Strengthen your feet and ankles to improve walking and saftey performance

As more Americans turn to walking for fitness, fun, and the pursuit of health, opportunities to participate increase every year. Walkers benefit from relay events specifically designed for them. Racewalking opportunities challenge those who wish to compete and find their own personal best. There are better coaching resources, seminars on walking, and multiple opportunities to connect with other walkers for group walks.

Walkers also find many exciting opportunities to get off the concrete and blacktop and pursue walking on more natural and yielding surfaces, such as sand, grass, gravel, snow, and mud. The Wildwood Trail in Northwest Portland boasts some of the finest mud around for a few months of the year before turning to hard-packed dirt, making for some amazing and ever-changing walking terrain.

As walkers venture off-road, they often experience a totally different physical walking experience than they have previously had on a flat, hard surface. They are challenged by walking up, down, and along hillsides. They find themselves needing to look down in search of roots, rocks, and uneven areas. They find a greater need for their bodies to accommodate different ground surfaces.This is where I come in. I am the keeper and preserver of the foot and ankle joints of walkers and runners. I am the sports podiatrist. I realize the crucial role played by the multiple joints of the walker’s feet and ankles that enables the walker to traverse undulating ground while keeping the body upright. I am keenly aware of how strong, adaptable feet and ankles can allow a walker’s entire body weight to pass over the talus bone painlessly, even when carrying a heavy pack.

This is accomplished by allowing the foot and ankle to do what they do best: adapt to changing ground and relay tactile details to the brain. The brain uses this information to activate the muscles of the body in response to what was sensed by the foot, ankle, and lower leg. When this happens as it should, walking is accomplished and perceived in an efficient and flowing manner.

Unfortunately, most Americans have not had the opportunity to develop strength and adaptability in their feet and ankles over their lifetimes. Exacerbating the problem is the current tendency of footwear retailers to promote certain technologies built into a shoe or boot, such as motion-controlling or anti-pronation features. Some Medical professionals also favor prescribing footbeds, orthotics, and arch supports. The philosophy of the anti-pronation crowd implies that there are defects in the adapting and sensing mechanisms of the feet and ankles of walkers, and that these defects can be corrected by applying some method of partial immobilization built or placed into the footwear of walkers.

In contrast to this common view, it’s my belief the human body was specifically designed for the activity of walking and will involuntarily develop strength and adaptability of the feet and ankles, except under certain select circumstances. The most significant of these circumstances is the use of footwear when walking. Close second, in severity of negative long-term consequences, is the lack of awareness that most footwear designed for walking is the most likely reason for injury experienced during extended walking. Because of this lack of awareness, footwear is not considered in the differential diagnosis of a walking injury.

Many walkers who have sought consultation with us have discovered the benefits of transitioning to footwear that enables their feet and ankles to function as nature intended them to.  That is, to be strong, flexible, and perceptive of the ground surface being walked upon.

-Written by Dr. Ray McClanahan

*See original article here

Should I wear Correct Toes with my orthotics?

Correct Toes eliminate the need for conventional orthotics in most people by enabling your foot arch (i.e., your medial longitudinal arch) to support itself. (Read more about natural arch support). In general, we DO NOT recommend wearing Correct Toes in combination with orthotics; we instead recommend weaning yourself off orthotics—slowly and progressively—when introducing Correct Toes. Correct Toes are, by definition, an orthotic, though conventional custom orthotics are placed under your foot arch (instead of between your toes) and attempt to alter foot position by using an unnatural methodology (i.e., by propping up your foot arch).

In other words, custom arch orthotics are not natural in any way. In fact, they violate the natural anatomy of your foot’s arches by artificially lifting them and placing material under them in a manner never seen in nature or in human-made structures, such as arch bridges. They may, initially, help gain a more natural foot position, but they do so artificially and the results are temporary. Our toe orthotic, Correct Toes, supports your foot’s arches in the exact manner nature intended, by placing your toes in their ideal natural alignment. So here we have two different types of orthotics attempting to do the same thing: one violates the natural anatomy of the foot, the other provides natural alignment to the foot and toes, and thus balance and support. Correct Toes are particularly effective in enabling optimal foot health when used in combination with a completely flat shoe surface (i.e., when they are worn in a shoe that possesses no heel elevation, toe spring, or motion control features).

While most people do not need orthotics if they use Correct Toes in footwear that allows proper toe splay, there are a few rare individuals who, even with Correct Toes and proper shoes, may not be able to restore their own arch structures simply by using their foot naturally. These few individuals may, in fact, benefit from Correct Toes AND orthotics. In even rarer cases, where the combination of Correct Toes and orthotics does not restore foot arch structures, a surgical procedure on the ankle may be warranted. Of course, Correct Toes should be worn after this surgery to help maintain proper toe and foot alignment.

Click here to get more information about Correct Toes and for answers to more frequently asked questions.

Children’s Footwear

The following quotes have been pulled from Dr. William Rossi’s article Children’s Footwear: The Launching Site for Adult Foot Ills.  Dr. Rossi’s article takes a look at the negative affects of shoes on children’s foot health.

“As a result, by the time the average shoe wearing child has reached the tender age of seven or eight, his or her feet clearly reveal a visible loss of anatomical or functional normality.  The medical practitioners are quick to attribute this to the wearing of “improper” or “ill-fitting” or out-grown shoes– not realizing there is no other kind because all (99 percent) of juvenile footwear, regardless or price or brand, is “improper” or “ill-fitting”.”

“For centuries, right to the present day, one of the most foot-negative features on the juvenile shoe has been the use of raised heels.  For infants and tots the shoe heel height begins at about 5/8ths of an inch.  By age five or six the heel height is 3/4ths of an inch, and by age eight a full inch– the same height as on a man’s shoe.  The heel heights are the same on sneakers as on conventional shoes.  Relative to body height, a one inch heel worn by a child of seven is equivalent of a two-inch heel worn by an adult.  So almost all children above age seven are wearing “high” heels the equivalent of two inches in height– and neither the shoe industry or the doctors has any idea of this absurdity occurring before their eyes.”

“Almost all lasts for children’s footwear, including sneakers, are “crooked” in contrast to the straight-axis alignment of the foot, heel-to-toes.  This has long been one of the chief causes of anatomical and functional foot deformity that begins in childhood and continues throughout all the adult years.”

“With those first steps the infant is now ready for prime time.  So onto its feet go it’s “first stepper” shoes.  And suddenly, the infant, having successfully launching its walking career barefoot, finds itself struggling to maintain balance and locomote with stiff, constrictive, alien objects on its feet.  It labors to take “normal” steps with shoes on– a physical and biomechanical impossibility because the “foot” steps and the “shoe” steps are two alien motions and opposing forces.”

“…the shoes soles, whether leather or other materials… automatically prevent 80 to 90 percent to the child’s normal flex angle, 55 to 65 degrees at the ball.  With shoes on there is very little heel-to-ball movement, thus denying the foot its normal step sequence.  The steps are pancake-like, seriously hampering the gait mechanics.”

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

Arch Support

Since much of the current treatment for foot and ankle disorders is centered on supporting the arch, we thought it would be helpful to discuss what arch support really means and discuss whether it is necessary or desired in the active foot.

In order to understand the treatment of rendering an arch support, one must understand the architectural principle of an arch, and liken that principle to the multitude of arches that naturally occur in the human foot. When you study the structure of the foot and the shapes of the bones of the foot, you quickly realize that most of the weightbearing bones of the foot, are indeed arches themselves by being shaped to have support ends at either end of the bone and an open space or boney arch in between the support ends of the bones.  For the purposes of the current discussion, we will concentrate on what might be considered one of the primary arches of the foot, sometimes called the medial (inside of the foot) longitudinal arch, the arch that spans between the rearfoot or heel bone and the forefoot or ball of the foot and toes.

Webster’s dictionary defines an arch as “a curved structure that supports the weight of material over an open space.”

Said another way, an arch is a structure that is able to support weight over an open space, by providing support on either end of that open space.

Applying this logical definition to the arches of the foot necessitates support on either end of the arch, and is exactly the opposite of the type of “arch support” that is available to consumers, either over the counter (i.e. Dr. Scholl’s or similar product), or from their healthcare professional (footbed, arch support, orthotic). These products attempt to “support” the arch, not by supporting the ends of the foot arch, but rather by lifting up under the open space of the foot arch. This does not make sense.

True support of the arches of the foot would suggest that the ends of the arches, on either end of the foot’s open space are the structures to be supported. This would mean that the heel and the forefoot joints (metatarsophalangeal joints and interphalangeal joints) are the structures that should be supported, and not the structures in between the ends of the arch.

As was mentioned above, current commercially available “arch supports” (which, by the way, are packaged under a number of names – arch support, footbed, orthotic, etc.) push up under the open space of the foot arch and not up under the ends. Many people feel a positive influence on their posture and walking comfort when wearing the current type of arch support, but this is not because they have a problem foot, but rather, because nearly all footwear that is available to today’s consumer expects the wearer to function well while walking on a ramp (the heel is elevated higher than the forefoot) with their toes bunched together (from tapering toeboxes) and the toes held above the supporting surface by footwear industry standard toespring, which is the elevation of the ends of the toes above the ball of the foot (the metatarsophalangeal joints).

But wait, didn’t we just confirm that in order for the arch of the foot to be supported, we need to support the ends, and not the middle, or open space?  Indeed we did, and as you can see from the description above, current footwear available to consumers is improperly positioning the support ends of the arch, by elevating the heel, which is one end of the arch, and unnaturally pinching the toes and holding them above the ball of the foot (metatarsophalangeal joints), which is the other end of the foot arch.

True support of the foot arch would then necessitate getting the heel bone (calcaneus) flat on the ground to provide support for the rearfoot support end, as well as getting the toes flat on the ground as well, so that the toes can help the ball of the foot to provide support for the other end of the foot arch in the forefoot.

Individuals who grow up barefoot, naturally have the support they need for both ends of their foot arch, and this is likely part of the reason why their foot arches function perfectly throughout their lifetimes, and their feet do not break down, unlike 80% of Americans who by nature of their habitual shoe wearing and compromised arches, will suffer some form of foot problem at some point in their lives.

This is not to suggest that we should all ditch our shoes and begin walking around barefoot, but it does suggest that our shoes are made improperly and are the cause of the arch problems and the associated deformities that many Americans experience.

Although there is scientific evidence that spending time barefoot is exactly what our weak arches need, the reason why it would not be a good idea for most Americans, is because much of our immediate environment is not compatible with our thin, moist skin and weak arches. We live in a world of cement and asphalt and multitudes of sharp materials, such as glass, that can become imbedded into our skin. Interestingly, the skin of the feet becomes thickened and resistant with prolonged exposure to hard objects such as gravel, cement and asphalt. Unfortunately, most Americans will never experience this hypertrophying and strengthening of the skin and arches of the foot, which is taken for granted in many developing countries, where all out sprinting over sharp rocks causes neither pain, nor injury.

What is suggested and recommended is that we make shoes that meet the need for protection of the skin of the feet, and that shoe manufacturers do not presuppose that the fashionable design features of heel elevation, tapering toebox, and toespring, are without significant deforming consequences.

In conclusion, the most likely reason for needing arch support, is because today’s footwear removes the structural integrity of the foot arch by altering the support ends in favor of supporting the open end, which is no longer an arch support, but an open space support.

Pushing up in the open space of the foot has the significant long term consequence of weakening of the muscles that span the open space of the arch, which are called the intrinsic muscles of the foot, as well as the numerous muscles in your lower leg which send tendons into their final insertions, many of which are in the ends of the toes.

-Written by Dr. Ray McClanahan

Link List Friday!

She hated running now she’s trekking across the United States.  Barefoot.  For summer Vacation.

Congratulations to Sanya Richards-Ross on her gold medal in the Women’s 400m!  She talks about winning here.

Beetroot and tart cherry juice improves athletic performance… suspicious at best or something you’ll try?  Some athletes are really into it!

If you’re in an Olympic medal ceremony always smile or this might happen to you.

Becoming a morning person isn’t impossible!

Just added this to my workout playlist.  Whats on yours?

Do’s and don’t of how to run.  Short and sweet.

Heel Elevation

Heel elevation is present on almost all shoes.

Since we learned to walk, we have been wearing shoes. Some of us even before then. Our parents wisely wished to protect our feet and were not aware of the limiting effects shoes were having on the development of our feet. Almost all of those shoes had a heel that was elevated above the surface more than the front part of the shoe covering our toes and the ball of our feet.  Consequently, we have ALL developed contracted or shortened lower leg muscles on the back of our leg.

The muscles that we mostly talk about are the calf muscles or the gastrocnemius and the soleus. There are actually 3 more very important muscles that are also in the back of the leg under the calf muscles that are also extremely important in helping our arch to function properly (posterior tibial, flexor hallucis longus, and flexor digitorum longus) as well as helping our toes perform their natural functions of grasping, balancing and directing our feet forward while we are pushing off of our toes (propulsion).

This is an extremely serious situation considering the fact that the shortened lower leg muscles are now contributing to faulty foot function in a number of ways. The most significant foot fault caused by elevated heels is that shortened posterior leg muscles pull improperly on the back of the heel to unnaturally increase the amount of flattening the arch will undergo. Said another way, chronically shortened lower leg muscles increase pronation of the foot and ankle. Pronation is the sequence of movements that has been given the most attention by foot care providers as being the cause of most foot and leg problems. If indeed pronation is the prime culprit for most foot and leg problems, it makes good sense to lower the elevation of the heel on your footwear so as to not allow the shoe to further shorten your lower leg muscles and increase your pronation.

Increasing your pronation certainly is cause for concern especially given all the attention to this movement by foot care providers and sports medicine providers, but in this author’s opinion, it is only one of many negative effects brought about by wearing a shoe with an elevated heel.

A more significant and potentially debilitating effect of heel elevation is that there is an involuntary stretch reflex built into the posterior lower leg, that can only be activated if the heel is allowed to come close to the ground. This does not occur in most shoes available to consumers today, EVEN amongst athletic models.

The problem here is that activation of that involuntary reflex is something that should happen with every step to help our forefoot with its most important task of propulsion.

Sadly most shoe wearing people do not get to experience normal gait and propulsion.

This may not seem like that big of a deal because after all we can still walk and many of us are able to participate in athletic endeavors. But it is a big deal when you consider that walking and participation in sport can not occur naturally, and our efforts are undeniably hampered by something so seemingly simple as the coverings we put on our feet. Shoes and their construction have been hypothesized to be the single most important identifiable feature that separates our long distance runners from those who grew up in countries where their feet and legs developed normally.

So next time you are in the market for a pair of shoes, bear in mind the negative features described above and choose accordingly. Your feet and your whole body will thank you.

-Written by Dr. Ray McClanahan

*See original here.