Barefoot activity has proven medical benefits

Do shoes contribute to knee pain, joint deterioration and arthritis? According to new research published by Drs. Andy Oliver Radzimski and Gisela Sole at the prestigious University of Otago, and Dr. Annegret Mundermann at the University of Constance, Germany, in most cases the answer appears to be a resounding yes.

For many barefoot runners and walkers who have avoided or alleviated their painful knees by shunning supportive shoes, arch supports, and orthotics (custom made arch supports), this research is nothing new. The barefoot community has known for years that barefoot activity is good for our knees, but now science is catching up.

Dr. Radzimski and his co-researchers reviewed the scientific literature on the effect of footwear and arch supports/orthotics on the knee. They looked at the external knee adduction moment (EKAM) when we are wearing shoes and when we are barefoot. EKAM represents knee load distribution from the inside to the outside of the knee joint. The higher the EKAM is, the greater and faster the progressions of deterioration (osteoarthritis) of the knee joint. In simple terms, a high EKAM is bad for our knee, while a low EKAM is good for the knee.

These researchers stunning findings came about after looking at a grand total of 348 scientific articles and including 33 studies in their research. In plain English: these highly educated and respected scientists evaluated all current knowledge and scientific information on the effect of footwear on the knee joint of healthy people and those with knee disorders with regard to EKAM. This impressive analysis of the literature is important because the ardent lovers of supportive shoes believe that our feet need to be encased in footwear will have a difficult time refuting the voluminous amount of scientific research analyzed.

Remarkably, these researchers found that sneakers and running shoes increased EKAM when compared to barefoot walking and barefoot running. Specifically, the knee has a greater load on the inside of the joint when wearing shoes as compared to going barefoot. In fact, the authors of this astounding research say that shoes that provide “stability” (or support) create increased load on the knee joint (again when compared to simply going barefoot).

Radzimski and his co-writers conclude by suggesting that people with knee arthritis on the inside of their knee joint should consider walking barefoot when possible. I recommend this too. Not only will your knees thank you, but your whole body will too.

This new, groundbreaking research is not proof that barefoot is better than wearing shoes, but if you will excuse the pun, it is yet one more step (in fact, a big step) in that direction. I do not expect this amazing research will convince the tiny percentage of supportive-shoe-loving zealots out there to take a step without their feet firmly encased in their thickly-padded shoes, but for the vast majority of people with an open mind, I urge them to give this research a read. More importantly, give barefoot activity a try!

Note: if you do decide to make the leap to barefoot walking or running, begin slowly, read up on the techniques of giving up your supportive footwear or shoes, and if you have any medical problems, proceed only under the care of your physician.

References:

Radzimski AO, et al, Effect of footwear on the external knee adduction moment – A systemic review, Knee (2011), doi:10, 1016/j.knee. 2011.05.013

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Biomechanics of Sport Shoes by Dr. Benno Nigg

A middle-aged woman arrived at my office last week complaining of heel pain and carrying a bag of custom-made foot orthotics (orthotics are custom made arch supports that are fabricated from a mold of the patient’s feet). Each orthotic this woman had with her was expertly fabricated by a different podiatrist and yet none of them had come close to alleviating her heel pain. At first I thought maybe these podiatrists didn’t know what they were doing. But, when I learned their names, I knew this woman had seen competent, skilled and reputable physicians.

I asked myself “how could this be?” More interestingly, no two sets of orthotics were even remotely alike. Further, given that nearly all podiatrists learn similar principles of biomechanics, shouldn’t orthotics for a given patient be the same regardless which podiatrist makes them?

After reading Biomechanics of Sport Shoes, Dr. Benno Nigg’s newest book, I have the answer. It is sobering, disturbing and I don’t want to believe it. Unfortunately, Nigg is one of the top biomechanic researchers in the field sport shoes, foot inserts and foot orthotics in the world. In fact, I imagine that Nigg spends more time thinking about biomechanics than a 17 year old boy spends thinking about sex. 

Foot Orthotics Debunked!

Nigg reveals that foot orthotics, which are devices designed to align misaligned feet, are actually not aligning the skeleton at all. In fact, Nigg’s book reveals many disturbing facts about orthotics, shoes and inserts: including that there is weak evidence orthotics lessen injury. Furthermore, changes in skeletal alignment due to inserts or shoes are inconsistent and minor.
 
Most importantly, Nigg goes on to warn that one of the dangers of the consistent use of orthotics is that they reduce functional demand on muscles may be associated with the deterioration of the muscles’ strength and function. So even though a foot orthotic often helps in the short term, over the long term Nigg warns their use may cause problems.

Repetitive Impact Not As Bad As We Thought!

Beyond orthotics, Nigg dispels the notion that running injuries are due to directly to impact forces and suggest that the new paradigm should be “muscle tuning” and the minimizing of vibration of the runner’s soft tissue. Nigg asserts that injuries are generally a result of intensity, duration, and recovery time.

Excessive Pronation May Not Be A Problem

Nigg then reviews foot, ankle and leg biomechanic research and shows that there is no evidence that excessive pronation when walking or running is a cause of injury. This finding is dramatic because many podiatrists believe excessive pronation is the root of many foot problems. 

Barefoot Running May Not Be Any Better

Despite Nigg debunking shoes, inserts and orthotics, you may be tempted to believe he must be a proponent of barefoot running. Not so. Nigg does not believe there is any evidence currently that barefoot runners sustain fewer injuries than shod runners. However, rather than closing the proverbial shoe box lid on barefoot running, he does say “barefoot training” is important and admits that barefoot running has a “small” performance advantage, but it may only be beneficial for a small group of runners.

He speculates that the functional adaptations of footwear based on the bare foot are positive and may persist, but the fashion adaptations based on the bare foot will disappear in relatively short time. 

Are You Ready To Be Unplugged?

One has to wonder the long term effects of the Biomechanics of Sport Shoes. Clearly, it should be required reading for every podiatrist. However, it may be difficult for some podiatric physicians, particularly those who have spent their life doing sophisticated biomechanical exams on their patients and meticulously fabricating foot orthotics, to open their minds to the content of this book.

Beyond health practitioners, patients themselves still generally believe arch supports, running shoes and foot orthotics are well-understood and the answer to their running injury woes. Until people begin thinking for themselves and asking questions both to themselves, to their doctors, and to the running shoe and arch support companies, 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 Nigg for not only puzzling-out the mysteries sports shoes, orthotics and running, but for having the courage to put his theories into the public domain.

If you are ready to open your mind to the latest information and theories on running, sport shoes and foot orthotics, I urge you to read Biomechanics of Sport Shoes.

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Can Barefoot Activity Cure Flat Feet?

Flat feet is a condition where the arch of the feet undergo collapse and flatten: That is why it is often also referred to as fallen arches. Individuals with flat feet can suffer from a variety of foot ailments, pain, and fatigue, which can also extend to the legs and back. This condition is present in up to 30% of all people, and it is unfortunately not reversible by the use of arch-shaping shoe inserts, whether over the counter or prescribed by a doctor.

Studies Suggest Shoe Wearing Predisposes To Flat Feet!

A very interesting Indian study ⁽¹⁾ analyzed the footprints of 2,300 children. It is commonplace in India for typical children to be barefoot most of the time, with only the higher classes usually shod in shoes. It found that the incidence of flat feet among children that used footwear was over three times greater than those who commonly played and ran in bare feet. The study unequivocally states that “shoe wearing predisposes to flat foot”. Flat feet can also be due to other factors, such as genetics, injury, etcetera.

A Remarkable Example of Barefoot Running Helping Raise the Foot’s Arch!

There have long been anecdotal reports that barefoot running can actually raise the arch of the foot and reverse flat feet, but now we have available the remarkable case study presented by a 41 year old male who recorded his foot print prior to engaging in a six month campaign of walking and running barefoot.

This individual has no history of medical problems and after a lifetime of conventional shoe wearing began to average 35 kilometers per week in running barefoot. He also shunned his footwear for most of this time in his everyday activities.

Remarkable Before & After Foot Prints!

The Before & After footprints posted above clearly show how the remarkable transition from a flattened foot (or  flat foot) to a healthy and normal arch. The individual also reports that since he has been barefoot, he has been suffering far less knee and ankle pain and swelling through his running.

Supportive Shoes Limit The Motion Exercise Of Foot Muscles!

This person’s fascinating experience is an example that even the most advanced shoes cannot provide the incalculable benefits of walking and running in bare feet. Indeed, supportive shoes tend to limit the motion exercise of foot muscles which can lead to further flattening of the arch!

Perhaps, it’s time to shun your shoes and regain flexibility and strength in your feet! Your arches will thank you!

(BTW, I would love to hear more “foot” reports – good and bad -  from other barefoot runners and walking! Please feel free to post comments with any foot-altering changes you have noticed as a result of barefoot activity.)

Key To References

1) Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 74 (4): 525-7.

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Walking suppresses appetite, so it's the dieter's best friend.

Are you feeling those hunger pangs, or craving chocolate? Don’t you wish that there was some way to stop feeling famished? There is! Go for a walk!

Recent clinical research is proving that walking not only does not increase appetite, but in some cases can even diminish your overall hunger while keeping you feeling full! The old wives tale that you get hungrier after a walk is 100% wrong! This factor is of specific interest to people who have diabetes as well as those interested in weight-loss. A University of Pittsburgh research study ⁽¹⁾ found that hunger and eating was not affected by walking, suggesting that walkers do not compensate for the energy cost of the walking session by eating more. When you walk you use up calories that you don’t end up overeating later to compensate, therefore you lose weight!

Walking Makes You Feel Fuller At Mealtimes!

A Scottish study ⁽²⁾ found that brisk walking actually diminished appetite! The researchers tested obese women and found that a 20 minute walk produced lower appetite as well as higher satiety and fullness perceptions. That means that after a walk, you actually feel fuller even though you want to eat less!

Lose Weight & Lower Your Blood Sugar By Walking!

Another study ⁽³⁾ tested the appetites of subjects two and five hours after they had undergone a 60 minute brisk walk, and showed that there were no essential differences from when they had not walked at all. While the one hour walk consumed an average of 439 calories, all the measures of appetite which include hunger, fullness, satisfaction, and prospective food consumption were not noticeably different. Just as significantly, the levels of substances which affect appetite relative to diabetes and overall health such as acylated ghrelin, glucose, insulin, and triacylglycerol were also unchanged! The conclusion of this study is that since walking does not make you eat more, it is a great way to burn up those excess calories! Great news for both weight-loss as well as sufferers of diabetes: Walking helps you lose weight and stabilize your blood sugar levels!

Walking Allows You to Consume More Fat!

A British study ⁽⁴⁾ concluded that a half hour brisk walk daily offsets the blood chemistry effects of substituting dietary fats for carbohydrates: This means that walkers can indulge in eating diets that are higher in satisfying fats without negatively affecting their blood sugar levels. Hard to believe that walking actually allows you to consume more fat in your diet and stay healthy, but that’s just one of the amazing effects of walking!

Walking Even Makes You Crave Chocolate Less! Wow!

The satisfying effect of a nice brisk walk can even temper your temptation to engage in sweet snacking. A British study ⁽⁵⁾ investigated the effects of walking on urges to eat chocolate. Subjects were sent out for a session of walking and then exposed to their favorite chocolates. The study found that a brisk walk reduced chocolate urges right across the board. Since chocolate is such a calorie rich snack, having the clinical evidence that walking does not increase your cravings for it, is a godsend to all chocolate lovers who wish to avoid a bulging waistline! It seems that walking is the dieter’s best friend to curb your hunger and calm your cravings! So… Walk, don’t choc!

Key To References

1) Unick JL, Otto AD, Goodpaster BH, et al. Acute effect of walking on energy intake in overweight/obese women. Appetite. 2010 Jul 30.

2) Tsofliou F, Pitsiladis YP, Malkova D, et al. Moderate physical activity permits acute coupling between serum leptin and appetite-satiety measures in obese women. Int J Obes Relat Metab Disord. 2003 Nov;27(11):1332-9.

3) King JA, Wasse LK, Broom DR, et al. Influence of brisk walking on appetite, energy intake, and plasma acylated ghrelin. Med Sci Sports Exerc. 2010 Mar;42(3):485-92.

 4) Burns SF, Hardman AE, Stensel DJ. Brisk walking offsets the increase in postprandial TAG concentrations found when changing to a diet with increased carbohydrate. Br J Nutr. 2009 Jun;101(12):1787-96.

5) Taylor AH, Oliver AJ. Acute effects of brisk walking on urges to eat chocolate, affect, and responses to a stressor and chocolate cue. An experimental study. Appetite. 2009 Feb;52(1):155-60.

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Since Ponce De Leon failed in finding the Fountain Of Youth, people have been seeking the magical and miraculous answers to staying and feeling younger into their advanced age. It turns out that the answers are neither magical nor miraculous but are found within ourselves, as the superlative new book Functional Fitness: Look Younger, Stay Active Longer reveals. 

Paul D’Arezzo MD is a board-certified emergency physician who has practiced in some of the country’s most beautiful spots: Florida, Colorado, and Hawaii. In his Functional Fitness: Look Younger, Stay Active Longer Dr. D’Arezzo has combined his considerable medical experience with salient points from yoga and various other human motion disciplines to present a compelling case for the benefits of exercise and activity. 

Through his years of practice, Dr. D’Arezzo has found that there are various activities which we can all perform in order to forestall muscle and joint pain as well as aging-related disabilities… or even prevent them outright. The techniques and tips which Dr. D’Arezzo shares in his book are of immediate concern to every American adult and thus Functional Fitness: Look Younger, Stay Active Longer is a must read book for all. 

A Paean To The Wonder & Efficiency Of Sheer Human Motion 

Dr. D’Arezzo is a gifted writer and possesses the remarkable ability to tackle complex and convoluted subjects and make them easily understandable to the lay reader. The result is that Functional Fitness: Look Younger, Stay Active Longer is not just another in a long line of exercise books, but a paean to the wonder and efficiency of sheer human motion. 

The book is structured in a logical and persuasive fashion to lead the reader in an adventure of rediscovering the beauty, harmony, and elegance of their own bodies in motion. The first chapter is adroitly titled You Don’t Know What You’ve Got Until It’s Gone and it outlines how the human body undergoes a gradual degradation, and what needs to be done starting now to hold off the ebbing which age brings. In the second chapter entitled Body Works, Dr. D’Arezzo introduces us to the basic anatomical structures which determine how we move, and goes on to a third chapter Aging which explains how our anatomy subtly changes as we grow older. 

Walking Restores Our Bodies To The Natural Motion They Were Designed For 

The book rolls on through examinations of The Importance Of Posture, and an analysis of the powerful effect of the body’s motion core, The Pelvis. In With Every Step We Take, Dr. D’Arezzo arrives at an evaluation of the value of walking in restoring our bodies to the natural motion that they were evolutionarily designed for. He discusses how best to preserve our ability to walk as we age; why the knees of seniors often hurt and how to avoid that pain; and investigates a number of professionally recommended easy but effective exercise regimens which can maintain elderly bodies walking smoothly and in a pain free manner.

 At this point, Dr. D’Arezzo proceeds to four beautifully interleaved chapters on Staying Strong, Flexible, Aligned, & Active. These four chapters form what in effect is a book within a book, and the recommendations he makes could easily serve as a complete guide to staying and feeling young right into our twilight years. The realities of the aging body are catalogued in the chapters on Arthritis and Back Pain which examines the medical aspects of these ailments while clearly demonstrating a series of motions and exercises which are so effective they can replace an entire medicine cabinet’s worth of pain relievers! 

Dr. D’Arezzo Honors The Importance Of The Bodymind Connection 

Functional Fitness: Look Younger, Stay Active Longer proceeds to describe a profound and in-depth extensive list of Exercises which are far from the conventional, repetitive, mind-numbing gym rat calisthenics, but are specifically designed to allow individuals of any age to engage in them to a high level of efficacy. Clearly demonstrating the wisdom which has gone into the writing of this book, Dr. D’Arezzo next examines the Bodymind aspect and its importance in providing us with the energy and motivation to achieve anything we set our minds to.

In his summary conclusion Putting It All Together Dr. D’Arezzo most certainly does, and wraps up any loose ends to vividly demonstrate how by following the tips, techniques, advice, and exercises in his book anyone can stay and feel younger longer. This book is a revelation to readers of any age, as it’s never too soon or too late to adopt a vivacious and vigorous lifestyle! 

Check it out! Functional Fitness: Look Younger, Stay Active Longer

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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 

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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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2009: Year of the Barefoot Runner!

Historians will remember 2009 as the year barefoot running surged in popularity. Google Timeline reveals the huge increase in 2009 in barefoot running on the Internet.

Many factors account for this recent explosion of interest in barefoot running: runners realizing that running shoes are mostly hype/advertising, a general interest in alternative medicine and holistic healing, and a dedicated group of barefoot runners educating the public with websites, online discussion forums, and even barefoot running clubs. However, the biggest factor, in my opinion, was Christopher McDougall’s book Born to Run. 

McDougall’s book was released in May, and according to Google Timeline the dramatic burst in barefoot running occurred in July. Clearly, this isn’t just a coincidence. McDougall went on a one-man marketing mission to sell copies of his book and in the process, whether he had intended to or not, sold barefoot running. 

McDougall talked to any reporter who would listen. A Google search on him and his book brings up nearly a million hits (yes, I like Google). 

More than sell books, McDougall gave barefoot running credibility. He made running barefoot respectable, and he backed up his claims with first hand accounts of the Tarahumara Indians and their “running” way of life. His book is not scientific fact, but a compilation of interviews and observations with the Tarahumara and others, including respected scientists. It was also his journey. 

Runners and even non-runners will find McDougall’s transition to barefoot running fascinating. Clearly, if there is a barefoot education superstar in the fight to spur public interest, scientific research, and barefoot running credibility, it is Christopher McDougall. He is the barefoot runners’ Man of the Year.

Barefoot Runners' Man Of The Year

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Everywhere you look someone is telling us the benefits of exercise. Of course, exercise can help our hips and gut, but could it also be the answer to foot and ankle pain and problems?

Anecdotal reports from people who regularly engage in barefoot activity—particularly barefoot running—reveals that exercise can improve abnormal biomechanics in our feet and ankles. Many barefoot runners claim that they have actually seen the arches of their increase in height.

Dr. Nirenberg “Experiments” on Himself

Fascinated with these claims, I decided to do a simple “experiment” on myself. I took a weight-bearing x-ray of the side of my foot prior to embarking on barefoot running and then after a few weeks, took another x-ray. Before I talk about what I discovered, I want to touch on some other important points.  

Podiatrists Debate Benefit of Exercise

The debate on whether strengthening and/or stretching foot muscles can affect the biomechanics of the foot was reinvigorated in recent days in the podiatry community. Within this group of doctors, there are those who advocate muscle-strengthening activity,  those who don’t, and those who fall inbetween. As a result, the arguments can be very heated.

Dr. Stephen Pribut, Past President of the American Academy of Podiatric Sports Medicine and writer of the blog 98.6, was interviewed for the Jewish Exponent article, Is Barefoot Better for the Sole. Pribut stated that over-pronation–or excessive rolling inward of the foot–happens because of bone structure and will not be corrected by strengthening the feet. In reply, Dr. Ray McClanahan, inventor of Correct Toes and president of Northwest Foot & Ankle, posted a lengthy reply on PM News.

McClanahan asserts that shoes are the cause of some biomechanical – not the cure. He explains that as shoes push the great toe inward (toward the other toes), pronation is increased. He advocates moving the great toe outward (away from the foot) to limit pronation. To achieve this McClanahan recommends avoiding shoes which taper inward at the big toe and using Correct Toes, a device he invented to move the big toe outward. Read his full article HERE.

(McClanahan has said that scientific proof is not required to prove his theory (that moving the great toe away from the foot limits pronation) because it is easily observable by simply trying it on your foot.) I commend McClanahan for thinking out-of-the-box and having the courage to pursue a new, cheap device that may prove more beneficial than expensive, complex orthotics.

Pribut replied by explaining that his quote in the article was essentially a sound bite and that this complicated subject matter does not lend itself to sound bites. He explained that injuries in runners he believes are multi-factorial with overuse being the primary cause of injury. Read his full reply HERE. (Pribut has taken a rational, middle of the road approach based on known factual science while recognizing a potential possible benefit of foot strengthening.) As of this writing, this debate continues to rage on.

A common argument against muscle strengthening exercise is that the there is not enough scientific proof of the benefits of exercise or barefoot activity. This is true, but initial research is leaning in the direction that muscle strengthening is beneficial.

Preliminary Research Leans in Favor of Muscle Strengthening Exercise

In 2008, breakthrough research was published that proved muscle fatigue (or muscle weakness) results in a lower arch. Specifically, fatigue of the plantar muscles of the foot cause flattening of the foot (worsening pronation) (Headlee et al).

Further, Dr. Benno Nigg, one of the world’s foremost experts on biomechanics of the foot, has said that strengthening muscles can, in principle, increase the arch of the foot, though he hasn’t seen a clinical study to prove this yet.

In my own foot I noticed changes with barefoot running. Clinically, the arch of my foot increased. The foot looked stronger, more robust. I then took an x-ray of the side of my foot while bearing weight and compared the x-ray with the one I took before barefoot running–the height of the arch had not changed. 

Is this proof barefoot activity fails to increase the height of the arch? Not at all. In fact, this little “experiment” is not proof of anything. Interestingly, there were other radiographic changes on the side-view x-ray of my foot: my foot shortened in length ever so slightly. Specifically, the metatarsals (the bones in my forefoot) had become more angled downward (more plantarflexed) and as a result my foot shortened. This finding has occurred with other barefoot runners and was documented in a research paper by Steven Robbins as an incidental finding in a barefoot-related paper.

Final Thoughts on Foot Strengthening

Without the strength of our foot muscles, the mechanical stress of walking is borne solely by our bones, ligaments and connective tissue, and without good muscular support, these structures become more likely to sustain injury: foot or ankle strain or sprain. An alternative to maintaining strong, supportive muscles is using a strong supportive arch support, shoe or orthotic.

The scientific literature recognizes the value of orthotics and arch supports, and is starting to recognize the value of foot strengthening exercises. In 2006 Jam states: Efforts should be made to address the dynamic control of pronation through neuromuscular exercises rather than purely through mechanical means. In 2003 Fiolkowski et al and Franco in 1987 advocated: Strengthening of the intrinsic and extrinsic muscles may help to increase muscular support of the arch.

If you are going to start barefoot activity or foot exercise, be sure to start slow and build up gradually. Feel free to peruse some introductory foot exercises HERE.

References:

Fiolkowski P, Brunt D, Bishop M, Woo R, Horodyski M. Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study. J Foot Ankle Surg. 2003 Nov-Dec;42(6):327-33.

Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008 Jun;18(3):420-5. Epub 2007 Jan 8.

Robbins SE, Hanna AM. Running-related injury prevention through barefoot adaptations. Med Sci Sports Exerc. 1987 Apr;19(2):148-56.

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Is it time to take off your shoes?

Few people would deny that exercise is good for us, and our feet. Now, mounting evidence suggests that exercising the foot’s arch muscles can not only strengthen our feet, but may even increase the height of our foot’s arch.

Our feet are one of the most muscle-rich areas of our body. In fact, there are 18 muscles within the arch of our feet, with additional muscles originating in our leg, inserting into the arches.

It is well known that the more a muscle is worked, the stronger it becomes. Of course, the converse is also true (we have all heard “use it or lose it”).

Now, breakthrough research by Headlee and Fiolkowski shows that when the muscles within the arches of our feet weaken, the arches will actually lower and become flatter.

If the foot’s arch decreases when our foot muscles weaken, it reasons that strengthening the muscles in our foot will raise the arch. Anecdotal evidence from runners who run barefoot shows this to be the case. These barefoot runners relate stronger arches and higher arches. Research by Robbins supports these findings.

Robbins showed radiographic changes in the feet of runners who gave up their shoes and began to run barefoot. In his study, the bones that make up the ball of the foot were shown—radiographically—to move closer toward the rear of the foot. That is, barefoot activity shortened the length of the foot’s arch. Robbins paper did not say the arch increased in these barefoot runners, but when the foot’s arch shortens, it height must rise.

Recently, Mark’s Daily Apple commented on the beneficial effects of exercise on feet, and I second it. Shoes lessen the need for and use of most of our foot’s muscles. As a result, the muscles weaken and the arch will weaken.

It’s time to take off your shoes and start exercising your feet.

I have written previously about foot exercises HERE.

The best foot exercise is barefoot activity — walking, running and playing barefoot! Barefoot activity is the best way to strengthen the muscles of your feet (assuming that you have good health — that is, you are not diabetic or plagued with poor circulation or other ailments). 

Like any exercise, start slow. Let your foot muscles gradually adapt to barefoot activity, and only go barefoot in safe environments – there’s no point having good foot muscles if there is a nail in your foot!

References:

Fiolkowski P, Brunt D, Bishop M, Woo R, Horodyski M. Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study. J Foot Ankle Surg. 2003 Nov-Dec;42(6):327-33.

Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008 Jun;18(3):420-5. Epub 2007 Jan 8.

Robbins SE, Hanna AM. Running-related injury prevention through barefoot adaptations.Med Sci Sports Exerc. 1987 Apr;19(2):148-56.

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