Shoes, Orthotics, and FEET

I once had a teenage patient tell me she liked the idea of becoming a physio but couldn’t get over the idea of touching and handling someone’s feet. She asked me how often I had to treat them and if she could get away with avoiding them and mostly treating other body parts lol. Unfortunately for her, feet are pretty dang important, and chances are we are going to assess them at some point if you come into the clinic. Fortunately for me, I LOVE working with feet 🙂

Yes, I have favourite parts of the body to treat and the foot and ankle are definitely up there. I love working on them because the joint structure and musculature are unbelievably intricate.  The ankle and foot are SO individual to the patient and are integral to their daily movement, walking being the most obvious activity. Assessing a patient’s walking or running cycle is another fun hobby of mine- your feet can look a certain way standing and then as soon as we get you to walk or run it’s a different story.

An old foot or ankle injury can have a lasting impact the whole way up the chain of the body. I have had many patients come in with knee or hip pain, and difficulty going up stairs or running uphill, and when I ask them to squat it’s the lack of mobility in an old ankle injury that has been limiting them. SO FUN! …For me. Getting to assess and treat you. I’m sorry you’re in pain 😦

Moving along, as most of you know I also have a fondness for working with runners in particular, and if a runner comes in with an injury they are usually  dealing with the foot, ankle, knee or hip. Regardless of which area is injured, I will always check your foot and your ankle. Sooner or later I get asked “Is it my shoes? What kind should I get?”

These are very general guidelines and you honestly should get checked by a physio before you go to town with this advice. In general, I love patients to wear minimalist shoes. If you are starting a running program for the very first time, I want it to be in a minimalist shoe. If you are currently a runner and wearing intense pronation control/ankle stability/maximum cushion shoes, I absolutely want you in a less supportive shoe but it needs to be a gradual regression into something with less support.

So what does minimalist shoe mean? I tell patients to bring in pictures or links to any shoes they are thinking of, and I’m such a nerd I probably know the shoe off the top of my head. In general, if you are at a store and shopping around, I like the shoe to be super light, and very bendable throughout the sole. The reason for this, and the reason why I advocate for less support, is because your foot is designed to support you. You have intrinsic (meaning small, located within the foot) muscles that are built to give you an natural, supportive arch.  When you create all that within a shoe, you are taking away that role from the feet and the intrinsic muscles will weaken, leading to potential problems overtime.

If you couldn’t tell already from that description of supportive shoes- No, I am not a fan of orthotics for the average person. When you constantly provide the body with artificial support, you lose the ability for natural support. Of course, there are exceptions to this rule where orthotics are needed (some acute injuries or pains, some post-surgical, heel lifts for significant leg length discrepancy, joint reconstruction etc), but in all honesty the people that always ask me if they need orthotics are the ones who have been told they pronate (foot falls inward), have flat feet, and have poor ankle stability. These are exactly the people who need to have the support taken from them, so they can become stronger intrinsically. I’m saying this as someone who was told they needed orthotics all their life growing up, as a physio, and as a runner.

Minimalist shoes have become increasingly popular over the last decade or so, due to popularity of books like “Born to Run” and with increasing research coming out that show runners have less injury and increased performance when using a minimalist shoe. Part of the proposed theory behind this (and therefore the reason I believe supportive shoes to be detrimental) is because they change the dynamic of your running cycle by increasing your cadence. There’s a lot of discussion about landing on the heel etc, but I would say the most general consensus in the literature is that a cadence of running around 180 spm (see my post on cadence, running pain) is the ideal pace to increase performance and avoid injury. Your cadence will decrease the more supportive of a shoe because your stride length will increase, which will displace your feel further from beneath your centre of mass, which will increase the load and impact on your body.

Whether you’re a runner or not, spend some time loving on your feet and go barefoot around the house. If it was socially acceptable would 100% be barefoot while treating patients as much as possible. One of the reasons I loved Australia so much is because so many people are barefoot everywhere (grocery stores, libraries… amazing!) I tell all my patients to do their exercises in socks or barefoot, so we can start to load the foot and ankle naturally.

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