Your feet, your pelvic floor.

Let's say it together: "It's all connected!"

Whenever I do an in-office or virtual assessment, I ask people to stand in the center of the room and pretend as though a perfect stranger isn’t staring at them, which of course, I am.

If I’m in-person with them, I get down on the floor, and start by looking at their feet. I often ask people to walk. Sometimes I ask their permission to film them.

And some people have the good sense to ask: How in the hell is this relevant?

Here’s the tl;dr:

• Your feet are the first part of your body to strike the ground (crazy, right!?). How they interact with the ground impacts how the rest of your body — particularly your pelvis — moves in order to keep yourself upright and doing what you want to be doing.

• Feet are meant to be strong and movable. Train them accordingly.

• If you’re on the struggle bus with foot pain and long term orthotic use, move slowly and with great care.

The deep dive:

I think it can be pretty easy to get lost in the minutia of the feet, because IMO, they are complicated AF. And that is kind of my point. The human foot has 33 joints (the pelvic girdle, by contrast, has 4). More joints mean more capacity for small, articular movements by design — and also more opportunity for each of those joints to malfunction.

But let’s keep this shit basic. How your foot works or experiences dysfunction has an impact on your pelvic floor. This is because the foot, with its many joints, works to create both stability and shock absorption in the kinetic chain.

It’s kind of like a trampoline: too much rigidity and you’re fucked. You don’t want a trampoline made out of wood. Similarly, too much shock absorption and you’re also screwed — cotton sheets as a trampoline material don’t make for a good time, either.

(Is this sounding familiar? Because I say the same shit about the pelvic floor all the time.)

To that end, research supports that decreased foot flexibility is correlated with increased urinary incontinence. While it’s tempting to think about a high arch as the end-all-be-all of foot health, the secret sauce is in the ability of the foot to adapt to the load or activity being put on it.

On the flip side, pes planus (i.e. flat feet) are also associated with increased urinary and anal incontinence. Once again, it’s a Goldilocks vibe here.

I couldn’t find any evidence around pelvic pain and foot alignment/strength, but it feels easy to make an inference here, and I’ll tell you from clinical experience that I see associations all the time. Generally speaking, folks with more collapsed arches and pronation (weight collapsing towards the center of the feet) have pain in the front of the pelvis, and folks with more rigid feet and supination patterns (weight on the outside of the feet) have more pain in the back of the pelvis.

Now’s a good time to try this out for yourself: Stand and don’t change anything about your normal patterning. Now, look down and observe your patterns. Try not to be an asshole to yourself if you notice “big” things: a hammertoe, or persistent flat feet, etc. etc.

Go ahead and exaggerate whatever patterns you notice, and observe what that feels like in your pelvis. Roll the weight to the center and to the outside of your feet. Walk around this way. How does playing with these changes impact the experience of your pelvis? Where do you feel tension or lack thereof?

Of course, there’s a genetic component (isn’t there always?). If you are on the hypermobile spectrum, for example, that can play into the stability of the foot’s ability to hold up under the load of standing and walking.

There’s also some genetic truth to foot shape and toe alignment, something I never believed until I met my own daughter. Girlfriend’s feet are like spaghetti plus the cutest hammertoe ever. *Shrugs in disbelief.*

But! Let’s talk about shoes.

The amazing biomechanist Katy Bowman often relates putting feet in restrictive shoes as wearing mittens to type. Side bar, Katy has a LOT of resources (a whole book, in fact! And many podcasts) on feet, and I highly, highly recommend them.

Go back to the whole evolutionary biology bit of how the foot has 33 joints, and every joint is made for movement. If we think about putting all of those joints into one rigid container and relying on the two joints in the ankle for the big actions of walking, running, and even prolonged standing, things are going to get messed up.

So shoes aren’t the devil, and it’s complicated, because we live in urban environments and you probably don’t want to be stepping on broken glass and dog crap in bare feet. Also, if you’re been living with “supportive” shoes and/or orthotics that eroded your foot strength and mobility for several decades, jumping into barefoot style shoes is not going to be a great strategy. It’s going to hurt. A lot. It’s a bad idea.

Here’s the take-home:

So, what should you do if you’ve got some pelvic floor and foot ishes, know they’re connected, but don’t know where to start?

Here are some great basics:

• Begin spending more time barefoot as tolerated. The best way to strengthen your feet is to let them do their thing! Slowly increase this time in a way that makes sense for you.

• If you’re itching to get new shoes but don’t think barefoot style is a good idea, at the very minimum, consider a wider toe box that allow your feet to be the shape they’re meant to be. Yeah, they’re less cute. But there are amazing brands out there doing the lord’s work — check Anya’s Reviews for a really excellent selection!

• Begin to strengthen and mobilize your feet and your lower legs. I love a good lacrosse ball-on-foot moment, and a slow, evenly distributed calf raise is a fantastic and simple way to begin strengthening.

More resources!