Foot pain and yoga

Foot pain and cramping is fairly common in all styles of yoga and has a variety of causes: some foot cramps are caused by sedentary modern lifestyles and shoes and some by yoga practice.

The foot is an intricate structure designed to carry the body’s weight through its arch and move at the toes and ankle. The hands and feet are structurally similar: both have many small muscles (called intrinsic muscles) that refine movements and stabilise the small bones structurally but also separate layers of larger muscles located in the forearm and lower leg which stabilise and move the wrists and fingers and ankles and toes respectively.  Foot pain can be caused by the intrinsic muscles of the feet but also by tension in the muscles of the lower leg. Hip and knee problems also cause foot pain as compensatory movement habits can develop that put strain on feet arches. Feet problems are also the cause of knee or hip pain, for the same reason.

General causes of foot pain

1. Shoes: People who wear shoes constantly may experience foot pain when they first start practising yoga as the intrinsic muscles of the foot adapt to practising with bare feet. New students may find it helpful to roll a tennis ball around under their feet while seated to stimulate the muscles and ligaments of the feet. Walking barefoot regularly, especially on uneven surfaces stimulates the feet. Women’s high-heeled shoes are a major cause of foot pain because normal weight-bearing is altered: weight is borne by the heel and ball of the foot, instead of the arch. The Plantar Fascia under the foot and muscles at the back of the legs shorten adaptively causing foot cramping and pain. The best way to prevent this to vary the heights of heels worn, alternating between flat and high-heeled shoes. Heel heights above 5.5cm are most problematic for feet if worn regularly.
2. Pronation of the feet (arches roll inwards) can cause pain in the foot either from weakness in the shin muscles, tightness in the Fibular muscles or weakness in the hip stabiliser muscles that causes the pelvis tilt to tilt sideways. This needs to be assessed by a physical therapist to determine the best treatment.
3. Muscles: The lower leg is often thought of as only the large calf muscles (Gastrocnemius) and smaller shin muscles (Peroneals) but there are many deeper muscles in the lower leg that stabilise the ankle and flex the toes. These muscles are released with circular movements of the feet, which aren’t often practiced in yoga. Peroneal muscles are stretched in Padmasana which is not a safe pose for many yoga students, especially beginners.  An alternative stretch for these muscles is to point the toes in Upavista Konasana, grasp the outer edge of the foot and pull it inwards. Yogis who can’t reach their feet can use a strap as pictured. The Soleus is a frequently-neglected calf muscle which can make the Achilles tendon very tight and is often the major reason why heels can’t touch the floor in Adho Mukha Svanasana. The Soleus can be stretched by bending the knees in the pose. It is difficult to stretch the lower leg muscles, due to the relatively limited range of motion at the ankle and self-massage may be the best solution for athletes such as runners and dancers
4. Nerves: some tingling or pain in the feet and toes may be misdiagnosed as being Sciatic nerve-related when in fact the nerves are being compressed by tight muscles in the lower leg. Nerve compression is probably not occurring in the hips or lumbar spine if the nerve symptoms can be reduced by massaging the muscles of the lower legs, particularly in the area around the Fibula – the outer sides of the calves.

Yoga-related foot pain

Toe cramping when pointing the toes is quite common in yoga and can be caused by excessive heel-lifting in standing poses, especially: Utkatasana, Prasarita Virabhadrasana (Horse squats) or Adho Mukha Svanasana because the calf muscles are much larger and stronger than shin muscles: intrinsic foot and shin muscles go into spasm when the calves contract if relative strength isn’t balanced. Heel-raising is practiced either to strengthen the calves – which may be unnecessary – or to challenge balance, with unintended consequences. Tension in the lower legs can also prevent relaxation in the Hamstrings, straining forward bending and splits. If calves are tense, it is useful to flex the feet and toes strongly in forward bending and push against the feet with the hands for added resistance, or walking on the heels to strengthen shin muscles. Self-massage of the lower legs may help with cramping toes.

Adductor muscles can also cause foot pain, particularly in the big toe or at the ball of the foot as an unintended consequence of the popular notion of ‘activating the adductors’ in standing poses. Adductors are powerful synergists of all leg movement and don’t need special attention – this only makes them tense and weakens the hips via reciprocal inhibition and is seen in yogis who routinely practice large quantities of standing poses but are unable to sit in Baddha Konasana. It is useful for beginner students to activate Adductor muscles by squeezing the knees in inverted poses such as headstands because this activates core muscles and the shoulder girdle via the fascial connection to the abdominal obliques. Standing poses are better for the feet and hips if they are practiced with the feet naturally grounded and weight distributed evenly throughout the foot. In squatting and one legged balancing poses, the body’s weight should be slightly more in the heels – heel action activates the hips – which is how the body functions naturally.

Reading sources:
Kendall, McCreary, Provance, 1993, Muscles: Testing and Function
Sharkey, 2008, The Concise book of Neuromuscular Therapy