A healthy, pretty foot.

Until 1949 when the millennium-long tradition was finally outlawed, most Chinese women had their feet broken and bound for life in order to adopt a desired pointed “lotus” shape. That practice sounds repugnant to modern women, thus it makes it even more surprising that a growing number of women are subjecting their feet to major surgical procedures for no other reason than to be able to walk in stilettos. 

Major Foot Surgeries Solely For Cosmetic Reasons 

Some of the surgeries include: 

Toe shortening - A bone segment is removed
Toe lengthening – The bone is cut and lengthened with an implant
Toe straightening – Bone near the joint is removed to fix a curl
Toe slimming – The bone is shaved
Foot padding – Filler or fat is injected into the ball of the foot
Foot narrowing – The entire foot is reduced in width 

Although some of these procedures are carried out to assist patients with deformed or injured feet, the recent boom in their popularity is strictly cosmetic: Women want their feet to look better in expensive shoes, or to be able to walk more comfortably on heels that can exceed four inches in height and place the foot at an extremely unnatural angle which is often greater than 45 degrees. 

The Desire For Carrie Bradshaw Feet 

The desire to have feet which could feature in Sex In The City protagonist Carrie Bradshaw’s ultimate Manolo Blahnik fantasy is driving thousands of women to undergo surgeries without considering the serious consequences. In a recent issue of the Wall Street Journal, I warned that these women “want to look their best and they don’t understand the risks.“ 

26 Bones & 30 Joints Designed To Hold Up Your Entire Body 

Both the American Orthopaedic Foot and Ankle Society, and the American Podiatric Medical Association which represents nearly 9 out of every 10 podiatrists in the United States, and have adopted strong positions against these forms of cosmetic surgery. The human foot is a delicate assemblage of 26 major bones and 30 joints, and these organizations do not believe that women’s aspiration to look good on a Saturday evening balances out the risk of lifelong pain and permanent deformities which may require several corrective operations. Some women are rendered unable to walk properly at all from these ill-advised cosmetic surgeries. 

Foot Surgeries Are Being Considered In The Breast Augmentation League 

Enchanting women by the allure of operations which are hyped under fanciful names such as The Cinderella Procedure, aesthetic foot surgeries are flourishing in the moneyed canyons of Beverly Hills and many of the country’s elite enclaves such as Manhattan and Miami Beach. Lulled into a false sense of confidence by the apparent ease of breast augmentation surgeries, women fall into the trap of believing that their feet can have an equally easy makeover: while failing to consider that feet are designed to bear the weight of the entire body through a wide variety of strides, and are not to be modified to fit fashion. 

Unlike breasts, you have to walk on your feet!

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About.com's Walking Guide Wendy Bumgardner at the International Marching League Walking Event in Israel.

Walking—as a form of exercise—might seem dull to some in this age of high-tech exercise gadgets, gizmos, New Age hip personal “celebrity” trainers and infomercial “get in shape” fads. Not so for the Internet’s walking guru/cheerleader/nurse/champion Wendy Bumgardner, a certified marathon coach and expert on walking for health and sport.

Research indicates a daily brisk walk helps shed excess weight, control blood pressure, strengthens the heart muscle and helps lower the risk of a stroke, breast and colon cancer and developing diabetes. It boosts good cholesterol while lowering the bad, strengthens bones, relieves arthritis, improves vitality and elevates mood by alleviating depression and anxiety. It is free, easy to do, incredibly safe and does not require special equipment.

Clearly, walking is the king of all exercise.

Queen of Walking

Every king needs a queen, and the queen of walking is definitely Bumgardner. Since 1996, she has been About.com’s Walking Guide.

Her site is a wealth of information about walking for fitness and sport. It covers everything from basic stretching exercises to the latest accessories and various esoteric and walking-related issues including nipple chafing, incontinence and how to react to a flasher on the trail. Her site helps people realize they are not the only ones having these problems.

Passionate About Walking

For Bumgardner, knee surgery was the spark that ignited her life-long passion for walking. The surgery left her with debilitating foot drop syndrome. This can occur when the nerve that causes the muscles to lift up our foot (to flex the foot) is injured or damaged. This is a known complication of knee surgery and it can be temporary or last for life. Bumgardner’s husband, an avid walker, urged her to go on a Volkssport walk, a six-mile non-competitive walk in Oregon.

Bumgardner says she didn’t think she could walk one mile, let alone six. She not only finished the walk, but was awarded a medal. From then on, she was hooked on walking.

Bumgardner says writing about walking for the About.com site has allowed her to help millions of people a year and thousands each week.

“I get a steady stream of e-mails thanking me for my half marathon and marathon training programs and advice. My readers let me know I have changed their lives for the better,” she says.

In addition, discussing walking for About.com has given her a great outlet for her passion for writing and has allowed her to make a few bucks, too!

“Walking is a great exercise for those who really don’t necessarily like exercise,” Bumgardner says. More than exercise, she loves walking because of its unique ability to connect you with the world around you. Clearly, walking on a trail or just about anywhere outdoors creates a spiritual connection, unlike pumping the leg press in the local gym.

Wendy "Walkaholic" Bumgardner at the NYC Avon Walk for Breast Cancer.

Bumgardner’s passion for walking comes through in her writing, giving her articles and posts a unique voice.

“I’m not a reporter. I’m a walker,” she says and, adds she is “embedded.” She lives the topic. It is not just a job. It is her main form of exercise, and she intertwines walking with her social activities, recreation, and vacations.

“If I want to review a half marathon, I pay the entry fee and walk the event myself, rather than report from the sidelines.”

Final Thoughts

Bumgardner has truly made a difference in the mental, spiritual and physical health of people around the world and I applaud her for her passion and hard work. Her site is one of my favorites and every time I visit, I learn something new and interesting. I often find myself spending a lot of time there!

I highly recommend you visit Bumgardner’s site and begin learning about the fascinating benefits of the oldest—and still the best—form of physical activity, walking.

Links:

Bumgardner’s Walking Site

Wikipedia on Walking

The Walking Site

The Walking Connection

Active Walking

Walking Info

American Volkssport Association

WalkaBlock Club of America

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Here I am at work, feeling great in my Vivo Barefoot Shoes.

Al Gauthier of  ‘Living Barefoot’ just posted a frank, detailed audio interview with me about barefoot activity and barefoot running. Al and his partner, Tina Dubois, were a pleasure to speak with and they asked many insightful questions. In particular, they asked what I thought it would take for barefoot running to be accepted by the medical community—my answer may surprise you.

To hear this loose and open discussion about barefoot activity from the perspective of a podiatrist who has spent 20 years treating foot problems and has become a strong proponent of the benefits of barefoot activity, listen to the interview HERE.

I look forward to speaking with Al and Tina again in the future on more narrow aspects of barefoot activity.

Links: Living Barefoot
Living Barefoot Show Featuring Dr. Nirenberg

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Is Your Pelvis the Cause of Your Pain?

What happens with a man spends more time thinking about a triangle-shaped bone at the bottom of our back than a teenage boy spends thinking about sex?

The answer is, he discovers a remarkably simple solution to alleviate low back pain and quite possibly, a way to help lessen or completely eliminate other painful bone, muscle and ligament ailments.

Richard DonTigny has spent 40 plus years puzzling out the intricacies of our pelvic ring: the bones, ligaments and muscles that comprise our waist, buttocks and hips.

“Pelvis” is Latin for “basin,” which is what our pelvic ring resembles. In medical-speak the pelvic ring is made up of the hipbones and the sacrum (the triangle-shaped bone at the bottom of your back). The joint between the hipbone and the sacrum is the sacroiliac joint, and that is the linchpin of DonTigny’s work: it is where the secret to pain-relief lies.

DonTigny is a physical therapist who has published over 25 journal articles, written chapters for medical textbooks, lectured extensively, and treated over 8000 patients with sacroiliac joint problems. He is also the author of the Powerpoint CD, “Pelvic Dynamics for the Professional.”

In “Pelvic Dynamics for the Professional,” DonTigny explains how the sacroiliac joint (and the pelvic ring) is prone to becoming out of alignment, setting up a chain reaction of tension and strain on the surrounding muscles, ligaments and other soft-tissue structures. Dysfunction of the sacroiliac joint, DonTigny says, is responsible for at least 85% of low back complaints. Beside the back, he says that a malfunctioning or misaligned sacroiliac joint may also be the culprit in sciatica, piriformis syndrome, and knee, hip, pelvic, or stomach pain, and indirectly cause neck, shoulder or foot problems.

Just one detailed illustration from "Pelvic Dynamics"

DonTigny states: “In 1992 at the First World Congress on the Sacroiliac Joint Dr. Joseph Shaw of the Topeka Bank and Neck Pain Clinic reported that in a series of 1000 consecutive patients he examined for low back pain (LBP) and sacroiliac joint he found that 98% had an SIJ problem. When he addressed that problem, his surgical incidence for herniated disks dropped to 0.2%.”

Once one delves into DonTigny’s CD—a whooping 600 plus slides—you begin to understand how the pelvic ring is the linchpin of our skeleton. It supports our spine, allows us to walk and do other activities by serving as a powerful fulcrum for our body.

DonTigny shows that even small sacroiliac problems can have far-reaching effects on the body, even altering normal function of the feet.

For example, a misalignment of the pelvis can increase the inward curve of the low back (increase lordosis) while increasing the outward curve of our back at the level of our chest (kyphosis). These actions can cause our hips to rotate outward and our shoulders to hunch inward and lead to our head jutting forward (causing neck pain). Sacroilliac joint dysfunction can also cause a curve of our spine in the frontal plane (scoliosis) and ultimately create what appears to be a leg-length discrepancy (one leg longer than the other). Clearly, the sacroiliac joint is the keystone for good, healthy walking, standing and even sitting.

On his CD, DonTigny brilliantly dissects the complex inner details of sacroiliac joint and through his hundreds of beautifully illustrated slides, he makes understanding this complex joint easy.

The crowning jewel of DonTigny’s CD is a series of adjustments – The DonTigny Method – that a physical therapist (or a patient can do themselves) to properly realign the sacroiliac joint.

One has to wonder why DonTigny’s method is not known more widely and more accepted. Clearly, having a patient do some adjustments prior to seeing an orthopedic man for a back fusion is preferable. Part of the answer may lie in the fact that adjustments to solve back pain (and other bone and muscle problems), are so simple that individuals with a financial stake in back pain may feel their livelihood threatened.

Or perhaps, and much more likely, it may be difficult for those health practitioners who have spent their life doing sophisticated back surgeries, injections and/or a myriad of therapy modalities, to open their minds to such an easy solution.

Beyond the health practitioners, patients themselves still, for the most part, believe the medical system has all the answers. Until people begin thinking for themselves, begin asking questions–both to themselves and to their doctors, the system will feed them what it always has.

I am reminded of a great quote from the film The Matrix:

“The Matrix is a system, Neo. That system is our enemy. But when you’re inside, you look around, what do you see? Businessmen, teachers, lawyers, carpenters. The very minds of the people we are trying to save. But until we do, these people are still a part of that system and that makes them our enemy. You have to understand, most of these people are not ready to be unplugged. And many of them are so inured, so hopelessly dependent on the system, that they will fight to protect it.”

On a personal note, I VIGOROUSLY applaud DonTigny for not only puzzling-out the mysteries of one our body’s most complex muscle-skeletal structures, but for having the COURAGE to put his theories into the public domain. Often, when someone proposes a new, revolutionary theory or solution—especially one that patients can do themselves—they will quickly experience the sharp pang of the medical community’s arrows in their back.

Final thoughts on DonTigny’s Pelvic Dynamics CD

If you are ready to open your mind to what is often the real cause of our muscle-skeletal problems, this CD is worth a look. Be aware: The sacroiliac joint is complicated and I found myself needing to re-read several of the slides, but the effort is worth it and again, the illustrations make understanding the sacroiliac joint much easier. I highly recommend Pelvic Dynamics for the Professional.

For more information on DonTigny’s work (or to purchase his CD), you should visit his site, The Sacroiliac Joint.

Links:

Interview with Richard DonTigny

The Sacroiliac Joint

Sacroiliac Joint on Wikipedia

Sacroiliac Joint Resources

Related Posts

Can Changing How We Walk Alleviate Our Aches and Pains?

We all want good health. . .   We want to be lean, strong, and free from pain, especially pain in our back, neck, hips, knees, shoulders, legs, ankles, and feet. Beyond good health, we want to live life with energy, confidence, and exuding youth. At one time in our lives, we had this pain-free vitality and more. For many of us, the day-to-day grind wore down our bodies, leading to sore, achy and perhaps arthritic joints, weak muscles, more fat, greater fatigue, and even depression. 

Walking—when done optimally and correctly—can give you all this. But, before we discuss that, we need to understand how we came to walk poorly and how improper walking patterns can lead to pain, disability, increased risk of injury, lack of fitness and muscle strength, and most importantly, a lack of spiritual vitality.    

“You Walked Into Pain” — Sherry Brourman, PT, Walking Instructor

Humans have always walked. With the recent discovery of the oldest known human skeleton, Ardipithecus ramidus, nicknamed “Ardi,” we now know we have been walking for at least 4.4 millions years. It is our most natural and most common physical activity.

Yet, walking is not innate. It is learned, through trial and error, in a haphazard way. The infant, toddler, and young child learns to walk by watching his or her parents or caretakers. The child’s ”adult pattern” of walking locks into place by age 8. Don’t believe me, go to the local shopping mall and watch children walk with their parents. More often than not, the child will walk like one parent or a combination of both.

(As a podiatrist, I recently saw a 10-year-old girl who limped for no apparent reason. In talking with her mother, the mother related that she had the same limp due to a hip that she injured in a car accident a decade earlier. The child had taken on her mother’s limp, even though she had no pain or injury.)

Herein we find the first problem with walking: we may be learning to walk by mimicking parents who are not walking correctly. I can hear some of you now: Wait a minute, Dr. Nirenberg, my parents walk just fine! They may, but it is much more likely they do not. Optimal walking is a combination of proper positioning of our joints, correct breathing, coordinated movement of our extremities, torso and pelvis, and good posture. 

The fact is, most people walk wrong. Yes, they get from point A to point B, but they are moving their joints and muscles in a way that will likely exacerbate or eventually lead to muscle-skeletal pain somewhere in their body (i.e. knee, hip, back, neck or shoulder pain). Likely, they have poor posture, and more likely, their body will be asymmetrical. That is, one shoulder may be lower than the other, one hip higher than the other, one hip more anterior, one foot flatter etc. 

Every Step We Take

So we learn to walk by picking up the bad habits of one or both parents. As youngsters, we can run, jump, even bungee jump, and we feel invincible. Slowly though, due to poor walking patterns or an outright injury, or our activities (or much more often our lack of activity), or habits, aches develop. We may strain a muscle here, twist an ankle there, or just get a slow gnawing discomfort in our back, neck, knee, hip, ankle, foot, or shoulder. 

By the way, when I say habits, I am talking about such things as repetitive strain activities (carrying a knapsack, purse, briefcase, or baby or a specific activity that creates wear and tear on the body), diet (obesity or in rare cases malnutrition), and worse of all, poor footwear, which can put the whole body in poor alignment and/or distort and alter foot function (and altered foot function will alter our entire body!).

It Only Takes One Injury. . .

It only takes one injury to one joint, muscle, or ligament to worsen our walking pattern. Our body is a incredibly inter-related functioning unit and a simple knee problem can quickly lead to back, neck and foot problems.Even if the painful knee subsides after a few weeks, problems with your alignment and the way you walk can remain. For example, let’s say you hurt your knee and for a few days you are miserable. So you begin putting most of your weight on the other leg. When our body makes these kinds of adjustments, we call it a compensation. However, shifting our weight in this manner will often lead to additional compensations throughout your body, and these will further alter the way you walk. Over time, the knee pain may go away, but now, your walking pattern has changed—for the worse—and it is unlikely you are going to return completely to the old pattern.  

We Break Down Slowly (aka You Don’t Know What You’ve Got Until It’s Gone)

As we age, we may start having a pain here and there, and as a result, we may avoid certain activities, perhaps we stop skiing, or playing racquetball or even just stop taking the stairs. We soon find ourselves moving less, sitting more and quickly gaining weight. More weight strains our body more, leading to more aches and pains and even less exercise. Our walk might become further limited and stiff because we are worried about another fall or injury, and in effect we begin walking worse. Ironically, for many of us, lack of exercise and movement was probably one of the big factors that contributed to our problems in the first place. Yet, REST is touted as a good treatment for what ails us. Perhaps it is for an acute injury, but 6 months after an ankle sprain, if you’re still resting, you’re in big trouble!  

Worse, when your body isn’t moving as well as it should it is at even more risk for injury. People often think injuries are random. But, when a person has a poor walking pattern, they are much more likely to become injured. The person may slip on the ice, twist an ankle on the front lawn, or even throw out their back bending down to pick up a quarter. When this happens, they may blame the injury, but the injury is just the symptom of an underlying problem: the person’s misaligned, weak, worn out body.    

Keep in mind: The part of the body that hurts may not be the problem.

For example, in my practice I see many people with back pain due to severly flat feet. Once we get these people into orthotics (custom made, medical grade arch supports) their back pain goes away. 

Some people in pain seek help: they may see their doctor, or a chiropractor, or some cases, a surgeon. But even if they have a back fusion, knee replacement or pop pills to mask the pain, if their poor walking pattern continues, their problems will continue, or worse, new problems or injuries will occur. By now, some of you might be saying, I know how to walk. Of course you do, and if I gave you a golf club and no instructions on how to tee off, you could probably manage to hit the ball. But, your swing would be average to horrible.  Perhaps, your walk is too?

There is poor walking and there is walking well—walking optimally. Correct walking positions your bones and joints in their best alignment, which in turn stimulates muscles that were not moving much to not only move but work well.   

Further, if we are not walking correctly, over time we will see an increased strain on our joints, muscles, and ligaments. This strain is actually micro-trauma.  Microtrauma is very insidious, but when it goes on step after step, mile after mile, its damaging effects can add up.

Are You in Symmetry?

Regardless of the mechanism of injury, our body will lose symmetry. Lack of symmetry or lack of alignment, will lead to some muscles contracting or tightening and others weakening or shortening. That is, every joint in our body is able to function or move because the muscles around joints oppose and balance each other. For example, in simplistic terms, our middle toe can bend upward (extend) or bend downward (flex), the muscle that flexes the toe is opposed or balanced by the muscle that extends (these muscles are for obvious reasons called extensor and flexor muscles).

When a joint in our body is out of alignment or out of its correct anatomical position, there is a lack of equal and balanced muscle tension on the joint. Thus, one or more muscles will become looser and weakened and their opposing muscles will become tense and tighter.  Muscles under tension, become tired and may go into spasm, and at some point pain sets in. Further, these muscles–already strained–are at risk for injury as soon as you they try to do an activity out of their normal routine. This is often how people end up with the good old “pulled muscle.”

The activity that pushes these already tensed, tired muscles to the breaking point does not have to be something radical like suddenly going for a run on the treadmill or doing a kick-boxing class. It could be as simple as bending down to pick up the newspaper or reaching high up to clean a window.

It does not always have to be a misaligned joint that starts the cycle of muscle imbalance. Muscle imbalances can cause the joints to BECOME misaligned. For example, a body builder may work his abdominal muscles more than their opposing back muscles. This would lead to imbalance affecting numerous joints, including the spine and pelvis.  

Even one joint out of balance (out of position) can potentionally lead to pain and problems anywhere else in the body.   

Modern medicine likes to break up the human body into its component parts or pieces. There are back doctors, foot doctors, hand doctors etc. The reality is the human body functions as a whole unit. For example, a foot that is out of position can affect the hips as easily as a hip joint that is malaligned can affect the feet. Cause and effect go up and down the body, and to an extent in other directions, too.

Now, you might be saying, I feel fine—I don’t have any hip, knee or back pain. And you may not. But, if you are walking incorrectly, you are likely heading toward some kind of loss of function, decreased flexibility and ultimately, pain. Your body just isn’t at the breaking point yet.

Even if your body never reaches the point of giving you pain, incorrect walking diminishes the effect of walking on many of your muscles, leaving them weaker and flabbier.   

Can We Walk Better?

Yes! Walking is a skill, just like golfing, but even better: recall that walking is our most common and most NATURAL activity. Because it is natural, we can improve on it–easily–to the point where it can be extremely beneficial.

I can hear some of you now going through all the reasons that you cannot change the way you walk: “it runs in my family”, “I’m too old to change”, “I have bad genes”, “I was born with curve in my back” and on and on.

Listen up! Your body and its muscles are under YOUR control. You can change the way you walk once you understand how to do it. You learned how to walk wrong without any help; now, with proper instruction, you can learn how to walk correctly.  

Right now, there are only a few people in the world teaching correct walking. One of the foremost experts on walking correctly is Sherry Brourman. Recently, I spent a three days studying with her at her Santa Monica studio.  Brourman, or “Sherry” as she likes to be called by her patients,  is author of the book Walk Yourself Well. She is also a Physical Therapist and Registered Yoga Teacher, and super dedicated to helping people walk better. 

When treating a new patient, Sherry will take a thorough history, observe how the patient stands and then she will watch them walk. Often, within seconds of the patient taking a few steps, she will point out the patient’s main walking problem. 

At that point, she would recommend ways for the patient to make small adjustments and often some basic exercises and stretches that will target the patient’s specific walking problem.  

Essentially, walking correctly involves a combination of optimal, unique joint and muscle movement, body posture, and breathing, and most importantly, a new and heightened awareness of your body.   

Developing an awareness of your body is key, and this is why it is  important to work with a good teacher. Often, we can’t see our abnormal walking pattern or our compensations because we are so use to them.  For example, when I first  met Sherry, she immediately spotted my left knee hyperextending. Despite having read her book and studying the science of walking and biomechanics for years, I had never noticed my knee hyperextending until she pointed it out.

Now, I am much more tuned into listening to my body, and I have learned that our bodies, in a sense, “talk” to us.  We just have to listen.

Many of the people who I saw going to Sherry for help were at the end of their medical rope. They had tried everything else modern medicine has to offer, and then–out of desperation–went to her. Sadly, some of these patients went through surgery or even surgeries, and they are still in pain.  As I watched Sherry work with them, I often found myself wondering how much better shape many of them would have been in, had they come to her earlier, perhaps, even before they had surgery.

In fact, from observing Sherry work with her patients, I have come to believe that there are few people who cannot be helped with these walking techniques. Further, I believe millions of surgeries could be avoided, if people first tried to walk correctly.  

Lastly, having spent a lifetime trying to alleviate pain for patients, I want to emphasize how impressed I was with Sherry. She brings an intuitive brilliance to training people to walk. Perhaps, this is because of her understanding of traditional medicine and yoga—a great mix! If you have structural pain and can get to the Santa Monica area, I would highly recommend seeing her for a few walking sessions.  

“Walking is man’s best medicine.” — Hippocrates

After studying with Sherry, I slowly began using her techniques with a handful of my patients who had muscle-skeletal pain and problems throughout their body.   

My most successful walking patient to date is a woman who complained of back pain to the point that every morning she needed to use a heating pad for 30 minutes. She also had another unusual problem: the seam of her pants or skirts always rode up on her left butt cheek.  

This patient constantly would have to pull the seam back into place. Now, after only working with her for 4 sessions, she no longer has a problem with the seam of her pants and more importantly, her morning back pain is gone!  

Further, all the patients who I have been working with are doing better to varying degrees. Of course, a handful of patients walking well and getting well is not scientific proof that walking better makes your body better, but it is very encouraging.   

(By the way, if you step into my common sense chamber for a moment, you would have to admit that it seems logical that walking better will make your mind and body feel better.)   

For now, I am continuing to study, explore, and learn new ways to help people walk better. I am meeting with various holistic and biomechanic experts and seeing what I can learn from them. Ultimately, I believe if  people walk better, they will not only experience increased weight loss and fitness and pain relief, but spiritual vitality. That is, beyond the physical effects that walking well bring, people often find that good, whole-body walking has a very beneficial effect on their emotional state. It can lessen anxiety, alleviate depression or just clear their minds–briefly–of psychological woes.

We should never forget that our mind and our body are tightly linked. Each  affects the other, and walking well will lift your spirits and when done regularly can become meditative and rejuvenating.   

“It is impossible to walk rapidly and be unhappy.” — Mother Theresa

“Everyday I walk myself into a state of well-being and walk away from every illness.” — Soren Kierkegaard

If you are in the Chicagoland or Northwest Indiana area and are interested in learning to walk better, please contact my office – Friendly Foot Care.     

Final Thoughts on Walking Better

Most exercise and fitness programs require a conscious decision to do them each day. When it comes to walking, you already are doing it. The average person walks 10,000 steps a day. Now, you can just do it better.

How do you walk? Do you walk well? Or poorly? I would love to hear your comments on walking!      

References:

Brourman S. Walk Yourself Well. Santa Monica, CA. 1998.  

Kendal FP. Muscles: Testing and Function, with Posture and Pain (5 ed). Philidelphia, PA: Lippincott Williams & Wilkins, 2005. Klenerman L, Wood B. The Human Foot. London: Springer, 2006.  

Kirtley C. Clinical Gait Analysis: Theory and Practice. London: Churchill Livingston, 2006.  

Kou AD, Donelan JM. Dynamic Principles of Gait and Their Clinical Implications. Phys Ther. 2010 Feb;90(2):157-74. 

Neumann DA. Kinesiology of the Musculoskeletal System: foundations for rehabilitation (2nd ed). St. Louis: Mosby, 2010.   

Oatis CA. Kinesiology: The Mechanics and Pathomechanics of Human Movement (2nd ed). Philadelphia, PA: Lippincott Williams & Wilkins, 2009.  

Perry J, Burnfield JM. Gait Analysis: Normal and Pathological Function (2nd ed). Danvers, MA: Slack Incorporated, 2010.  

Rose J, Gamble JG. Human Walking. Philadelphia, PA: Lippincott Williams and Wilkins, 2006.  

Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, 2001.  

Subotnick SI. Sportsmedicine of the Lower Extremity (2nd ed). Philadelphia:Churchill Livingstone, 1999.  

Zajac FE, Neptune RR, Kautz SA. Biomechanics and muscle coordination of human walking. Part I: Introduction to concepts, power transfer, dynamics and simulations. Gait Posture 2002; 16: 215-232.  

Links:

Sherry Brourman 

About.com Walking  

The Walking Site  

Walking on Wikipedia  

AARP – The Numerous Benefits of Walking  

Active.com – Walking  

Walk About Magazine

EroFit 

Marathon Walkers 

Related Posts

Essentially, Sandler’s book is a great follow up to  Born to Run by Christopher McDougall. Sandler takes McDougall’s observations of the Tarahumara Indians amazing ability to run many miles regularly in flimsy sandals (Huraches) and adds the science of barefoot activity and a reasonable training regimen, and much more!

Sandler’s personal journey to barefoot running began with his realization that fewer injuries occur in less expensive running shoes than expensive ones, that there is a higher impact on the body in shoes than out of shoes, and balance is better in thinner, less cushioned shoes, and lastly, children who did not wear shoes were less likely to have fallen arches or other foot deformities. Starting slowly, Sandler describes his successful transition to barefoot running.

Barefoot Running is a comprehensive book, covering everything you could possibly want to know about barefoot running. Among the topics Sandler addresses: Barefoot running verses running in shoes, the philosophy and science of barefoot running, how to run barefoot, stretching exercises, foot care tips for barefoot runners, dealing with weather extremes, nutrition, minimalist shoes and much more. Other topics covered include:

• A brief history of barefoot running
• The latest science behind the benefits of barefoot running, including findings of Dr. Daniel Lieberman’s 2010 British Science Journal Nature study (very important!)
• How to heal and stay injury free
• Building balance, strength, endurance
• Building strong feet, legs, hips, muscles, tendons & joints
• Developing strong pads on the bottoms of your feet
• Training routines including cross training
• How to use shoes as a helpful tool
• Adjusting to different surfaces & terrain
• Children and Barefoot Activity (also very important!)
• Meditation, quieting the mind and connecting with nature

The book itself is well organized, beautifully designed and printed with an easy to read text, high quality paper, and great photographs (though I wish there was an index!).  

Critics of Sandler’s book will say that the scientific fact for barefoot running is thin, and it is, but scientific evidence that expensive, thickly cushioned running shoes are better for you is even thinner. 

Final Thoughts on Barefoot Running

Barefoot Running is not for everyone, nor is it safe for everyone, but if you are interested in learning about the incredible benefits of running bare or how to barefoot run safely, Barefoot Running is a must read!

I give Barefoot Running my highest rating — 5 Toes Up  

Links:

Michael Sandler’s Barefoot Running site

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Your Pedicurist Could Be Your Foot's Best Friend

Pedicurists have had a bad rap lately. They have been accused of not sterilizing their instruments properly, leading to infections in their clients’ feet. When I heard about these pedicure-related infections, I contacted a local pedicure school. I quickly found—to my relief—that sterilizing instruments was not a problem. However, in talking with the teachers and students I realized that these professionals were on the front lines of looking at feet and were the ideal people to spot foot problems or cancer in the foot early.

Now, I lecture regularly to pedicurists on common foot problems to watch for, including certain kinds of cancer that may show up in the foot first.

For some people, their pedicurist looks at their feet more than anyone else–including themselves. In fact, some people have difficulty seeing between their toes or under their feet and the person best suited to check all these areas, is their pedicurist.

Checking your feet regularly for any suspicious moles, masses or other lesions is very important. A mole may be nothing to worry about or could be melanoma, a type of cancer.

Melanoma starts as a small mole, lesion, or freckle. When melanoma occurs on the foot it is usually not caught until it is too late, often resulting in the loss of the foot or leg, and even death. Each year more than 8,000 people die from melanoma—nearly one death every hour.

Fortunately, when caught early, most people with melanoma survive. Melanoma does not discriminate. It occurs in the young and old, in African-Americans and in Caucasians, and in males and females. Though, Caucasians or fairer-skinned people are at higher risk.

Always have any suspicious lesions, masses, pain, or swelling, thoroughly checked by a good podiatrist.   

Diabetics should watch their feet for any pain, sores, infections, abnormal sensation, or color changes. The smallest sore, blister, or infection can quickly accelerate to a severe problem or gangrene, and quickly lead to the need for amputation of a toe, the foot, or even the leg. Studies show that one in five diabetics will endure an amputation. Sadly, most of these amputations are preventable, if caught early. As a general rule, diabetics should have any foot or ankle problem checked by a podiatrist.

Recently, I was interviewed about my efforts to enlist pedicurists in spotting serious foot problems early. Read the whole story by CLICKING HERE.

Lastly, the next time you choose a pedicurist, you may want to find someone who a basic knowledge of foot problems. It could just save your life.

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Recently, EmpowHer invited me to write a column – here it is!

Pain and problems in the female foot are common—four times greater than for men. One study found that eighty-two percent of U.S. women report having foot pain, seventy-two percent have a foot deformity, and of all foot surgeries in the U.S., women undergo ninety percent of them.

Incredibly, it isn’t just the woman’s foot that leads in pain and problems. Females suffer with more ankle, leg, knee, hip, back, and neck problems. Clearly, when it comes to pain, this is one place women have too much equality!

Don’t despair! You can do simple things to prevent and alleviate pain now. Before I get to that, I want to explain why women are more prone than men to experience muscle-skeletal pain and ailments.

The Feet Are Our Body’s Foundation

Feet are your foundation—whether you are man, woman or child. Strong, well-functioning feet and ankles are essential for support and balance. Working in unison with the body, your feet rapidly adapt to maintain balance over a variety of surface, whether you are running, walking, jogging, carrying a backpack, baby, purse, or all three, or even recovering from a sudden stumble. Feet do it all.

Having incredibly dynamic feet is great until something with them goes wrong. The smallest imbalance in your feet shows up as larger problems up above—in your knees, hips, back, and/or neck. Thus, a misaligned foot leads to a misaligned hip and/or back and/or neck.

Our body depends on agonist-antagonist muscles pulling against each other around our dozens of joints, and any joint imbalance will cause weakness of the muscles on one side of the joint and tension and strain of the muscles on the other side. The result is pain.

Further, these muscle-skeletal misalignments are more likely to occur due to the unique shape of the woman’s “normal” foot.

How is Woman’s Foot Unique?

Compared with males, the female’s foot is generally shorter, narrower, and the length of instep is not as long. The average woman wears a size 8.5 (her foot is approximately twenty-four centimeters or 9.5 inches in length, about an inch shorter than the foot of the average male). The woman’s heel is narrower when compared to the ball of foot, which is wider and has a larger girth relative to the rest of the foot. 

Overall, the woman’s foot is flatter than the male foot. This lower (or more pronated) foot is the root cause of the many of the body’s structural problems.

When feet flatten more than necessary (or over-pronate), the legs compensate by rotating excessively inward. This increased internal rotation creates abnormal stress on the knees causing them to become painful and deteriorate (osteoarthritis). With the knees now strained and out of alignment, a “ripple effect” can occur, causing imbalances, pain and arthritis in the hips, back and neck  Since a woman’s foot is already on the flat-side, she is more predisposed to this painful cascade of events. (For those people whose feet are high arched (or supinated), a similar cascade of joint misalignment occurs leading to pain, imbalance and osteoarthritis.)

To make this chain-of-events even worse, a foot—male or female—that is on the flat side (excessively pronated) is more prone to become even weaker through a vicious downward foot-flattening cycle. Ultimately, this progressive flattening of the foot results in even more foot problems and more muscle-skeletal problems throughout the body.

What You Can Do About Foot, Knee, Hip, Back and Neck Pain

To restore normal alignment to your body, you need to restore balance. The best way to do this is by strengthening agonist and antagonist muscles around your major joints with the goal of improving posture.

This sounds complicated, but there is a very simple way to start: walk barefoot. Shoes act as braces for your feet, altering the alignment of your body and negating the need for many muscles to work at all. Walking barefoot or in minimalist footwear (very flexible shoes such Terra Plana’s Vivo Barefoot), allows your body to “feel” the ground. Do as much walking barefoot as safely possible.

Barefoot activity allows your body’s muscles to develop and remarkably, an innate biofeedback system kicks in that tells your body how to make subtle, unconscious adjustments in the way you walk (your gait). To walk correctly takes a lot of work and study, and is beyond this article, but barefoot walking is a great way to start.

When you must wear shoes, less is more. As mentioned, wear minimalist shoes or very flexible, thin shoes that provide basic protection but still let your feet sense the ground beneath them.

Final Thoughts on Muscle-Skeletal Pain

Now, you can begin to understand the effect of foot misalignment and other joint imbalances on your body. The simplest way to start to strengthen your muscles and rebalance your body is through your feet, and how by losing your shoes, you will be on your way to losing the pain.

If you have any questions or foot, ankle or walking-related topics you would like to learn about, please post in our Forum Section.

References:

Bingefors K, Isacson D. Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain–a gender perspective. Eur J Pain. 2004 Oct;8(5):435-50.

Stubbs D, Krebs E, Bair M, Damush T, Wu J, Sutherland J, Kroenke K.Sex Differences in Pain and Pain-Related Disability among Primary Care Patients with Chronic Musculoskeletal Pain.

Khang YH, Kim HR. Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders. J Womens Health (Larchmt). 2010 Jan;19(1):109-16.

Terrier P, Dériaz O, Meichtry A, Luthi F. Prescription footwear for severe injuries of foot and ankle: effect on regularity and symmetry of the gait assessed by trunk accelerometry. Gait Posture. 2009 Nov;30(4):492-6. Epub 2009 Aug 25.

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I know most people think their feet get enough exercise, but walking—even a lot—in supportive shoes, does NOT exercise your feet. It may exercise your legs and your triceps, but not the 18 muscles in each arch of our feet or  many of the other muscles entering our feet.

Supportive shoes, arch supports, and orthotics allow our feet to function without needing to work most of our foot muscles. As the saying goes, use it or lose it. Worse, without strong muscles our feet are at risk for injury.

In general, shoes are detrimental to feet. Scientists and doctors have known about the effects of footwear on our feet for over 50 years, but most of the public believes feet require expensive, supportive shoes. In fact, in 1949 The Journal of the National Association of Chiropodists published “Survey of Feet in China and India That Have Never Worn Shoes.” The researchers concluded:

“People who have never worn shoes acquire very few foot defects, most of which are painless and non-debilitating. Shoes are not necessary for healthy feet and are the cause of most foot troubles. Footgear is the greatest enemy of the human foot.”

Clearly, the first step to healthy feet is to give up supportive shoes—or at least limit the amount of time your feet are in shoes.

By simply walking barefoot, you will start to use your foot muscles and your feet will soon become stronger. (Note: Only healthy people should give up their shoes. Persons with diabetes, poor circulation, impaired sensation or other serious problems should wear shoes.)

The best way to wean off supportive shoes and increase barefoot activity is by going slowly, and by supplementing barefoot activity with foot exercises.

Now, there are two sources for foot exercises. One is the book Fantastic Feet by Aliesa George and the other is the FootBook by Dr. Paul Conneely.

Fantastic Feet and the FootBook are both great little books with plenty of photographs and detailed, easy to understand instructions. Fantastic Feet is for the public, written in layperson’s terms. The FootBook is for physicians, written in medical terms. Some of the exercises in the books are the same but many are different, and for those who are serious about their foot health, both books offer unique and highly beneficial exercises.   

These books provide a superb workout for your feet, ankles, toes and arches. In fact, many of the exercises will benefit your entire lower extremity! From each book you can choose a handful of exercises that suits your needs and soon you will be on your way to healthy, strong feet.

References:

FootBook

Fantastic Feet

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Barefoot or Shoes?

Running barefoot may seem odd and even dangerous, but a new study published in the prestigious Journal of American Academy of Physical Medicine and Rehabilitation found that barefoot running puts less damaging torque on our hip, knee, and ankle joints than wearing supportive running shoes.

The study was written by D. Cassy Kerrigan, M.D. et al and titled: The Effect of Running Shoes on Lower Extremity Joint Torques.” The researchers compared barefoot to shoe running and found a remarkable 54% increase in the hip torque and 38% in knee varus torque in running shoes. The study used the most technologically advanced non-invasive techniques to asses the biomechanics of running.

For thousands of years Man ran without supportive footwear. It is only in the last few decades that some people, mostly shoe companies, told us our feet needed support, control, and stability. This research shows a huge reduction in joint torques on the main weight-bearing joints of our lower extremities. Could the barefoot runner have been on to something?

Interestingly, I have not found one published study showing any detrimental effects to running without shoes or in just minimalist footwear.

The paper says, there is no clinical evidence to support that  modern running footwear promoted long-term health in runners. That line is worth reading again!

The running shoe business is huge and yet none of these billion dollar companies can provide ANY clinical evidence that running shoes promote long-term health!

And now this paper supports less torque on runners’ joints when they wear nothing—just running barefoot. Who would’ve thunk it?!

To be clear, Dr. Kerrigan’s study found that the effect of the typical modern-day running shoes is to increase joint torques at the hip, knee, and ankle. This doesn’t mean every running shoe will increase torque, but given the huge difference in torque between barefoot and shod, it is reasonable to expect that just about every shoe will have some increase in joint torque over going barefoot.

The good news is that Kerrigan’s study advocates that running shoes should encourage or mimic the foot’s natural function. Thankfully, she is in the shoe design business! This is what the shoe industry needs—someone who backs up their work with sound research. It is time runners demand clinical evidence a shoe works; not million-dollar ads!

I am sure the shoe, insole and arch support lovers (and business people), will find ways to discredit this research or try to simply dismiss it.

These studies are rarely perfect and ultimately, just because there is more torque, does that mean there will be more injury or damage to the joints? The answer is obvious–of course! But, this study hasn’t proven that. To show actual damage to a joint, a long-term study would need to be done with MRIs or CAT Scans or some such technology. Regardless, this study is a huge first step, and all the hole-poking in the world will not negate the magnitude of this study’s findings.

Final Thoughts on Proof Running Shoes Increase Torque on Our Joints

This study is but one. I hope that more scientists will begin to investigate the effects of running with shoes or barefoot. It is time for a rational discussion on the proven benefits and hazards of running in hundred and eighty dollar trainers or just your bare skin.

References:

Science Daily

Better Health Research

Telegraph

Medical News Today

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