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.

Exercise your way to "almost" eternal health!

 Staying Strong, Flexible, Aligned & Active

 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.

Senior Activity: 1, Gravity: 0

Functional Fitness Puts It All Together 

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 

(Illustrations herein by Nathanael Letteer and from the book Functional Fitness)

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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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The purpose of shoes is to protect feet and provide warmth. Beyond these basics, some shoes are a fashion accessory, while others supposedly help us run faster, walk better, tone our legs, or even alleviate foot ailments.

Comparing the feet of people who did not and currently do not wear shoes with those who wore shoes and currently wear shoes provides insight into the consequences of wearing shoes.

1. Shoes Weaken Bones in Our Feet

According to renowned anthropologist Erik Trinkaus of Washington University, humans began habitually wearing shoes 40,000 years ago. He reached this conclusion by examining the toe bones of people who lived in the range of 10,000 to 100,000 years ago and found that at 40,000 years ago, the bones became less robust. That is, when humans began wearing shoes the bones in our toes (digits 2 to 5) became less thick and strong; or in other words, the toe bones became more delicate and smaller.

Bones adapt to the loads placed under them. In response to increased loads (or forces), bones become stronger and thicker. Conversely, if the loading on a bone decreases, the bone will become weaker and thinner (Wolff’s Law).

Wearing shoes changes how we walk and how weight (or the ground’s loading force) spreads out across the bottom of our feet. Trinkaus describes our toes as being large and robust for most of human history, but suddenly with the wearing of shoes, they became “wimpy.”

Essentially, shoes limit the peak force on our toes by distributing loading across the entire forefoot and shoes eliminate the traction role of our toes. The result is weaker bones, leaving them at increased risk for fractures or other problems.

Shoes don’t just limit the peak forces on toes, they change the way our feet work. The actually working of our feet is referred to as the foot’s biomechanics and within shoes, our feet function differently. Essentially, shoes alter the foot’s natural motion. 

2. Shoes Limit and Alter the Normal Motion of Our Feet

Changing the way our feet work, can lead to problems. Earlier we discussed how supportive shoes obviate the need for many foot muscles to the point where, during normal walking, they are not used. Muscles that are not used weaken. Weak muscles on the bottom of our feet increase pronation motion (Headlee et al). Up to a point, foot pronation is normal. Too much pronation or over-pronation can cause foot pain, problems, and deformities. 

Sebastian Wolf at the University of Heidelberg compared foot motion of children 8 years old when barefoot and in shoes and found significant differences in biomechanics. Wolf found that shoes impaired the foot’s normal motion and shoes limit the normal widening of the forefoot while walking.

Interestingly, Wolf found that the foot’s need to widen while walking was more limited in the average commercial children’s shoe than in a much thinner, more flexible shoe even though the width of both shoes in the forefoot was identical.

Previously, the culprit for many foot ailments (such as Morton’s Neuroma or hammertoes) has been the tight-fitting shoe. Based on Wolf’s findings, perhaps we need to add to add to “tight-fitting,” the inflexible shoe and the thick-soled shoe.

In October of 2009, foot and shoe data from the prestigious Framingham Study of 3,378 subjects over the years 2002 to 2008 found past shoewear use in women was associated with hindfoot pain. Meaning, even if a woman’s shoe is not causing foot pain now, it could later—even after the woman has long stopped wearing the shoe.

Specifically, the Framingham study states:

“Young women should make careful choice regarding their shoe type in order to potentially avoid hindfoot pain later in life.”

The Framingham study faults the use of high heel shoes and encourages women who persist in wearing these types of shoes to perform stretching exercises to decrease the likelihood of foot pain occurring later.

Beyond altering the normal motion of our feet, wearing shoes can actually change the normal structure and shape of our feet. 

3. Shoes Deform Our Feet

Overwhelming evidence shows that wearing shoes deforms our feet. Foot deformities can potentially cause pain and other problems.

Udaya Rao at the Department of Orthopaedic Surgery, Kasturba Medical College, Karnataka, India compared flatfoot deformity in children (age 4 to 13) who wore shoes with those unshod. He found the incidence of flatfoot was 8.6% in those who wore shoes and 2.8% in those who did not wear shoes.

Further, Rao discovered that flatfoot occurred most often with children who wore closed-toe shoes and less often when children wore sandals, slippers, and least in those children who walked barefoot. He concluded that shoe wearing in childhood is detrimental to the development of the foot’s normal arch.

Simon Mays in the Physical Journal of Anthropology published a study on bunions. Bunions are painful protrusions of bone on the inside of our feet and are associated with the big toe drifting toward the other toes. Mays states that the majority of bunions result from wearing shoes; few are hereditary.

Mays says bunion deformities are rare in non-shoe wearing populations until the people start wearing shoes. Then the incidence of bunions rises sharply.

Further, Mays says that incidence of bunions in a population is related to the type of shoes worn. In populations wearing more constrictive Western-style shoes as opposed to loose-fitting footwear, the incidence of bunion deformities increased.

Kristiann D’Aout compared barefoot and shoe-wearing populations and found differences in both foot shape and the peak pressures under the foot. Barefoot peoples have wider feet and exhibit more equally distributed peak pressures. Shoe-wearing peoples had narrower feet and showed higher focal pressures at the heel, big toe and ball of the foot.  These higher peak pressures put the foot at more risk for injuries, such as metarsalgia, capsulitis, fracture or tendonitis.   

Further, Dr. Bernhard Zipfel at the University of the Witwatersrand has dedicated his academic career to the evolution of the human foot. Zipfel’s research paper “Shod versus unshod: The emergence of forefoot pathology in modern humans?” concluded that shoes were a factor in the development of foot pathology. 

Ways to Protect Our Feet from Shoes

Dr. Lynn Staheli, Director of Orthopedics at Children’s Hospital and Medical Center in Seattle asserts that, optimum foot development occurs when barefoot.

Clearly, in general, shoes are not good for the development of our feet. The best shoe merely protects feet from the environment.

When it comes to toddlers and children, the best advice I can give parents is try to have their children go barefoot as much as possible. I cannot emphasize this enough!

Of course, going barefoot is not without risks. Parents must find areas where it is safe to walk without shoes. Further, when possible have your child walk barefoot on uneven terrain to encourage his or her feet to use as many muscles as possible.

During times when children must wear shoes, choose the most flexible, barefoot-like shoe you can find. If my child had to wear a shoe, I would put them in soft shoe or even a sandal or flip-flop before a big, stiff well-padded running shoe.

For the shoe-wearing adult who has healthy feet and no concomitant medical problems (i.e. diabetes or poor circulation), to stop wearing shoes suddenly, would likely cause foot pain and problems.

These adults should start by SLOWLY transitioning to less supportive, more barefoot-like shoes. They should look for shoes with a wide toe-box (wide around the toes) and less stiff, more flexible shoes. Some shoes that help simulate barefoot activity while providing some degree of protection include, Vibram Five Fingers, Nike Free and Terra Plana’s Vivo Barefoot.

In addition, adults transitioning out of stiff, supportive shoes should do foot strengthening and stretching exercises. Years of wearing supportive shoes will have weakened many of the small muscles in the arch, ball and toes of the feet, and these muscles need to get strong again. Gradually, these adults should begin barefoot activity.  

Lastly, persons with foot problems, such as impaired sensation (i.e. diabetics), poor circulation or other problems or deformities should not go barefoot or try barefoot-like shoes without first checking with their podiatrist. 

Where Do Podiatrists Stand on Shoes?

The American Podiatrist Medical Association (APMA) has issued a statement on going barefoot, entitled “Podiatrists Urge Americans to Think Twice Before Going Barefoot.” You can read the APMA’s statement by clicking HERE. 

Final Thoughts on Shoes and Foot Problems

Podiatrists are quick to point out that there are people who have never worn shoes and suffer from foot pain and problems, including flatfeet, bunions, hammertoes and other problems. This is true.

Foot deformities and problems are not always due to wearing shoes, and can occur due to a myriad of reasons: congenital, ligamentous laxity, rheumatoid arthritis, obesity, structural factors within the foot (metatarsal head shape, first ray hypermobility), over-pronation, trauma, diabetes, polio, vascular problems and the list goes on.

When it comes to foot deformities and foot problems, shoes are one possible factor. Shoes may be part of the problem for a particular person or the whole problem.  

Interesting Links:

Take Off Your Shoes and Walk

Parents for Barefoot Children

Naturally and Healthy Barefoot Activities

Why Shoes Make Normal Gait Impossible

Living Barefoot

References:

Dufour AB, Broe KE, Nguyen US, Gagnon DR, Hillstrom HJ, Walker AH, Kivell E, Hannan MT. Foot Pain: Is Current or Past Shoewear a Factor? Arthritis Rheum. 2009 Sep 29;61(10):1352-1358.

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

Mays SA. Paleopathogical study of hallux valgus. Am J Phys Anthropol. 2005 Feb;126(2):139-49.

Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br. 1992 Jul;74(4):525-7.

Staheli LT. Shoes for Children: a review. Pediatrics. 1991 Aug;88(2):371-5.

Trinkaus E. Anatomical evidence for the antiquity of human footwear use. Journal of Archaeological Science, Volume 32, Issue 10, October 2005, Pages 1515-1526.

Tinkaus E, Hong S. Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir. Journal of Archaeological Science, 35(7):1928-1933.

Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2008 Jan;27(1):51-9. Epub 2007 Mar 13.

Zipfel, B., Berger, L.R. 2007. Shod versus unshod: The emergence of forefoot pathology in modern humans? The Foot. 17: 205-213

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When most of us think of the color of our shoes, we think about which outfit or pair of pants we’re going to wear with them. However, the color of your shoes can affect your feet.

The Science of Shoe Color and Foot Temperature

In one study, researchers compared the temperature of water in a balloon inside white-colored shoes verses black-colored shoes. After 30 minutes, the water temperature rose in both the white and black-colored shoes, but the water inside the black shoes showed a mean increase beyond the temperature of the white by 7.8 to 13.6 degrees Fahrenheit.

The researchers deemed the increase in temperature in the black-colored shoes (over the white shoes) “significant” (DeLuca and Goforth, 1998). I agree–a 7.8 to 13.6 increase in temperature IS SIGNIFICANT, and this is a shoe without an active, moving, perhaps sweaty, foot inside!

These researchers presented two cases where people with insensate feet (due to neuropathy associated with diabetes) sustained burns because of wearing black-colored footwear on a hot day. These two diabetic patients (with neuropathy) ended up needing foot amputations.

Shoe Color Can Affect All Our Feet — Not Just Those of Diabetics

Even if you are not diabetic, the effect of a shoe color (black) that increases the temperature of your feet can be a problem. When the temperature in your shoes increases, blood vessels in the foot dilate as blood leaves your arterioles and enters veins. This process promotes the release of heat out of the foot, but causes the foot to swell (Henry and Gaucer, 1950).

Normally, muscles pump swelling in the feet out, particularly during walking. However, even vigorous walking has been shown to not to be able to reduce venous pressure (pressure in our veins due to swelling).

Worse, for a foot wearing a dark-colored shoe, our foot muscles themselves generate heat. Muscles in our legs dissipate half their heat directly to the surrounding environment (Gonzalez et al, 1999). By extrapolation, our foot muscles likely release half their metabolic heat into the shoe, further increasing the temperature. Again, this increased heat could worsen swelling (edema).

Swelling or edema of feet can lead to poor perfusion of blood to the tissues, constriction, varicose veins, joint stiffness, diminished function, and symptoms of pain, heaviness, cramping, and restlessness (Blattler et al, 2008).

Today, more than 10 years after DeLuca’s study, the Medicare diabetic shoe program continues to approve dark-colored (and black-colored) shoes for diabetics, and shoe and running shoe companies continue to manufacture dark-colored shoes.

One has to wonder how many people are having more swelling and in the case of diabetics, foot sores and even amputations, due to the dark-colored shoes.

Final Thoughts on the Effect of Shoe Color on Your Feet

Few people would wear a black shirt on a hot summer day, but these same people would not think much of slipping on black-colored shoes. It is common sense that darker-colored material will absorb more heat than lighter-colored material. The next time you buy a shoe, use your common sense and buy a light-colored shoe. Your feet will thank you!

References:

DeLuca PA, Goforth WP. Effect of shoe color on shoe temperature and potential solar injury to the insensate foot. J Am Podiatr Med Assoc. 1998 Jul;88(7):344-8.

González-Alonso J, Calbet JA, Nielsen B.  Metabolic and thermodynamic responses to dehydration-induced reductions in muscle blood flow in exercising humans. J Physiol. 1999 Oct 15;520 Pt 2:577-89.

Henry JP, Gauer OH.  The influence of temperature upon venous pressure in the foot.  J Clin Invest. 1950 Jul;29(7):855-61.

Hansen L, Winkel J, Jørgensen K. Significance of mat and shoe softness during prolonged work in upright position: based on measurements of low back muscle EMG, foot volume changes, discomfort and ground force reactions. Appl Ergon. 1998;29(3):217-24.

Blättler W, Kreis N, Lun B, Winiger J, Amsler F. Leg symptoms of healthy people and their treatment with compression hosiery. Phlebology. 2008;23(5):214-21.

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Could Blood in Your Pee Be a Good Thing?

Hematuria – or blood in the urine occurs with some runners, and it is common. In one study, 18% of marathon runners had blood in their urine.

The general theory of why runners have blood in their urine is trauma. That is, foot strike causes mechanical destruction of red blood cells. However, new evidence has clouded whether this is the whole reason or more likely, part of the cause of hematuria.

In general, exercise induced destruction of red blood cells seems more prevalent and occurs to a greater extent with runners, but it has been seen with many activities—including non-traumatic activities such as swimming and cycling.

As a result, mechanical trauma is not the only factor in the destruction of red blood cells in athletes. Red blood cell fragility can be the result of dehydration, electrolyte changes, lactic acidosis and free radicals that  are released during exercise.  

Another cause of sport related hematuria is repeated impact of the bladder wall against the bladder sac. In one case, the problem resolved when the runner with the problem stopped emptying her bladder prior to running.   

Sport Related Hematuria May Be Beneficial

Some researchers believe hematuria in athletes is NOT a problem, but the body responding to the athlete’s need for more iron and protein.

This finding was boosted by a study by Shiraki et al that showed increasing the protein intake in the athlete’s diet caused the hematuria to disappear. Shiraki states that red blood cells are breaking down to give athletes the iron and protein that they need during endurance activities. Robinson (2005) also questions if hematuria is even pathologic.

What About the Pee of Barefoot Runners?

Intuitively, one would think barefoot running would be worse for your red blood cells. That is, the increased trauma of a barefoot hitting the ground would, in theory, mean more red blood cells destroyed, which in turn means more blood in your pee. However, one study compared protein in the urine of barefoot and shod runners and found no difference.

Interestingly, when the researchers measured the hemoglobin in the blood, the hemoglobin concentration of barefoot runners was higher.   

Final Thoughts on Blood in the Urine of Athletes

The cause of blood in the urine could be due to a serious underlying medical problem, such as kidney, blood or prostate abnormalities. Thus, you must see a doctor for a blood test to make sure nothing serious is occurring.

References:

Siegel AJ, Hennekens CH, Solomon HS, Boeckel B van. Exercise-related hematuria. Findings in a group of marathon runners. J Am Med Assoc 1979; 241: 391–392

Shiraki K, Yamada T, Yoshimura H.  Relation of protein nutrition to the reduction of red blood cells induced by physical training. Jpn J Physiol. 1977;27(4):413-21.

Robinson Y, Cristancho E, Böning D Intravascular hemolysis and mean red blood cell age in athletes.. Med Sci Sports Exerc. 2006 Mar;38(3):480-3.

Shaskey DJ, Green  Sports haematology. GA.Sports Med. 2000 Jan;29(1):27-38. Review.

Miller BJ, Pate RR, Burgess W. Foot impact force and intravascular hemolysis during distance running. Int J Sports Med. 1988 Feb;9(1):56-60.

Telford RD, Sly GJ, Hahn AG, Cunningham RB, Bryant C, Smith JA. Footstrike is the major cause of hemolysis during running. J Appl Physiol. 2003 Jan;94(1):38-42. Epub 2002 Aug 9.

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Are Good, Supportive Shoes Addictive?

Addiction can be physiological or psychological and can take many forms, from our morning Starbucks to chronic spending at the mall. One thing all addictions have in common is withdrawal symptoms upon discontinuation of the addictive activity or substance.

This article concerns the physiological dependence of wearers of supportive shoes, particularly running or athletic shoes (though, in theory this dependence can occur with any supportive shoe).  

In the July/August Issue of Canadian Running Magazine the article Stone-Age Stride by Alex Hutchison quotes Benno Nigg, renowned professor of biomechanics at the University of Calgary, as stating that when wearing shoes only two muscles of the ten muscles in our foot are needed to walk.

To be correct, there are actually 20 muscles within our foot (intrinsic muscles) and 12 muscles from our leg that attach to our foot (extrinsic muscles). According to the article, Nigg states that only the tibialis anterior (a shin muscle) and triceps surae (calf) muscles are needed.   

In my communication with Nigg, he explained that many muscles are not used (or used minimally) when ambulating in supportive shoes and as a result, these muscles (thirty of them for each foot) lose potential.

Use It or Lose It – Where Did My Foot Muscles Go?

Not using a muscle causes the muscle to weaken. When this happens, the size (girth) of the muscle will diminish. In theory, muscle disuse can lead to atrophy; however, given that most people will remove shoes for a portion of each day (perhaps when in their home) complete atrophy is unlikely.

In general, when the muscles within our feet weaken, most of the joints in our feet lose support. Given that each foot has 28 bones, 33 joints, and 100 ligaments, muscles play a valuable role in supporting these complex structures.

The good news is that while our feet are in supportive shoes, the shoe takes over for the muscles and does their work. Research in runners has shown that the less a foot muscle or foot-related muscle works, the less oxygen (and energy) the runner consumes. The scientific literature takes these findings further and states that the more comfortable a running shoe (as perceived by the wearer) the less the muscles work, and again, the less oxygen consumption needed.

At this point, I imagine that you are thinking it is time to find yourself a comfortable, supportive shoe. However, what happens when you remove these shoes?

Before we discuss that, let’s review the remarkable anatomy of the muscles of the human foot, particularly those on the plantar surface. The bottom of our foot has four layers of muscles.

Foot Muscles

When these muscles are fatigued (or weak) and supportive shoes (or orthotics) are absent, the arch of the foot lowers/drops and pronation increases (Headleea et al 2008, Wong 2007, Fiolkowski 2003). The foot, lacking shoes and strong, muscular support has increased pronation, a lower arch, more instability, and consequently, is at increased risk of injury, further fatigue, and deformity.

Further, when the four layers of muscles on the bottom of our feet our strong and robust, they provide a measure of protection to our foot during impact. With the muscles weak and frail, that protection is less, increasing the risk of injury (i.e. plantar fasciitis, stress fractures, metatarsalgia etc.)

The person who had been wearing the supportive shoes finds him or herself with achy, sore feet (and maybe even injury) and quickly decides that they need to get back into their shoes. They are hooked! Worse, as their muscles continue to weaken, they will need increasing amounts of support. 

Being addicted to supportive shoes (or even orthotics) is not necessarily a bad thing. But, it is a lifestyle choice. If such wearer of supportive shoes chooses to walk or run in non-supportive shoes or barefoot, they are risking injury, fatigue and likely, will experience pain and muscle/foot strain.

How Did the Need for Supportive Shoes Evolve?

Historically, shoes were for protection from the environment: prevention of puncture wounds and warmth. Relatively recently (in the last 40 years), the shoe industry (and some medical experts) told us we needed support and the more support the shoe industry gave us, the more we needed more support. A vicious cycle ensued.

(Keep in mind that research shows that good supportive shoes (and orthotics) help promote muscular development, but primarily the triceps (calf)—not the other 30 muscles unnecessary in supportive shoes.) 

Breaking Free of Supportive Shoes

Not everyone should try to give up his or her supportive shoes or athletic shoes. Diabetics and others who have peripheral vascular disease in their legs or decreased sensitivity in their feet should probably resolve to wear supportive shoes whenever walking. For those of us with healthy feet who want to keep them that way, start weaning off your supportive shoes or supportive athletic shoes slowly.

Remove the insole (or sock liner) from your shoes and walk without them for a short time each day. Gradually, build up to wearing the shoes all day without the supportive insoles, and then transition to a less supportive shoe. In time, you may want to consider transitioning to a minimalist shoe such as Nike Free, Vibram Five Fingers or Terra Plana.

Keeping your feet healthy and free of addiction is easy. Next time the salesperson offers you an expensive shoe with great support, pass on it and choose the less supportive shoe. Your feet will be healthier and you’ll save money too!  

I hope you found this post thought provoking and would love to hear your comments!

References:

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

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.

Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int. 2007 May;28(5):617-20.

Nigg BM. The role of impact forces and foot pronation: a new paradigm. Clin J Sport Med. 2001 Jan;11(1):2-9.

Hardin EC, van den Bogert AJ, Hamill J. Kinematic adaptations during running: effects of footwear, surface, and duration. Med Sci Sports Exerc. 2004 May;36(5):838-44.

De Wit B, De Clercq D, Aerts P.Biomechanical analysis of the stance phase during barefoot and shod running. J Biomech. 2000 Mar;33(3):269-78.

Murley GS, Landorf KB, Menz HB, Bird AR.Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review.

Gait Posture. 2009 Feb;29(2):172-87. Epub 2008 Oct 14. Review.

McMillan A, Payne C. Effect of foot orthoses on lower extremity kinetics during running: a systematic literature review. J Foot Ankle Res. 2008 Nov 17;1(1):13.

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