There’s a habit amongst runners to treat our bodies like cars: we put a lot of time and effort into developing the engine and body (cardio and strength), a lot of thought about fuel and fluids, and a fair amount of thought about the tires (shoes).
On a car, when you buy new tires, they’re carefully fitted to the wheels, balanced, and aligned. Without it, there is a risk of irregular wear, or having serious handling and performance issues. Anyone who has driven a car with an alignment issue likely got a terrific arm workout, gripping the steering wheel as it shook like a kitchen mixer.
But what about our bodies’ wheels, the foot and ankle?
Amongst runners and sports-medicine folk, there’s a tendency to ignore foot function. Like a lot of wheels, they’re ignored unless there’s a problem–usually outright ‘flats’–acute pain such as plantar fasciitis (or other foot pain, that is not the actual fascia).
But how we load the foot–how the foot strikes the ground, how the arch is aligned, and how the ankle and lower leg sit upon the foot–shockingly affects function of the entire stride and how well all the muscles of the leg fire.
It’s time to pay attention to the foot.
‘In and Out:’ Optimal Foot and Leg Alignment Creates a Turbocharged Hip
I’m just beginning to grasp the incredible importance of a balanced, ‘loaded’ foot and lower leg. This alignment is more than simply avoiding foot or leg pain. It’s about how a balanced, loaded foot and leg impacts hip-muscle engagement, pelvic stability, and overall stride power.
Efficient foot landing, where the rubber meets the road, consists of two elements: a foot-in loading and an outward-knee alignment.
Foot-In Loading
The medial longitudinal arch of the foot is a long, high structure that runs from heel to big toe. It includes (from rear to front) the medial calcaneus, navicular, first cuneiform, first metatarsal, and proximal and distal phalanx.
While our feet are designed for many motions and actions, with locomotion–walking and running– the most powerful and important power-generating structure is the medial arch. As such, I call it, ‘The Power Ray.’
Image: WebMd.com, amended by Joe Uhan
The yellow line denotes the medial arch, or The Power Ray. Through this structure is where we should do all our weightbearing, footstrike, and push-off in both walking and running.
The blue area of the lateral foot is designed more for balance and for cushioning at initial contact. Normal gait involves initially contacting on the outside, then quickly transitioning to The Power Ray engagement.
Knee-Out Alignment
Engaging The Power Ray is essential to stable loading and powerful running, but it’s only the beginning. What happens above the foot plays the critical role in a powerful running engine.
In order for the foot to transfer power up the leg to the hip, the lower leg (tibia) must be aligned with the foot. Optimal lower-leg alignment occurs with a relative outward rotation of the tibia and knee (denoted by the yellow arrow) such that the knee stays relatively outward over the third toe.
Seems pretty complicated, doesn’t it? It is, especially if a runner is unaccustomed to having this alignment. But the pay-off is enormous.
Foot In + Knee Out = Hip Blast-Off
When the foot is loaded through The Power Ray on a neutral (outwardly rotated) tibia, this action creates an automatic, full-blast activation of the gluteal muscles: both the gluteus medius–the main leg and pelvic stabilizer–as well as the gluteus maximus, the most powerful muscle in our body. Proper foot and leg alignment allows ground-reaction force to flow up the leg (red arrow) through the activated hip muscles, creating a powerful, effortless, and automatic push-off.
To summarize, efficient, powerful leg loading involves:
Assertively engaging the medial arch or The Power Ray of the foot (at initial contact and stance), and
An outward rotation of the tibia: keeping the knee ‘out’ over the third toe.
This ‘foot in, knee out’ alignment creates instantaneous and automatic power flow from the ground to the hip, and out behind us, from the hip to the foot to the ground!
Weak Feet: The Consequences of Deficient Foot and Leg Loading
Foot and lower-leg loading dysfunctions occur usually in two forms: ‘In and In’ or ‘Out and Out.’
‘In and In’ Collapse
Most runners are familiar with the dangers of over-pronation and/or inward knee collapse. Over-pronation is a catch-all term for any condition where the arch is allowed to collapse inward. This is usually accompanied by an inward collapse of the knee.
Most runners are familiar with this issue because of the acute injury stress this causes. Arch collapse stresses the foot, and a knee collapse stresses the knee and hip. An entire industry of supportive footwear and inserts have been created to help correct this, albeit in a passive, thoughtless manner.
But what about the opposite condition?
‘Out and Out’ Arch Avoidance
The converse condition is where the runner lands only on the outside of the foot. They ram down on the lateral aspect of the foot, avoiding The Power Ray entirely, either by conscious ‘fear of pronation’ or unconscious instability avoidance.
In this strategy, runners over-use the lateral foot, as if the brain doesn’t trust the medial arch (or, if for some reason the arch is sore, weak, or unstable). While they might be avoiding collapse stress, the consequence is the same: the foot and lower leg are improperly aligned, and the hip muscles fail to activate.
Either way, improper foot and leg loading fails to activate the hips. Compensations and dysfunctions invariably follow.
The Lateral Foot: The Telltale Sign of Poor Foot Loading
What happens if the foot isn’t properly loading? In the collapse scenario, the midfoot drops, which causes the bones of the forefoot to flatten and ‘abduct’ to the side:
Image: The Robert Charles Clinic, amended by Joe Uhan of a collapsing, ‘abducted’ foot. The arch collapses, the foot splays out to the side, and the lower leg rotates in. This creates a disruption of the power flow to the hip, and the outward foot in push-off.
Ironically, this effect is also seen with ‘Out and Out:’ any avoidance of The Power Ray causes the foot to shoot laterally, as the body is out-and-out avoiding straight-on loading and rolling through.
Decreased and Misdirected Propulsion: Consequences of a Weak Foot
Improper loading results in a tremendous power drain with serious consequences.
Deficient push-off often creates landing stress on the opposite leg
If the leg is not pushing off as powerfully as the other side, the opposite leg has to over-reach in order to make up the deficit. This is the primary cause of landing-stress injuries, such plantar foot pain, shin pain, IT-band pain, and many others.
Deficient hip activation creates compensation
If the hip muscles are not fully activated, the other leg muscles have to take up the slack. If that lightning bolt cannot travel up to the hips, then the lower leg muscles–the quads, hamstrings, and calves–do the bulk of the propulsion. This is a primary factor in both ‘dead legs’ (namely quads) and leg cramps in long races, as these muscles are often overworked in place of proper hip activation.
Worth noting: in my 20 years of running, coaching, and professional practice, I have yet to ever hear of a gluteal muscle cramping.
A power deficit is a problem. A power misdirection is even worse.
A sideways foot creates a sideways push-off. The tell-tale sign of a weak foot–an abducted, or sideways foot–is much more than an aesthetic anomaly. An abducted foot–like cross-country skis–will shoot the force at a lateral angle, rather than straight ahead.
So rather than propelling your body straight ahead, a weak, sideways foot will shoot the body–you guessed it–sideways!
This is really bad.
The entire point of running is straight-forward propulsion. Any force that changes that, creating a lateral force, can wreak havoc on the stride and runner’s body.
Photos: Joe Uhan of right versus left push-off. Note the difference in foot rotation–much more on the right–and the resultant left-sided trunk shift.
In the above image, this runner has experienced chronic left-sided leg and pelvic pain for nearly two years. A simple examination of trunk alignment clearly demonstrates why: his trunk is shifted to the left.
Looking more closely, the left foot (in the right photo) is modestly angled outward, as he is standing on his right leg. But during right-footed push-off, his trunk is thrusted to the left. This is already evident in mid-air! By the time he lands on the left leg, his trunk collapses further left. Note the outward angle of the right foot.
To summarize: a weak foot splays out to the side, pushing the trunk to the side, rather than straight ahead.
Very often, runners and sports-medicine professionals alike tend to hyper-focus on the symptomatic landing leg (in this example, the left). They will focus their treatment on stretching, massaging, or strengthening the left leg and hip in order to prevent the collapse.
But whose fault is it, really? It’s the right foot, for pushing the trunk too far to the left! The linchpin to the issue is right leg (namely right foot and lower leg) strength and stability. Conversely, any efforts to shore up the left leg usually result in only temporary relief.
I know from experience, dude:
Photos courtesy of Joe Uhan of him demonstrating a left lateral trunk shift, as a result of a weak right foot. From left to right: mile 55 at the 2012 Western States 100; finishing the 2014 Lake Sonoma 50 Mile; running at Craters of the Moon National Monument in 2008–my first photographic evidence of the issue.
Above is a collection of running pictures over the past seven-plus years. Note the presence of a left-trunk lean (red line) with corresponding right lateral foot angle (yellow line).
My dysfunction dates back to a serious foot injury in 2002, where I injured the joints of my right medial arch (The Power Ray). Since then, because of unconscious avoidance of The Power Ray, I’ve had a myriad of injuries, nearly all on the left side: all landing and over-loading stresses. My right leg has had issues, but those are related to the push-off deficit: ankle, pelvis, and low-back pain.
So… how do we fix it?
Amazing Discovery: How Optimal Foot and Leg Loading Automatically Improves Hip Power
When I began studying this earlier this spring, I conducted a case-study experiment in the clinic using a small group of about 10 patients. They were all runners with ongoing leg pain, who also had a previous foot and ankle injury.
For each subject, I conducted three running trials:
A pre-test running trial. I tested each runner at a comfortable speed, wearing their preferred shoes.
A supported-foot running trial. For each runner, I then kinesio-taped the previously injured foot, such that the medial arch was maximally supported and facilitated to engage The Power Ray. They ran at the same speed.
A post-test running trial. The tape was removed, and they once again ran at the same speed.
I video-recorded the side view of each trial. No running cues were given, nor were they given any information as to why I was taping his or her foot. Hip-extension angles–the range of motion measure correlated to push-off power–were measured.
The results: in nearly every subject, hip-extension range of motion improved by 10% with supportive foot taping. This effect disappeared when they were re-recorded, without foot support.
[Author’s Note: Subsequent studies will include a sham-tape control group–where the foot is taped, but in a non-supportive way–to control for any placebo effect, though the runners did not have any notion that foot pain would improve hip power.]
Photos: Joe Uhan of an example of improved hip-extension range, running at the same speed. More hip equals more power and efficiency at a given speed.
Both the runners and I were shocked at the automatic improvement in hip extension push-off when the foot was placed in a supported, optimal-loading position.
What I concluded was that simply getting The Power Ray to engage the ground was enough to improve hip activation and push-off. Moreover, anything that creates an automatic, unconscious improvement in stride power is worth investigating further!
And the ‘Elite Feet’ concept was born.
‘Elite Feet:’ A Strong Foot Heals All
Over the years, I’ve tried positively everything to correct my trunk alignment, including:
Thinking about running straight ahead,
Taping my trunk, so it would not drift left,
Doing side-skip drills and exercises to strengthen the left hip and improve trunk alignment,
Shifting my pelvis to the left while I ran,
Doing every hip-stability exercise I know to improve push-off and landing,
Running clockwise on a track so I would ‘lean right,’ and
Widening my stance on the left leg to avoid trunk collapse.
Alignment and pain improvements were temporary. There was a lingering force that continued to force me left.
Until I finally addressed foot loading.
Efficient push-off–both power and direction–begins at the foot. Simply put, optimal foot and lower-leg alignment is loading The Power Ray, with the foot straight ahead, rolling through a strong arch, and pushing the foot straight behind.
Elite Feet is the term for this action, as elite runners do this flawlessly:
Loading the ball of the foot and big toe,
Rolling straight through, and
Pushing the foot straight behind.
It’s that simple. But to do so successfully and consistently requires focus, and a great deal of strength development of both the foot and the lower leg.
Simple Foot and Ankle Strength: The Power-Ray-Biased Heel Raise
For starters, Elite Feet strength involves only one exercise: the heel raise. These are standard calf raises, except the emphasis is on loading the medial arch: the arch, the ball of the foot, and the big toe.
To perform them, stand flat or (more powerfully) on the edge of a stair. To lock in the ‘In and Out’ position, drive your weight powerfully into The Power Ray (ball of the foot and big toe). Avoid curling the toes down and in: they should remain flat, but activated. Then, while the foot is active, bend the knee slightly (equal or behind the toes), and rotate the knees outward until the kneecap is centered over the third toe. Once this position is achieved, you might already feel gluteal-muscle activation. You are ready to go. Raise your heel by rolling through The Power Ray–the ball of the foot and big toe–for a one-count, then slowly lower (again, biased onto medial arch) for a slow three-count.
There’s no hard data on just how strong Elite Feet should be. But I propose a guideline: Runners with Elite Feet should be able to perform 100 consecutive double-leg heel raises, and 50 consecutive single-leg heel raises.
This ensures adequate strength to maintain a strong, neutral, and efficient foot and lower-leg platform, through which the hips are max-activated.
Put it into Practice: Ankling, Walking, and Running with Elite Feet
Ankling Drills
Elite Feet must be practiced. The Ankling Drill is a fun, quick-feet drill designed to practice engaging The Power Ray and quickly and powerfully pushing off. YouTube contains myriad good examples of ankling drills, which involve rolling quickly and popping off The Power Ray. During the ankling drills, be sure you’re powerfully engaging The Power Ray while keeping the knees out over the third toe. Perform 3-4 lengths of 10-15 meters, as demonstrated in the various videos.
Squats and Single-Leg Exercises and Drills
Any single- or double-legged strength exercise is an opportunity to practice Elite Feet. Lunge, single-leg step downs, or simple air squats are all opportunities to work on powerfully loading The Power Ray while keeping the knee outwardly aligned. Double-leg exercises with a resistance band around the knees accentuates the knee-alignment component.
Whatever exercise you choose, be sure you’re powerfully loading the The Power Ray! Maximizing hip activation and strengthening depends on it!
Running and Walking
Quite simply, when running and walking, be sure you’re engaging The Power Ray of the medial arch, ball of the foot, and big toe, all while keeping your knee ‘outward rotated’ over the third toe! Then, be sure your body is rolling straight over the foot, then actively pushing the foot and big toe straight behind you.
How we walk is how we run. Walking habits carry over and impact our running, so walking (and even standing) is the easiest way to practice this Elite Feet loading without actually running.
Photos: Joe Uhan of one of his coaching clients before foot strengthening (left two photos) and after focusing on Elite Feet (right two photos). Note the improved straight-back-foot push-off, and improved trunk alignment. Also note the improved ‘knee out’ in the stance leg.
The Role of Orthotics in Elite Feet
What role do orthotics play? A supportive shoe orthotic may be helpful (and possibly necessary) to assist the medial arch achieve the required stability in order to sustainably load The Power Ray. If there is joint instability, severe hyper-flexibility, weakness, or pain, then an insert might help facilitate sustainable loading of The Power Ray.
But orthotics, alone, are not the answer. Too often orthotics thrust the runner too far laterally. While it might relieve pain temporarily, orthotics may simply turn an ‘In and In’ foot into an ‘Out and Out,’ and create a whole new group of problems!
Consult a skilled physical therapist or podiatrist to determine if a shoe insert is necessary for you. But recognize that the ultimate solution requires the runner to develop the requisite foot and lower-leg strength, then apply it, in order to achieve Elite Feet.
Consequences of Weak Feet and Benefits of Elite Feet
Wonder if you have weak feet or Elite Feet? Check this list. If you experience any of these problems, you might have weak feet:
‘In and In’ collapse: foot, medial ankle, medial shin pain; medial knee or IT band pain, hip (front, side and rear) pain.
‘Out and Out’ landing: lateral foot, ankle, and shin pain; IT band pain, lateral-hip pain.
A leaning trunk: any foot, leg, hip, pelvis, or back pain on the leaning side. Ankle or hip pain on the weak side.
Lateral feet: if you toe outward (or inward) when you push-off.
Want to get healthy and strong? Get Elite Feet! Here are the benefits of strong, powerful feet:
Maximum hip activation: Elite Feet automatically turn on the glutes.
Decreased quad, hamstring, and calf soreness: These muscles are used as accessory movers, without being over-used.
Faster stride rate: Elite Feet quickly bounce off the ground, limiting ground contact time and automatically improving stride rate.
Decreased leg soreness: Less time on the ground equals less energy wasted through shock absorption.
Faster running! More glutes, faster feet, and less wasted energy equal dramatically faster running!
Elite Feet Self-Testing
If you’re curious about your foot strength, try these two tests:
The Heel Raise Test. How many heel raises (described above) can you do?
60-100 doubles (30-50 singles) —–> Excellent, you might have Elite Feet!
30-40 doubles (20-30 singles) ——> Fair to good strength, but keep working!
<30 doubles (<15 singles) ———–> Poor, you have weak feet!
Video yourself. Have a friend video your stride from the rear. A simple smartphone video will do. If your foot fails to push off straight back into the screen, if it angles out to (either) side, and if your trunk shifts to one side and/or the other, you have weak feet!
Where the Rubber Meets the Road: Strong Feet Make Strong Running
Be mindful of your feet. Get them stable, get them strong, and practice the ‘In and Out’ alignment. Work on it while walking, and think about it when running. Strong feet equals strong hips, and strong, healthy running!
Call for Comments (from Meghan)
What issues do you feet have? Do you think you have weak feet or Elite Feet?
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