We discuss in this interview about improving feet and ankle mobility:

  • The complex nature of the ankles
  • Connections with posture and other elements of the body
  • Lower level biomechanics
  • Breathing exercises
  • Reducing tension
  • Squats
  • Balancing exercises
  • The importance of weight loss
  • Elastic bands
  • Ankle rotations
  • Interactions between fascia and muscles

Clint – Welcome back to RheumatoidSolutions.com! Today we’re going to be talking about feet and ankle mobility, and also strengthening exercises. If you’ve got problems in that area, or discomfort, or rheumatoid arthritis in the ankle, or if you feel that you’re alignment’s out, or if you feel that the whole area needs strengthening or you just want to learn more. Then, today’s episode is going to be great for you and to guide us through this. I’ve invited back one of our specialist coaches inside Rheumatoid Support, which is in our sports forum area, and his name is Carl Reader. He’s been on the show many times and he’s helped many people inside our sport for him to improve different areas of their body through optimal use techniques. Techniques that are natural for the body, and can also help to build strength and flexibility. Ultimately, to relieve pain in painful joints. So, Carl, welcome back.

Carl – Clint, it’s good to be back. Currently, I was just recovering from COVID and I’m very glad to be back and joining you guys. It’s nice to be able to talk again.

Clint – Yeah, I’m sure, and thank you for doing this. We were scheduled for last week and you said you just need another week just to be able to do this professionally. Before we get into all of the stuff that we’ve got planned today, I think it would be interesting for the viewers and for listeners just to hear about your experience, I drew the metaphor before we got started here. If someone like the Rock or Dwayne Johnson can fall susceptible and contract COVID and his whole family had COVID, which affected him a lot. It just shows that no one is immune to this naturally, and you being a health, fitness, and strength coach. It just goes to show that we’re all exposed and we all got to be careful. Tell us what was your experience was, how you feel that you got this, and how it affected you and your family?

Carl – My wife was around some people, like friends, and it was just a local playdate with the kids. They told us they had covid and we waited about nine days, but we had no symptoms or anything. Then suddenly after the ninth day, me and my wife had bad flu and lots of headaches came. My wife struggled with her breathing, which is not a fun thing to go through. We haven’t been vaccinated yet and it hasn’t gotten to our level yet. During that time, we were just very weak and tired. You’ll notice with my talking that I’ll be talking less passionately this time. I can just even walk like one mile and you are finished. Then, you just have to come home and sleep. Even now after this interview, I might go lie down for half an hour and just rest, it’s pretty hectic.

Clint – Obviously, I’m very sorry to hear that you went through that and around the world so many people have been through similar situations. Thankfully, you’re on the other side and you’re going to have a full recovery. Also, everyone in the family is healthy and that’s the main thing. Thanks for being so good and still being here to share. It must be good to be able to do something productive and useful after feeling probably not many of those sorts of feelings over the last couple of weeks.

Carl – It was such a challenge for the family and my kids had it as well. You got no support because no one wants to be or can be around you for two weeks. We had it for two weeks and that’s pretty bad. It’s a real mind game more than anything you just mentioned. Just having to stay strong and not entirely getting back to life and exercise. I know that’s quite relevant with the ankle and feet because it’s something that also takes time to deal with foot pain, it really tested my patience.

Clint – Let’s move into that part of our conversation. Last time we had a really well-received conversation about upper body exercises using elastic bands. They are bands that you can buy online very inexpensively. If you didn’t watch that episode and you’re interested in building upper body strength, back shoulders, chest triceps, and you just want to have a very inexpensive workout at home. Then go and check out the most recent episode that Carl and I did together, and you can see it at rheumatoidsolutions.com. Just search for Carl and you’ll see that, and you can also download a free PDF on those exercises. You can follow them at home if you just want to grab the cheat sheet. Today, we are going to talk about feet and ankle mobility. Why don’t you guide us through some of the ideas that you had to share with us? Then, I will jump in with questions and ask as we go.

Carl – It’s quite popular for a lot of people to have struggle with the (inaudible) and the ankles. They’ve been advised to do ankle exercises. There are usually three camps of people or groups and there are those who do ankle exercises, but they do hate them and they feel worse afterwards. There are also those who do it for thee benefits and to feel great, and it’s a great way to maintain it. There’s another group that I work with along and they are quite popular. This group doesn’t do any ankle exercises, feel their core, squats, and sort of whole body exercises but still there ankles feel better. You have to know where you are or what camp you are or what your experience is? But it’s important to be aware that it’s the ankle and it’s very complex. It composes of 22 bones, 33 joints, and over 100 soft tissues, tendons, muscles, and ligaments. It’s a very complex part of the exercise.

Clint – Can I just clarify something there? You said that a lot of the time when you’re with your clients, working on the upper parts of the leg can actually experience improvements to their ankles.

Carl – I just have a client now in the US, who we are working with, she had some sore ankles. The main thing that she said was, please help me with my core and with my back. We started doing exercises and I asked about the recently healthy ankles. Then she said, they are good and I just haven’t any pain. I haven’t done any ankle exercises with her. The ankle is very susceptible to posture. So any possible changes and obviously weight gain is a problem as well. But if you can improve your posture even slightly, it has a huge effect because of gravity and it’s the foundation of your body. Any changes in the posture can go down to the ankle.

Clint – It does make sense, doesn’t it? When we would seek to improve our posture, are we talking about maybe getting those shoulders back, chest out, and not slouching at the table? I mean, walk us through some fundamentals there.

Carl – Ideally, when you’re standing and your other knee is slightly bent. A lot of people have that sway back postural and they’ve got too much curvature in the spine. It’s trying to get the balance in the curvature of the spine back in order as possible. As you said, getting the shoulders not to hunch forward and a good alignment at all. It sort of impacts directly on the arm and the ankle. Obviously, if you got pain or if you got back pain or you got knee problems then there’s a lot of compensation and shift weight. With that, the foot starts getting too much weight on one side of the body. I see often people say when they stand 80% of their weight is on one side. The ankle is taking it all pretty much and you’ve just shifted all the load on 1 ankle, and that’s a big problem.

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Clint – Fantastic. I can certainly attest to issues that arrive with the ankle. It happens when you don’t have a nice balance weight between both legs. I used to have an unbelievably swollen and inflamed left knee for years with inflammation limping awfully. People would look at me and thinking, how can that guy is not in the emergency room with the amount of pain and discomfort that he would get around with. Then for subsequent years of just having bad osteoarthritis in that knee and sometimes favoring it perhaps going up the downstairs and so forth. But as a result of that, I don’t have inflammation in the left ankle, but it rolls in a lot. The left ankle is more rolled in than my right ankle is, which looks completely normal. So that sounds like a consequence of the upper body area having problems like we’ve been discussing.

Carl – We have to look at what we call lower level biomechanics. The whole leg (mainly your glutes), your buttocks, muscles, and your hamstrings are the key to stopping what we call over rotating of a lower-body anterior rotating. We’ll touch on that later once we get on the balance exercises. But a big thing is, which is really important for listeners to hear, you want to reduce what’s called neural tension in the nervous system. What does that do? It’s just basically from pain or from stress and it causes the calf muscles to overwork. When you talk to most people, they’re always calling it calf stretches or some sort of calf exercise. You want to get the gluteus hamstring to do most of your work when you’re balancing and not the calf muscles. A lot of people doing balance exercises over with the calf. The key thing here or the big problem is the calf stretching that people do. They put their leg behind them to stretch the calf muscles and it actually causes an over pronation in the ankle. You’ll notice when you do a calf stretch, your whole ankle collapses. It tries to stretch your calf muscles and it actually can really compromise the ankles, especially if someone like you is prone to that rotation.

Clint – All right, that’s good. We’ve learned so far that posture is in the forward plane, the chest outback, shoulders back, and all of this is really important. I also have soft knees when we’re standing up. We want to keep our weight balance as much as possible. We’ve learned that the ankles are susceptible to all these things like limping, balance, and so forth. Everything that happens in the upper part of the body can play a big impact on how the ankles end up. Let’s talk about what we can do then. Both through the upper body strengthening, stretching. As well as the actual part that we’re worried about itself, which is the ankle and the foot.

Carl – I think if we start with them with the most important thing. The ankles love when you do what we call breathing exercises. One of the biggest secrets is just letting go of tension, even if it’s meditation or deep breathing, just let go of the tension. It’s important because it’s that wiring like the nervous system that affects the ankle. Whenever you do ankle mobility exercises, you always want to have a little leg bent. A lot of people do the ankle alphabet and they do ankle rotations. You always want to make sure your leg is bent and never do with the leg straight in front of you. It is because that puts tension on the nervous system. I think we’ve talked often in our podcast about learning how to squat properly. It is because if you are squatting correctly, like getting up and down from a toilet or a chair, your knee goes too far forwards and you compress the ankle joints. Wherein, it promotes that whole falling arch overpronating. In simple terms, just learn how to squat properly, which I’ve been doing with my clients a lot now. It just has a profound effect not only on the ankle but also your whole body.

Clint – Let’s just pause there and talk about the squat. The one that you’ve shown me in the past inside our forum. It just basically putting an object behind you so that your buttocks can come down to touch a certain point. In the gym, a lot of the heavy lifters call it a box of squats. But in this instance, the box in inverted commas is quite high to begin with. We want to put our arms out in front of us to create a counterbalance weight in the heels, lean back, and touch our bottom against something. At first, it was quite high, easy, and just do a whole bunch of them. Then with time, slowly lower the elevation so that we can get a bit deeper. Am I correct?

Carl – Correct. A lot of the gym guys or in general talk about not in the knee of past the toes. The key thing is you should not go across the midfoot. There’s your foot and you only need to be in line with here, not in line with your toes. It is because that puts too much strain on the ankle joints. You get compression on the ankle joints and then that compromises the toes and the mechanics. Weights in the heels are fine in the beginning but you do want to try and get your weight more in the midfoot as well. It is because when you put your weight in the heel for beginners, which I do teach, it activates the glutes, the buttocks, and the muscles. Eventually, you want to try to get your weight even distributed. We are talking about a grounded sort of feeling. Some of my clients say they feel that they are anchored and that is helpful because it pushes the whole foot. Otherwise, putting too much pressure on the heel can have a long-term negative effect or be non-functional.

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Clint – Okay, that is wonderful. What is the next step or what is another tip?

Carl – A lot of people’s calves are tight and there is a solution for that. You can get on the other side of the step or some telephone books or whatever and just stand. Then just drop down slowly and you’ll get your calf stretch. As opposed to putting it behind you, reaching back, and it kind of stretches out the calf muscle.

Clint – Ok, so would you say that your body needs to be more vertical than leaning forward?

Carl – You will have to lean for a little bit to get that stretched. But you’ll get less compression and rotation in the ankle joint from doing that. If you were to put the leg behind you and try to stretch out, which is very common.

Clint – Ok, a slight bend in the knees?

Carl – A slight bend in the knee and just listen to it. We have a body awareness in the ankle because you are going to get compression. If you do and I’ll take you guys through this. But what I like to do is I like to do pointing exercises with my clients. When you point the foot down or you point your toes down, it then opens up that joints. Then I go do the calf stretching while standing up. It is because very often, there’s a bone called the tallus that sits on top of your heel or the calcaneus, gets restricted or blocked. When people try and strengthen or try to stretch that calf muscle, they actually get what they call a bony limitation and it is like a stuck feeling. Then they get a lot of compressions and it aggravates that ankle. To visualize the pointing of the toes, we can do our stick drawings. The pointing of the toes really opens up those ankle joints and it’s a very nice exercise. You can point it down and try to cool your toes as well. Hold it for 10 seconds as well, while you are pointing it down. It’s avery good exercise for the smaller muscles.

Clint – I’m doing it right now. I’m barefoot at the moment and I’ve just squeezed my quads. My legs are straight out in front of me and I’m pointing my toes down. It feels good on top of the foot.

Carl – It’s correct if it opens at the top of the foot.

Clint – For those of us with kids or who’ve witnessed kids who just sit on the heel or sit on the sort of calf muscles. It is like in a Japanese style, as they say in yoga. You will do this for seemingly like an hour at a time. The foot is totally outstretched and flat against the floor. It just seems like a functional or natural position for the foot to be in. Whilst I cannot sit on my heels, I actually think that it’s preventing a natural range of motion. Otherwise, human beings should be able to go put themselves in.

Carl – It’s one of my advanced moves, but it’s something that I do quite effortlessly. It’s has a lot to do with neural tension and there’s a lot of tension in the nervous system. It’s very hard to get that release all the way down in the body and obviously the knees. If you got compromised in the knees and the hips then there’s a lot at play. But just another tip for people doing the squats, you should use a rollator. It’s also good for the ankle and you’ll only stand on it. It’s easy to use because you’ll just put your heels on top of it. Obviously, you’ve got like a little bit of an elevation and it’ll help you to squat easier. It will just take a lot of pressure off your Achilles tendon and the calf muscles. It is because if you are restricted in the ankle and the knees, that makes squatting so much easier, especially for clients who are struggling with bad ankles or hips. I put the towel on probably about an inch and a half, and that really feels like a heel. You feel like you’re wearing heels and then you squat down.

Clint – I’ve seen that at the gym too. When I first started going to the gym, I was about 20 or something, I have no idea what I was doing. My friends and I used to squat with a 45 lb plate underneath our heels, and it was used to get some elevation. We had no idea why we were doing it other than we were seeing other people do it. It’s not as common with these sorts of trends and fashions at the gym, and I don’t see it as much. Barefoot squatting seems to be really popular at the moment at the gym. There are just guys squatting in their socks or even barefoot or even joggers with a very little heel underneath and I see that a lot. Over the years, I witnessed a lot of people squatting with their heels up.

Carl – If you’ve got very tight joints, has pain and you’ve got back problems. It’s a great thing to do and it makes it much easier. When you try deep squats, you’ve got physical limitations and neural tensions. It can start damaging and compromising other areas of your body. I like the (inaudible) and that’s more advanced. If you’ve got the ability, then go for it. But for those who are struggling, you just need a sort of prop to help you.

Clint – Yeah, I love it. What’s next on our to-do list here, Carl?

Carl – Yes, especially when you are letting go of that tension. A lot of people do like to pull the towel while they are barefoot. They use toes or something like that to pull and you’ve probably heard that as well. You can also use marbles to sort of picking them up from the floor. You’re looking at what’s called an intrinsic small muscle and it does help. There have been people who benefit from that. Just remember, if you lose your hands or you were born with no arms or hands. The brain or the body is amazing how the neuroplasticity can actually use your foot as a hand. With your foot, you can write and you can pick up something. Those intrinsic muscles are used as a redundancy in a sense. But in terms of supporting arches and foot pain, there are some who benefits from it and some don’t. It’s very difficult and it’s a very fine motor skill. As I said before, you got to look at more the upper limb body mechanics, which you can go into now. You can also do sorts of balancing exercises and that’s what we need to work on. It’s so important to get that control to stop that rotation of your lower body or lower limb turning inward. Does that make sense?

Clint – Yeah, it certainly does. Can you guide us through our balancing routine?

Carl – The most important is the glutes and you want to do those exercises while standing up. There’s a lot of exercise that you see people lying on this side and that’s called the clam. This position is sort of open up and it does target those muscles where you can lift your leg up in the air. It does target the glutes but it’s not functioning on the ankle. The solution for that is standing up and you would probably be barefoot. The secret here in this balancing exercise, you must have the knee in a soft position. If that’s your knee, it mustn’t be bent but just be relaxed. Just loosen the knee, which then gets what we call the posture chain muscles. It includes your hamstrings, your, calf, and your glutes to do the work. Most people do when they do a balancing exercise is they lockup that knee and they find the calf muscles doing all the hard work, which you don’t want. It is because the calf is not your balance muscle. Your balancing muscles are the glutes, your buttocks muscles, and the hamstrings. When you do balancing, you should look straight ahead and don’t look down. It is because that also puts tension on the nervous system.

Carl – Love it. My experience from doing lots of yoga over the years is the more you balance on one leg, the more secure and strong you feel in the ankle. The ankles are working like crazy during those times

Carl – Those are fine and they are the little intrinsic muscles. You’ve got like a hundred soft tissue structures that are doing stuff at a level that we can’t even comprehend. It’s just by doing basics, which is balance and that’s key. I’ll be cautious to advise the listeners that it depends where you are in your journey. But be careful of wobble boards and you might just want to stand on a towel. If you get too much wobbling action, you actually can really be in a lot of pain. It can really be too quick and you run the risk of twisting your ankle as well. I find that it puts a strain on people’s ligaments. I’m quite reluctant and I’m very cautious when it comes to safety, especially for clients. I always remind my clients to be careful to jump them onto wobble boards or soft mats. A yoga mat is good and you can use it. It gives you not too much, but you buy those naturalistically because you can cause a lot of pain.

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Clint – Yeah, those wobble boards are too big to be on what we’re trying to achieve. I think we’re trying to talk about standing 1 leg here. We’ve talked about balancing, but we haven’t really spelled out that we’re talking about getting on 1 leg and slightly bent knee. We’ve got to look straight ahead and really concentrate on trying to hold the balance. I imagine that at first, it’s ok to reach out and maybe even put one finger on a chair in front of you while balancing on 1 leg. Just a little challenging before you’d be able o to advance onto no support.

Carl – Yep, very good. The key is to focus on the knee and not the ankle. Quite a lot of people and I coach them online, especially they struggling with that over-rotating. They try to go to the other extreme on the outside, which you’re going to be careful of. Some people just do it to avoid pain but try to stay in a neutral position. Try to find what that feels like and then concentrate on your knee. If you concentrate on your ankle, your real brain goes to where you’re given instructions. If you were trying to focus on the ankle and trying to be so much on that neutral position, the knees are going to shake. If you can keep a knee in a good alignment, like straight or not letting it go towards into the midline, then the ankle naturally just stays in a neutral position. It’s a little subtle change, but it makes a big difference to focus on what are the knees doing rather than your ankle.

Clint – Fantastic, that’s a great tip. If people have learned nothing else except just listening to this concept of balancing on 1 leg and trying to hold that position for as long as possible, then this will strengthen and improve the ankle. Then this will be a valuable use of your time. I have found that personally and definitely over the years by going to yoga. Interestingly, I always felt like as the ankle got stronger the whole balancing ability just explodes. It almost feels like the weakest link I feel in a lot of the balancing exercises. In my case, I used to have to concentrate on just trying to not roll left or roll right at that ankle. It is because at one point when the ankle was inflamed on the left side rolling into it, it really aggravates it and I noticed that the next day. When I was in these standing positions, I was like, do not roll left and right. I must stay right in the middle and I was happy just to put the other leg down rather than falling for more than just a brief moment. Immediately the leg would go down on the other side to stop rolling into the painful areas. This really works and this really strengthens the ankle standing on one leg.

Carl – It’s because you’ve got the lower limb mechanics and it’s the whole lower limb part of the body. It’s like the whole kinetic chain that we have talked about. In the past, this hasn’t been a success because it didn’t produced good results. From my own experience, while I was starting out 20 years ago when we did these exercises. But we didn’t do it because we didn’t see a lot of good results. It was because most of the time we had clients and patients standing in the clinic, and their legs and knees are locked. They were just trying to balance on the ankle, and it actually inflamed and aggravated it. But when the minute I find this whole thing softening the knees. The other thing I want to bring is just a slight forward lean from your hips and not standing upright. Some are the extreme will be the airplane position and you also see people do lean while their hands rock forward. You can do that if you’ve got the mobility, but just very slightly lean. It will then start to bring on the glutes, the buttocks, muscles, and hamstrings. Remember, you don’t want to remain too upright. You can to the advance lean and it does help to bring on the glutes, especially if you’re running or walking.

Clint – Okay, great. I have a question regarding a little elastic band that I have here around my ankles. But I want to bring that up once you’ve sort of exhausted everything that you already had planned to talk about with the ankles before we move on with the feet. Is there anything else you wanted to add about the ankles?

Carl – I like to do where you have to shake the legs. I (inaudible) sitting down with my feet flat on the ground. You just sort of shake your muscles in the lower limbs. I also just shake my hand to release the tension. For example, you’ll see like tennis players, sort shake it off and it just lets go of that neural tension. By shaking the legs, shake your legs in a comfortable position, and not by a wide open and close movement. With that, you’ll damage your hips and knees, and it also has a huge effect on the ankles. Actually, the ankles love releasing tension. When you let go of the tension, your ankle feels like it’s soft and mobile.

Clint – Are you going to demonstrate that to us in a minute or is that the other one?

Carl – The shaking one?

Clint – Yeah, I just can’t quite get that one right in my mind

Carl – You just basically wiggle like I could shake off like shaking.

Carl – Actually, there was a client the other day and she said that she did it at a conference. Then, I said it’s a nice thing that I’ve discovered and it’s amazing how it releases attention. Then I also said, that’s it and you to get rid of the tension.

Clint – Yeah. It’s almost like this is the weird way of putting it. It’s almost as if you’re trying to like wiggle fat on your legs, even if there’s nothing.

Carl – Yeah, it feels kinda weird.

Clint – It’s good and it’s the best way I could describe it. OK, let’s shake it off.

Carl – You should be careful with the ankles. It is because when you change and start to mobilize the ankle, sometimes it realigns. Then the knee and the hips are like, what’s happened? You might end up getting knee pain, hip pain, and sometimes the (inaudible), which is the sacroiliac joint where your pelvis and spine meet. It can get sore and you just got to be careful with those things as well. Sometimes when I overdo my ankle, I feel my knees are sore and I’m like, why does that hurt? Then I go back, do a squat and it’s gone because I’ve been experimenting or developing exercises with my ankle. If you notice in climbing when you do too much ankle works, the knee is the next up the chain and it sort of complains.

Clint – Ok, all right. Anything else then before we talk about my band here?

Carl – No, I’m happy with that. The elephant in the room, in a sense, is the weight loss and it’s a big part as well. If you can lose weight, even in small amounts, you need to reduce that load. Obviously, if you get bedridden that is not easy. Just any sort of cardiovascular tackling or something that can just get a bit of (inaudible) and it’s very important.

Clint – Okay, great. Anyone doing Paddison Program will find that if they’re carrying excess pounds beforehand, they should find it fairly easy to shake it off. We have a lot of people, who at first have a little bit of a weight issue, but they can certainly find it easy to lose the excess pounds with their dietary adjustment. So that’ll help their ankles, which is another bonus. For those people listening to this, we’ve got a massive rubber band and you can get these online, and these are also inexpensive. You can get a set of them and they come in different grades of challenge, and the one I’ve got here is a light one. We talked about my left ankle having the overpronating, meaning that I’m rolling in towards the area between my feet. What I have been doing recently, intuitively feels right certainly doesn’t give me any pain, I just stand with my feet at shoulder-width apart position and I just have this band wrapped around my ankles. Then I simply roll my ankles out against the band and what I find is that they feel good afterwards. It just feels like I’m doing something to counteract that evolution of misalignment over the years. Do you think that it’s going to be ok? Do you think it has promised to actually create some positive changes?

Carl – Yes, certainly as long as you also have that soft knee position. It is because you don’t want to be just doing too much in the ankle. You should also be working a lot with the glutes and the hamstrings in that exercise, which we call the external rotators. You’ve got that internal or external, and that’s very important. Now, are you coming up on your toes and doing that as well or are you just standing up? And that might be advance as well and it’s quite good to get up on the toes that have been extended rotate as well. You’re kind of doing that action, which is what I work a lot on as well. I use that especially for the surfers in your community and for the athletes as well. We also get them to get that ankle mobility there.

Clint – Yeah, great.

Carl – The minute you lose is the minute you get that overpronation, especially in balance sports. You lose your balance quickly, so we work on that a lot. In which, they sort of tend to roll out onto their feet as well.

Clint – Yeah, good. So coming up onto the toes, just slightly if I want to experiment with that. Then externally rotate the ankles against the band and then back down again.

Carl – Exactly. It’s alright if it’s half an inch or just a little bit to play with that lifting. It’s called a pharyngeal break, it is where your toe is at a 45-degree angle. When you step up as you’ll notice with my hand, it sort of rolls at an angle. When people do step-up exercises, they tend to do that. They tend to just stay on their big toe, but you actually want to go onto the side toes in the sense. With that, we can get a better balance and even when you’re walking. When you walk, your toe tends to come to the side and also while standing on your toes. I see a lot of patients and clients that they want to stay on their big toe. Unless they roll completely off to the side but just try to feel all those toes are bending or flexing, and that’s a good exercise.

Clint – Okay, nice

Carl – It’s a normal walking exercise.

Carl – I can see that here because the toes, given that the big one is further away from your heel than the little one creates, a 45-degree angle. All right, let’s move on to the feet. I’m sure some of the concepts we’ve talked about can also be applied to our feet. Could I bring up the challenges that we hear about in the rheumatoid community a lot, which is insufficient foot arch? It is something that comes up with pain in the metatarsals, which is maybe a little beyond the scope of what you can address. It is just physical things that obviously remain a big challenge. But it’s not maybe something we can address just with mobility exercises. It can be anything else that you think could be helpful if people are not optimal in this area.

Carl – Even learning to squat or paying attention to what you do throughout the day can have a huge effect on your feet. Standing too long, be aware of those balances, asymmetries, the weight shifting, and that’s a big thing. A lot of people on YouTube are mobilizing their feet as well. They are putting their toes back in and that’s not my area. Just make sure you work with someone who maybe can guide you to that process as well. Self mobilizations do work, but it can also be painful. If you’re not trained to know what to do or push it too much, it can be painful. The things like where you’re twisting your feet, and rolling it in and rolling it out. There’s a lot of that online at the moment on YouTube to help improve mobility. But again, just make sure you do that cautiously and see how you feel afterwards.

Clint – With regards to that pointing of the toes that you talked about before, which stretches the top of the feet. Intuitively when I do that, it seems to feel good to improve my foot arch. It feels like the muscles under my foot are being recruited to pull my toes down and to do that stretch probably in conjunction with calf muscle. I look at my foot in that position, especially when you curl the toes, there’s an excellent foot arch. I think I like this approach to try and improve my foot arch. Do you think that over consistency can improve the arch-like that?

Carl – It’s my number one go-to and I start with that first. The pointing of the toes for the whole for 10 seconds and I bolted to 15 seconds, depending on how people respond. But I definitely see once they start to then do the step up as well. When they do that, after developing their basic strength as a progression, then we do see slight changes. It takes time to improve it for us, but there are definitely benefits. People definitely respond to that pointing of the toes as if it’s a natural movement. It really gets all those muscles and all the different flex muscles engage as what you’ve said or feel. You’re getting the strength of those muscles and plus you’re getting that top part of your arch released. We said that when people sit down at a chair or just in general, they sit often behind the knees. They’re not getting that mobility of the point. I mean, how are you pointing your toes and you’re not getting that full range of motion? I think that is why you also like it.

Clint – Okay. My football team here in Australia is the Parramatta Eels and one of the playmakers got injured in last year’s finals. I was reading the detail of the recovery therapy that he was given. It is because he came back to play for only 2 or 3 weeks after he did a major injury to his knee. One of the exercises that they had him doing was a toe exercise. Wherein, he had an elastic band and was using his big toe while doing toe exercises. Now, given that we’re on the topic of feet. Have you ever used any kind of toe resistance exercises like I’ve described here and any benefits?

Carl – I haven’t used bands, but I do get some of my patients who can do to lift their big toes up. It is because it’s very hard to spread your hands. But it’s also difficult to sort of spread your feet and your muscles unless you’ve got some sort of gift of mobility. The big toe is as important and as what we call in the medical side, the windlass mechanism. As the big toe bends or as you push on it, it has a pulling effect on the arch. You need mobility because it is important. Often people with rheumatoid, lose that big toe or it gets inflamed or they don’t get that flexion and that makes it quite tricky. But you are just starting off with the mobility exercises. Just try to move your big toe and learn is enough as a resistance. I personally haven’t tried that and I can see how that could work, especially for football players. You have to be guided by how you feel at some point and your awareness also. You should always notice the effects after you’ve done the exercise. I’m amazed when I speak to people online and coaching them how they’ve been for 3 to 6 months of pain and I think they still keep going. As I just said, maybe give it a couple of days but don’t continue just on and on. It’s tricky to give exercises that are not natural and you wouldn’t really be using your feet to grab onto something. You don’t need that sort of strength unless we talked about you writing with your feet or you’re doing those sort of exercises or tasks.

Clint – Yeah, absolutely. It just gave me an idea about something we had agreed to talk about but we haven’t covered it yet. What are the cautionary steps prior to anything we’ve discussed with people if they have inflammation in the ankles before they get started? With that, we don’t end up having counterproductive outcomes?

Carl – As I said, you want to start with your releasing tension. In a way that they have to release that tension and they can do breathing meditation or just let go of that tension. Then with any sort of ability, try to do the mobility with a leg bent. Like I said, you can restore your heel on your knee, and just do it smoothly and slowly. Sometimes the ankle clicks and there are restrictions, don’t try to push through those restrictions. Just sort of work the other way around and some people do the alphabet. They write the alphabet by stretching their ankles. The positions that you’re going to feel are restricted and I think it’s with the ankle. Whenever you try and push it, that’s where you start to get the pain. Rather than that, do the pointing exercise a couple of times. Then, keep it there and then go back to another exercise. But don’t push through restrictions of the ankle because you can tell a second base very often.

Clint – I’m just throwing things off the top of my head, about things that I’ve tried and seen. What about ankle rotations? Extend your leg out in front of you, off the edge of a couch or something, and just rotate them one way and then the other.

Carl – Yes. Again, you must have something on your knee. Don’t do that with your leg stretched, especially with people who are prone to calf tightness. You are not going to get that ability that you’re looking for there. Always remember, you can always switch exercises. If you try something and it doesn’t feel comfortable, stop and maybe do a calf stretch or maybe do a step up. Then if it doesn’t feel comfortable, then go back to a rotation this way. It’s so individualized and that’s what the coaching helps. But just to switch it up a bit, don’t just do 12 this way or 12 that way. It is because you’re trying to unlock it just like your 33 joints that are moving all together with 100 muscle soft tissues. If that doesn’t work or it doesn’t feel good, you should stop and maybe do some breathing. But try to find your own individual program that would work and what feels good. For example, I made my own exercise today and it felt so good. With that exercise, keep on with that or try and switch things up. Like the other day when I was lying with covid and we’re talking about the podcast with my ankles, I was like, oh hang on that doesn’t feel good. It actually made my ankle feel very unstable afterwards. You have to just pay attention to the effects of the exercise that are having on you.

Clint – Yep, great. What about using a foam roller for the calf muscles, hamstrings, and quad?

Carl – We must be in accord because I was about to talk about that. I’m 50/50 with those exercises because when you release, you must remember with fascia, it’s like the guy will stay off the yacht and it stays coming down. When you start to release on 1 side, the other side takes tension. You’re going to be very careful of just going in and just releasing fascia, especially under your feet. You’ll meet people, who want to put a golf ball or something, then you start having plantar fasciitis, and it’s excruciating or a painful feeling. If you ever try that or had done it with marble or golf ball, others haven’t walked for two weeks after using that. If you would be using the foam roller, I would maybe do what I call gentle foam rolling. I would be very careful to go and really try to release the tension in the calf. It just might relieve the tension in the calf that can cause problems down (inaudible) other way. I’m very cautious with those exercises.

Clint – Would we agree to say that, if there are no consequences that are negative after giving it a gentle go, is the principle of foam rollings fine?

Carl – In principle, yes, and that’s what I do with my clients online. You must balance that with strengthening, so you’ve got to get to the muscles while the fascia tights in the first place. It happens very often because the glutes, buttocks muscles, hamstrings, and your core are not strong enough. Whenever I give my clients that, I make sure that they are going to do strengthening. It is because if you release it and you don’t make those changes, then you’re going to end up with it even becoming even tighter or weaker

Clint – I love it. I’ve always talked about strengthening and stretching. I think it’s the triangle or the triad that includes strengthening, stretching, and releasing. It is whether that be tension or the fascia. With that, you could bundle those together.

Carl – Remember, the fascia always works with the muscles. There’s a whole lot of it because it surrounds the organs and every part of the body. The key thing is that fascia always responds to the muscles. If you have atrophy or if it’s groin, it’s a sock around the muscle. If the muscles are tight then the fascia gets tight. What happens now is if you go and release the pressure, which you haven’t touched the muscles and there is a very intimate connection between the histamine, a lot of things are going on there. The inflammation plays a big role as well. It is because you get the inflammation of the fascia first. It is because you can’t build muscle until you build to the sock. You need to release the muscle in order to release the fascia. People are firm running the fascia, but they’re not changing the strength or the mobility of the muscle underneath. With that, you temporarily feel good with the fascia stretching and that’s why it’s going global. It feels so good to do that but it’s in many cases people can end up in a worse situation. It is because they haven’t dealt with the muscle underneath, and it’s easily connected and also technical.

Clint – I love that. Would you say that it actually provides a sense of, not complacency, but something similar to that? Which in, can turn to create a situation where the person is. Therefore, it’s less likely to actually continue to explore things that are more beneficial. If you start to feel good from the rolling, you can get addicted to that. But you’re actually not then getting into doing it daily.

Carl – Remember the muscle is giving communication to the fascia and the fascia has to change to correspond. And that’s why when you do muscle building and you want to build strength, it’s the changes in the fascia that has something to do with estrogen. When we think of estrogen it’s all about the female hormone but there is also estrogen in men, and it’s one of the reasons it’s digressing. But why do women in that time of the month, often can feel very more flexible, especially in the seat. It is because it has the estrogen in the plantar fasciitis and it has receptors that actually help to strengthen fascia. It also serves as their hormone relaxant as well and there’s a lot going on there. But to get back to the point is, you’ve got to address the muscle underneath before you start exercising. If you’re rolling out your hamstring fascia, but you’re not doing any hamstring exercises or changing the way those hamstrings or the order of the sequence or how they pattern, then you’re going to get a temporary feel good effect. But you’re going to still end up with tighter fascia because the muscles are not doing what they’re supposed to do.

Clint – Fantastic. All right, there are a lot of great information here. What haven’t we covered that you’d like to touch upon?

Carl – As I said, I find that doing the ankle exercises is beneficial. But once we get people’s posture, their glutes are cool and working and have that basic core strength. It has such an effect on their posture, even those slight 1-2 degrees. How many people had(inaudible) on my client and even myself have. I just felt my ankles become really loose and supple, without even doing any calf exercises. Just to leave people with something just be aware of tension in your body, the effects, and the core of the body. We’ve heard so often that we should strengthen our core. It’s just amazing when that core is strong, the body is able to balance the pelvis and everything, the ankles are very grateful.

Clint – Yeah. Ok, and just while I was thinking. I wonder whether or not there are any comments you might have around walking? Is there a way that we should be walking? Should we walk with slightly toes out or should our walk be feet that are perfectly parallel when they land? Should we heel strike? Is there any sort of absolute musts that we should be paying attention to with walking?

Carl – I think walking is the most underrated exercise we can do and it’s so good. Then with some tips on walking, you obviously want a heel strike. If you’re in pain, people are going to compensate and just be aware of how you walk. If the balls of your feet are sore or maybe when your toe is sore, you might be making compensations there but his can lead to back troubles. Just do a smaller stride and try not to do too much uphill walking because that really overworks the calf muscles and it puts a lot of strain on the ankles. Be careful of walking on the beach as well, like with soft sand, it requires too much mobility and it can aggravate the ankles as well. Toes that are arched are for squats and deeper squats, You don’t want to have a squat, in my opinion, whenever you stretch your feet. Whatever you do, balancing exercises and that is by standing on one leg while the feet straight. If you’re squatting, the big toe turns out slightly. But when you’re walking, (inaudible) feet be facing. Obviously, there is a very slight (inaudible) as your foot turn a little bit. But you don’t want to walk where you’re trying to look like a duck.

Clint – All right, that was fantastic. There’s so much stuff that we’ve covered and I’m not going to go through and summarize all that from my notes. It is because we’ve had quite a natural conversation. Wherein, we’ve jumped over there, jumped here, and jumped there a little bit with what we’ve covered. I hope that it’s been really helpful for our audience. It looks like you’ve got one more thing.

Carl – When you are walking, try not to squeeze the muscles. It’s very common for people to be walking bracing and squeezing in muscles, just try to get away from that. I know that the concept of trying to work your tummy muscles or your glutes, but again that adds attention to the body. When you are walking, you’ve got everything stiff and rigid or you are trying to get your core strong, it doesn’t help the ankles.

Clint – Ok. All right, thank you. I’d just like to go over some of the real basics without going through my big list. I’ve created a very long list here and it contains all the things that I’ve taken throughout our conversation. We were in sort of topic terms and we discussed it part by part. We’ve got to work on our posture, relaxation, and building strength in the upper parts of the leg. It is because the ankle is downstream and it’s basically all reactionary to everything else that’s going on upstairs. Just by doing that can take a lot of ankle pain away. Balancing is one of the key things to target ankle improvement directly. It is because the ankle has to really work hard to maintain balancing in one leg and that’s therapeutic for the ankle. All of the stuff at the ankle itself is a hit and miss, and that’s experimental for everyone. It includes the rotational, the flex (inaudible), and that’s where people need to work. It is either with someone like yourself or at home. Then take some careful notes and make sure that they’re recording what they’re doing. With that, if something doesn’t work, they don’t repeat it and they try something else. We just want to work on sensible things and don’t aggravate the ankle. Aggravation is clearly not the right way or there’s no progressing.

Clint – Thank you so much. I think that we’ve gone over a ton here. We did create, as I said, a one-page checklist for everyone in the previous episode. I don’t know whether or not what we’ve covered really calls for that in this episode. But if you would like to put something together, then I’ll share it. When you feel a little bit better, we’ve got a couple of weeks as we’re recording this before it’ll be released, you can do maybe some homework. If you do have some things that will complement this, then we’ll share them on this podcast page, which will be over at www.rheumatoidsupport.com. You’ll be able to search for Carl and this episode will come up. Carl, I hope you continue to feel better and hope your family continues to get back to 100 percent. As always, thanks for sharing today.

Thanks, Clint. It always has been good to be on the show.

Clint Paddison

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  1. Very good and informative article. I do the ankle exercises and they seem to help a lot. I have RA and plantar fasciitis, so yes, the exercises help.
    I’m also on the Pattinson Program now since Feb 15, 2021. Lost 50lbs, only on metho (20 mg p/week, no NSAIDS or pain killers. No pain really, just sore in the morning upon waking, and nagging inflammation in wrists, first two fingers, and in ankles. I was diagnosed with RA in Nov 2020.

    Thanks Clint and keep up the great work!

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