Is your prescription of distance running shoes evidence based?

The following quotes are pulled from the study conducted by Craig E Richards, Parker J Magin and Robin Callister from the British Journal of Sports Medicine.  The study was designed to see if the traditionally prescribed distance running shoe is based on scientific information.

“Distance runners are notorious for their high rates of minor musculoskeletal injury, with 37-56% of average recreational runners becoming injured at least once each year.[1] In recreational and competitive runners alike, running injuries almost exclusively affect the lower limb and are primarily due to chronic overloading rather than acute traumatic events. Our capacity to prevent such injuries is currently limited, with training advice and footwear prescription forming the mainstays.[2] As such, the prescription of the right running shoe, either alone or in concert with an orthotic, is considered a crucial and highly valued skill.”

“Since the 1980s, distance running shoes with elevated heavily cushioned heels and features to control sub-talar motion have been consistently recommended to footwear prescribers as the gold standard for injury prevention.[2-6] Prescribed on the basis of foot type, over-pronators, mild pronators and supinators are prescribed ‘motion control’, ‘stability’ and ‘cushion’ shoes respectively.[4,6] In the absence of existing nomenclature to describe these shoes as a group, we propose the term ‘Pronation control, Elevated Cushioned Heel’ (PECH) running shoes.”

“The use of cushioning in running shoes is based on the following assumptions: 1) that impact forces whilst running are a significant cause of injury, 2) that running on hard surfaces is a cause of high impact forces, 3) that a cushioned shoe can reduce impact forces to a less injurious level, and 4) that the potential of the cushioning to itself cause injury is minimal.”

“It has been suggested that an elevated heel is incorporated into the PECH shoe to decrease Achilles tendon strain and thus Achilles tendon injury.[3,12] It also allows placement of a substantive heel cushioning system.”

“The protective effect of normalising sub-talar joint motion is built on the following assumptions: 1) that over-pronation and supination are causally linked to overuse injuries, 2) that promoting limited pronation reduces this risk, and 3) that PECH shoes are an effective means of reducing injuries via this approach.”

“No articles were identified that reported original research addressing the capacity of PECH shoes to prevent injury. Six systematic reviews were identified whose scope included interventions to prevent injuries in runners, or injuries common in runners.[21-26] Two were outdated systematic reviews for which updated versions were identified.”

“If we accept this finding, we are then faced with the realisation that we have been prescribing a therapy without proven benefit for over twenty years. Worse still, these footwear prescription practices have not gone uncontested in the literature. Despite the absence of a systematic review specifically addressing the capacity of PECH shoes to prevent injury, the lack of evidence for their use and their potential to cause injury has been raised by a number of authors, including leading authorities in the field.”

To read the entire study click here.

Achilles Tendinitis

Achilles Tendinitis

Your Achilles tendon is a strong cord made of fibrous connective tissue that attaches your calf muscle to your calcaneus, or heel bone. Your Achilles tendon is located at the lower end of your calf muscles, and it is the continuation of your gastrocnemius and soleus muscles. This tendon is one of the strongest tendons in your body and is essential for many performing occupational and recreational activities, especially athletic activities.

Condition Information

Achilles tendinitis is inflammation, swelling, and pain in your Achilles tendon. This health problem can affect any part of your tendon, though it most commonly manifests at the point where your Achilles tendon attaches to your heel bone or less than 1 inch above this point. Shoes that continuously rub on the back of your heel may irritate your Achilles tendon and heel bone, causing a condition known as traumatic Achilles tendinitis, or pump bump.

The pain and inflammation you experience with traumatic Achilles tendinitis can only be relieved by removing the cause of your inflammation: your shoes. Shoes that are too short in heel-to-toe length and shoes in which the heel counter—the rounded cup-shaped part of your shoe that covers the back of your heel—does not match the shape of your heel may cause a pump bump. Excessive motion of your heel bone during walking and other activities may also be a factor in causing this health problem. Examine the inside of your shoe’s heel counter to see if the material at the back of your heel is worn away.

Causes and Symptoms

Achilles tendinitis, though commonly caused by the use of inappropriate footwear, may be caused by numerous factors. And this health problem is seen in people with different foot types. Some of the most common causes of (or factors that contribute to) Achilles tendinitis include:

  • A rapid increase in training volume among runners, walkers, and other athletes
  • A sudden increase in training intensity
  • A rapid transition from running shoes with heel elevation to racing flats or spikes
  • Tight calf muscles
  • Arthritis and bone spurs (more common among middle-aged individuals and seniors)

Achilles tendonitis caused by a rapid increase in your training volume or intensity is called overuse Achilles tendinitis. Transitioning too quickly from shoes with heel elevation (including running shoes and high heels) to shoes with little heel elevation may cause Achilles tendinitis because your Achilles tendons have to stretch up to 1 inch, due to the contraction of this tendon that occurs from the prolonged use of high-heeled shoes. The stretching forces that your Achilles tendon experiences in this scenario are often sufficient to cause inflammation and other tendinitis-related signs and symptoms.

Common signs and symptoms associated with Achilles tendinitis include:

  • Pain and stiffness along your Achilles tendon that is worse in the morning and with activity
  • Extreme pain in your affected area the day following exercise
  • Achilles tendon thickening
  • Chronic, or long-term, swelling in or around your Achilles tendon
  • Bone spurs in your affected area
  • Observable changes in your gait


Conservative treatment of Achilles tendinitis usually involves PRICE: Protection, Rest, Ice, Compression, and Elevation.

  • Protection: Protect your Achilles tendon from shoes that rub against it.
  • Rest: Avoid the activities that caused the inflammation until all signs of inflammation are gone.
  • Ice: Ice your inflamed area for six to 10 minutes, several times per day.
  • Compression: Compress your swollen area with an ACE (all cotton elastic) wrap or ankle brace.
  • Elevation: Elevate your injured tendon above your heart to help decrease your swelling.

Calf and Achilles tendon strengthening exercises may also be helpful in treating tough cases of Achilles tendinitis. These exercises involve dropping your heels lower than your forefoot, which causes your Achilles tendon to contract yet simultaneously elongate. This type of muscle contraction is called an eccentric contraction. You can add more weight (handheld weights or barbells) to increase the intensity of your Achilles stretch as you get stronger. An athletic trainer or physical therapist is an excellent resource for help with this treatment.

Traumatic Achilles tendinitis (pump bump) usually responds to appropriate footwear changes. Consider switching to backless shoes or sandals that place no pressure on your affected area. Once your tissues heal and your Achilles tendinitis disappears, you will need to have your shoes and boots professionally fitted to prevent a recurrence of this painful problem.

Achilles tendinitis is a serious health problem and should be treated immediately to help avoid health complications. Achilles tendinitis, if left untreated, may lead to prolonged pain and inflammation and scar tissue formation. Scar tissue can decrease your Achilles tendon’s flexibility and increases your likelihood of experiencing a complete rupture (the tearing of your Achilles tendon away from your heel bone or into two pieces).

Tapering Toeboxes

Have you ever noticed the foot of a child? Particularly a child who has just been born? The child will have a forefoot that is wider than the rest of the foot. Meaning, the tips of the toes are wider than the ball of the foot and there are natural spaces in between the toes. Unfortunately, we fail to recognize the importance of these natural findings and begin to cripple the foot of the child by placing the child’s feet into shoes that push the toes into an unnatural alignment. It is practically impossible to find a pair of shoes or boots that are manufactured wider at the end of the toes than at the ball of the foot. On the contrary, almost all shoes and boots, including athletic models, squeeze the toes into a triangular shape that compromises their natural grasping and balancing functions. We accept this because we have been doing it since people began to wear shoes, but we also accept it because most people do not fully understand the importance of the function of the toes, including many doctors entrusted in the care of them.

The toes are critical for our sense of balance, which is very important when we go onto our toes just before we toe off in the part of walking and running that we call propulsion. When our toes are not properly spaced and grasping the ground, our legs and upper bodies are forced to make compensations for the instability of our toes and our gait is less balanced and less efficient. Most shoe wearing people begin to lose the function of their toes early in life because almost all shoes push the toes together and hold them above the ground surface. We make compensations for our faulty walking, but the cost of these compensations is foot deformity, leg and back pain and abnormal gait. Thus, it makes sense to find shoes that allow an individual to spread their toes and have the ends of their toes next to the ground. Unfortunately, there are few such shoes available, and furthermore most shoes have an elevated heel which further compounds the imbalance within the toes of the foot. A good example of a shoe that would be healthy is a shoe that is shaped like a Birkenstock sandal.

So, how do we go about the task of finding shoes that give our toes the room they need? I do not have much hope that shoe and boot manufacturers are going to make any radical changes, since fashion and cosmetics have been the traditional motivators in their market.

Consequently, the best recommendation is to find a shoe store that specializes in wide shoes and removable insoles. To see if the toebox will have adequate room for your toes, it is recommended that you find shoes with removable insoles and stand on them with the socks that you intend to wear, preferably with your toes spread. If no part of your foot expands beyond the insole, especially your toes, that shoe may work for your feet. Unfortunately even amongst wide brands you will find that most toeboxes are more tapered, narrow and pointed than the average foot. So why do we tolerate it? We tolerate it because we are not educated about the potential problems associated with this bad positioning of our toes and the front of our feet. And we tolerate it because that is the way most shoes are built.

Some of the potential problems are:

Ingrown Toenails
Tailor’s Bunion
Heel Pain
Athletes Foot Infection
Tendon Imbalances
Morton’s Neuroma
Fungal Toenail Disease
Black Toenails

These problems occur very rarely in cultures where shoes are not worn, but they are exceedingly common in our shoe wearing culture.

It is interesting to note that the above foot problems include most of the common foot problems that are treated by medical professionals, yet treatment most often does not include education as to how to prevent these problems once they have been identified. Worse still, reconstructive surgery is often recommended for some of these conditions, without mention of need to modify the types and shapes of shoes that are worn.

Testimonial- Ricky

One thing our Correct Toes team loves most is seeing the change that comes from people embracing a new outlook on foot health!

We’ve been fortunate to receive email updates from Ricky, a Correct Toes wearer in Japan.  Ricky bought his first pair of Correct Toes back in June 2012 and has since seen some great improvements in his feet.  He had moderate bunions, flat feet, and burning sensations in his metatarsals from standing for long periods of time at his job.  Through an internet search Ricky found our website and ordered his first pair of Correct Toes!

This is a picture of Ricky’s feet 3 days after receiving his Correct Toes.

Ricky’s feet 6 weeks (top) and 3.5 months (bottom) after wearing Correct Toes.  Big difference!

Here is what Ricky has to say about his Correct Toes experience so far~

Here are my feet 3 mo after.  A lot of that stretchy feeling is gone.  It feels nice and loose at the bottom of feet.   Almost no stiffness at end of day when I wear minimal shoes.  In the Birkenstock, when I feel like I don’t want to walk like a ninja all the time it will stiffen up.  I am now back to 3 x a week jump roping 20-25 min a day only in the vivobarefoot shoe.

I modify the correct toe to accommodate the shoes.   I split off and made a separate spacer between 3-4 toe to bring the toes in closer.  The great toe and toe 2-3 are connectedly spaced. I still wear the 5 toe set up at night …
I follow all of the doctors stretch advise from the tube.
Well all for now

Our team would like to thank Ricky for graciously letting us share his Correct Toes journey so far!  We look forward to seeing continued progress.

And, guess what?  We want to hear from YOU too!  Send us some pictures and tell us your story of how Correct Toes has taken your feet from funky to functional!

High Heeled Diva, Do What Heals Ya!

A Foot and Toes Survival Guide for Today’s Fabulous Fashionista.

Written by: Dr. Robyn Hughes, ND & Dr. Ray McClanahan, DPM

You’re a contemporary fashionista who dresses to impress. You faithfully don your high heels to conform to business dress standards, impress your employees, boss, or coworkers, and look fierce, maybe even sexy. You’re aware that wearing your fashionable heels may result in painful footsteps, but well, you’re willing to squeeze them on for the sake of good looks. If this
description mirrors your experience and thoughts, you may be well on your way, unfortunately, to birthing a bunion (you know, that unsightly bump that appears at the base of the big toe) not to mention developing hammertoes, clawtoes, interdigital neuromas (ball-of-foot pain), and plantar fascia problems (heel and/or sole pain), all of which are associated with prolonged high heels use. Ouch.

So what’s a fabulous fashionista to do? Ignore the demands of fashion and cold turkey your heels habit? Strike a bold new fashion path? Succumb to the fashion dictocrats and accept your lot in (business) life? Boldly continue wearing high heels and deal with the pain (and possibly surgery) later?

We at Northwest Foot & Ankle / Correct Toes certainly understand the draw toward beauty, creativity, and self-expression that’s provided by fashion. But we’re also a sports podiatry clinic, and so we experience first-hand, all day long, our patients’ foot pains and deformations that are caused by long-term use of fashion footwear. So while we enjoy fashion’s runway shows as much as anyone, we find that as we pan head to toe, we delight in the innovative hair, makeup, shirts, dresses, pants, accessories… but once our gaze reaches the high-heeled pointed-toe footwear, we cringe inwardly. We just know, too well, the negative implications of this style of footwear.

In this article, we offer several top tips on how to safeguard your feet and toes from the perils of a contemporary woman’s urban existence. We discuss a middle path that will allow you to maintain office decorum and retain your femininity yet spare your digits the devastation commonly wreaked by women’s conventional dress footwear (not to mention the footwear that will be seen at the upcoming New York Fashion Week). Please proceed with an open mind and an adventurous heart. The truth will set you (and your toes) free.

Practice Clandestine Foot Health in Your Cube

If you spend a good portion of your day sequestered in your office or cube, you have the perfect opportunity to practice clandestine natural foot health. Away from the gawking leers of your peers, and under the cover of your designer bureau, you can let your feet run as wild and free as these true marvels of human anatomy were designed to be. That’s right. We’re talking about ditching your heels and going barefoot in your office as often as possible [a collective gasp is heard throughout the corporate world]. If the idea of baring your feet while on the clock is beyond comprehension, consider a constructive alternative: Bring a pair of flats or sandals to
work and wear them outside of business meetings or high-powered exec lunches. If you can’t eliminate high heels from your business life, minimizing your time in them certainly is the next best option.

Consider, too, taking a few minutes for yourself several times each day to perform key stretches at your desk or console. Chief among these stretches (and especially important for heels-wearing women) is the bunion stretch—a stretch that can help you prevent that much-feared and loathed
bunion. Check out our bunion stretch video in which Dr. Ray McClanahan, inventor of Correct Toes toe spacers, demonstrates proper bunion stretch technique and explains why this exercise is so important for big toe health. Two other office-friendly foot exercises we recommend include the toe extensor stretch (for ball-of-foot pain) and the plantar fascia release exercise, which helps massage your plantar fascia (the thick band of tissue that runs from your heel to your forefoot). Perform the plantar fascia release exercise by rolling the bottom of your foot back and forth over a hacky sack or golf ball.

Stand (or Sit!) Corrected

All fashionistas can benefit, to some degree, from Correct Toes—a revolutionary toe-spacing device that realigns your toes in their normal anatomical position. Even if you can’t permanently retire your heels, you will undoubtedly enjoy spreading your toes on a regular basis when sitting
at your desk or living your life outside the office. You can use Correct Toes to help treat or prevent many common foot and ankle ailments, including bunions, hammertoes, and Achilles tendinitis, among other problems. Wearing Correct Toes during weight-bearing activity should be done in combination with compatible footwear (i.e., footwear that is widest at the ends of your toes, not the ball of your foot).

Consider placing metatarsal pads in your non-work shoes to help preserve your foot health. A metatarsal pad—a small, soft, and unobtrusive pad that sits within your shoe—helps spread your transverse foot arch and stretches tight toe extensor muscles. It also helps realign your forefoot
fat pad to a position that cushions the heads of your metatarsal bones. Without proper cushioning for your metatarsal heads, and with the excessive stress and pressure high-heeled shoes place on this region of your foot, you are vulnerable to several common foot problems, especially
interdigital neuroma. We’ve put together a helpful video demonstrating how to optimally position your metatarsal pads.

Educate the Powers That Be

Your boss or coworkers need to be sympathetic to your situation and support your decision to wear the healthiest possible footwear for your feet, even if your shoes stand out in the office like a cravat on casual Fridays. If your office has a dress code in place that requires you to wear foot-deforming shoes, consider making an earnest plea to your employers about the necessity of appropriate footwear for long-term foot and lower extremity health. Impress upon them how much more productive—not to mention pleasant!—you could be if you were allowed to wear comfortable shoes all day long. If appealing to their hearts doesn’t work, appealing to their wallets might: adopting foot-healthy footwear may save your firm, office, or agency big dollars in health care expenses, especially if your foot problem gets you bounced to a podiatric surgeon.

We recognize that fashion exerts a strong influence on what’s acceptable and what is not, and that office realities certainly do exist, but there is no harm in becoming an advocate for reasonable footwear in your office, and possibly much to gain. Nature intended your foot to be widest at the ends of your toes, possess excellent toe splay, and have strong, sturdy arches.
Crooked and mangled toes, bunions, and ingrown toenails do not need to be your destiny, Fabulous Fashionista, as long as you respect nature’s brilliant design by using tools (such as Correct Toes) and footwear that allow your foot to function like a bare foot inside your shoe. It’s time to redefine what’s beautiful in feet and footwear and put conventional office footwear in its place (i.e, something only seldom worn). So, we ask you, what’s uglier? A wide toe box shoe with no heel elevation, or crooked toes and a big, throbbing bunion at the base of your big toe? Just sayin’.

Lead a Double (Foot) Life

So your boss refuses to grant your feet immunity and insists you wear high-heeled shoes while at work. Bummer, yes, but all is not lost. You can still lead a double foot life. The minute you punch out at work, slip on your Correct Toes and wide toe box footwear for a gym workout (we
recommend Altra running shoes for most athletic activities, including gym sessions, due to the spacious toe box and other beneficial design features included in this brand’s shoes). Spending as much weight-bearing time as possible in Correct Toes and healthy footwear will go far in countering the deleterious health effects associated with conventional office footwear. Weight bearing activities conducted with your toes in their proper anatomical arrangement can have a profound corrective effect on many shoe-induced foot deformities.

4 inch high heel vs. zero drop Leming


The strategies mentioned above can help slow the progression of foot problems and foot degeneration. It’s difficult to completely undo all the damage caused by years of conventional footwear use, especially if you keep wearing the shoes that cause the damage, but our best advice
as doctors to help prevent and resolve chronic foot problems is always to quit wearing foot-deforming shoes (or wear them only minimally). Men (if you have read this far), you are not exempt! Men’s dress shoes (even the ones that claim to be healthy), cowboy boots, and the tennis shoes that perhaps some of you less fashion-savvy gentlemen think pass for high fashion: all contribute to foot and toe deformation and problems.

We do recognize, as did natural foot health expert, podiatrist William A. Rossi, the powerful hold fashion has on our psyches. Rossi notes:

“Fashion plays an enormously influential role in our lives, often involving and affecting our health physically, emotionally, psychologically and psycho-sexually. And this applies particularly to fashion footwear … Fashion has been with us since earliest civilization, even before, because it serves a vital role by feeding two of human nature’s most powerful motivating forces: status and sex attraction.”

We appreciate fashion and respect the artistic expression and creative genius of fashion designers, though we wish foot health was a higher priority in the fashion industry. We excitedly await a paradigm shift in the fashion and footwear industry toward more natural footwear for the
preservation of normal, healthy foot anatomy. Until that happens, practice the above-mentioned strategies to keep your toes in line and your feet feeling fine!

Plantar Fasciosis

The following quotes have been taken from Glen Ingram and Ray McClanahan’s article Treatment of Plantar Fasciosis.  To read the complete article click here.

“Plantar fasciosis is an extremely painful disorder affecting 10% of the population at some point in their lives. (DeMaio, 1993).”

“Note the use of the term plantar fasciosis instead of plantar fascitiitis.  This change in terms came about due to a study by Harvey Lemont, DMP.  In his study, biopsies were taken of the plantar fascial ligament in patients with severe plantar fasciitis.  The result was not the finding of inflammatory tissue, but of necrotic tissue. Lemont concluded that plantar fasciitis is not an inflammatory process but a degenerative process characterized by microtears and necrosis of the plantar fascial ligament and intrinsic flexor muscles of the foot at their attachments on the calcaneus. Hence, the disorder is better termed plantar fasciosis (2003).”

“One possible cause of necrosis and pain in the plantar fascial ligament is decreased blood supply to the area due to entrapment of the posterior tibial artery by the flexor retinaculum. When the first toe is held in adducted and extended position, the abductor hallicus pulls the flexor retinaculum and can restrict blood flow to the affected area.  As blood supply is decreased to the sole of the foot, tissue in the foot begins to degenerate, with the fastest degeneration occuring in the tissue that sustains the most trauma.  Athletes and people who stand for long periods of time on hard surfaces are most prone to plantar fasciosis.  They also sustain the most trauma to the sole of the foot.”

“Most Americans spend most of their lives with their great toe in an adducted and extended position.  Three features that are almost ubiquious in modern footwear are responsible for this unnatural position: heels, toe springs, and tapered toe box.”

“The most important treatment for plantar fasciosis is getting the patient into a shoe that allows his or her foot to be in its natural position: heel flat and level with the forefoot, toes down against the support surface level with the ball of the foot and toes spread out.  Such a shoe is flat, widest at the toe box, and has no toe spring.  We also like to recommend shoes that are flexible throughout the entire sole.”

“…the toe extensor stretch… stretches the toes into plantar flexion at the metatarsal phalangeal joints.  It is most easily performed when sitting in a chair or stool.  From this seated position, extend one foot back behind the body and place the dorsal surface of the toes on the floor.  This should bend the toes at the MPT joint.  Then plantar flex the foot fully by pressing the heel down towards the floor.  The stretch should be felt along the dorsum of the foot and anterior lower leg.”

“The exercise that goes along with this stretch is simply walking and functioning in a flexible shoe as much as possible.  Flexibility in a shoe allows the joint to bend during activity and the muscles of the foot to engage, especially the intrinsic flexors.”