How to Modify Your Correct Toes

In this video Dr. McClanahan shows how to modify Correct Toes to better fit your foot.

Have you used any of Dr. McClanahan’s modification tips?  Which ones and how has it made a difference in your experience with Correct Toes?

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Bunions and Hammertoes

The following excerpts are from Dr. McClanahan’s article on bunions and hammertoes. 

Bunions are a sometimes painful dislocation of the 1st metatarsophalangeal joint or 5th metatarsophalangeal joint that occurs primarily in shod or shoe-wearing populations. There have been many suggested causes of bunions, but the one cause that has been shown to be consistently reversible is the tapering toeboxes on most conventional footwear available to shoe wearing people.  Tapering toeboxes have a long history of standard inclusion in most shoe models, including most athletic models. The unfortunate side effect of the tapered forefoot shape of our footwear is that it holds our toe bones and joints in an unnatural proximity to one another, forcing the great toe into the space that should be occupied by the second toe, to create the classical bunion deformity. The tailors bunion, on the outside of the foot, is created when the fifth toe is forced in under the fourth toe, and the head of the fifth metatarsal is forced into the outer aspect of the shoe, sometimes causing pain, swelling or bursa formation.

photo credit: MDGuidlines

Hammertoes are another forefoot deformity that can take a walker out of their activity. Hammertoes generally represent a tendon imbalance in the toes caused by one of the toe tendons getting an advantage over another toe tendon. Most commonly, it is one or all of the long extensor tendons on the top of the foot that gets an advantage over one or all of the flexor tendons on the bottom of the foot, to cause the first joint in the toe to be elevated above the ground. Most shoe wearing people chronically alter the delicate balance that co-exists amongst the toe tendons whether they know it or not.

photo credit: Arch City Foot & Ankle

This occurs because most footwear has heel elevation and a feature called toespring, which holds the ends of the toes above the ground, in relation to the ball of the foot. These two features, coupled with the tapering toeboxes mentioned above, are responsible for the development of most hammertoe and bunion deformities. Hammertoes generally cause walkers to experience pain and dysfunction in three distinct areas: 1) One the top of the contracted joint, known as the proximal interphalangeal joint, due to callus buildup or bursa formation that occurs from the toe joint now rubbing against the top of the toebox of the shoe; 2) One the tip of the toe, since now there is an unnatural bend in the toe, which causes pressure on the end of the toe. This is a problem because the skin on the end of the toe is not as strong and resilient as the skin on the bottom of the toe; 3) Under the ball of the foot. When a toe becomes hammered, also termed contracted, it unfortunately puts downward pressure on the metatarsal bone, causing pain, swelling, and sometimes callus formation.

If you wish to prevent or cure a bunion or hammertoe deformity naturally, you must be willing to view your footwear as health equipment, rather than as fashion statements. Even our walking and running shoes have tapering toeboxes, heel elevation and toespring, which encourage bunion and hammertoe formation, yet the market shows us that fashion and style rule most people’s agenda when it comes to buying footwear.

Interested in learning more?  Click here to read the article in its entirety.

Trail Walking and Minimal Shoes

Walking on blacktop or concrete is a generally predictable experience, as far as the foot and ankle are concerned. Since these surfaces are mostly flat, the numerous joints in the foot and ankle become aware of moving within limited ranges of motion.

However, the foot and ankle undergo a different, less predictable experience the moment a walker decides to go off-road. Here, these same body parts will be called upon to keep the walker upright and moving forward while simultaneously adapting to ground surfaces that at one moment will require large amounts of pronation, and in the next step require large amounts of supination.

Here is where we believe a problem exists. Many walkers are going off-road in their street shoes. And we don’t mean their dress shoes. They are often going off-road in footwear that is holding their foot in a manner that does not allow the many joints of the foot to spread out and adapt to an ever-changing ground structure.

Experiencing the full capabilities of the foot and ankle adapting to non-linear surfaces takes practice and time. It also requires wearing no footwear, or choosing footwear that does not restrict foot and ankle motion.

Unless you have grown up completely barefoot — which we are fairly certain most of you have not — then we recommend the latter. The challenge is finding appropriate shoes. Many footwear companies are capitalizing on the walking boom and making trail versions of their urban walking shoes.

The problem is that instead of making shoes that are more flexible and foot-shaped, they are making them more stiff, sturdy, and over-designed.

Off-road Footwear Should Offer the Following:
• Protection. Ideally this should involve a covering that goes over the entire foot and is snug over the ankle to keep rocks, twigs, and other trail debris from getting into the shoe.
• Traction. Soles that are smooth will be dangerous on loose and wet surfaces. A contoured sole with ridges and grooves will generally help provide better traction. The problem here is that these materials add extra weight, which is undesirable.
• Lightweight. Footwear that is light allows the walker to respond quicker to a changing ground surface.
• Flexibility. The closer a walking shoe is to a moccasin or a slipper, the more likely that shoe’s design will allow the joints of the foot and ankle to adapt to the trail surface. Most walking shoes currently available are not flexible.
• Foot shaped. There are three features built into footwear that stray from the natural foot shape, and they should be avoided:

1. Heel elevation. Soles should be completely flat.
2. Toespring. The ends of the toes should be flat and level with the ball of the foot.
3. Tapered toe boxes. The space allotted to the ends of the toes should be wider than the ball of the foot.

Leave us a comment below and tell us your favorite minimal hiking shoe!

*Article written by Dr. Ray McClanahan and Glenn Ingram

*As printed in Walkabout Magazine, Issue 24

Frequently Asked Questions

Are you new to using Correct Toes?  If so, you probably have quite a few questions about how Correct Toes work, what to expect, and how to move on from here.  Below are a few of our frequently asked questions.

How can Correct Toes help me?

With Correct Toes, you can:
– Correct many common foot and leg problems
– Increase athletic performance and decrease injuries
– Improve strength and flexibility of the toes and feet
– Enhance balance and stability

What conditions can Correct Toes help?

Regular use of Correct Toes in shoes that are sufficiently wide, lightweight, and flexible can, over time, correct a wide variety of foot problems. Examples of conditions treated are: bunions, hammertoes, ingrown toenails, heel pain or plantar fasciosis, corns, neuromas, capsulitis, lower leg pain, and runner’s knee.  Amazingly, no orthotics, surgeries, or medications are required!

Why do Correct Toes work?

Correct Toes spread the toes such that they re-approximate natural anatomy.  Why is this important?  We spend a lifetime in footwear that is too narrow at the ends of the toes. The result is that our foot shape actually changes such that the toes become scrunched together. But having spread toes is essential to proper gait. Correct Toes work in a similar way to how braces work for teeth (orthodontia). Correct Toes place the toes into optimal alignment, and slowly and progressively, the foot architecture changes. The muscles and other tissues of the foot and body are able to adapt and strengthen accordingly. Ultimately, the goal is to return the foot to its natural shape!

How do I use Correct Toes?

Correct Toes are placed in between the toes. They are designed to be worn either barefoot, in wide slippers, or in shoes. Important note: the shoes MUST be wide enough to accommodate the toes with Correct Toes in place. (See the diagram. The shoe on the left is too narrow. The shoe on the right is wide enough). The best results are seen when people incorporate them into their daily weight-bearing activities. Also, it is important to incorporate Correct Toes SLOWLY and progressively. We recommend wearing them for a half-hour the first day and then increasing the time by approximately 30 minutes each day.  This will allow your body to adjust to the changes. You may experience some soreness at first, as would be expected when muscles are being utilized in a novel way. Just like with any new activity, the soreness should subside and your muscles will end up stronger and more capable than before

.wide shoe

What are the different sizes of Correct Toes?  How do I figure out my size?

Correct Toes comes in two sizes: small/medium and medium/large. Unlike many other foot products, the Correct Toes size you require does not depend on your shoe size. Instead, the Correct Toes size best suited for your individual toes depends on the width of your feet, the width of your individual toes, and the degree to which your toes are already splayed, or spread. Your Correct Toes toe-spacing appliance should not “bunch” between your toes—this would be a sign that your Correct Toes toe spacers are too large. Your toe spacers should not pinch your toes, either. Toe spacers that pinch your toes are too small. Correct Toes can be further customized for a wide variety of feet. Most women and many men find the small/medium size most beneficial, though this is not universally true. Some people may need to start out in the small/medium and graduate to the medium/large as foot adaptations take place. In most cases, we find that the larger size works with individuals who wear a men’s size 11.5/12 shoe and higher.

If you think you might be in-between sizes, you can send us (CustomerService@nwfootankle.com) a picture of your feet taken while standing next to a ruler (to show the length and width of your foot). This image can give us a more accurate picture of which size is most appropriate for you.

Not finding the answers you’re looking for?  Leave us a comment below with your questions!  If you’re a Correct Toes “veteran” leave a comment with your advice and tips on how your transition experience has been.

Fashion and Footwear

In his article, Fashion and Foot Deformation, Dr. William Rossi explores the influence that fashion has had and continues to have foot health. The following quotes from Rossi’s article push us to think about the effect that status, fashion, and culture can have on our health.

“There is a significant message seeking to get through here: Fashion is not a modern invention.  It has been with us since the earliest civilizations.  There is no mystery or “mystique” about fashion.  Nor is it flighty or frivolous or fickle or shallow.  And least of all is it associated with “vanity”.  It is, instead, a vital force of human nature and essential to our state of well-being and self image.  To be “properly dressed” means to be dressed in the current fashion to suit the occasion.  And perhaps the single most important role of fashion: It must reshape and deform the body or some particular part of it, actually or in an illusory manner. ”

“Has fashion “crippled” or “ruined” our shoe-wearing feet? These are extremist labels. The shoe-wearing foot clearly has been dramatically reshaped and deformed by our shoes, yet most people assume they have a “normal” foot. And, disturbingly, even most podiatrists assume that the average shoe-wearing foot, free of any distress or visible lesion, is normal
and with natural form. Thus the ironic reversal of standards: the abnormal becomes the norm, the unnatural the natural.”

“But the only fundamental difference between men’s and women’s footwear is the height and design of the heel. Otherwise the male foot is as much a captive of the shoe as is the female foot.  In any shoe-wearing society it is as impossible to find a fully natural or normal male foot as it is to find a comparable female foot. The toes of the male shoe-wearing foot have lost as much as 60 percent of the natural prehensibility.”

How has fashion influenced your footwear choices and foot health?

*To read Dr. Rossi’s article in its entirety click here.

The Worlds Healthiest Feet are the Ones Without Shoes

In 1905, Phil Hoffman, M.D., traveled to numerous undeveloped countries to observe the foot and skeletal structures of people who lived barefoot. He noticed the differences between their feet, and those he had observed during his medical work in the US. These differences were subtle, such as toes being generally straight, in comparison to our upturned toes, and their wider toe-spread, versus ours, which are tapered. Time has shown these differences to be hugely significant.(1)

Studies have since shown that barefoot cultures have fewer foot and knee problems. For example, Rush Medical Center proved that going barefoot prevents the development of arthritis in the knee. Several other studies have recently been published directly linking the wearing of footwear with foot deformity and injury.(2,3)

This is important news for walkers. These studies demonstrate a path to foot health and injury prevention. That path is to be trod barefoot. For most American walkers, this is not possible.(4)

Fortunately, you do not have to give up your shoes and go barefoot to derive the benefits of a “barefoot” foot position. Those benefits can be had if you can find a walking shoe that allows your feet to position themselves as if they were bare inside the shoes.(4)

Unless you have a walking shoe custom made, or walk in footwear not specifically designed for fitness or race walking, this is nearly impossible.(4)

Take a look at your shoes, and note the following: Most walking shoes have the heel part elevated twice as high as the front part of the shoe. When barefoot, the heel always stays level with the whole front of the foot.

Walking shoes elevate the toes; this is called toe-spring. When barefoot, toes always touch the ground.

Walking shoes are built so that the widest part of the foot is forced to become the ball of the foot area. When barefoot, the widest end of the foot is at the end of the toes. Look at a baby’s toes: Ideally, an adult foot should look similar.

Most walkers will benefit from the addition of a metatarsal pad to their shoe. These are designed to pull the toes down from their artificially raised position. Silicone toe spacers can also spread the toes out wider than the ball of the foot.

While research proves there are significant benefits to walking in a barefoot position, the change cannot be made overnight. The transition should be made slowly, allowing for the feet and legs to become stronger. It can take as long as a year to adjust to walking with your feet in a new position.

Be patient with your body, and aware of your shoes.

-Written by Dr. Ray McClanahan

Original article can be found in Walk About Magazine.

FREE Barefoot Running Clinic “Have Mercy On Your Feet”

Doctors join forces to host a

FREE 12 WEEK BAREFOOT RUNNING CLINIC AT THE WATERFRONT-  DONATIONS BENEFIT MERCY CORPS,

“HAVE MERCY ON YOUR FEET”

Portland, Ore., July 9, 2012 — Drs. Sanatan Golden, PT, DPT, CSCS and Ray McClanahan DPM, and their respective staff at Therapeutic Associates Downtown Portland and Northwest Foot and Ankle are excited to announce their clinics will be offering a new program on how best to benefit from barefoot running techniques. The condensed new 12-week “Minimalist Mondays” curriculum will feature weekly clinics.

Who: Clinics are FREE and open to anyone interested in reducing injury and increasing running efficiency, regardless of running experience or current footwear.
What: Doctor of Physical Therapy Dr. Sanatan Golden of Therapeutic Associates and Podiatrist Dr. Ray McClanahan at Northwest Foot and Ankle will help participants understand the safest and most effective methods of transitioning to minimalist and/or barefoot running.
Where: Tom McCall Waterfront Park in Downtown Portland, OR at the Salmon Street Springs Fountain.
When: Every Monday from 12:00 to 12:30pm from July 23rd through October 22nd. Each clinic is followed by optional break-out run.

Minimalist Mondays will also feature a charitable partnership with Mercy Corps, global leader in humanitarian aid, to create awareness and support for the people of Ethiopia and Somalia through, “Have ‘Mercy’ on Your Feet: Barefooting for the Horn of Africa”. This unique program raises funds by collecting donations based on the distance walked or run barefoot while completing the Minimalist Monday curriculum. On the last session, the group will present donations at the Mercy Corps World Headquarters at the end of a 5k fun run/walk down the Waterfront. Ethiopia is home to many of the world’s great runners, including 1960 Olympic marathon gold medalist Abebe Bikila, who ran his winning race completely barefoot!

Drs. Golden and McClanahan are both avid barefoot runners and have been recognized as regional experts in transitioning to minimalist running, often speaking publically on this increasingly popular topic. Dr. Golden got the idea for Minimalist Mondays as a community-education project last August, when his clinic began seeing an increase in new patients sustaining injuries attempting the transition to running in more minimal footwear. He describes, “It broke my heart seeing people hurting themselves trying to return to running how humans have for millennia, with minimal to no footwear. Unfortunately there is a lack of useful information readily available and many people dive into this technique unprepared and under-informed, which may lead to injury. Ray and I designed Minimalist Mondays to be the solution. We want Portland to be ground zero for the natural running movement, so its citizens become the healthiest, happiest, and most well-informed runners in the country.”

Many participants in Minimalist Mondays are very impressed with the results after taking part in the clinics. A recent participant states, “I had near-constant knee and foot pain, and was told that I would always need orthotics. Now I am stronger than I have ever been and not only do my feet no longer need outside support, but I can count on them to support me in my running, biking, stair workouts, and boot camp classes.”

For detailed information on Minimalist Mondays, including a curriculum outline, please visit http://www.therapeuticassociates.com/locations/oregon/portlandvancouver/downtown-portland/minimalist-mondays/

Watch examples of barefoot running techniques and drills used in this program. http://www.youtube.com/MinimalistMondays