More on the scourge of Flip Flops. Riding the inside edge of the sandal. Mystery hunting with Dr. Allen.

Tis the season upon us. Riding the inside edge of the sandal.
You can see it in the photo, the heel is a third of the way off the sandal.

You either have it or have seen it. It is frustrating as hell if you have it. Your heel rides on only half of your flip flop or summer sandals. You do not notice it in shoes, only in sandals, typically ones without a back or back strap. This is because the heel has no controlling factors to keep it confined on the rear of the sandal sole. There is no heel counter on open backed shoes and sandals, the counter keeps the heel central on the back of the footwear. There is a reason this inside edge riding happens to some, but not everyone. It is best you read on, this isn’t as simple as it might seem.

These clients may have restricted ankle rocker (dorsiflexion), restricted hip extension and/or adductor twist (if your reference is the direction the heel is moving towards). I could even make a biomechanical case that a hallux limitus could result in the same scenario. So what happens is that as the heel lifts and adducts it does not rise directly vertically off the sandal, it spins off medially from the “adductor twist” event. This event is largely from a torque effect on the limb from the impaired sagittal mechanics as described above, manifesting at the moment of premature heel rise resulting in an slightly externally rotating limb (adducting heel). The sandal eventually departs the ground after the heel has risen, but the sandal will rise posturing slightly more laterally ( you can clearly see this on the swing leg foot in the air, the sandal remains laterally postured). Thus, on the very next step, the sandal is not entirely reoriented with its rear foot under the heel, and the event repeats itself. The sandal is slightly more lateral at the rear foot, but to the wearer, we believe it is our heel that is more medial because that is the way it appears on the rear of the sandal or flip flop. Optical illusion, kind of… . . a resultant biomechanical illusion is more like it.

You will also see this one all over the map during the winter months in teenagers who swear by their Uggs and other similar footwear, as you can see in the 2nd photo above. This is not an Ugg or flip flop problem though, this is often a biomechanical foot challenge that is not met by a supportive heel counter and may be a product of excessive rear foot eversion as well. This does not translate to a “stable” enough shoe or boot, that is not what this is about. This is about a rearfoot that moves to its biomechanical happy place as a result of poor or unclean limb and foot biomechanics and because the foot wear does not have a firm stable and controlling heel counter. This is not about too much pronation, so do not make that mistake. And orthotic is not the answer. A heel counter is the answer. The heel counter has several functions, it grabs the heel during heel rise so that the shoe goes with the foot, it give the everting rearfoot/heel something to press against, and as we have suggested today, it helps to keep the rearfoot centered over the shoe platform. To be clear however, the necessary overuse and gripping of the long toe flexors to keep flip flops and backless sandals on our feet during the late stance and swing phases of gait, clearly magnifies these biomechanical aberrations that bring on the “half heel on, half heel off” syndrome.

There you have it. Another solution to a mystery in life that plagues millions of folks.

Shawn Allen, the other gait guy

Toe extension matters.

The season to pathologize our feet is upon us. Toe extension matters.

I blew out my flip flop,
Stepped on a pop top;
Cut my heel, had to cruise on back home.
But there's booze in the blender,
And soon it will render
That frozen concoction that helps me hang on. - Jimmy Buffett

I continue to see more and more people with inadequate toe extension. It is complicated. I see those who do not even have the awareness of toe extension, loss of strength of toe extension, loss of endurance of toe extension, loss of global range of toe extension (dorsiflexion at the MTP joint), more failure of long toe extensor (EHL) strength and more prominence of increased short toe extensor strength (EDB) and more frightening, a lack of disassociation of toe extension (MTP dorsiflexion) and ankle dorsiflexion. Many clients when asked to life their toes, will drive into ankle mortise dorsiflexion; ask them to just purely toe dorsiflex and the mental games begin, a wrinkled brow, intense concentration. If you cannot extended the toes sitting, how are you going to find them in swing phase of gait when balance, and other things, are more important?
Stand and lift your toes. The arch should go up, you have engaged the Windlass Mechanism, that winds up the plantar fascia and raised the arch. If you do not have competent, unconsciously competent, toe extension, your arch is not all that it can, and should, be. If you cannot raise your toes, thus raise the arch, thus plantarflex the first metatarsal, then in gait, when the foot is on the ground, you cannot properly position the sesamoids, properly get safe terminal ranges of hallux dorsiflexion at toe off, properly position the foot for loading and unloading, adequately achieve ankle dorsiflexion, adequately offer the hip a chance for ample hip extension, offer the glutes optimal chance to work in all phases to help control spin of the limb during loading and unloading, and the list goes on and on. I am sure I left much out there, this was written in a few minutes and unedited, just a short rant for the weekend. But if you have not championed toe extension, both in an unloaded and loaded foot (on the ground), achieved control of both long and short extensor muscles to the toes (and paired them well with the long and short toe flexors), disassociated toe extension from ankle dorsiflexion, and then figured out how to properly, timely, engage all these processes into your gait unconsciously, you are working on less of an optimal system than you should be. So, if your feet hurt, hips hurt, or a plethora of other problems that you are trying to fix with orthotics or other toys, maybe start with, "can you lift your toes?". It is a piece of the puzzle, trust me.
Or, you can just stay in your flip flops and perpetuate your toe flexion and wait for bad things to take root After all, tis the season soon !
Yes, toe extension in flip flops (we must flex our toes to keep them on) is as rare as a good multi-tasking man.

Shawn Allen, one of the gait guys.

" "Stand and lift your toes. The arch should go up, you have engaged the Windlass Mechanism, which winds up the plantar fascia and raises the arch. If you do not have competent, unconsciously competent for that matter, toe extension, your arch is not all that it can, and should, be. If you cannot raise your toes, thus raise the arch, thus plantarflex the first metatarsal, then in gait, when the foot is on the ground, you cannot properly position the sesamoids, properly get safe terminal ranges of hallux dorsiflexion at toe off, properly position the foot for loading and unloading, adequately achieve ankle dorsiflexion, adequately offer the hip a chance for ample hip extension, offer the glutes optimal chance to work in all phases to help control spin of the limb during loading and unloading, and the list goes on and on."

Flip Flops not so bad? We still think they suck and here's why...

We have talked about the dangers of open back shoes (Including flip-flops)  and loss of ankle rocker as well as changes in forefoot rocker and great toe dorsiflexion on our blog many times.

The findings of this study, with slower cadence and shortened stance are not surprising (especially since you need to fire your long flexors to keep them on!) nor are ankle joint kinematics (flip flops have no heel counter and are not torsionally rigid, so naturally there would be increseased subtalar motion), however we really question the interpretation.

 "Many have long suspected the answer, but a new study would appear to resolve the question: Are flip flops really that bad for your feet? According to Chen and colleagues from the Department of Biomedical Engineering at The Hong Kong Polytechnic University, flip flops are most likely no better than barefoot when it comes to lower-limb co-contraction and joint contact force in the ankle. The authors had hypothesized that the popular rubber footwear would increase co-contraction of the muscles between the knee and ankle joints in what they thought was a compensatory mechanism for the unstable foot–sole interface and would affect gait kinematics and kinetics.

In the study, the researchers had 10 healthy males perform 6 walking trials under 3 conditions: barefoot, sports shoes, and thong-type flip flops. Participants, who reported they were not “regular flip flop wearers,” were fitted with numerous markers that were monitored while they walked on a 10-meter pathway. The study looked at several muscle pairings that stabilize the knee, ankle, and subtalar joints, including vastus lateralis and gastrocnemius medialis; vastus lateralis and biceps femoris; and peroneus longus and tibialis anterior.

In pairwise comparisons, the walking velocity of flip flops was lower than that of sports shoes (p<0.01) but comparable to barefoot (p>0.05), findings that were consistent with the published literature. Although not significant, the minimalist footwear produced a slower cadence and shortened stance phase in walking trials compared to the other 2 types of footwear. Joint kinematics differed significantly in the ankle joint (F[2,18]=6.73, P<.05) and subtalar joint (F[2,18]=4.45; P<.05); Furthermore, ankle and subtalar range of motion was higher for flip flops than for sports shoes. However, co-contraction was not enhanced. The authors propose that walking speed does not need to be consistent for real-world activities and the slower speed could be a natural approach to avoid injury.

The authors conclude that the slowed walking speed of flip flop users could account for the comparable joint biomechanics between flip flop use and barefoot. They note, however, that, for injury prevention, the closed-toe design of the sports shoe would provide better support for joint motion and loading compared to the other 2 options."

Source:

Chen TL, Wong DW, Xu Z, Tan Q, Wang Y, Luximon A, Zhang M. Lower limb muscle co-contraction and joint loading of flip-flops walking in male wearers. PLoS One. 2018;13(3):e0193653."

image and article source: http://lermagazine.com/issues/may/flip-flops-bare-feet-or-sports-shoes-which-are-best-and-which-are-worst

The season to pathologize our feet is upon us. Toe extension matters.

I blew out my flip flop,
Stepped on a pop top;
Cut my heel, had to cruise on back home.
But there's booze in the blender,
And soon it will render
That frozen concoction that helps me hang on. - Jimmy Buffett

I continue to see more and more people with inadequate toe extension. It is complicated. I see those who do not even have the awareness of toe extension, loss of strength of toe extension, loss of endurance of toe extension, loss of global range of toe extension (dorsiflexion at the MTP joint), more failure of long toe extensor (EHL) strength and more prominence of increased short toe extensor strength (EDB) and more frightening, a lack of disassociation of toe extension (MTP dorsiflexion) and ankle dorsiflexion. Many clients when asked to life their toes, will drive into ankle mortise dorsiflexion; ask them to just purely toe dorsiflex and the mental games begin, a wrinkled brow, intense concentration. If you cannot extended the toes sitting, how are you going to find them in swing phase of gait when balance, and other things, are more important?
Stand and lift your toes. The arch should go up, you have engaged the Windlass Mechanism, that winds up the plantar fascia and raised the arch. If you do not have competent, unconsciously competent, toe extension, your arch is not all that it can, and should, be. If you cannot raise your toes, thus raise the arch, thus plantarflex the first metatarsal, then in gait, when the foot is on the ground, you cannot properly position the sesamoids, properly get safe terminal ranges of hallux dorsiflexion at toe off, properly position the foot for loading and unloading, adequately achieve ankle dorsiflexion, adequately offer the hip a chance for ample hip extension, offer the glutes optimal chance to work in all phases to help control spin of the limb during loading and unloading, and the list goes on and on. I am sure I left much out there, this was written in a few minutes and unedited, just a short rant for the weekend. But if you have not championed toe extension, both in an unloaded and loaded foot (on the ground), achieved control of both long and short extensor muscles to the toes (and paired them well with the long and short toe flexors), disassociated toe extension from ankle dorsiflexion, and then figured out how to properly, timely, engage all these processes into your gait unconsciously, you are working on less of an optimal system than you should be. So, if your feet hurt, hips hurt, or a plethora of other problems that you are trying to fix with orthotics or other toys, maybe start with, "can you lift your toes?". It is a piece of the puzzle, trust me.
Or, you can just stay in your flip flops and perpetuate your toe flexion and wait for bad things to take root After all, tis the season soon !
Yes, toe extension in flip flops (we must flex our toes to keep them on) is as rare as a good multi-tasking man.

Shawn Allen, one of the gait guys.

Riding the inside edge of the sandal. Mystery hunting with Dr. Allen.

You can see it in the photo above, the heel is a third of the way off the sandal. (there are 2 photos provided today, find the arrow and tab to see both)

You either have it or have seen it. It is frustrating as hell if you have it. Your heel rides on only half of your flip flop or summer sandals. You do not notice it in shoes, only in sandals, typically ones without a back or back strap.  This is because the heel has no controlling factors to keep it confined on the rear of the  sandal sole. But there is a reason this happens to some, but not everyone. It is best you read on, this isn’t as simple as it might seem. 

These clients have restricted ankle rocker (dorsiflexion), restricted hip extension and/or adductor twist (if your reference is the direction the heel is moving towards). I could even make a biomechanical case that a hallux limitus could result in the same scenario. So what happens is that as the heel lifts and adducts it does not rise directly vertically off the sandal, it spins off medially from the “adductor twist” event. This event is largely from a torque effect on the limb from the impaired sagittal mechanics as described above, manifesting  at the moment of premature heel rise resulting in an slightly externally rotating limb (adducting heel). The sandal eventually departs the ground after the heel has risen, but the sandal will rise posturing slightly more laterally ( you can clearly see this on the swing leg foot in the air, the sandal remains laterally postured). Thus, on the very next step, the sandal is not entirely reoriented with its rear foot under the heel, and the event repeats itself. The sandal is slightly more lateral at the rear foot, but to the wearer, we believe it is our heel that is more medial because that is the way it appears on the rear of the sandal or flip flop.  Optical illusion, kind of… . . a resultant biomechanical illusion is more like it.

You will also see this one all over the map during the winter months in teenagers who swear by their Uggs and other similar footwear, as you can see in the 2nd photo above. This is not an Ugg or flip flop problem though, this is often a biomechanical foot challenge that is not met by a supportive heel counter and may be a product of excessive rear foot eversion as well.  This does not translate to a “stable” enough shoe or boot, that is not what this is about. This is about a rearfoot that moves to its biomechanical happy place as a result of poor or unclean limb and foot biomechanics and because the foot wear does not have a firm stable and controlling heel counter.  The heel counter has several functions, it grabs the heel during heel rise so that the shoe goes with the foot, it give the everting rearfoot/heel something to press against, and as we have suggested today, it helps to keep the rearfoot centered over the shoe platform.  To be clear however, the necessary overuse and gripping of the long toe flexors to keep flip flops and backless sandals on our feet during the late stance and swing phases of gait, clearly magnifies these biomechanical aberrations that bring on the “half heel on, half heel off” syndrome.

There you have it. Another solution to a mystery in life that plagues millions of folks. 

Dr. Shawn Allen, mystery hunter, and one of the gait guys.

Looking for the subtle clues will help you. You should have hypotheses and work to prove or disprove them. 

“Remember, this client is displaying these weight bearing differences side to side for a reason, this is their adaptive strategy. It is your job to prove that this is the cause of their pain, their adaptive strategy to get out of pain, or this is now a failed adaptive strategy causing pain, yet still not the root of the problem.”

We used to call this a “windswept” presentation. It is not that it is incorrect, but it is so vague.  

Look at these fippy floppers. Look closely at the dark areas, where foot oils and whatnot have played their changes in the leather upper of the flops. The right f.flop displays more lateral heel loading, rear foot inversion if you will. You can even see that there is less big toe pressure on this right side and even some increased lateral forefoot loading. This client appears to be more supinated clearly. You can even see there is more lightness to the arch leather on the right, again, more supination is suggested.

The left f.flop suggests the opposite. More medial heel pressures and more over the medial forefoot and arch. 

Now this clients f.flops tell a story.  So, this client is being windswept to the right we used to say, appearing to pronate more on the left and supinating more on the right.  Why are they doing this? Is the left leg functionally longer and by pronating they reduce the functional length of the leg (yet, increase internal spin of the limb and the host of naughty things that come with that). Is the right leg shorter, and by supinating they are raising the ankle mortise and arch which helps reduce the length differential ?  MAybe a bit of both, finding common ground for a more symmetrical pelvis ?  Who knows. This is where you need your physical exam, but, now you have some hypotheses to prove or disprove. 

“Remember, this client is displaying these weight bearing differences side to side for a reason, this is their adaptive strategy. It is your job to prove that this is the cause of their pain, their adaptive strategy to get out of pain, or this is now a failed adaptive strategy causing pain, yet still not the root of the problem.”

Is there some right hip pain from the right frontal pelvis drift creating some aberrant loading on the greater trochanter from ITB tension ? Perhaps a painful right hallux big toe, and they are unloading it to avoid pain? Maybe some knee pain or low back pain ? Who knows? Take your history and start putting the pieces together, it is your job. Just don’t screen them and throw corrective exercises at them, you owe it to them to examine them, take their history, watch them walk, teach them about what you see, and then sit down, spread the puzzle pieces out, look for the straight edges and corner pieces, and begin to build their puzzle. 

Clues, they are everywhere, if you look for them.

Dr. Shawn Allen, one of the gait guys

The Abductor Heel Twist: Look carefully, it is here in this video.

This should be a simple “piece it together” video case study for you all by this point. This young lad came into our office with left insertional achilles pain of two weeks duration after starting some middle distance running.

What do you see here ? It is evident on both the right and the left, but it is a little more obvious on the left and can be seen on the left when he is walking back toward the camera as well.  You should see rearfoot eversion, it is excessive, and a small rearfoot adductor twist. Meaning, the heel pivots medially towards the midline of his body.  Some sources (Michaud) call this an Abductory Twist, but the reference there is typically the forefoot.  Regardless, to help our patients, we sometimes refer to this is “cigarette butt” foot. It is like stepping on a lit cigarette to put it out via twisting/grinding it into the ground. 

So, now that you can see this, what causes it? 

The answer is broad but in this case he had a loss of ankle dorsiflexion range.  The ankle mortise clearly did not have enough of ankle rocker range during midstance so as that limitation was met, the heel raised up prematurely during the moments when the opposite leg is in full swing imparting an external rotation on the stance limb (hence the external foot spin (adducting heel/abducting foot……depending on your visual reference)). There is a bit more to it than that, but that will suffice for now because it is not the central focus of our lesson today.

What can cause this ? As we said, a broad range of things:

• hallux limitus
• flexion contracture of the knee (swelling, pain, joint replacement etc)
• short calf-achilles complex
• weak tib anterior and extensor toe muscles
• Foot Baller’s ankle
• limited/impaired hip extension
• weak glute (minimizing hip extension range)
• sway back (lower crossed syndrome-type biomechanics)
• short quadriceps (similarly impairing hip extension)
• flip flop excessive use (or any other motor strategy that imparts more flexor compartment dominance (read: calf-achilles, FDL)
• excessive pronation
• impaired foot tripod mechanics
• etc

The point is that anything impairing TIMELY (the key word is timely) forward sagittal gait mechanics can, and very likely will, impair ankle rocker.  Even the wrong shoe choice can do this (ie. someone who suddenly drops from a 12 mm heel ramped shoe into a 0-4mm ramped heel shoe and who thus may not have earned the length of the calf-achilles complex as of yet).

The abductor-adductor twist phenomenon is not a normal visual gait observation. It is a softly seen, but screaming loud, pathologic gait motor pattern that must be recognized.  But, more importantly, the source of the problem must be found, confirmed and resolved.  In this fella’s case, he has some weakness of the tib anterior and extensor toe muscles that has lead to compensatory tightness of the calf complex. There was no impairment of the glutes or hip extension, as this was just 2 weeks old or so, but if left unaddressed much longer the CNS would have likely begun to dump out of hip extension and gluteal function to protect……another compensation pattern. Remember, ankle rocker and hip extension have a close eye on each other during gait.

Clinical pearl for the true gait geeks…… if you see someone with a vertically bouncy forefoot-type gait (you know, those people that bounce up and down the hallway at work or school) you can usually suspect impaired ankle rocker and if you look closely, you will usually see a quick abductor-adductor twist.

Shawn and Ivo

the gait guys

Podcast #13: Caffeine, Nicotine & Lance

here is the link for podcast 13

http://thegaitguys.libsyn.com/webpage

______________________________

1- Malcolm gladwells piece on drug doping (PEDs) in sports:

“Gladwell argued that we should think about cycling the same way we think about auto racing — where teams should be rewarded for using science and bending the rules to their breaking point to succeed.
"When you look at what Lance is alleged to have done. Basically he was better than everyone else at using PEDs,” Gladwell said. “He was the guy who sat down and was rigorous and focused and thoughtful and intelligent and cutting edge in how to use them, and apply them and make himself better. Like, I don’t know, so is that a bad thing?”

Read more: http://www.businessinsider.com/malcolm-gladwell-lance-armstrong-2012-10#ixzz29QBKJpAJ

2- Caffeine: A PED ?
Mens health online magazine, also found in our Sunday edition Oct 14th, 2012 newspaper:

http://news.menshealth.com/chew-gum-before-races/2012/04/12/

Chew on this: Caffeinated gum can improve your athletic performance—if you start chewing it at the right moment, finds a new study from Kent State University.

NICOTINE: http://www.t-nation.com/free_online_article/most_recent/50_hits_of_nicotine
Nicotine has been used in energy drinks in Japan for years.
stimulates the release of acetylcholine, providing a sense of increased energy. Arnold used to do commercials for them.
Nicotine can improve reaction time.
Nicotine can be addictive, much like caffeine. But addiction to nicotine gum, lozenges, or patches is rare, if not unheard of.
MAYO clinic: http://www.mayoclinic.org/medical-edge-newspaper-2009/apr-24b.html

3- DISCLAIMER:We are not your doctors so anything you hear here should not be taken as medical advice. For that you need to visit YOUR doctors and ask them the questions. We have not examined you, we do not know you, we know very little about your medical status. So, do not hold us responsible for taking our advice when we have just told you not to !  Again, we are NOT your doctors !

4: Maryland Guy Running a marathon in flip flops:

“Some of the rules: It can’t be a heal strap. There can’t be any other means to hold the flip flop on your shoe besides just the normal thing between your toes,” Levasseur said. “I don’t know what happens if I get a blowout.”

Read more: http://www.wbaltv.com/news/sports/Man-to-run-Baltimore-marathon-in-flip-flops/-/9379464/16917220/-/remeou/-/index.html#ixzz29QDIyW4d

5-Managing Ankle Sprains:
http://www.running-physio.com/anklesprain/

6- HIIT
 http://www.the15minutes.info/2012/10/12/what-is-hiit-and-what-can-it-do-for-you/

http://sportsmedicine.about.com/od/anatomyandphysiology/a/Deconditioning.htm
Studies have shown that you can maintain your fitness level even if you need to change or cut back on you exercise for several months. In order to do so, you need to exercise at about 70 percent of your VO2 max at least once per week.

7- EMAIL FROM A Blog follower:

middleagedathlete asked you:
I searched the site and didn’t see anything on bow-leggedness (if that’s a word) and it’s impact on gait. I have mild to moderate bow legs and never even knew it until I started running and it was pointed out to me by a PT I was seeing for knee pain. Is there an optimal (or at a minimum least bad) strategy for running with bow legs? I am 6'0" tall and have a gap of about 2" between my knees when standing with my ankles together and my legs straight. I am curious to hear your thoughts.

8- from the newspaper:
from Barefoot Running University.com
Article: Running up Hill

 http://barefootrunninguniversity.com/2012/10/12/uphill-running-technique/
9- Blog post we liked recently: October 5th, Gait Running and Sound. Are you listening to your body ?
 
 
10- Random topic: Wednesday october 10th Peter larson who runs Runblogger did a review of the following article:

Minimalist Running Results in Fewer Injuries?: Survey Suggests that Traditionally Shod Runners are 3.41 Times More Likely to Get Hurt

we have not gotten through the research article yet but we will, and we will try to address out thoughts on it and pete’s in the next 1-2 podcasts.  We want to make sure our thoughts are heard as well.  We bet Pete did a phenomenal job but we like to see things for ourselves, just like pete does. He is a stickler to details like we are, which is why we like alot of his work.  So, stay tuned !

11- Our dvd’s and efile downloads
Are all on payloadz. Link is in the show notes.
Link: http://store.payloadz.com/results/results.asp?m=80204

Podcast #11: Walking and Ozzy

http://thegaitguys.libsyn.com/podcast-11-walking-and-ozzy

Topics and Show Notes:

- Flips Flops, Walking Biomechanics, Minimalism Shoe Formula

Payloadz link for our DVD’s and efile downloads: http://store.payloadz.com/results/results.asp?m=80204

1- NEUROSCIENCE PIECE: Walking Statistics

2- Email from a Facebook Follower:
Hey guys, I was wondering if you had any links to articles about the effects of open back shoes on gait?  All I can seem to find are articles about flip flops, which I know have the similar effect, however some of my collegues don’t agree with that, so I was hoping to help inform them on the effects of the open back shoes/sandals on gait function.
 Thanks for your time,Tyler

http://www.ncbi.nlm.nih.gov/pubmed/22185067
http://www.webmd.com/healthy-beauty/features/worst-shoes-for-your-feet?page=3

3- DISCLAIMER:
We are not your doctors so anything you hear here should not be taken as medical advice. For that you need to visit YOUR doctors and ask them the questions. We have not examined you, we do not know you, we know very little about your medical status. So, do not hold us responsible for taking our advice when we have just told you not to !  Again, we are NOT your doctors !

4-  Updates and Sponsor talk:

A-  more lectures available  on www.onlineCE.com   Go there and look up our lectures

B- In January we will be taking on sponsors for our podcast.  We have had some interest already but we wanted to work out the quality control issues first. Early in means savings.

Contact us if you would like to be a sponsor……If we believe your product has value to this listener community we will give you a professional and personalized company or product plug and advertisment.  From our lips to our listeners ears ! 
We will basically expose your product to our international fan base.
The sponsors will help make our mission possible, defray costs and time to put out this podcast and blog. These things take is away from our practices a little.  Each week we will have 2 center-Stage sponsors . Your sponsorship can run as long as you want.

5-  Mail from an International Follower of our Blog:

Hi Dr’s,
Im here again. Just a quick question about functional LLD’s again. As you said before, most people who have a LLD are functional, but what causes such an apparent problem? What muscles are affected? Also, what exercises do you do to start to fix a functional LLD?

Thanks again for your reply and the attachment. It would be great if you could put it on a future podcast, I am keeping up with them. I’m a little sad as the first thing I check on facebook each day is what you guys have put on. The seminar over here is still a possibility, I was thinking about coming out to you guys first if that’s a possibility to learn direct? Have you thought about trying to do the fitness conventions? Experts like paul chek, Charles Poliquin, Gary Gray amongst others have been very successful and made a lot of money doing this. Gary Gray has done a huge dvd educational series and offers an internship out of his house, which he does once per year and is always full. I personally know 12 people from this country that have done it. Regarding your comment on facebook, I find the case studies more educational than anything else you put on there as it directly relates to my clients, but I have to keep watching them to fully appreciate what your saying. I can imagine most trainers just want quick fixes and new exercises they can give their clients as they are easy to understand. What are your sales of case studies on the onlice CEC compared to your performance downloads?  I can imagine not as many?   Kind Regards,   Luke

6- EMAIL FROM A Blog follower: 
Dear GaitGuys, on the video “Doing Squats, Lunges as well as Walking and Running using the Big Toe Ineffectively.”, I would like your opinion on the participation of the intrinsic (lumbricals) muscles, in stabilizing the proximal phalanx when we activate the FHL. I would consider it important, would be pleased to hear your opinion on it. Thanks, keep up the good work! Regards,  - Claudio

7- Blog READER EMAIL:
 field100 asked you:
Hi I wondered whether you could point me to the best exercises to increase strength and arch in the foot - I am flat footed. Also would you recommend the use of vivobarefoot shoes or the like to increase overall strength in the foot and ankle. thanks

 8- Blog post we liked recently
Minimalism: Is there a formula?
On one of our many forays into cyberspace, we ran across this easy to understand formula, from one of our friends Blaise Dubois. After we contacted him, he allowed us to reprint it here, for your enjoyment. Thank You Blaise!

Today, we propose a new formula so that you can rate your running shoes on a scale from 1 to 100 (100 being “extremely minimalist” -bare feet- and 1 “extremely maximalist”). The range of variation of your final rating will be more or less 5 points regardless of the comfort criteria, which is subjective. The only thing you need to do is to choose a language, then select the tab of your country at the bottom of the formula page, rate your shoes on the 6 criteria set out and there you go! Please note that we have used average values for criteria to which you don’t have the information. The multiple formats of the formula for every country are represented in accordance with their measuring system, currency and the average selling price of a running shoe for each of these countries.

As for health professionals and scientists, you will see that weighting factors have been applied to all criteria as a function of their importance, which is their effect on the body (biomechanics, tissue adaptation, etc.)
You can now rate your running shoes based upon The Running Clinic’s “TRC Rating” methodology!

12 - Email from a Blog Reader

hoblingoblin asked you:
I have a very strange gait problem that has caused me a great deal of problems in my everyday life. I get a painful, loud snap somewhere in my tarsal tunnel (Post tib, FDL, or something) as I try to control my foot descent from heel strike to midstance and also sometimes as I try to plantar flex at toe off. My ankle also feels kinda loose. I’ve seen multiple ankle specialists who don’t really have answers for me. Any thoughts?        

Category
Educational

Training Tip: Ditch the Flip Flops. Our mention in Triathlete magazine.→

Our brief mention in  Sept 16th issue of Triathlete magazine

link is above….. Jene Shaw the editor did a nice job on a touchy subject.

Training Tip: Ditch The Flip-Flops

 
Published: Sep 16th 2011 3:09 PM UTC by Jené Shaw

Although they date back to King Tut and Cleopatra, your favorite thong-style sandal may be bad for your running health according to biomechanical experts The Gait Guys (Thegaitguys.com), Dr. Shawn Allen and Dr. Ivo Waerlop.

In 2008 Auburn University researchers found that wearing flip-flops alters your gait, which can result in biomechanical issues from your foot to your spine. “In flip-flops the kinetic chain is essentially asked to function differently,” Allen says. “They can force changes in step and stride length, reduce function of the glutes, and compromise lower leg and foot intrinsic muscles, to name a few.”

When wearing flip-flops, use of the foot intrinsic and toe extensor muscles is reduced in the stance phase of gait. What’s important about this is that the toe extensors, found in the lower leg, are synergists for ankle dorsiflexion (the upward movement of the foot), which is key in running. Without ample function of these muscles, the toe flexors, calf and Achilles shorten and tighten, which impairs optimal ankle and foot joint function.

3 strikes against flip-flops:

• Without sufficient strength in the anterior tibial compartment (the front of your lower leg) you are at risk for several problems, including shin splints.

• Lack of adequate function of the toe extensors can lead to toe flexor dominance (look to see if your toes have a gentle curl to them at rest; if so, you are in that group!) which has implications with general weakness of the foot muscles responsible for arch strength and general foot health.

• In order to keep a flip-flop on our foot, we tend to grip with our flexors, which forces us deeper into this scenario.

If you are going to wear sandals and you want healthier feet, The Gait Guys recommend wearing sandals that have straps that fasten to your heel or lower leg.

Gluteal deficiency and Hip Extenion: 5 minute video with rockstar Dr. Ivo Waerlop of The Gait Guys…….flip flop and opened back shoes……flexor dominance can kill ! and a bit about glutes and hip extension