A healthy, pretty foot.

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

Major Foot Surgeries Solely For Cosmetic Reasons

Some of the surgeries include:

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

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

The Desire For Carrie Bradshaw Feet

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

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

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

Foot Surgeries Are Being Considered In The Breast Augmentation League

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

Unlike breasts, you have to walk on your feet!

Related Posts

Can Changing How We Walk Alleviate Our Aches and Pains?

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

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

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

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

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

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

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

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

Every Step We Take

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

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

It Only Takes One Injury. . .

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

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

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

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

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

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

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

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

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

Are You in Symmetry?

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

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

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

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

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

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

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

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

Can We Walk Better?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Final Thoughts on Walking Better

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

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

References:

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

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

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

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

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

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

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

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

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

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

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

Links:

Sherry Brourman 

About.com Walking  

The Walking Site  

Walking on Wikipedia  

AARP – The Numerous Benefits of Walking  

Active.com – Walking  

Walk About Magazine

EroFit 

Marathon Walkers 

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Your Pedicurist Could Be Your Foot's Best Friend

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Feet Are Our Body’s Foundation

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

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

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

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

How is Woman’s Foot Unique?

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

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

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

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

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

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

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

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

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

Final Thoughts on Muscle-Skeletal Pain

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

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

References:

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

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

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

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

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Is this the Barefoot Walker’s Dress Shoe?

Vivo Barefoot Gives Balances Protection with Barefoot Benefits

More importantly, the Vivo Barefoot shoe provides basic protection for your foot, decent grip against the ground and mild foot support, but still lets your foot “feel” the ground. The best way to transition to minimalist or barefoot running or walking hasn’t been defined, but for those looking to make the leap, Terra Plana’s Vivo Barefoot may be the best way to go.

Vivo Barefoot Shoe's Removable Insole

To help with the transition to barefoot, the shoe is incredibly flexible to let your foot bend and flex naturally, has no added heel to throw your body forward, a thin sole, and the Vivo’s insole is removable. I recommend that those people who are new to barefoot activity wear the Vivo with the insole for a while, and then, as their feet adjust, they remove the insole.  As an aside, I removed the insole within a day or two to improve that great barefoot feeling (though, the insole was very comfortable).  

Vivo Barefoot Shoe's Sturdy Tread

A Minimalist Shoe that Feels GREAT

Speaking of comfort, this shoe has what it takes! It feels great on your feet. And, as a podiatrist, I liked the nice wide toe-box (that area at the front of the shoe). Plus, the roomy shoe let my foot breath (something that most shoes do not!).

Final Thoughts on Vivo Barefoot Shoe

The Vivo is a great shoe for stimulating barefoot activity that you can wear unobtrusively while at work, weddings and shopping. It is also a great intermediate shoe to help you on your journey toward barefoot walking or running. 

I give the Vivo Barefoot my top rating — 5 Toes Up 

Links of Interest:

Barefoot and Grounded Vivo Review

Barefoot Runner Vivo Review

Barefoot Walking Lifestyle Vivo Review

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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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Are Female Feet Different From Male Feet?

Women have beautiful feet.  I am not talking about beautiful in a sexual sense, though many women do have attractive feet and later, I will discuss those, but for now “beautiful” refers to their design. 

Unique from the male foot, the woman’s foot is a remarkable symphony of engineering, the result of millions of years of tiny evolutionary adjustments—that are still occurring.    

A true work in progress, the female foot is entering its most exciting era.

As a practicing podiatrist, I am amazed at how many of my female patients believe their foot problems are their fault—due to wearing high heels.  Doctors, the public, pop magazine articles, have all sold women on the idea that their foot problems are their fault.  I bought into it, too.  But, over the years I began to realize high heels were only part of the story.

Many of my young female patients who had terrible feet, with such problems as large, ugly bumps on the inside of their feet (bunions), and bent and contracted toes (hammertoes), just to name a few, told me they had never worn high heels. 

How could this be?

There are several reasons, and number one is the female foot’s unique shape.  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).

Further, 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. 

Evidence supporting that the woman’s unique foot is the result of genetics, comes from a study of toddlers.  Even at this young age, the study found boys and girls walked differently, and their feet differed in size and shape.  Girls have a narrower foot than boys and when walking, put more weight on the ball of their foot and their toes. 

Clearly, the woman’s foot is uniquely different from the male foot.  Scientists have long pondered how this “female foot” came to exist.  The answer lies in the forces of evolution, but it isn’t what scientists would have expected.

When the human foot is looked at over hundreds of thousands of years and the effect of pregnancy on the foot is considered, modern woman should have a foot longer and wider than males.  This expectation stems from the fact that the feet of nearly all pregnant females widen to support the increased load, and because women carry this load in front, their center of gravity moves anteriorly and therefore the feet lengthen to maintain balance.  Helping with this process is the pregnancy chemical relaxin, which causes ligaments to weaken and go lax.

How Did Evolution Give Us a Smaller Female Foot?

Some scientists believe that human males, over the ages, preferred youthful females who had never given birth (for males, it was especially important their mate never delivered a baby fathered by a rival male).  A small foot implied youth.  Clearly, children have small feet, and in general, foot size increases with age.  Further, since pregnancy makes feet larger, a small foot signaled that there was a reduced the chance that the woman ever bore children.  As a result, male’s selected females with smaller feet, and over time, surviving females’ feet became smaller. 

Even today, support for this theory exists.  In one study, all other factors being equal, scientists proved that the smaller a woman’s feet, the more attractive she was to both men and women.  With respect to men, foot size has no bearing on attractiveness (this, despite a myth that foot size relates to the size of something else. In case you’re wondering, scientists have disproved this theory).

The Female Foot Never Had a Chance

The shape of the female foot—a slender heel, short instep length and wide ball—makes it more likely to develop problems.

One of the most amazing things about the foot—male or female—is its ability to rapidly “lock” or become rigid and “unlock” or become flexible.  With every step, the foot becomes a rigid lever to propel us off the ground and rapidly loosens as our heel strikes the ground and the foot must flatten and adapt to the surface. 

The locking and unlocking of the foot is incredibly complex and unless you are planning to become a podiatrist, you don’t need to understand all the intricacies but a few things are important.

The rear third of the foot is comprised of two bones, the calcaneus or heel bone and the bone above it, called the talus.  These bones cross and uncross to lock and unlock the rest of the foot.  A foot that is neither locked nor unlocked is in the neutral position.  The term for the foot unlocking is pronation and locking is supination.  These two words—pronation and supination—are the most important terms to podiatrists.  If you want to understand the foot, especially the female foot, it is important you have a basic understanding of pronation and supination.

Pronation and supination are a complex series of muscle, bone, joint, and ligament motions that result in the locking and unlocking of the foot.  A certain amount of this locking and unlocking is normal, however, if a foot unlocks (or pronates) excessively or locks (or supinates) excessively problems can develop.

When the heel strikes the ground, the foot rapidly unlocks (pronates) so it can adapt to the ground. Then it quickly locks (supinates) as it pushes off the ground.

An example of an extremely pronated foot is the flat foot and an example of an extremely supinated foot is the foot with a high arch.  These are the extremes.  A foot that is neither supinated nor pronated when weight is borne is in neutral position.  This is a “normal foot.”

Now, for the first time, we can say that this “normal foot” applies to the typical male foot.  The typical female foot is mildly pronated (or mildly unlocked).  In the podiatry world, too much supination can be problematic but excessive pronation is the root of evil.

Over pronation, beyond the normal amount needed to walk, creates an inherently unstable foot and promotes the formation of bunions, hammertoes, ankle weakness, heel pain and other foot problems, and even leads to leg, knee, hip and back pain, and just plain tired feet. A foot that pronates excessively is predisposed to more pronation, creating a vicious cycle, leading to even more problems.

The Sway Of Her Hips

Women walk differently than men. From a distance too far away to see the details of a person’s face, hair or style of dress, people can tell quite quickly (in less than three seconds), with incredible accuracy, the gender of the person walking.

This ability appears to “hard wired” into our brain.  Researchers believe we have special neurons that only fire when we see males and special neurons that fire when we see females.

Indirect evidence of this exists in other species where during mating animals will walk or strut in a unique manner as a sexual signal.  With humans, by watching someone of the opposite sex walk most people can guess, usually correctly, if the person is gay or straight.  Video analysis of homosexuals and lesbians walking on a treadmill showed that the gay men had a walk that was similar to most women and the gay women walked like most men.    

For women who want to display their sexuality to the maximum they may accentuate their “wiggle” by alternately forcing their weight onto one hip and then the other.  Marilyn Monroe found an easy way to achieve this: she simply shortened one the heel of her high heel shoes.

Florenz Ziegfeld who produced some of the most extravagant and successful musicals of the early 1900s, choose many of his showgirls solely based on the way they walked.  Women auditioned by walking, in high heels, behind a backlit screen.  By the women’s walk, without ever seeing their faces, he would choose his showgirls. 

Though most women can accentuate their “wiggle,” to avoid doing it at all would be difficult, if not impossible.  The “wiggle” is technically a lateral sway of the hips and buttocks combined with a semicircular swing motion and it is necessary to maintain balance.

Maintaining balance is specific to the person’s shape and proportions.  Women have a proportionately wider pelvis, narrower waist and shoulders, a shorter torso, and longer legs (in relation to their height).  As a result, the sway occurs in the hips and buttocks, whereas men have greater lateral movement in their chest and arms.

Another factor affecting how men and women walk is their genitals. Male genitals are outside the body and thus, men walk more open-legged.  The cliché male walk being that of the cowboy.  Since female genitals are in a sense inside, women have a close-legged stride, placing their feet within three to five inches of each other. 

What does the sway of the woman’s hips have to do with her feet?  Plenty.  Her wide hips tend to make her knock-kneed, which in turn tends to make her feet pronate or unlock.  Recall, an excessively pronated foot can lead to a host of foot problems, including more pronation.  This chain reaction can work in reverse: that is an excessively pronated foot can lead to knock knees, which can lead to wider hips and pain in the ankles, knees, hips and back.

Other Pieces of the Female Foot Puzzle

The main building blocks of the foot are bones.  At first glance, the bones of the female foot look like those of the male.  Yet, from any of these bones forensic scientists can determine the person’s sex—so they must be different. 

Doctors now agree the bones of the female foot are unique from the male foot, and further, these differences contribute to women developing foot problems. The particular shape of a bone in the female’s big toe joint—the metatarsal bone—increases the likelihood she will form a bunion.  At the ankle the main bone of the leg, the tibia, is narrower in women and its outer shell (or cortex) is thinner.  Both these factors contribute to ankle fractures.

Beyond shape, the joints of the foot differ in the female. 

There are 33 joints in the foot.  A joint is a fluid-filled capsule that connects two bones and allows movement.  Within the joint, cartilage (the shiny white gristle that you see on the ends of chicken bones) covers the edges of the bones that are touching each other.

The joints of the female foot have less fluid, less surface and the cartilage is thinner.  As a result, the joints are more likely to breakdown and become arthritic. 

Ligaments—strong, thin bands of tissue—hold joints together.  In women, ligaments are more lax or looser than in men.  A looser ligament creates a weaker joint, which in turn, contributes to women experiencing more ankle sprains, dislocations of the foot bones, and misalignment problems, such as bunions, flat feet and crooked toes. 

These looser ligaments are due to the hormones’ estrogen and progesterone.  The levels of these hormones fluctuate with the woman’s menstrual cycle.  Some scientists believe that during ovulation (day 10-14) when the amount of estrogen in the body is the highest, the woman is most at risk for a ligament injury.  One study that looked at knee problems that found women tended to injure one of their main knee ligaments on days 10 to 14 of their menstrual cycle.

Is The Female Foot Really Prettier?

At the start of this article, I said women have beautiful feet, and many do.  Few people can explain what makes a foot is beautiful, though most can spot an ugly one.  This ability seems hardwired into our brains—we just know it.  Clearly, when people think of attractive feet, few think of the male foot, and society’s number one fetish, is the foot—and usually, the female foot. 

When we talk about Beauty, whether with regard to feet or faces, it is difficult to define and it varies with culture.  Some criteria recur.  For one, beauty implies youth.  As discussed above, in evolutionary terms, youth has equaled a small foot.  Beyond size, other youth or beauty triggering signals in the foot are its shape, color, skin texture, amount of hair, condition of the toenails and even its softness. 

The amount of fat in the foot determines its softness.  When compared to men, women have more fat under their skin throughout the entire body.  As a result, women’s feet are generally softer.  Two things work against this extra fat: aging and tight fitting shoes.  As women age, fat tends to pool in the hips, buttocks and stomach, but in the foot, it gradually disintegrates.  Accelerating the foot’s loss of fat is pressure from tight fitting shoes.  

Look at a newborn’s feet and you will quickly see they are mostly fat.  The loss of fat starts almost from the time we take our first steps.  Ironically, the feet are the one place we need fat; not for appearance (though, for some that is important), but to cushion our bones and joints.  Foot specialists have tried doing fat transplants but they have never been successful.  Perhaps someday, though, we’ll go in for a tummy tuck and leave with our feet feeling better.

The strength and development of our muscles also helps determine the softness of the foot.  Generally, males have more developed foot muscles, giving their feet a heavier appearance; women’s feet are softer and more contoured.  Our feet have large muscles originating from our leg and many small muscles that start and stop within our feet.  These small muscles will wither away with enough exposure to a tight-fitting shoe.  While one would at first think that would make the foot slimmer and appear less heavier, what happens is, without these tiny muscles working at full capacity or in some cases not at all, the position of the bones and joints changes and foot deformities develop.  Common problems seen are bunions and other bent, contracted toes called hammertoes.  

The female’s foot has less hair than the male foot.  Lack of hair implies youth and thus, beauty, and it makes the woman’s foot look cleaner. 

Regardless of ethnic population, skin of the female is always thinner and lighter than the male.  Again, lighter, thinner skin makes the women’s foot appear more youthful.  Historically, women were considered more refined if their skin was light.  Women went to great lengths to cover up their skin, wearing gloves in the summer sun and using umbrellas to shield their faces.  It is only in relatively recent times that dark, tanned skin became fashionable.

When we talk about the female foot, we are really talking about both of the woman’s feet. One of our standards of beauty of symmetry and an interesting finding emerges when you consider pairs of feet of men and women: female pairs of feet are more symmetric.  That is, the right and left foot are closer to being identical in females than males. 

Few female feet have all of the above beauty characteristics, though most have one or two.  Over eons of evolution, the generality of woman having prettier feet than men emerges.

As today’s male places more emphasis on other parts of the female anatomy when searching for a mate, the foot will take a less prominent role and in the distant future, could become as large, and perhaps even similar to, the male foot. Size aside, differences will always remain.

If you are woman, make sure your podiatrist understands the specifics of women’s foot problems, and you should keep in mind: what is good for a man’s foot may not be good for your feet.

Resources for Women’s Health:

Healthy Women

Women’s Health Magazine

World Health Organization

Mayo Clinic Women’s Health

Women’s Health Issues

Harvard Medical School Women’s Health

Women’s Fitness

Free Women’s Fitness

Running for Women

Women’s Running

Running for Women

Women’s Healthcare Topics

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