This is a follow-up to my article “The Three Dimensional Foot: The Role of the Toes and Metatarsals in a Typology of Transverse- Arch Rotations” (Boblett 2014). I presume readers will enter this with a knowledge of the previous article’s contents. Very briefly, I presented five types of foot patterns: two presenting in Internal clients, three presenting in External clients. [My definitions of Internal and External (IE) are those of Jan Sultan, as far as I have understood him correctly.] I then presented a few strategies for increasing function in each of the five types of feet.

In this article, I respond to a single question. Several colleagues contacted me to ask: “In your typology, can a client’s two feet present two different patterns?” Answer: “I never saw that, but the difference between two feet often points to a difference in their respective levels of competence in their shared pattern.” This in turn leads to intervention strategies that seem to contradict what I wrote in my previous article.

Visually, palpably, and in motion, a foot  can present as consistent and even classical for its type, yet require treatment that seems more appropriate to a different and even opposite type. In fact, I suspect that this is particularly likely when a foot presents with either of the most common two patterns: Long-arch Internals or Short-arch Externals.

How Does This Happen? And What Can We Do?

Let’s study a single example. Looking at Figure 1, this right foot (shown in stasis) belongs to a strongly Internal client: pointy occiput, high-amplitude spinal curves, anterior sacrum, internally rotated femurs, strong agility, weak stability. Not surprisingly, this foot in isolation follows the most common Internal pattern: long arch, long Achilles, tight retinaculum, stuck-up cuboid, strong abductor digiti minimi (ADM), and good separation of metatarsals one and two. In the figure itself, we see healthy separation of the toes.

Figure 1: Left and right feet, stasis.

But this foot has several symptoms associated with it: pain at the distal Achilles, stress pronation, and combined valgus knee collapse and medial rotation of the right femur. Ouch! This client is a marathon runner and has stressed his tibial collateral ligament and medial meniscus. Sacral tilt differential switches sides periodically due to frequent chiropractic adjustments.

So what’s wrong? Well, let’s just compare this foot with its left-side partner. In fact, let’s do this in stasis and then in various motions. Compare the left and right feet in Figure 1. In stasis, the left foot’s metatarsals one and two are more separate. The other metatarsals show a smaller but detectable difference: more spread on the left foot.  In palpation, the juncture at the proximal end of metatarsals one and two is more elevated in the right foot. (One cannot see this visually.) In other words, the right foot is still a textbook Long-arch Internal foot, but less so than the left foot.

Will this show in motion as well? We’ll pursue three areas of contrast between the feet.

First, understandably, the right foot has   a strongly enervated ADM. With the right hallux pressed down, the client is able to abduct the remaining four toes (Figure 2). He does this in a way very difficult to teach to anyone without a sophisticated Long-arch Internal foot. But contrast this with the left foot, where the ADM is stronger, with more intra- metatarsal space, especially between the crucial metatarsals one and two. Can we begin to see why the right foot is more apt to pronate under stress, acting a bit more like a brittle arch on a Short-arch External?

Figure 2: Left and right feet, ADM active.

Next we test not only ADM strength but also its degree of independence. Again, the client presses down the right hallux, but now he tries to abduct the little toe with little abduction of the middle three toes (Figure 3). He does this remarkably well for a European-American. But observe the left foot: its little toe abducts further, with less pulling-along of the middle three toes. In other words, this second motion test shows an even more dramatic contrast between the two feet. This has implications for the ability of this left foot to avoid valgus collapse at the knee, which happens under stress on the right.

Figure 3: Left and right feet, ADM isolated.

Finally, the client presses down the right little toe and abducts the hallux using the little-used  abductor  hallucis  (Figure 4).

Figure 4: Left and right feet, abductor hallucis active.

He can do this, but his foot cramps in the process. Why? Because the little toe must press down strongly to allow the hallux the independence to go its separate way. Hallux abducts further in left foot; and, while the photo cannot show it, there is no cramping. Again, the left foot fits its inherent pattern better.

Conclusion: the left foot is more ‘competent’ at its inherent tasks as a Long-arch Internal foot. The right foot is classical for the same type, but less so.

So What Do I Do?

Controversially, I maintain that  there  is no hard-and-fast rule governing whether to begin with the symptomatic versus asymptomatic side of an imbalance. Commonly the symptomatic side is the more functional one. It is angry because  it is doing the work. So I test for motion. Often the symptomatic side is the mobile side, with the real problem residing in the immobile side. Work on the asymptomatic

side often produces the necessary shift. But in this case, I go back to the question of competence. In the model, the left foot knows its job. The right foot is less certain.

Another distraction may be the  desire  to influence the client in the direction of neutrality with respect to IE differences overall. Certainly this is a better goal than chasing symptoms, yes? But here symptoms may point us to a better strategy: help the client access the strengths of the IE pattern inherent in the structure (a Long-arch Internal foot in this case) before introducing its opposite. Indeed, I generally go back and forth between the two processes: accessing the dominant IE pattern, then accessing its opposite, etc. Competence in each set of tasks increases as competence builds in the opposite tasks.

So over the whole body, I often find it useful to discern which side of a bilateral structure fits the IE pattern and which side contradicts it. Obviously, it is rarely the case that one side remains consistent in this respect all the way up the body. However, the patterning often remains the same along long segments with trouble arising where that consistency ends.

Before I turn this right Long-arch Internal foot into something different, I find it useful to teach it how to be a competent Long-arch Internal foot. So I do my manual and movement work primarily on the right foot, to bring it to competency more equal to that of the left foot, with relatively little intervention in the left foot. Manually, my intervention looks more like what I presented for a Short-arch External foot in my earlier article: separate metatarsals one and two, widen toe box, treat navicular as stuck up, treat cuboid as stuck down, and lengthen the Achilles. In movement, I treat this foot with respect for its Long-arch Internal abilities: I seek to bring them in line with those of the more-competent left foot. To  accomplish this, I ask the client   to do the three exercises outlined above, teaching him to compare and contrast his lagging right foot with his more competent left one. More generally, I teach the client to use both digiti minimi and hallux abduction to offset the temptation to pronate. In time, this weakens the temptation of the right knee to go valgus under stress, reducing stress on the tibial collateral ligament and medial meniscus.

In sum, successful strategies for foot typologies depend on asking not just what type a client presents, but which side is more competent in expressing that type. This will lead to a review of strategies, sometimes requiring out-of-pattern strategies for relatively out-of-pattern feet.

As with my previous article, I welcome your feedback.

Michael Boblett works in San Diego, California.

He has been a Certified Rolfer since 2003 and a Certified Advanced Rolfer since 2008. His graduate degrees (MA, MDiv, and DMin) are from Pacific School of Religion in Berkeley, California. At seminary, his focus was on the anthropology of religion with experiential training under Michael Harner, author of The Way of the Shaman. He does competitive trail running and leads hikes in the San Bernardino Mountains, wearing Vibram Five Fingers for both sports.

Bibliography

Boblett, M. 2014 Dec. “ The Three Dimensional Foot: The Role of the Toes and Metatarsals in a Typology of Transverse- Arch Rotations.” Structural Integration: The Journal of the Rolf Institute® 42(2):33-38.

The Three-Dimensional Foot, Part 2[:]