Why we start at the feet
Pain in your knee, hip or back often has a clue lower down. A stiff big toe, a tight calf or an ankle that rolls in can all change how you walk — and you take thousands of steps a day. We check your feet as part of a full head-to-toe assessment, not instead of it.
What we check
- 1Toenails
- 2Toe shape
- 3Big toe bend
- 4Your arches
- 5Back of the heel
- 6Ankle line-up
- 7Calf tightness & strength
- 8One-leg balance
Number 8 is checked standing on one leg, so it's not on the drawing.
1. Toenails
We look at length and shape. Nails that reach past the end of your toes can press against the front of your shoe with every step. Nails cut too short, or rounded at the corners, can grow into the skin.
An ingrown or infected nail hurts — and pain makes you walk differently to protect it. That needs a doctor before we build a plan around it. We also note thick or discoloured nails and send you to the right professional.
Source: Mayo Clinic, ingrown toenails
2. Toe shape
- Bunions. A bump at the base of the big toe, with the toe leaning in toward the others. Family history plays a big part, and shoes with a narrow, pointed toe box can push the toe further out of line.
- Hammer toes. Toes that bend up in the middle. They come from an imbalance in the muscles that bend and straighten the toes, and tight shoes or high heels make it worse.
- A longer second toe. Usually a sign that the long bone behind your big toe is on the short side. That shifts extra load onto the second toe when you push off.
What it tells us: which shoes suit your foot's real shape, and which foot muscles need work. We don't straighten bones — if a bunion is painful or getting worse, that's a conversation for your doctor.
Sources: OrthoInfo (AAOS), bunions · OrthoInfo (AAOS), hammer toe · Physiopedia, Morton's toe
3. How far your big toe bends
Every time you push off to take a step, your big toe bends back — normal walking needs roughly 45 to 60 degrees. When it can't bend that far, people change how they walk without noticing: shorter steps, pushing off from the outside of the foot, and turning the hip out.
We check how far it bends with your weight on it, and look for what's holding it back.
Source: Physiopedia, hallux rigidus
4. Your arches
We compare both feet while you stand. A low arch or a high arch isn't automatically a problem. What matters is whether the muscles holding it up actually switch on when we test them — so we test, not just look.
Flat feet get their own plan: flat feet & dropped arches. That page also covers footwear — including why going back to narrow, raised-heel shoes undoes the work, and the shoes I wear myself.
5. The back of your heel
A hard bump at the back of the heel, where the Achilles tendon attaches, is sometimes called a "pump bump." Experts aren't certain what causes it, but shoes with stiff, tight backs, a tight Achilles and high arches are all linked to it.
We look at your shoes and your calves. The bump itself is bone, so if it's sore or swollen, your doctor comes first.
Source: Cleveland Clinic, Haglund's deformity
6. How your ankle lines up
You stand with your feet a little apart. We stand a bank card on its edge on the floor, right beside the outside of your ankle — it only reaches a little above the ankle bone. If your ankle is lined up, the card touches the floor, the side of your foot and your ankle bone all at once. If it only touches one of them, your ankle is rolling in or out.
Lined up
The card touches your ankle bone and the side of your foot at the same time.
Rolls in
The card touches your foot, but there's a gap at the ankle bone. The inner arch drops flat. This often goes with flat feet.
Rolls out
The card touches your ankle bone, but there's a gap at the foot. The inner arch sits high. This often goes with high arches.
An ankle that rolls in often goes together with a dropped arch — it's a well-known sign of flat feet. The card shows us that it's happening. The muscle testing tells us why.
Source: Physiopedia, pes planus
7. Calf tightness and strength
Tight or weak calves change how your ankle bends and how you push off. We check a few things:
- How far your ankle bends. Facing a wall with your heel down, you bend your knee forward to touch the wall, and we measure how far back your toes can be. For reference, a 2026 study of 899 healthy adults found an average of about 11 cm for adults under 30, dropping to about 6 cm by age 80.
- Calf strength. Holding a wall, you rise all the way up onto your toes, again and again. We count, and we watch the quality — wobbling or losing height tells us as much as the number. For reference, a 2025 study of about 500 adults found most people did around 25 single-leg rises, with a wide normal range.
- Which calf muscle is tight. Stretching with the knee bent works the deeper calf muscle; with the knee straight, the upper one. Knowing which one is tight tells us which stretch you need.
Sources: McBride et al., 2026, Musculoskeletal Science and Practice · Visser et al., 2025, Brazilian Journal of Physical Therapy · CU Orthopedics, calf stretches
8. One-leg balance
We time how long you can balance on one leg — with a wall beside you and us standing close. Balance affects how you walk, handle stairs and avoid falls, and it can be trained.
It's also a useful health signal. In a study of 1,702 adults aged 51 to 75, about 1 in 5 couldn't stand on one leg for 10 seconds. Over the next several years, that group had a higher risk of dying from any cause, even after accounting for age, sex and health conditions. That's a link, not proof that one causes the other.
If you feel unsteady, don't test your balance on your own.
Source: Araujo et al., 2022, British Journal of Sports Medicine (via University of Bristol)
What happens with the results
Every check above feeds one plan: the exercises you do, the shoes that suit your feet, and what we re-test next time. You see your own numbers at the start and again at the re-test — so progress is something you can see, not just feel.