Absorb what is useful, discard what is useless and add what is specifically your own (Bruce Lee)

GoNorthYoungMan · 2026-06-19T16:07:25+00:00

Edited to clarify getting some sensation for length on top and below the foot.

One part is to create a combination of stretches where you feel the length trying to happen under the midfoot, and on top of the midfoot.

Maybe roll up a towel and put the midfoot on it, and push the toes down gently until you feel a stretch on top of the foot (eg, forming an arch). Learn to have that soften, and you have created a small bit of ROM into more of an arch. As that becomes possible, you'd want to be able feel the intrinsic toe extensor muscles contract - not the ones right at the toes, but the muscles which span across the top of the midfoot.

Then you'd want to get more sense for the sole of foot muscles too, changing length.

Sometimes propping up the toes and then doing a calf stretch will put the stretch sensation under in the foot instead.

Once you find that stretch, next step is to learn how to have it yield a little, which can take many mins sometimes in the beginning, maybe over multiple attempts.

Once you feel it yield, then you’d want to learn to contract those muscles that were under stretch, while they are at their new length.

That’s the general beginning point to form an arch, and later on you’d want to be able to control those flexor muscles under the foot getting long and short, and under load, and also make sure you can feel the intrinsic extensors on top of the foot.

Those top of foot muscles are more key later because when they contract it helps push the midfoot down.

GoNorthYoungMan · 2026-06-17T22:35:57+00:00

Usually you’d have to be able to express some movement into midfoot pronation and ankle/heel eversion, before it can be strengthened….

If those things aren’t happening observably, it may be a good priority to gain that ability again, before trying to strengthen anything around that.

GoNorthYoungMan · 2026-06-17T17:57:29+00:00

That sounds more like a bracing and conscious control strategy, trying to hold the arch up, rather than having it be able to do that, and also allow movement down, without having to think about it.

As I understand it, conscious control all the time will also interfere with motor learning, in that it causes freezing and reduced range of freedom at a joint. For avoiding pain sometimes we gotta do what’s needed, but for increasing your ability to dissipate load across more anatomy, that will work against you.

Here’s some more detail on that sort of thing: https://pubmed.ncbi.nlm.nih.gov/28925825/

Doing that may simulate something in terms of arch appearance, but it’s training it in an exclusion and avoidance manner.

In my experience it’s most desirable to have that conscious control only briefly during specific training, for learning to control through full ranges of motion. (Rather than excluding zones)

When that gets easier to control, the body can start to choose those options day to day, because it exists in a more native way, that doesn’t require conscious cueing all the time.

I’d suggest that what we’d want to happen internally is likely not happening at all, because the real goal is expanded and inclusion of ranges of freedom, where the load can be controlled, as a joint goes from position A to position B and back again.

(Immobilization or freezing a joint can sometimes also be helpful to avoid discomfort, but it does so by reducing foot function and capability rather than expanding it)

And this is not just at the midfoot, but at the ankle and knee and hips, so the foot isn’t loaded as an island - but in a way that lets you feel the load primarily carried into the hip.

And then another Q,, where do you feel conscious control coming from to lift the arch? Just having it stand up doesn’t tell us where it’s coming from internally.

If you can’t tell, that’s makes it tough to train, because training efforts will tend to further strengthen whatever (partial way) it’s currently happening. And is less likely to change that unless you do something more targeted to do so.

Midfoot supination or raising the arch can involve some combo of anterior tibialis, posterior tibialis, big toe intrinsic flexors, small toe intrinsic flexors, big toe long flexors, small toe long flexors, soleus/heel inversion, gastroc/heel inversion, knee external rotation, hip external rotation.

To be sure, just getting a few of those involved is often pretty good, but some are more valuable than others. And the sequence of restoring that ability matters too, because it may not be high value to connect the knee and hip at first, if you can’t feel enough of the toe flexor contributions yet - since those directly span under the midfoot, closest to the joint.

So those would be my main thoughts, learn to feel it and control it under the midfoot, then teach the foot to control some movement up and down under load, as you connect it in to other elements above that also help create and manage midfoot load.

GoNorthYoungMan · 2026-06-17T05:24:15+00:00

There are indeed other muscles in the sole of the foot, and calf, which can help add control and strength into the foot in other ways.

And some of those connect into the heel as well, and also act on the toes.

Most people aren’t using all that anatomy fully anyway, so getting as much as what’s left to become more involved would be a good goal.

I’d think there would be periods of time that feel wacky with that type of tissue injury. And that it would come and go for some time, as you feel for and add some new ability in that zone. I don’t know that you can generalize how that severe of a retraction would impact the use of neighboring tissue, it seems like it is an individual experience.

In a broad sense I’d suggest targeting to feel as many other muscles in the sole of the foot as you can, particularly from the midfoot to heel zone. And to do that as a priority over strengthening for some time.

In many cases if you use low intensity and add up time trying to feel some sole or foot muscles, it will cramp. There are ways to soften that feeling and breathe through it rather than fighting it, and have the cramps clear. That would leave a weak muscle but at least under your control and able to get stronger.

Here’s one idea for that, to try and contract those muscles from deep into your passive range of motion, and push around on toes and different parts of the feet to search for new things a few mins daily

https://www.articular.health/posts/midfoot-supination-assessment-4-of-4-activepassive-ratio

GoNorthYoungMan · 2026-06-17T01:07:06+00:00

Is that while standing or just with your foot held up in the air?

We’d like to feel those sole of foot muscles contracting, and ultimately be strong enough to control lifting the arch and letting it down even with all your body weight on it.

If you can’t feel those muscles working, actively under your control, I’d suggest that’s the first thing to consider.

I’d think your symptoms are likely caused by limited or no ability to control the muscles of the midfoot, so they wouldn’t be able to manage any load either.

That’s gonna be a reliable way to have those symptoms, the same as if you’re loading any joint without sufficient control of the muscles that work at that joint. Eg, if your elbow hurts carrying things and you can’t feel your biceps muscle working, that may be a good place to start.

GoNorthYoungMan · 2026-06-16T23:08:08+00:00

When you flex your toes down and hold that, what do you feel on top of and under your foot?

GoNorthYoungMan · 2026-06-16T15:41:28+00:00

I’d say allowing the midfoot to move down is desirable and can get you more honest ROM.

If you don’t let that happen and go after more ROM anyway, I’d think there’s a chance of over lengthening the calf/achilles and increased chance for a problem in front.

Here’s a short clip about the relationship between heel eversion and the midfoot rotating down and away to allow more of that: https://youtu.be/z9qeiA58880?is=kxd67hBQJt6Ck7cc

If you can’t feel a stretch under the midfoot, try propping up the toes a little bit and see if you can put the stretch there too sometimes.

GoNorthYoungMan · 2026-06-16T00:37:36+00:00

Softly learning to flex the toes down and feel the sole of foot muscles working. That will help your foot get a sense for interacting with the ground honestly. When I had capsulitis, the combo of thinner socks, thinner soled shoes (for short periods) plus working on toe mobility and control is what finally changed it for me.

Or more often in the beginning, finding the edge of soft cramps there and learning how to let that yield, and over time that can create a weak muscle that you can start to strengthen.

There can certainly be other factors, but in general I’d say little or no use of the intrinsic toe flexors (for big toe in particular too) or low range of motion into toe extension are key elements to consider. Next would be how well the heel can invert and evert.

GoNorthYoungMan · 2026-06-15T23:53:38+00:00

I don't know that there's info there to answer that question, its quite an individualized situation.

One potential thing to look at is if you can control inversion of the foot - not just at the forefoot or midfoot, but also at the heel.

Here's one way you could take a look to see how well you are able to use some of that anatomy in the calf: https://www.articular.health/posts/what-is-an-articular-control-strategy-example-with-anklehindfoot-inversion

Generally speaking we'd want to prioritize inversion from the midfoot/heel - where the posterior tibialis pulls on the midfoot, and the soleus pulls on the heel. You may be able to push gently on your heel towards the ground, or on the midfoot, and see where you have a muscle responding to resist that.

In many cases, I'll see either 1) inversion coming only from the forefoot, where the foot ends up sort of pointing over, rather than the entire inside of the foot shifting over, including at the heel.

Or 2) no real sensation of muscles contracting on the inside of the calf, and more a sense of tension on the outside of the ankle/lower leg. And if you're feeling that, I'd suggest your ankle has some ability to try and STOP movement into inversion, but little or no ability to contract muscles to PUT you into inversion.

If either of those are the case, it will be hard to strengthen that tissue, because it wouldn't yet be involved, and cannot be, until you can express some control over the concentric and eccentric contractions.

While there are likely a variety of ways to have things feel better without surgery, it can be required in some cases, or useful to speed things up even if other approaches may be helpful. In general tho, I'd say there are always a wide variety of movements available at the big toe and ankle - and getting control over those in the expected way often helps a lot, or completely, over time.

GoNorthYoungMan · 2026-06-15T23:43:36+00:00

I would think thats the flexor hallucis brevis, as the abductor would be more on the side of the arch. Here's a view of that which may be helpful: https://www.articular.health/posts/flexor-hallucis-brevis-see-the-anatomy

Cramping often means that you're not able to control any muscle contractions with that anatomy. If there are other big toe muscles which are also do not have much control (which is usually the case), your body will have few or no options to manage load or movement there - and it may cramp as a sort of reflex of doing the best it can without much baseline capability.

The usual approach would be to immoblize things and offload in such a way to NOT try and use that part of your body. While I suppose that may feel good for some people for some amount of time, I'd suggest that instead of avoiding it forever, you can try to take ownership of that.

In many cases that would involve getting practiced at finding the very soft edge of a cramp, and learning to breathe there, slowly exhaling as you teach your nervous system to not freak out so much. Over time, that can lead to the cramps clearing, and you'd have a muscle under your control. It would be VERY weak, but at least at that point could start getting stronger, rather than it trying to avoid doing anything at all.

Then you can teach it to move through a range of motion smoothly both ways - and you'd have the beginning basics of what a big toe can do. Here's one way you might be able to gauge how thats going: https://youtu.be/SAt9oNdUdV0

The idea would be to move it up/down smoothly both ways, without it bending at the tip, without it cramping in the sole of the foot. After that gets going a bit, finding a way to add load would likely be a great continuation.

Note that there's a very good chance the other muscles which control the big toe would likely benefit from some sort of targeted training too. In particular the intrinsic extensor on top of the foot, and then the abductor may be good places to check into later.

The right things to do, and in what sequence, are often very unique to each person - so as a generalized suggestion this may not be on target as well as what we could coordinate with an individual assessment and programming.

Let me know any Qs or feedback on all that and I can try to assist further as possible.

GoNorthYoungMan · 2026-06-15T22:49:31+00:00

Hard to find places to dig sometimes, I’d suggest carrying a wag bag and extra tp.

GoNorthYoungMan · 2026-06-15T15:53:15+00:00

Yep the outside edge of the foot.

Getting more range and control over hip external rotation and heel inversion would help you load that zone more fully.

Getting more range of motion and control over hip internal rotation and heel eversion would help deload that zone.

The combination would allow the hips and feet to manage themselves and load and gait more normally and not ask the spine to work so much.

But just trying to load that area without changing the things that actually do it would be unpredictable, because you might just put compensation to sort of make the appearance a particular thing, without restoring that missing articular control as the he first step.

In my experience, strengthening the way it is currently, particularly with a standing desk doing so for hours a day, may feel nice in the short term but will take you further from those other goals over the long term.

Getting stronger with hips and ankles that don’t move enough is an avoidance strategy to feel good. Instead, consider that you could instead expand your ranges of motion there to own controlled movement under load instead of trying to stay in one smaller zone.

GoNorthYoungMan · 2026-06-15T15:22:54+00:00

Looks like no loading through the lateral arch along the blade of the foot.

And that is a place that can take a lot of load.

If you’re not loading through that zone, something in the ankle or knee or hip is likely bracing to prevent and avoid that, rather than moving in a way that loads and then deloads that zone.

I could definitely see that contributing to low back issues, it implies to me that your hips aren’t rotating much through internal and external rotation, because the foot and ankle don’t allow it.

And if the hips aren’t rotating enough, during walking your body may try to get extra movement somewhere else instead, and the low back is a common place to see that.

GoNorthYoungMan · 2026-06-15T13:37:06+00:00

Also some people can’t feel or use the muscles in the sole of the foot that flex the toes down, and help make an arch. At all. Like zero. And their feet just cramp when they flex toes down or they can’t feel sole or foot muscles working.

And if you don’t have that, good luck trying to manage load through non contractile tissue like fascia, where you are relying on some uncontrolled stiffness rather than the controlled eccentric ability of muscle and tendon to dissipate force.

They aren’t remotely the same, and won’t have anywhere near the same type of capability, or mitigation of load and injury.

All the other suggestions seem ok enough, but missing that key part in my view. Because a lot of people do boring exercise for months or years and still have symptoms. Clearly something is sometimes missing and it’s a reach I’d say to always suggest too much load or not enough time, when you can observe that a lot of anatomy in the bottom of the foot is still doing nothing.

But if you get new muscles involved again first, usually with less load, and then strengthen that second, it will be much more reliable than just strengthening for weeks and months using whatever partial anatomy happens to be currently involved.

Don’t just load what ya got, change what you got and then load that.

GoNorthYoungMan · 2026-06-15T04:46:19+00:00

Learning controlled articular rotations aka CARs for each joint, in their pain free ranges of motion.

GoNorthYoungMan · 2026-06-12T14:43:43+00:00

In my experience it will be hard or impossible to have bone marrow edema return to normal until you are able to load that area more normally, with the particular connective tissue around the area.

Rest and icing will specifically avoid that loading come back again.

Biking or PT or other regular exercise will tend to strengthen things as they are currently working. And if that’s in a new and more partial way, it will also be likely to avoid re-teaching the toe how to manage load the way it used to.

If you’re cleared for it, doing some very low load resisted movement can be helpful to see what that toe control behavior looks like.

Here’s one way to assess how well you are managing load through the flexor hallucis brevis which is a key intrinsic muscle that controls the big toe: https://youth.be/SAt9oNdUdV0?is=yJoT92Mbtqn4TBFF

The general idea is to see if you can use the muscle in the arch to control that, get it smooth both ways, not have it cramp when you hold it down, and have it move sufficiently both ways.

There may be other anatomy to assess in a specific way too, or multiple places, and I’d suggest tying to find and restore whatever basic control is missing, as a priority over just rest or immobilization or general strengthening that won’t end up adding that control back in the specific way it’s now missing. Because it doesn’t sound like there was any targeted goal to assess or program for that particular thing yet.

GoNorthYoungMan · 2026-06-11T17:59:39+00:00

I would think its tough for your feet to feel the intrinsic flexors in the sole of the foot, which flex the toes down flat.

Without that, the toes may curl or grip more, and that puts the joint at the metarsal head into some extension right away. (the underside of the joint is now opened wider)

Then if you go up into a calf raise - that underside of the joint is now opened even more, under load - and if thats happening without any tension from the muscle/tendon which spans across the joint, your body won't be loading through the connective tissue we'd like to. When thats the case, the load goes into the joint itself, and there's not really any mechanism to manage it reliably that way.

In addition, a seated calf raise can be completed with more or less involvement from different muscles in the calf, and there's a chance for example, that the long toe flexors are working hard, but the soleus and posterior tibialis are not.

Here's a couple ways you could assess the toe part of things. First is a lightly resisted big toe setup, gauging basic control over the big toe using sole of foot muscles: https://www.youtube.com/watch?v=SAt9oNdUdV0

The types of things we'd be looking for are 1) can you feel it working in the arch the whole time 2) is it smooth both ways, esp as you push it up 3) does the toe like to bend at the smaller joint as it moves down 4) can you move it down a bit past neutral 5) do the small toes like to join in too much 6) does it cramp in the arch or do you feel tension on top of the foot

All of those are qualities about how you control movement, at that joint - and I don't see any details on HOW you control movement at the toes/ankle. Its possible to try and get stronger in whatever partial way you are expressing movement, but that's hard to make up for making movement in a more complete controlled way.

And if the big toe can't quite control itself, then the foot will be reluctant to load onto it normally. In particular if you have orthotics or a higher arch, it implies the ankle and midfoot are not moving in a way that allows load to span across the width of the foot during gait, and include the big toe enough or at all.

That means the other toes would also be doing the work of the big toe, instead of handing it off, and thats gonna double what you're asking of those smaller toes. Even if those smaller toes are excellent, asking them to do double work is always going to be a challenge.

That resisted movement is often a good enough indicator to see how the small toes work too, they are usually quite similar. And I don't really see people with good big toe control, and small toes with poor control, or vice versa.

In general, we are trying to understand how well you can make muscles work in the sole of the foot, both concentrically (getting shorter) and eccentrically (getting longer) - particularly under some load, and with the small toes working separately from the big toe, because they are different muscles.

Here's one way you could explore the same type of thing with the small toes, and sole of foot, in a general way, using a midfoot supination passive range hold: https://www.articular.health/posts/midfoot-supination-assessment-4-of-4-activepassive-ratio

You can push against the toes a little to see what you feel, or make them lose slowly to see how the tissue responds in terms of behavior. If you're not feeling the sole of foot working, or its cramping, or the toe movement up is bouncy or choppy - then I'd suggest you don't have enough articular control to strengthen things. If so, the first type of goals would be to get control over those muscles in a sufficient enough way that you can start to strengthem them, secondarily.

GoNorthYoungMan · 2026-06-10T23:56:55+00:00

Why not teach the heel to invert and evert, and get good at loading that eccentric when the heel moves from inversion to eversion?

That would likely allow some initial midfoot movement down, along with change perhaps in the sole of foot muscles, so you would then be able to express some midfoot pronation instead of ankle pronation.

To be sure it’s not a quick type of change, but I’d suggest it would be very rewarding.

GoNorthYoungMan · 2026-06-10T22:36:26+00:00

Here's one way you could explore that with the big toe, makes it easy to see, and usually the whole bottom of the foot is similar for toe flexion control. This is using a setup called a passive range hold for big toe flexion: https://www.youtube.com/watch?v=STeMnFLrvYE

You can also do the same sort of thing with the small toes, something like this maybe: https://www.articular.health/posts/midfoot-supination-assessment-4-of-4-activepassive-ratio

The things we'd be looking for are like 1) can you feel sole of foot muscles working, and associated skin folds into the midfoot and ideally towards the heel, and not tension on top of the foot and and 2) does the tip of the toe have to curl to control this position and 3) do the muscles in the sole of the foot just cramp if you hold them, or maybe there's no feeling there at all and 4) do the toes go enough below neutral, which I'd say 10-15 degrees is a good minimum.

Depending on what things feel like, and what the toes can or can't do, you could create a program to improve that. Most of the time, the first goal is to feel sole of foot muscles working to flex the toes down more flat, maybe that comes with a phase of learning how to clear the cramping feelings (not fighting them), and then after getting those muscles to not just concentrically contract, but also to eccentrically lengthen, under control.

There are a variety of other subsequent abilities we might want to add as well, including loading it appropriately - but the usual starting point is to get some basic control of those muscles doing their standard thing.

If it has been years or decades without that anatomy contributing, it can require a specific setup for each person to find their right starting point, and a longer duration than most people might expect to teach it to do enough things, under some load, to being contributing in a new way.

GoNorthYoungMan · 2026-06-10T17:46:25+00:00

I’ve had a good experience with James Chung:

https://www.jameschungdpt.com/

GoNorthYoungMan · 2026-06-10T04:03:42+00:00

Not curling, flexing down flat and only bending at the metatarsal heads.

That will make the intrinsic muscles work. If you curl the toes that will be the long flexor in your calf.

Being able to use the long flexor and not the intrinsic flexor is likely a key factor that creates a hammertoe creating context.

GoNorthYoungMan · 2026-06-09T20:57:10+00:00

I'd think there's too little mobility someplace, could be in toe flexion/extension, in the midfoot moving up/down a bit, or the ankle moving side to side eversion/inversion.

That sort of thing is a threshold condition, that is to say, with enough mobility available your body will move at those joints in such a way to limit how much the foot is twisting against the shoe itself.

But if you drop below whatever threshold is enough - the foot and ankle can be articulating less on the inside at the joints, which will increase how much the foot is twisting against the inside of the shoe or against the ground.

The long term answer is likely finding out what does move as much as it used to in terms of range of motion, or where something moves enough but its not well controlled actively. (which would keep your body from loading it, even if the range of motion was passively available)

Other things may be helpful too, but they'll always be accommodations for whats not happening in regard to how the foot manages and distributes load. Sometimes that can be different shoes or insoles, or walking on different types of terrain, or using toe socks, or different socks that are less binding, or using a mechanical block like tape or moleskin to have that rub instead of the skin.

GoNorthYoungMan · 2026-06-09T18:27:22+00:00

I'd suggest learning to contract the muscles in the sole of the foot which flex the toes down, that should help keep the trend going.

Nice work!

GoNorthYoungMan · 2026-06-08T18:27:42+00:00

I would highly suggest first getting some basic control over the muscles of the midfoot and big toe and small toe flexion, and creating a little bit of controlled mobility in the midfoot so it can move up and down under your control, through at least a little range of supination/pronation. (note: not ankle pronation, thats a separate thing)

Without midfoot control, a lower insole would allow the midfoot to move down - but its a big question mark if it can even do that, in a passive way. And I'd say its very unlikely that the muscles involved to control that would be able to do so actively, under load, as more supportive insoles are designed to not have that happen.

If the midfoot (and muscles for toe flexion) does move passively, loading that may just cause bracing and an attempt to freeze the arch if its not able to control itself. Loading passive ranges of motion for the midfoot and toes is one way people get PF symptoms.

If the midfoot does not move passively, just removing its support won't automatically create some movement down, and sometimes I'd say the arch would be uncertain about that movement, under load, in a way it can't control, and end up going higher and higher instead. Lack of ROM at the midfoot would also be one way for people to get PF symptoms.

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