Foot Dynamics Custom Footbeds and Orthotics Blog
Heel elevation in footwear may be the most fundamental and significant cause of foot pathologies in our society. There are no scientific studies that I know of that prove what I have learned over the past 5 years. However, the anecdotal evidence is over whelming.
To give you a bit of a background story, I’ll begin by saying, I’ve practiced Pedorthics since 1990.
I partnered up with a fellow that owned a Birkenstock specialty store in the downtown area. I was already in the business of making custom Birkenstocks for the Podiatric market so the relationship was a natural one.
We began by marketing ourselves to local doctors, PTs, Chiropractors and Podiatrists. Boise is an active community and since many of the medical professionals are runners, cyclists, skiers and hikers themselves, my skills and background in this area quickly gave me a reputation among referring physicians, many becoming my clients.
In 2010, I met Christopher McDougall, author of “Born to Run”. It was his signature book about the Tarahumara Indian tribe of distance runners in Mexico that started the barefoot/minimal running craze. That year I had the opportunity to speak with Micah True. Micah was the character known as “El Cabello Blanco” in McDougall’s book who befriended the Tarahumara and was responsible for bringing them to the attention of the running world¹. While the book is credited with promoting barefoot and minimally shod running, my takeaway was quite different.
McDougall blames Nike for the dramatic rise in injuries since the introduction of the modern running shoe which was designed to facilitate a heel strike running style¹. The shoes were created with an elevated heel which was supposed to provide additional shock absorption for the calcaneus. No sooner did they elevate the heel of the shoe, and then there was a sudden rise in rotational injuries like shin splints, IT Band and hip pain. The running shoe industry response was to make “motion control” shoes since the obvious cause was that 70% of the population over pronates. I don’t agree. I believe that to a large extent, the cause of the over pronation is the elevated heel causing a premature heel strike that crashes the forefoot to the ground in a lever arm effect.
It was armed with this knowledge, that I discovered a running shoe brand that did not have an elevated heel but was not flimsy or minimal footwear.
I decided to try trail running and hiking in their shoes. Since there were no dealers in our market area, I ordered eight pairs and put seven of them into stock. As I began to have my patients try this new radical, “zero drop” shoe I kept getting the same reaction, “Wow!”. Patients started buying the shoes for wellness and got better quickly. Some with orthotics and many without. I wondered why.
I started using the Silfverskiӧld test², the classic evaluation technique for Equinus, as part of my regular evaluation. I discovered that a large majority of my patients had little, if any, range of motion in the ankle with the gastrocnemius engaged and not much more with the knee bent. Many people showed the classic signs Equinus. I was beginning to understand why they had problems like plantar fasciitis, bunions, neuromas, Achilles tendonitis and more. Humans need at least 10 to 20 degrees of ankle dorsiflexion to ambulate normally³ and avoid injury; and the patients in question, didn’t have it.
It makes sense, as there is an epidemic of Equinus in our society and the causes are chairs, cars, shoes with heels and toilets. When do we ever get the natural stretching of the posterior compartment we need?
The hamstrings, Achilles tendon, gastrocnemius and soleus are all allowed to shorten as we walk around in shoes with 10 – 12mm of heel elevation, sit on chairs at work and lie in bed at night.
I started using the zero drop shoes with my plantar fasciitis patients. I reasoned that, the treatment for plantar fasciitis is arch support, rest and stretching then bringing down the heel height of the shoes may actually start treating the cause instead of the symptoms. After all, when a patient is sent to physical therapy for treatment of plantar fasciitis they are going to work on stretching the posterior compartment. The rest of the day is spent with the foot plantar flexed. So I encourage my clients to wear zero drop shoes with arch support during the day and Birkenstock sandals (also zero drop) at home. The results have been dramatic.
Here are 2 cases studies to share showing the zero drop concept on people for whom zero drop footwear might be contraindicated.
#1, a morbidly obese, diabetic patient with a cavus foot in Equinus and severe callousing on the balls of his feet.
The text books say to dispense full contact orthoses and elevate the heels to address the tight Achilles. I made the orthotics and put them in a pair of Altra zero drop shoes. The patient returned for a follow up a couple of weeks later and he told me I had changed his life. Now this may seem a little dramatic until you understand that during the evaluation he had neglected to tell me he didn’t sleep at night due to muscle spasms and cramping in the back of his legs. Now that he is getting the stretch from having his heels on the ground he no longer has night time cramping. His callouses are gone too.
Patient #2 had acute Achilles tendonitis. The conventional wisdom is to elevate the heels and refer to physical therapy (stretching). I asked her if she was comfortable barefoot at home. She said that other than the discomfort from a lack of fat pad on the balls of her feet she was fine and was most comfortable in her Birkenstocks. She told me “it only hurts when I wear my shoes”. I put her in a pair of zero drop shoes and she had instant relief.
I have sold over 4,000 pairs of zero drop shoes over the past 5 years. I repeatedly have positive results. While zero drop shoes may not be the solution in all cases, the efficacy of this approach to treatment of foot pain has been more than amazing.
A recent edition of Podiatry Today features an article titled Understanding the Biomechanics of Equinus. The article, written by Craig Clifford DPM, claims that Equinus is the root cause of most foot pathologies including plantar fasciitis, neuromas, bunions, flat footedness and Achilles tendonitis. He goes on to say that the common treatments include, intense physical therapy, taping, Botox injections, surgical elongation of the tendons and…heel lifts?²
Although this is based on anecdotal evidence, I think that many of the conventional approaches for treating common foot problems are fundamentally incorrect. Consider adding 6mm of heel lift to a shoe that already has 12mm of drop. This puts the foot at 18mm of plantar flexion. This patient is then sent home to do their stretches. We should be recommending footwear that encourages the same stretching of the posterior compartment that we would get in our natural condition. Elevating the heels in shoes even 6mm promotes poor foot health and function.
Our success with zero drop shoes has not gone unnoticed by the other medical professionals in our market. We routinely get referrals from podiatrist, physical therapist, chiropractors and rheumatologists now for zero drop footwear and it is not hard to understand why. They want to refer their patients to someone who can help them.
Today, I have nine employees and we have become one of the largest brick and mortar retailer of Altra footwear in the country. We are also the largest Birkenstock dealer in Idaho and one of the top in the Northwest. This is not because we are clever retailers, it is because we have gained a reputation for helping people. When we explain the benefits of zero drop footwear, and the patients experience the difference, they not only continue to buy shoes from us they tell their friends and family as well.
¹ McDougall, Christopher. Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen, 2009
² Clifford Craig. Understanding the Biomechanics of Equinus, Podiatry Today Vol. 27 Issue 9 September 2014
³ Root ML, Orien WP, Weed JH. Clinical Biomechanics. Vol II: Normal and Abnormal Function of the Foot, Clinical Biomechanics Corp. Los Angeles, 1977
My new favorite hiking boot is the Altra Lone Peak which isn’t a hiking boot at all. This trail running shoe has all the critical components for high performance backcountry foot wear: lightness (remember 1lb. off your feet is the same as 7lb. off your back), stability, breathability, durability and ample toe box room. Among these critical attributes is “stability”. Because this shoe is of Zero Drop design, the heel is at the same height as the ball of the foot with a stack height of approx. 8mm. Since most hiking boots have about 12mm to 14mm of heel rise and a stack height of around 8mm, this brings the heel much higher off the ground. It is this foot elevation that creates foot instability thus requiring more “support” in the shoe with a higher cuff and/or stiffer soles. These more “supportive” shoes weight two to three times as much as the Altra’s without providing more more stability or performance.
Hitting the slopes on a sunny spring day is a favorite for many skiers—who enjoy warmer temperatures and a little sunshine while zipping down slopes. Foot pain, however, can quickly put a damper on your spring skiing fun.
Ill-fitting boots are most often the cause of foot pain while skiing by pinching, rubbing or allowing too much movement of the foot. Arch pain and cramping can occur when your foot is unstable, preventing even weight distribution. Without realizing it, you may be trying to use the muscles of your foot to fill space in your boots to turn and stop more effectively. This strain on your foot muscles can cause cramps and aches in your arches.
Everyone’s feet are different, and boot manufacturers design the boots to fit the greatest possible variety of feet. If they were to make the footbeds in the boots too supportive, it would “offend” some peoples’ feet and they might not buy them. This is also why boot manufacturers tend to make their liners very cushioned, to initially feel comfortable to the greatest variety of foot shapes. But foot pain can occur if the liner is too soft, allowing the foot to move around inside the shell.
Providing a stable foundation in the boot– usually involving custom ski footbeds/orthotics—will support the foot in a neutral position. Custom footbeds/orthotics reduce motion caused by the natural tendency for the foot to spread out and roll to the inside or outside, helping relieve the muscle fatigue that causes your arches to ache.
Shin splints, or medial tibial stress syndrome (MTSS), are a common condition in runners and cause throbbing and aching in the lower part of the leg between the knee and the ankle. The pain might strike during your run, after your run or you might just be unlucky enough to feel it all the time.
Shin splints generally result from too much force being placed on your shinbone and the connective tissues that attach your muscles to the bone, and may be caused by:
- Irritated and swollen muscles
- Stress fractures
- Over-pronation or flat feet
Having the proper equipment for any sport is important to minimize the risk of injury–and shoes are the most important piece of equipment for a runner. Most companies who specialize in running shoes make significant investment into the technology and science of developing high performance footwear—and appropriate footwear can help prevent and reduce the effect of shin splints. However, good running shoes may not be enough to prevent this painful condition – especially for those runners with over-pronated feet, or feet which have fairly good arches when not standing up, but flatten excessively when walking or running.
While shin splits often heal on their own, ignoring them can result in more serious injuries, such as stress fractures to the bone. Rest and applying ice are common treatments for shin splints, but new shoes and custom running orthotics may be the answer. Orthotic insoles are useful in that they help prevent over-pronation and provide heel cushioning to reduce impact while providing heel stability.
Let Foot Dynamics Help! Our running orthotics are designed to complement modern running shoe technology, with full length, semi-flexible orthotics designed to control excessive foot motion under high impact. ORDER YOURS TODAY!
Hot Foot? Douse the Flames for Good!
Many cyclists suffer from metatarsalgia or “hot foot” — a burning pain in the ball of the foot that can radiate toward the toes. Severe cases can feel like someone is actually holding a blowtorch to the ball of your foot. Hot foot occurs most often on long rides and may develop more quickly or intensely on hilly courses because climbs cause greater pedaling pressure. The pain results when nerves are squeezed between the heads of each foot’s five long metatarsal bones in the ball of the foot just behind the toes.
Feet always swell on long rides, especially in warmer weather, causing pressure inside shoes that normally fit fine. Besides tight shoes, another risk factor is small pedals, particularly if you have large feet. Small pedal surfaces concentrate pressure on the ball of the foot instead of spreading it the way a larger pedal will. If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.
With hot foot, it is not actually heat that causes the pain; rather, it is pressure on nerves that causes the burning sensation. Many cyclists believe that splashing water on their feet will help alleviate the problem, but that is a symptomatic treatment that doesn’t really address the root of the problem.
Having the proper footwear can make all the difference in the comfort of your feet during and after a ride. Here are several options you can try to put out the flames:
- Adjust shoe straps. Tighten the top strap nearest your ankle to help stop your feet from slipping around in your shoes.
- Wear thinner socks. This will give your feet more room and is especially helpful if your shoes are on the snug side.
- Buy new shoes. Look for a model with a wider-and-higher toe box and a stiffer sole and footbed with a metatarsal button.
- Purchase custom cycling orthotics from Foot Dynamics. These footbeds are fit specifically to your feet with built-in metatarsal buttons. If you are a cyclist, be sure to order orthotics designed specifically for cycling, as cycling is a forefoot activity and orthotics designed for running or other full gait activities won’t provide the support you need.
My flight from Minn. to Boise after the American Birkibeiner race was cancelled. While stuck in a hotel overnight I ran into Steve Poulin, the President of Swix Sports. He told me that the importance of a flat ski for glide cannot be overstated. He thinks the Nordic ski community needs to look much more closely at the interface of the foot to Nordic boot to ski in both classic skiing and skate skiing. We hope to continue the conversation in the next few months. Thanks Steve.
Among the most effective treatments for heel pain is stretching, especially the posterior c compartment which includes the Achilles tendon, hamstrings, soleus and gastrocnemius muscles. Unfortunately even five minutes of stretching several times a day isn’t likely to have much impact over the course of a full day of walking with your heels elevated 12 mm or more. By lowering your heel height to zero you will get the benefit of a full day of stretching without stopping to make time for a stretching regiment. Birkenstocks and Altra shoes are the perfect choice for healthy footwear.
Numbness in the toes is caused by a pinching of the nerves as they pass through the inter space between the metatarsal joints. This can be caused by a collapsing of the transverse arch as load is put on the forefoot during the pedal stroke and can be exacerbated by shoes that are too narrow. The best solutions are orthotics with metatarsal pads and/or Bont cycling shoes which have a wider oblique toe box.
The greatest benefit of carbon fiber for ski boot construction is that the carbon fiber material is unaffected by ambient temperature. This means the boot stiffness at 10* below zero is the same as it is at 40* above zero. They are also incredibly light weight.
Only if you want the best performance and comfort from your boots. Because the foot in a ski boot is in its unlocked and flexible condition the muscles and tendons of the foot are fighting to support the arch while 2 to 3 times your body weight is forcing the ach to flatten. This can cause cramping, pain and a loss of leverage on the ski edge.