toe when relaxed. If your foot falls a long way out to the side and you have a big toe that’s more prominent at the knuckle then tapers above as if squashed inside a pointed shoe, you may have this issue. Stand up and look forward. March on the spot for a few seconds and then stop. Then look down at your feet. What is the position they came to rest in? If it’s ten to two (on an imaginary clock face where directly forward is 12 o’clock) or wider you may need to think about remedial action. Finally, lie on your stomach in front of a mirror. Bend your knees to 90 degrees and then allow your feet to fall out to the sides. Check to see if your feet fall the same distance on each side or if they reach the acceptable range of at least 35 degrees from the vertical (for guidance, a five-to-one clock position would represent a 30-degree range from the vertical on each foot). I see a lot of runners who only manage about 15 degrees on their problem leg. 

Recommended moves: If you have a stiff big-toe joint, try pulling the toe into extension while watching TV or push it up against a wall with your heel and foot flat on the floor. You can get a splint for a stiff big toe, which is designed to be worn at night (a Strassburg sock).

For the piriformis, lie face-down on the floor and stretch the muscle in the same way you tested it, allowing your feet to drop out to the side. Or sit with your knees together and feet out wide (with the knees bent to 90 degrees) bringing the hip into medial rotation and guiding it back towards alignment.

Standard piriformis stretches also work well, either laying on top of a bent knee (the forward bend pigeon pose) or pulling your shin towards your head while lying on your back.