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.picture of shin muscle being stretched 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

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12 thoughts on “Foot pain and yoga

  1. I am so happy to find this article. I have been practicing yoga with regularity since December 2012. I am a former dancer and I’ve flirted with running. I run into foot pain during standing straddle splits. The pain is on the outside edge of my foot and prevents me from going deeper. I have talked to my teachers and they are also looking into it. Do you have any ideas on why? This article was very informative, but I’m not sure of all the foot anatomy and how it applies to me. Thanks for the article and any reply.

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    • Hi Lindsey
      I can tell you my ideas if you can give me a little more information
      When you stand in straddle, how low are you going? Are you managing to keep your feet flat on the floor or are they pronating (the arch rolling inwards) or supinating (the arch rolling outwards)? Is your weight on your heels or evenly distributed across your foot?

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      • I try to have the weight evenly distributed, but it’s probably more on my heels than I realize. Also, I probably have the tendency to roll the arch outwards. These are my guesses, but I will ask my teacher to check during the next class too.

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  2. It’s possible that your foot pain comes from tightness in the muscles of the lower leg from dancing and running: you can check that out by massaging your lower leg, paying particular attention to the deeper muscles on the outer sides and then stand in straddle and see if you feel more comfortable. Massage and stretching should then bring an improvement
    If not, the problem might be in the arch of the foot or the upper leg or hip and it would be wise to see a professional who could diagnose the source of your pain.

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  3. I love how you shed light onto what could be causing the pain and how to handle it. Very informative and insightful! Thanks for sharing!

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  4. Niki-

    I’m an ex-jock (male) who had lots of ankle sprains/issues throughout my career – turned to yoga five years ago and love it – Vinyasa, Power, Bikram, etc. you name it – last six months my “good” ankle – the one with less damage – became “inflamed” – the top front portion in the pronated position. I thought it might be a hairline fracture of the talus bone – have had x-rays and MRIs now and nothing is showing up. But area is still sensitive/vulnerable – pressure as basic as Child’s Pose will make it spark up. Any experience/ideas for this issue? Or will I spend my life with “toes curled under”?

    Thanks,
    Dean C.
    Chicago

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    • Hi Dean
      Apologies for not replying sooner, I missed your comment.

      My feeling is that you either have a strength imbalance between your shin and calf muscles, or that you are unconsciously putting your bodyweight onto your ‘good’ ankle in this position to spare the ‘bad’ ankle and it is taking strain. Try deliberately putting all your weight on the ‘bad’ ankle and see how it responds to the pressure – if it’s uncomfortable, you may need to always use the toes curled under position.

      If you have a strength imbalance between calves and shins, that can be caused by doing too many poses balancing on your toes. This would make your shin muscles and tendons tight and the pressure on them in child’s pose would get unpleasant. The antidote to that would be to spend some time walking around on your heels, if your previous injuries allow for it. Try this for a while and see how it responds. If it helps, you need to balance time on the balls of your feet with time on the heels.

      Let me know if that helps
      Niki

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      • Thanks Niki – just checked back in and I will try this approach. With rest the sensitivity has improved over time – but I’m not back to my old practice frequency yet. Appreciate the follow-up – will let you know how things evolve.

        Dean

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  5. Hi Niki, I am a 63 year-old male and I have been practicing the Ashtanga primary series for over 8 years. In the last 6 months I have been having trouble with the bottoms of my feet but more with the right than left foot. Symptoms: when standing/walking in bare feet, I feel like I’m standing on a pebble or folded sock with some numbness. I’m getting some tingling in the 3rd toe to the right of the big toe in the right foot. I have no pain, just the feeling I am standing on a pebble located in the fleshy area behind the 3rd toe. Have similar symptoms in the left foot, but not as bad.

    A podiatrist examined me and found some grinding and swelling consistent with Morton’s neuroma (interdigital perineural fibrosis), which is a thickening of the connective tissue near a nerve junction in between the area behind the 3rd and 4th toes.
    Treatment: injections, padding, surgery. No way to reverse scar tissue formation.
    The literature says this is more common in women and caused by wearing high heels with a tight toe box. Mine is due, I think, to not being able to keep/get my heels on the floor (being up on my toes) in Downward Dog during Surya Namaskara A & B.
    As I mentioned earlier, the symptoms began about 6 months ago and they have been getting progressively worse.

    I do not want to stop practicing, but I am concerned the problem will only get worse and I will eventually be forced to stop practicing and have surgery which would lay me up for 4-6 weeks of recovery.

    I have tried modifying my practice using a wedge made of cork to place under my feet when in Downward Dog to take the pressure of the feet. This seems to help some. The other option I am exploring is to learn the Vinyasa Krama tadasana sequence and other Vinyasa Yoga sequences from Anthony Grim Hall’s books and videos as taught to him by Srivatsa Ramaswami, who studied Vinyasa Yoga with Krishnamacharya. The idea here is to maintain/modify my Vinyasa practice by not doing the standing poses that seem to be aggravating my problem, and replace the standing sequence with other Vinyasa Krama sequeces so as not to lose the ability/benefits of the yoga practice I have.

    Any help or suggestions you could provide would be greatly appreciated. Thanks!

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    • Hi John

      I would be more inclined to suspect that jumping back into chaturanga is the original source of pain. It’s possible that you hurt these toe joints at some point and continuing to practice keeps them inflamed. I did that to myself a couple of times jumping back on a hard floor and it takes a while to heal, especially as you get older. Any poses when you are up on your toes will continue to aggravate the problem and I highly recommend avoiding jumping back, chaturanga and any other poses that have you on your toes – intentionally or otherwise – also, ice and ultrasound therapy.

      Ultrasound relieves pain, reduces inflammation and breaks up scar tissue. It’s particularly helpful for connective tissue problems and you may only need a couple of treatments if you follow up with regular ice treatment at home. I suggest that you see a sports therapist or a chiropractor that utilises mechanistic modes of treatment (as opposed to the vitalistic school of thought).
      Podiatrists tend to work with the results of long-term usage of footwear rather than sports injuries and may give you a more negative prognosis and only surgical options as opposed to someone who treats athletes for injuries.

      Do you have limited ankle mobility? This will also put more strain on the joints of the feet. Getting your ankle joints mobilised will help, if this is the case.

      I looked at AGH’s Tadasana sequence as published on his website and I think that the pasasana and low utkatasana may be problematic for your toes if you have limited hip and ankle mobility and cannot get that low with feet flat on the ground. If that is possible for you, then I think you should look at getting Quads and hips much stronger as a way of improving flexibility in general and especially in down dog. These muscle groups are commonly quite weak in long-term Ashtanga practitioners and muscle balance needs to be restored before stretching has any effect and will take the strain off of your toes. Wedges can only take some of the weight off of the toes and continuing to do this doesn’t address the root of the problem.

      Niki

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      • I began physical therapy yesterday and I gave the therapist a printout of our discussion. The therapist said your advice was spot on. The first session involved intake, an exam, followed by icing the soles of both feet for 20 minutes while providing electrical stimulation. This was followed by ultrasound treatment of both feet. Feet were a mildly sore afterward. Glad I found a good PT through a friend and he seems to be what you described I should look for in a therapist. A good beginning. Thanks again for your help!

        John

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