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	<title>America&#039;s Podiatrist</title>
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		<title>Army Study Goes Big, Recommends Barefoot</title>
		<link>http://www.americaspodiatrist.com/2013/01/army-study-goes-big-recommends-barefoot/</link>
		<comments>http://www.americaspodiatrist.com/2013/01/army-study-goes-big-recommends-barefoot/#comments</comments>
		<pubDate>Tue, 08 Jan 2013 22:05:45 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
				<category><![CDATA[2. Should You Go Barefoot?]]></category>
		<category><![CDATA[3. Must Reads]]></category>
		<category><![CDATA[anterior foot strike]]></category>
		<category><![CDATA[barefoot running]]></category>
		<category><![CDATA[foot strike pattern]]></category>
		<category><![CDATA[minimalist shoes]]></category>

		<guid isPermaLink="false">http://www.americaspodiatrist.com/?p=2199</guid>
		<description><![CDATA[&#160; &#160; &#160; &#160; &#160; &#160; &#160; &#160; Whether storming the beaches of Normandy or sweeping across the Kuwaiti border, the U.S. Army is known for making big, bold statements. Take their latest medical research as further proof. This study was huge and thorough. The study sampled over 2,500 people, all of them serious runners. The [...]

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<a href="http://www.americaspodiatrist.com/2009/08/consider-wearing-this-shoe-if-you-want-to-run-barefoot/" rel="bookmark">Consider Wearing this Shoe if You Want to Run Barefoot</a><!-- (9.44208)-->, 
<a href="http://www.americaspodiatrist.com/2010/11/can-barefoot-running-walking-fix-flat-feet/" rel="bookmark">Can Barefoot Running &#038; Walking Fix Flat Feet?</a><!-- (9.30499)-->]]></description>
				<content:encoded><![CDATA[<p><a href="http://upload.wikimedia.org/wikipedia/commons/thumb/c/c3/Barefoot_on_the_asphalt.JPG/308px-Barefoot_on_the_asphalt.JPG"><img class="alignleft" title="Barefoot" src="http://upload.wikimedia.org/wikipedia/commons/thumb/c/c3/Barefoot_on_the_asphalt.JPG/308px-Barefoot_on_the_asphalt.JPG" alt="" width="308" height="240" /></a></p>
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<p>Whether storming the beaches of Normandy or sweeping across the Kuwaiti border, the U.S. Army is known for making big, bold statements. Take their latest medical research as further proof. This study was huge and thorough. The study sampled over 2,500 people, all of them serious runners. The average person in the study had been a runner for eight years! Army physicians evaluated the incidence of injuries in runners who wore traditional shoes, minimalist and no shoes at all. Did barefoot runners prove to be the healthiest yet again?</p>
<p><strong>Score Another One for Barefoot</strong></p>
<p>As you might have guessed by my enthusiastic buildup, the answer is a resounding &#8220;Yes!&#8221; Runners who opted for minimalist footwear and no shoes at all fared bar better than their shod peers. It wasn&#8217;t only in the feet, either. Those who reported their preference for wearing supportive, cushioned running shoes had more injuries in the foot, ankles, lower leg area, knees and even hips! Sometimes when I read these studies, I wonder if there shouldn&#8217;t be a Public Service Announcement warning about the dangers of your thick, cozy running shoes.</p>
<p><strong>How Do Your Feet Pound the Pavement?</strong></p>
<p>When looking at the effects of supportive shoes on the lower body, you have to take into account <a title="From Minimalist to Bare Naked: A Better Way to Run" href="http://www.americaspodiatrist.com/2013/01/2180/">the way your feet strike the ground</a>. In the classic scenario, your feet will connect first at the heel of your foot and then at the balls of the feet. This heel-first system (known as a posterior foot strike) is dominant whether you are wearing your favorite stilettos or a pair of expensive running shoes. Once you take the padding away and increase your ability to feel (and respond) to the ground, your foot strike usually becomes different.</p>
<p><strong>The Balls of Your Feet: Where the Muscles Are</strong></p>
<p>Taking out the thick cushions in traditional running shoes and trying a minimalist shoe often leads you to a different sort of foot strike pattern. Without all the padding, your feet tend to connect first at the balls (an anterior foot strike) at an area of the foot that is better equipped to absorb the stress of your body weight. Remember that the runner who tore his path from Marathon to Athens to proclaim victory over the Persians did so without shoes! He might have dropped dead right afterwards, but I bet his feet were fine. Some muscles in the bottom of our feet weaken from lack of use. This problem is worsened when our shoe’s thick support does the work of holding up the foot rather than its own muscles. Instead of allowing muscles to toughen and strengthen, we soften them with our traditional supportive shoes and leave ourselves susceptible to injury.</p>
<p><strong>How Do You Bridge the Gap?</strong></p>
<p>While the evidence supporting barefoot and minimalist running and walking mounts, you have to be careful about your transition. After a lifetime of wearing shoes, you&#8217;ll need to start slowly and do some lower extremity strengthening exercises. If you&#8217;ve ever spent a summer at the beach, it&#8217;s like the days when you first go barefoot on the boardwalk. After a while, you&#8217;re ready to stroll as far as your beach villa. Next thing you know, you&#8217;re ready to stroll around town, forgetting the need for shoes. Your feet have toughened up.</p>
<p>Take the same approach to minimalist shoes. Start with short distances and see how your feet respond. Stop at signs of pain. Once you feel the power in your feet, try a dose of barefoot. Keep increasing until you learn what I have learned: Barefoot is the only way to go! Yes, I&#8217;ll don my Vibram Five Fingers when the weather is bad, but the results are the same. Once you’re accustomed to going without traditional shoes, you&#8217;re on your way to fewer injuries and better health.</p>
<p>Reference: <a href="http://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=6c48c114-5b64-4230-b0cc-42df5ed70da2">Relationships among Self-Reported Shoe Type, Footstrike Pattern, and Injury Incidence</a><br />
LTC Donald L. Goss, SP, USA<br />
Michael T. Gross, PhD</p>


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		<title>From Minimalist to Bare Naked: A Better Way to Run</title>
		<link>http://www.americaspodiatrist.com/2013/01/2180/</link>
		<comments>http://www.americaspodiatrist.com/2013/01/2180/#comments</comments>
		<pubDate>Fri, 04 Jan 2013 23:50:37 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
				<category><![CDATA[2. Should You Go Barefoot?]]></category>
		<category><![CDATA[barefoot running]]></category>
		<category><![CDATA[barefoot walking]]></category>
		<category><![CDATA[minimalist footwear]]></category>
		<category><![CDATA[running economy]]></category>

		<guid isPermaLink="false">http://www.americaspodiatrist.com/?p=2180</guid>
		<description><![CDATA[&#160; &#160; &#160; &#160; &#160; &#160; &#160; You may have read the title of this post and immediately started thinking about your favorite minimalist writers (who doesn&#8217;t like Samuel Beckett?), but the topic of the day is running. The benefits of minimalist shoes have been highlighted on this blog before, but the evidence continues piling up [...]

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				<content:encoded><![CDATA[<p><a href="http://upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Marathon_Runners.jpg/320px-Marathon_Runners.jpg"><img class="alignleft" title="Runners" src="http://upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Marathon_Runners.jpg/320px-Marathon_Runners.jpg" alt="" width="320" height="213" /></a></p>
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<p>You may have read the title of this post and immediately started thinking about your favorite minimalist writers (who doesn&#8217;t like Samuel Beckett?), but the topic of the day is running. The benefits of minimalist shoes<a title="The Altra Adam: The Eve Of The Next Phase In Minimalist Shoes" href="http://www.americaspodiatrist.com/2012/01/the-altra-adam-the-eve-of-the-next-phase-in-minimalist-shoes/"> have been highlighted on this blog before</a>, but the evidence continues piling up in favor of the less-is-more approach to mobility. In fact, we may be on the verge of seeing <a title="How A 3-Time All-American Runner Discovered Barefoot Running" href="http://www.americaspodiatrist.com/2012/07/how-a-3-time-all-american-runner-discovered-barefoot-running/">a barefoot running revolution</a>.</p>
<p>The release of a Dublin City University study has prompted new rumblings online and in the scientific/medical community. Specifically, the study suggests that barefoot running does improve running economy (how efficiently your body uses oxygen). Can we bypass minimalism and go radically barefoot?<!--[endif]--></p>
<p><strong>Getting through the Transition Period</strong></p>
<p>One interesting part of the study centered on the period when runners started first simulating the barefoot style. Naturally, if you&#8217;re wearing shoes outside every day of the year (give or take a few weeks at the beach), your feet are not prepped for the harsh effects of the road and the world at large. A transitional format is thus recommended.</p>
<p>In the case of running, that duty would fall to Vibram Five Fingers (VFF), the minimalist shoes known for many “barefoot” walking and running enthusiasts. When wearing your VFF footwear, you&#8217;re gearing up for the great barefoot challenge. Meanwhile, you&#8217;ve got the protection of a 3 mm sole that shields foot bottoms from severe wear and tear on the road.</p>
<p><a href="http://www.americaspodiatrist.com/blog/wp-content/uploads/2013/01/Vibram-Five-Fingers-VFF-300x238.jpg"><img class="alignleft size-full wp-image-2190" title="Vibram Five Fingers VFF (300x238)" src="http://www.americaspodiatrist.com/blog/wp-content/uploads/2013/01/Vibram-Five-Fingers-VFF-300x238.jpg" alt="" width="300" height="238" /></a></p>
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<p><strong>Your Body Changes to Adapt to Shoes &#8212; in a Negative Way</strong></p>
<p>The most fascinating part of this ongoing research is the suggestion that shoes do indeed force feet to adapt &#8212; in a negative way. Scientifically, it may sound complex. For everyday runners, it might be easiest to say that your legs and feet anticipate impact on the ground when you run significant distances in your shoes. This anticipation ends up causing stress on your lower body, which in turn causes stress on your core and impacts your overall physique when walking or running. Translation: you are probably better off exploding those silly air cushions in your &#8220;advanced&#8221; running shoes.</p>
<p><strong>The Road through Minimalism Before the Barefoot Revolution Takes</strong></p>
<p>While barefoot walking and running fully takes hold, the VFF method is an excellent transition. To simulate the barefoot condition, this minimalist footwear is your ultimate ally. Again, it will take some adjusting to get through the period immediately following shod running and heading into the fully shoeless method. That protection from the dangers of the open road could turn out to be a huge difference while you embrace the path ahead.</p>
<p>In the meantime, you can do yourself another favor and lay off the high heels for a while. As <a title="When Style Harms Substance: Fashion and Female Foot Pain" href="http://www.americaspodiatrist.com/2013/01/2162/">another recent post points out</a>, there is no mystery why women are experiencing more foot pain than men. The high heels and other fashion footwear are directly linked to these conditions. In the words of a famous Nike sneaker ad: &#8220;It&#8217;s gotta be the shoes.&#8221;</p>
<p>Reference: <em>Four-week habituation to simulated barefoot running improves running economy when compared with shod running. </em>J. P. Warne, G. D. Warrington, Applied Sports Performance Research Group, School of Health and Human Performance, Dublin City University, Dublin, Ireland, Corresponding author: Joe P. Warne, School of Health and Human performance, Glasnevin, Dublin 9, Ireland. Tel: +353017008472, Fax: +35317008888, E-mail:warnej2@mail.dcu.ie</p>


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		<title>When Style Harms Substance: Fashion and Female Foot Pain</title>
		<link>http://www.americaspodiatrist.com/2013/01/2162/</link>
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		<pubDate>Thu, 03 Jan 2013 23:29:58 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
				<category><![CDATA[4. When Good Feet Go Bad]]></category>
		<category><![CDATA[fashion]]></category>
		<category><![CDATA[foot pain]]></category>
		<category><![CDATA[footwear choices]]></category>

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		<description><![CDATA[The results from the Staffordshire University study aren&#8217;t going to shock folks at the next New York Fashion Week. Teenage girls are choosing their shoes based on style alone. As for function to go along with that beautiful form, those concerns were secondary. The problems is these choices are not changing later on in life. [...]

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				<content:encoded><![CDATA[<p><a href="http://upload.wikimedia.org/wikipedia/commons/thumb/b/b6/High_Heels_pink_.jpg/320px-High_Heels_pink_.jpg"><img class="alignnone" title="Heels" src="http://upload.wikimedia.org/wikipedia/commons/thumb/b/b6/High_Heels_pink_.jpg/320px-High_Heels_pink_.jpg" alt="" width="320" height="211" /></a></p>
<p>The results from the Staffordshire University study aren&#8217;t going to shock folks at the next New York Fashion Week. Teenage girls are choosing their shoes based on style alone. As for function to go along with that beautiful form, those concerns were secondary. The problems is these choices are not changing later on in life. As women experience increased foot pain and deformity &#8212; much of it a result of fashion footwear &#8212; these choices didn&#8217;t get any better.</p>
<p><strong>Is the Image All that Counts?</strong></p>
<p>While it is understandable for someone to wear high-heeled or tight-fitting shoes for a special event, it&#8217;s against better judgment to wear heels every day of the week. You might look good in the short run, but major foot problems can develop later.<span id="more-2162"></span>For starters, feet deformed by wearing ill-fitting shoes are more prone to arthritis. The potential for experiencing a great deal of foot pain exists for everyone sucking up the pain to look good in shoes.</p>
<p><strong>The Pressure Is Definitely On</strong></p>
<p>You can&#8217;t turn on a television, pull up a website or fold open a newspaper without seeing glamour shots of the world&#8217;s most beautiful women. As a society, we have become obsessed with celebrities, many of whom represent an ideal of physical beauty that is difficult to match. Of course, without photo retouching, we&#8217;re not sure what they actually look like.</p>
<p>Nonetheless, we are fed this image of the ideal &#8220;cover girl&#8221; model and many young women feel inferior when they don&#8217;t try to meet that ideal. Without a look at the alternative and without a lot of coaching on the part of parents, you may be allowing them to sacrifice their feet later in life. If they aren&#8217;t sure about the consequences, forward them the right materials. A quick browse through the Staffordshire University paper will reveal plenty of scary insights.</p>
<p><strong>More than Foot Pain Awaits</strong></p>
<p>Research done in the past has linked foot problems to lower back pain and spinal troubles. Women who favor high-heeled shoes tend to experience these problems far more frequently than the rest of the population. In other words, it&#8217;s more than added foot pain you&#8217;re risking when you wear shoes on the basis of how they look; you&#8217;re also risking your posture and overall health. The more young women that know these facts, the more will opt for breaking up long runs wearing the high-fashion shoes.</p>
<p><strong>The Simple Arithmetic of Shoe Shopping</strong></p>
<p>Most surprising from the study findings was the revelation that many of he young women participating didn&#8217;t bother to try on the shoes at all. How could they know whether they caused screaming pain or had the highest potential for callouses? The fact is there was no way they could have known. The entire thought process was focused on the look of the shoes. No other concerns ever factored into the debate. Responding to the body&#8217;s acceptance or rejection of an item or clothing is always advisable. Too many health problems arise when we ignore the pain in our bodies. When it comes to shoe shopping, it&#8217;s often not even considered.</p>
<p><strong>A Compromise is in Order</strong></p>
<p>No one expects function to trump all fashion concerns. However, don&#8217;t forget to devote some care to your feet. When you&#8217;ve been wearing heels for days, give them a rest. Find a solution that produces no pain. If you are having trouble going through the motions, see your podiatrist and start treating your feet right before it&#8217;s too late.</p>
<p>Reference: DOI: 10.1177/1359105312463585<br />
J Health Psychol published online 27 November 2012<br />
Helen Branthwaite, Nachiappan Chockalingam, Marc Jones and Sarah Grogan<br />
Footwear choices made by young women and their potential impact on foot health</p>


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		<title>Research Proves Pregnancy Leads to Fallen Arches; How to Respond</title>
		<link>http://www.americaspodiatrist.com/2012/12/research-proves-pregnancy-leads-to-fallen-arches-how-to-respond/</link>
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		<pubDate>Thu, 20 Dec 2012 21:42:24 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
				<category><![CDATA[5. The Female Foot: Beautiful But Prone To Problems]]></category>
		<category><![CDATA[fallen arches]]></category>
		<category><![CDATA[foot trouble during pregnancy]]></category>
		<category><![CDATA[rehabilitation]]></category>

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		<description><![CDATA[&#160; &#160; &#160; &#160; &#160; &#160; &#160; &#160; &#160; &#160; If you&#8217;ve discovered you have fallen arches following pregnancy, you&#8217;re not alone. A new study appearing in the American Journal of Physical Medicine and Rehabilitation concluded that fallen arches are essentially a given following pregnancy. While your first pregnancy might produce the most drastic changes in arch [...]

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<p>If you&#8217;ve discovered you have fallen arches following pregnancy, you&#8217;re not alone. A new study appearing in the <a href="http://http/journals.lww.com/ajpmr/pages/default.aspx" target="_blank">American Journal of Physical Medicine and Rehabilitation</a> concluded that fallen arches are essentially a given following pregnancy. While your first pregnancy might produce the most drastic changes in arch height and solidity, each subsequent birth will have an impact on arches. Women (who already face higher risks for musculoskeletal disorders) should know the facts about postpartum foot conditions in order to avoid discomfort and reduced mobility.<span id="more-2141"></span></p>
<p><strong>Seeing the Proof</strong></p>
<p>Researchers noticed a slackness in the arches while women were carrying children. This softening leads to the eventual reduction in the height of arches, which are in essence tendons grouping together for support. Once the height and slope disappears, you are said to be flat-footed (no longer a reference to a police officer known for pounding the pavement). Foot pain and joint pain can result, meaning you will find yourself searching for relief following pregnancy, a time typically difficult enough to handle.</p>
<p><strong>There Are Solutions</strong></p>
<p>Finding yourself with fallen arches following childbirth is not the end of the world. Though research aimed at reducing the amount of height lost <em>during pregnancy</em> is being conducted, the best approach now is reacting to the damage at hand. Your podiatrist will be able to affirm if you indeed have fallen arches. Once the condition is confirmed, podiatrists could recommend whether any treatment is necessary. Treatments may include exercises, physical therapy, medication or mechanical support. If these treatments do not work, surgery is a possibility that may be explored.</p>
<p><strong>A Study of Great Relevance</strong></p>
<p>The research team behind this study clearly wanted to highlight health issues women face following pregnancy. Getting back into a sound physical condition is an important part of the recovery process. Ask your podiatrist how to approach this issue of fallen arches, which almost definitely will come into play. Whether orthotic devices do the trick or another remedy is suggested, you are bound to feel better and be able to approach your activities with your full strength behind you. After all, with youngsters soon to be on the loose at home, you’ll need to be chasing after them at your fastest foot speed!</p>
<p>Source:  SegalNA, Boyer ER, Teran-Yengle P, GlassNA,HillstromHJ, Yack HJ: Pregnancy leads to lasting changes in foot structure. Am J Phys Med Rehabil 2012;91:00Y00.</p>


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		<title>The Patient’s Response.com is Up and Running!!!</title>
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		<pubDate>Tue, 11 Dec 2012 17:51:03 +0000</pubDate>
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		<description><![CDATA[I’m pleased to announce that The Patient’s Response – our new initiative to highlight issues that affect patients in the U.S. is up and running. The Patient’s Response will bring attention to poor patient care and call out those responsible, while also acknowledging and highlighting the exemplary and revolutionary efforts of those individuals and organizations [...]

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				<content:encoded><![CDATA[<p><span style="font-size: small;"><span style="font-family: Calibri;"><a href="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/12/cross1.jpg"><img class="alignright size-thumbnail wp-image-2135" src="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/12/cross1-200x200.jpg" alt="" width="200" height="200" /></a>I’m pleased to announce that <em>The Patient’s Response</em> – our new initiative to highlight issues that affect patients in the U.S. is up and running. <em>The Patient’s Response</em> will bring attention to poor patient care and call out those responsible, while also acknowledging and highlighting the exemplary and revolutionary efforts of those individuals and organizations who are striving to provide good patient care or improve existing patient care. Here’s a link to the blog: <a href="http://www.thepatientsresponse.com/">www.thepatientsresponse.com</a>. Please check it out.<span id="more-2133"></span></span></span></p>
<p><span style="font-family: Calibri; font-size: small;"> </span></p>
<p><span style="font-size: small;"><span style="font-family: Calibri;"><em>The Patient’s Response</em> is an effort to bring attention to patient issues so that they can be resolved, not to criticize anyone or any organization. So where attention will be brought to poor patient care and those responsible – pharmaceutical companies, medical supplies manufacturers, insurance companies, hospitals, clinics, health care professionals, government agencies, socialized medicine programs, etc. – will be called out, attention will also be brought to good patient care and the efforts of the individuals and organizations involved will be appreciated.</span></span></p>
<p><span style="font-family: Calibri; font-size: small;"> </span></p>
<p><span style="font-size: small;"><span style="font-family: Calibri;">Again, please check out <em>The Patient’s Response</em> and let us know what you think about it. Please also help us accomplish our mission by sending us stories you think we should cover, tips that may help other patients, relevant news stories that interest you and you think may interest others, photos or videos you think may interest other patients, any Information about improper medical care, information about red tape in government agencies, stories of poor medical care or poor government health care polices, stories of healthcare cover-ups, etc. Also send us your experiences of good patient care and stories or information about the efforts of individuals or organization to provide good patient care. You can do so by either leaving a comment on the blog or by emailing us at: tips@thepatientresponse.com</span></span></p>


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		<title>Nike Backed Research Proves Less Is More</title>
		<link>http://www.americaspodiatrist.com/2012/11/nike-backed-research-proves-less-is-more/</link>
		<comments>http://www.americaspodiatrist.com/2012/11/nike-backed-research-proves-less-is-more/#comments</comments>
		<pubDate>Tue, 20 Nov 2012 17:58:30 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
				<category><![CDATA[2. Should You Go Barefoot?]]></category>
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		<guid isPermaLink="false">http://www.americaspodiatrist.com/?p=2120</guid>
		<description><![CDATA[A recent study entitled Effect Of Increased Mechanical Stimuli On Foot Muscles Functional Capacity which was financially supported by Nike showed that various foot muscles were actually strengthened by minimalist footwear running. The researchers found that several key foot muscles were strengthened by a significant level over a control group that used conventional training shoes, [...]

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<a href="http://www.americaspodiatrist.com/2012/07/how-a-3-time-all-american-runner-discovered-barefoot-running/" rel="bookmark">How A 3-Time All-American Runner Discovered Barefoot Running</a><!-- (19.1942)-->, 
<a href="http://www.americaspodiatrist.com/2012/02/hailing-the-benefits-of-barefoot-walking-on-shoedigest-com/" rel="bookmark">Hailing The Benefits Of Barefoot Walking On ShoeDigest.com</a><!-- (15.7863)-->, 
<a href="http://www.americaspodiatrist.com/2012/01/the-altra-adam-the-eve-of-the-next-phase-in-minimalist-shoes/" rel="bookmark">The Altra Adam: The Eve Of The Next Phase In Minimalist Shoes</a><!-- (13.2592)-->]]></description>
				<content:encoded><![CDATA[<p><a href="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/11/AmPod-Post-Pic.jpg"><img class="alignnone size-medium wp-image-2121" title="Less is more" src="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/11/AmPod-Post-Pic-263x300.jpg" alt="" width="263" height="300" /></a></p>
<p style="text-align: justify;">A recent study entitled <em>Effect Of Increased Mechanical Stimuli On Foot Muscles Functional Capacity </em>which was financially supported by Nike showed that various foot muscles were actually strengthened by minimalist footwear running. The researchers found that <span style="color: #ff0000;">several key foot muscles were strengthened</span> by a significant level over a control group that used conventional training shoes, thereby providing clinical evidence to the widely held belief in the barefoot running community that wearing less on our feet provides an advantage in muscle development.</p>
<p><span style="color: #0000ff;"><strong>Foot muscle strength increased by over 20%</strong></span></p>
<p style="text-align: justify;">The study covered both a number of male and female runners over a period of five months and<span style="color: #ff0000;"> the results are extremely encouraging for barefoot enthusiasts</span>, with the most notable improvement occurring in the flexor strength of the joints between the metatarsal bones of the foot and the proximal bones of the toes. While the control group showed a strengthening which ranged from 228 before the study to 237 afterwards, or an improvement of just under 4%, the group using the minimalist shoe went from 232 to 279 which represents a jump of over 20%!</p>
<p><span style="color: #0000ff;"><strong>Supportive shoes weaken foot muscles</strong></span></p>
<p style="text-align: justify;">The support that a conventional athletic shoe provides to the foot proved to have the opposite effect. Strength not only did not improve, but actually lessened! The research has shown that <span style="color: #ff0000;">when the foot is extensively supported key muscles weaken</span>. Essentially, when these foot muscles are supported they are not being placed under the necessary loads to strengthen and tone them. The conclusion of the study that footwear technology impacts the mechanical loading and the biological response of the muscular structures of the foot should be welcomed by the barefoot community at large as one more scientific proof that we’re on the correct side of the conventional athletic shoe debate!</p>
<p><em>Reference:</em></p>
<p style="text-align: justify;"><em>Brugemann G, , Potthast W, Braunstein B, et al. : Effect of increased mechanical stimuli on foot muscles functional capacity. In: ISB XXth Congress—ASB 29th Annual Meeting. Cleveland, OH: American Society of Biomechanics; 2005:553.</em></p>


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		<title>How A 3-Time All-American Runner Discovered Barefoot Running</title>
		<link>http://www.americaspodiatrist.com/2012/07/how-a-3-time-all-american-runner-discovered-barefoot-running/</link>
		<comments>http://www.americaspodiatrist.com/2012/07/how-a-3-time-all-american-runner-discovered-barefoot-running/#comments</comments>
		<pubDate>Sat, 07 Jul 2012 00:45:38 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
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		<guid isPermaLink="false">http://www.americaspodiatrist.com/?p=2114</guid>
		<description><![CDATA[Since Jeremy Johnson&#8217;s feet are 4E wide they are not a perfect fit into most racing shoes, so he wasn&#8217;t about to just put up with footwear that would restrict his running ability. A Master of Science in Applied Mathematics who was also a three time All-American and the University of New Mexico&#8217;s Male Track [...]

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<a href="http://www.americaspodiatrist.com/2010/12/the-canadian-medical-association-examines-barefoot-running-worthwhile-reading/" rel="bookmark">The Canadian Medical Association Examines Barefoot Running: Worthwhile Reading!</a><!-- (13.7646)-->]]></description>
				<content:encoded><![CDATA[<div id="attachment_2115" class="wp-caption aligncenter" style="width: 310px"><a href="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/07/APJohnson.png"><img class="size-medium wp-image-2115" title="APJohnson" src="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/07/APJohnson-300x236.png" alt="" width="300" height="236" /></a><p class="wp-caption-text">Jeremy Johnson and his 4E bare feet burning up the course</p></div>
<p style="text-align: justify;">Since Jeremy Johnson&#8217;s feet are 4E wide they are not a perfect fit into most racing shoes, so he wasn&#8217;t about to just put up with footwear that would restrict his running ability. A Master of Science in Applied Mathematics who was also a <span style="color: #ff0000;">three time All-American</span> and the University of New Mexico&#8217;s Male Track and Field Athlete of the Year for two years &#8220;running,&#8221; he set his analytical mind to investigate whether running shoes are necessary for any runner, regardless of foot size.</p>
<p><span style="color: #0000ff;"><strong> Running shoe components are marketing gimmicks?</strong></span></p>
<p style="text-align: justify;"> Quoting the Bible, Hebrews 12:1, he “threw off everything that hinders” and ditched his running shoes to find that his favorite sport was now more pleasant and enjoyable, his legs felt more elastic, and his times became faster. Examining the actual mechanics of barefoot running vs. shod feet, he realized that <span style="color: #ff0000;">the components of almost all conventional running shoes on the market may be counterproductive</span> to comfort and mechanical efficiency. The placement of a wedge underneath an anatomical structure which is designed over millions of years of evolution to be a consummately efficient mechanism actually defeats the purpose of running better! Johnson goes as far as claiming that most of these running shoes components are gimmicks which serve the purposes of the marketing department, not the runner.</p>
<p><span style="color: #0000ff;"><strong> Barefoot running is liberating</strong></span></p>
<p style="text-align: justify;">Jeremy Johnson’s finely trained intellect arrived at a scientific determination which many runners from all “walks” of life are beginning to glimpse on their own. Minimalist footwear and outright <span style="color: #ff0000;">barefoot running is a natural, effective, enjoyable, efficient, and comfortable way</span> to enjoy the liberating and exhilarating feeling of running.</p>
<p style="text-align: justify;">Find out more about Jeremy’s barefoot running at <a href="http://naturalrunningcenter.com/2012/07/06/faster-barefoot-runner-america-jeremy-johnson/" target="_blank">http://naturalrunningcenter.com/2012/07/06/faster-barefoot-runner-america-jeremy-johnson/</a></p>


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		<title>The Amazing Story Of How Anthony Field Got His Wiggle Back!</title>
		<link>http://www.americaspodiatrist.com/2012/04/the-amazing-story-of-how-anthony-field-got-his-wiggle-back/</link>
		<comments>http://www.americaspodiatrist.com/2012/04/the-amazing-story-of-how-anthony-field-got-his-wiggle-back/#comments</comments>
		<pubDate>Sun, 15 Apr 2012 00:19:48 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
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		<description><![CDATA[How I Got My Wiggle Back A Memoir of Healing Anthony Field with Greg Truman Any parent who has spent any time at all watching children’s television with their kids is well acquainted with The Beatles of the pre-school set: The Wiggles. Anthony Field is a founding member of the popular children’s group, and it [...]

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				<content:encoded><![CDATA[<div id="attachment_2110" class="wp-caption alignnone" style="width: 310px"><a href="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/04/510yp1T2OFL._SS500_.jpg"><img class="size-medium wp-image-2110" title="Anthony" src="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/04/510yp1T2OFL._SS500_-300x300.jpg" alt="" width="300" height="300" /></a><p class="wp-caption-text">How I Got My Wiggle Back</p></div>
<p><a href="http://www.amazon.com/How-Got-My-Wiggle-Back/dp/1118019334/ref=sr_1_1?ie=UTF8&amp;qid=1334449137&amp;sr=8-1" target="_blank"><em>How I Got My Wiggle Back</em></a><br />
<em>A Memoir of Healing</em><br />
<em>Anthony Field with Greg Truman</em></p>
<p style="text-align: justify;">Any parent who has spent any time at all watching children’s television with their kids is well acquainted with The Beatles of the pre-school set: The Wiggles. Anthony Field is a founding member of the popular children’s group, and it is telling to The Beatles connection that prior to this venture, Anthony and his brothers had an Australian rock band named The Cockroaches. Anthony and The Wiggles are a worldwide phenomenon, being named the top-earning Australian entertainers for four years in a row and earning upwards of $40 million in a year.<span style="color: #ff0000;"> The Wiggles have sold over 17 million DVDs and four million CDs,</span> an amazing number which exceeds many superstar musicians. This spectacular success was not much gratification to Anthony as throughout his career he has been plagued by a series of inexplicable and debilitating health issues.</p>
<p><span style="color: #0000ff;"><strong>Inexplicable Ailments</strong></span></p>
<p style="text-align: justify;">Anthony’s health problems started his mid twenties, first with a stubborn case of clinical depression which brought overwhelming sadness and anxiety as well as suicidal thoughts, then proceeding onto various digestion problems. Due to The Wiggles’ punishing touring schedule, Anthony found himself on the road for an inordinate amount of time and with the topsy-turvy eating and sleep patterns that come with long-term travel he began to gain weight. Soon<span style="color: #ff0000;"> his ailments graduated to severe and troubling foot, ankle, knee and back pain,</span> along with various sprains and strains.</p>
<p><span style="color: #0000ff;"><strong>Nothing Seemed To Work</strong></span></p>
<p style="text-align: justify;">Anthony saw a variety of medical doctors, chiropractors and alternative healers who came up with diagnoses for fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, hernias, and a plethora of unresolved back pain issues. These medical experts would usually dispense good advice along with a laundry list of medicines, but <span style="color: #ff0000;">nothing seemed to help Anthony to any significant degree</span>. Anthony had discolored teeth since childhood so he had them capped to a pearly white for his media appearances. On the first night of an American tour the entire group was out for some of that famous New York City pizza and after one bite Anthony’s caps came out with the pie. A dentist was quickly sought and after many hours and thousands of dollars of dental work another set of caps was implanted. This work may have brought his smile back, but only superficially as he started to suffer from constant body pain, neck stiffness and intense headaches along with mysterious circulation problems and a blooming of varicose veins.</p>
<p><span style="color: #0000ff;"><strong>Massive Dental Work</strong></span></p>
<p style="text-align: justify;">A dental specialist was called in and told Anthony he required immediate extensive corrective surgery. Anthony decided that it was so extensive that he wanted to go home to Australia and his dentist to have it done. The Australian dentist discovered that the work that had been done in New York was significantly substandard. Over a short period of time <span style="color: #ff0000;">Anthony had a staggering 23 root canals,</span> teeth were removed, titanium posts put in, and crowns and caps replaced. Unfortunately, his health problems continued unabated and Anthony continued to be examined by a broad range of doctors who were unable to assist him in any meaningful way.</p>
<p><span style="color: #0000ff;"><strong>Dr. Stoxen Diagnosed Anthony By A Gait Examination</strong></span></p>
<p style="text-align: justify;">After visits to an endless array of medical professionals Anthony met Dr. James Stoxen, a Chicago chiropractor. Unlike the others before him, Dr. Stoxen was able to swiftly diagnose the source of Anthony’s problems, and he did so by a simple examination of his gait! Dr. Stoxen is the originator of the Human Spring Approach dealing with the interconnected mechanism that governs and protects the way the body moves, and he applied his methodology to determine that Anthony’s Spring was broken due to a weakness in the pronator-supinator cuff muscles supporting the arch of the foot. The spring suspension system muscles of Anthony’s pelvis were inherently weak leading to his crippling lower back pain. <span style="color: #ff0000;">Dr. Stoxen helped Anthony reset his spring suspension</span> and taught him the critical exercises required to keep his entire muscular system working at top efficiency. Working with a chiropractic colleague Dr. Rich Gringeri, Anthony was put on a proper whole food diet, along with supplements and digestive enzymes, which helped him to reset his entire Human Spring.</p>
<p><span style="color: #0000ff;"><strong>A Quarter Billion Ground Collisions</strong></span></p>
<p style="text-align: justify;">Dr. Stoxen’s revolutionary anatomical and kinesthetic concepts are based on the human body being a spring mechanism, not a lever one as is currently acknowledged by medical practitioners. By utilizing the Human Spring mechanism you can protect your body from the over quarter billion collisions with the ground you will experience in your lifetime through a marked improvement of your walking and running processes. <span style="color: #ff0000;">Dr. Stoxen accurately diagnosed the breadth of Anthony’s chronic symptoms to a breakdown and lockage of his own Spring</span>, and his remarkable and unique insights into this aspect of the human body can be applied to virtually anyone plagued by chronic and otherwise unexplained aches, pains, and various symptoms.</p>
<p><span style="color: #0000ff;"><strong>Keeping The Spring Working</strong></span></p>
<p style="text-align: justify;">To this day, Anthony works very hard daily performing the specific exercises taught by Dr. Stoxen to keep his Spring working at optimal levels, and he continues to be free from the pain and symptoms which plagued him through most of his adult life. And that’s how <span style="color: #ff0000;">Anthony Field Got His Wiggle Back</span>!</p>


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		<title>Hailing The Benefits Of Barefoot Walking On ShoeDigest.com</title>
		<link>http://www.americaspodiatrist.com/2012/02/hailing-the-benefits-of-barefoot-walking-on-shoedigest-com/</link>
		<comments>http://www.americaspodiatrist.com/2012/02/hailing-the-benefits-of-barefoot-walking-on-shoedigest-com/#comments</comments>
		<pubDate>Mon, 20 Feb 2012 17:11:06 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
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		<description><![CDATA[I was recently invited by the editors of shoedigest.com to write an article which addresses the question: Should Walkers Go Bare? To the surprise of everyone involved I managed to get the entire article written without once dropping in a mention of Lady Godiva or Sports Illustrated Swimsuit Issue cover model Kate Upton. The article [...]

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				<content:encoded><![CDATA[<p><a href="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/02/Dr.-Nirenberg-Wearing-Minimalist-Terra-Plana-Shoes.jpg"><img class="alignnone size-medium wp-image-2079" title="Dr. Nirenberg Wearing His Minimalist Terra Plana Shoes" src="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/02/Dr.-Nirenberg-Wearing-Minimalist-Terra-Plana-Shoes-186x300.jpg" alt="" width="186" height="300" /></a></p>
<p style="text-align: justify;">I was <span style="color: #ff0000;">recently invited by the editors of</span> <a href="http://www.shoedigest.com/athletic-shoes/barefoot-minimalist-walking-shoes/" target="_blank">shoedigest.com</a> to write an article which addresses the question: Should Walkers Go Bare? To the surprise of everyone involved I managed to get the entire article written without once dropping in a mention of Lady Godiva or Sports Illustrated Swimsuit Issue cover model Kate Upton. The article is all about bare feet, and I analyzed the various advantages whereby barefoot and minimalist footwear walking can be better and healthier for you than imprisoning your feet in $200 worth of leather and latex. There&#8217;s a really naughty joke there but it&#8217;s soooooooo far from family-friendly that I&#8217;d be tarred, feathered, and run out of Crown Point on a rail so let&#8217;s proceed…</p>
<p><span style="color: #0000ff;"><strong>I&#8217;ve rarely seen rusty nails stuck in feet</strong></span></p>
<p style="text-align: justify;">In the article I discussed that scientific research has proven that shoe wearing populations tend to have more back and knee problems, greater instances of arthritis, as well as varied foot problems and deformities. We&#8217;re not talking Chinese foot-binding here, but strictly conventional shoes: everything from penny loafers to the most expensive sports shoes lucratively endorsed by basketball stars. I explained in the article that the primary argument against barefoot walking is that you might step on a rusty nail but<span style="color: #ff0000;"> in my two decades as a podiatrist I have rarely seen patients with items like that stuck in their feet</span>, so it&#8217;s about as likely as Rosanne Barr actually succeeding in getting elected President.</p>
<p><span style="color: #0000ff;"><strong>Minimalist footwear provides protection + comfort</strong></span></p>
<p style="text-align: justify;">The development of a broad array of minimalist footwear adequately tackles head on the arguments about foot protection and comfort. After all, even though I am a barefoot evangelist I sure wouldn&#8217;t want to walk with unprotected soles on the asphalt parking lot of the Tucson WalMart on a July afternoon. The magnificent new minimalist footwear manufactured by top ranked shoe companies such as Asics, Brooks, Nike, Reebok, and Sketchers allows any walker or runner to benefit from <span style="color: #ff0000;">the unquestionable health benefits of barefoot exercise</span> without leaving foot skin sizzling on hot asphalt in Arizona, or frostbitten on the ice in Minnesota.</p>
<p><span style="color: #0000ff;"><strong>Transition gradually to the barefoot lifestyle</strong></span></p>
<p style="text-align: justify;">Although minimalist footwear is the greatest thing since sliced bread or even better (try strapping Wonder Bread to your feet and see how well you walk), I advise against a sudden barefoot epiphany which sees you toss your entire Imelda Marcos collection of shoes into a dumpster. You likely have been wearing supportive shoes since you were knee high to a grasshopper so an overnight transition to barefoot walking could lead to injury. The support within the shoes you&#8217;ve worn forever has likely weakened some of your foot and leg muscles, so you need to build them back up gradually before you can join the barefoot brigade. You should also <span style="color: #ff0000;">consult your friendly neighborhood podiatrist (or</span> <a href="http://www.friendlyfootcare.com/" target="_blank">Friendly Foot Care</a><span style="color: #ff0000;">!) if you have any medical issues</span> which can affect your feet such as diabetes, poor circulation, or deformities. Tell them Dr. Mike sent you… and no, we podiatrists don&#8217;t work on commission!</p>
<p><span style="color: #0000ff;"><strong>Once you try bare, you won&#8217;t go back to Air</strong></span></p>
<p style="text-align: justify;">I&#8217;m looking forward to writing more articles for the readers of shoedigest.com and hope that I<span style="color: #ff0000;"> can continue to spread the word about our wondrous feet and the benefits of barefoot activity</span>.</p>
<p>I have lost my old footwear<br />
I don&#8217;t care, I&#8217;ll go bare<br />
Bye, bye Nike LeBrons<br />
They weren&#8217;t very good to me.<br />
Pronated me, hee, hee, hee.<br />
Bye, bye Air Jordans<br />
I won&#8217;t miss that little foam wedge beneath me<br />
If you see &#8216;em don&#8217;t tell &#8216;em where to find me<br />
I have lost my old footwear<br />
I don&#8217;t care, I&#8217;ll go bare<br />
Track shoes, bye, byeeeeeeeeeeeee!</p>


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		<title>Diabetic Foot Care Is Critical To Avoid Amputation</title>
		<link>http://www.americaspodiatrist.com/2012/02/diabetic-foot-care-is-critical-to-avoid-amputation/</link>
		<comments>http://www.americaspodiatrist.com/2012/02/diabetic-foot-care-is-critical-to-avoid-amputation/#comments</comments>
		<pubDate>Wed, 15 Feb 2012 23:50:05 +0000</pubDate>
		<dc:creator>Dr. Nirenberg</dc:creator>
				<category><![CDATA[6. Top Ways To Care For Your Feet]]></category>
		<category><![CDATA[ailment]]></category>
		<category><![CDATA[amputation]]></category>
		<category><![CDATA[blood]]></category>
		<category><![CDATA[circulation]]></category>
		<category><![CDATA[cold]]></category>
		<category><![CDATA[diabetes]]></category>
		<category><![CDATA[diabetic]]></category>
		<category><![CDATA[Feet]]></category>
		<category><![CDATA[Foot]]></category>
		<category><![CDATA[glucose]]></category>
		<category><![CDATA[heat]]></category>
		<category><![CDATA[illness]]></category>
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		<category><![CDATA[jog]]></category>
		<category><![CDATA[jogging]]></category>
		<category><![CDATA[neuropathy]]></category>
		<category><![CDATA[nirenberg]]></category>
		<category><![CDATA[numbness]]></category>
		<category><![CDATA[pain]]></category>
		<category><![CDATA[podiatrist]]></category>
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		<category><![CDATA[run]]></category>
		<category><![CDATA[running]]></category>
		<category><![CDATA[sores]]></category>
		<category><![CDATA[sugar]]></category>
		<category><![CDATA[type 1]]></category>
		<category><![CDATA[type 2]]></category>
		<category><![CDATA[walk]]></category>
		<category><![CDATA[walking]]></category>

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		<description><![CDATA[Although it is becoming so widespread that many Americans are taking it for granted, there is ample medical evidence to prove that diabetes is a very serious and potentially deadly disease which is affecting one out of every twenty people… and the number is rising daily. Diabetes is no laughing matter as our lifestyle which [...]

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				<content:encoded><![CDATA[<div id="attachment_2073" class="wp-caption alignnone" style="width: 269px"><a href="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/02/DSC00564.jpg"><img class="size-medium wp-image-2073 " title="Dr. Nirenberg treats a diabetic foot" src="http://www.americaspodiatrist.com/blog/wp-content/uploads/2012/02/DSC00564-259x300.jpg" alt="" width="259" height="300" /></a><p class="wp-caption-text">Dr. Nirenberg treats a diabetic foot</p></div>
<p style="text-align: justify;">Although it is becoming so widespread that many Americans are taking it for granted, there is ample medical evidence to prove that <span style="color: #ff0000;">diabetes is a very serious and potentially deadly disease</span> which is affecting one out of every twenty people… and the number is rising daily. Diabetes is no laughing matter as our lifestyle which is increasingly centered on consuming massive quantities of empty calories while sitting on our ever-expanding netherregions is not-so-slowly killing us.</p>
<p style="text-align: left;"><span style="color: #0000ff;"><strong>Foot care is required in Type 1 &amp; 2 Diabetes</strong></span></p>
<p style="text-align: justify;">I was recently interviewed for an article in Northwest Indiana’s The Times newspaper entitled <a href="http://www.nwitimes.com/niche/get-healthy/health-care/importance-of-foot-care-for-diabetics-regular-checks-are-vital/article_4c35ddc7-115a-5824-9855-e66d4f111d09.html" target="_blank">Importance Of Foot Care For Diabetics: Regular Checks Are Vital For Healthy Living</a>, where I discussed <span style="color: #ff0000;">the necessity for all diabetics to take meticulous care of their feet</span>.</p>
<p style="text-align: left;">Diabetes is classified into two types:</p>
<ul style="text-align: left;">
<li style="text-align: justify;"><strong>Type 1:</strong> This is the diabetes that is generally inherited and surfaces at an early age. Most sufferers of Type 1 diabetes require continual insulin injections and there is no practical cure.</li>
<li style="text-align: justify;"><strong>Type 2:</strong> This is the diabetes that is developed in adult life, almost always in part from overeating and making poor food choices. This diabetes type can be  delayed or in some cases, reversed through weight loss and proper diet.</li>
</ul>
<p style="text-align: left;"><span style="color: #0000ff;"><strong>Diabetes disrupts blood flow through your body</strong></span></p>
<p style="text-align: justify;">Diabetics suffer from disruption of their circulation system which affects many parts of the body such as the kidneys and eyes, and in many cases the foot. About one quarter of all diabetics will develop problems with their feet, primarily through diabetic neuropathy which can cause severe numbness to the point where the patient will no longer be able to feel heat, cold, or pain. In my practice <span style="color: #ff0000;">I have actually pulled out sharp objects from the feet of diabetics which they didn’t even know were there</span>! Unless you’re a professional firewalker or a fakir who walks on a bed of nails, the last thing you want is to have your feet this immune to pain!</p>
<p style="text-align: left;"><span style="color: #0000ff;"><strong>Tips to avoid diabetic foot problems</strong></span></p>
<p style="text-align: justify;">The best way to ensure that you don’t have problems with your feet is to adhere religiously to the treatment regimen administered by your physician to<span style="color: #ff0000;"> keep your blood sugar levels within acceptable parameters</span>, maintain a healthy low fat diet, and it’s also a good idea to follow these tips:</p>
<ul style="text-align: left;">
<li style="text-align: justify;">Don’t cross your legs for extended periods of time</li>
<li style="text-align: justify;">Keep your feet away from extreme cold or hot conditions</li>
<li style="text-align: justify;">Don’t wear socks or garters which restrict your legs to the point where blood flow to your feet is minimized</li>
<li style="text-align: justify;">Use a quality moisturizer to avoid the skin on your foot from drying out and cracking</li>
<li style="text-align: justify;">Switch up your exercise routine to activities that are fairly gentle on your feet, such as swimming or prone exercises</li>
<li style="text-align: justify;">If you’re smoking stop now</li>
</ul>
<p style="text-align: left;"><span style="color: #0000ff;"><strong>Check your feet daily with a mirror</strong></span></p>
<p style="text-align: justify;">Furthermore, it is a good practice for diabetics to check their feet once a day with a mirror to ensure that there aren’t any cuts, sores, blisters, or bruises that they could not ordinarily see (<a href="http://www.americaspodiatrist.com/2009/06/how-weighing-yourself-daily-could-save-your-feet-%e2%80%93-especially-if-youre-diabetic/" target="_blank">previously I reported on a scale that has a mirror built in so you can see your feet and your weight</a>). You spend a considerable amount of time in front of the mirror making sure that your hair is “just so” and that nasty forehead zit doesn’t make you look like a Cyclops, so you can certainly spend 30 seconds a day checking your feet for problems that might turn you into a modern day version of peg leg Captain Ahab. At the first sign of problems<span style="color: #ff0000;"> “run don’t walk”</span> <span style="color: #ff0000;">to your nearest podiatrist</span> to have your feet checked and treated before the new, small problem turns into a crisis which may require an amputation! Your feet are precious and you need both of them, so don’t jeopardize their health… or very existence!</p>


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