Footwear IS Medicine

We always have said that "Shoes ARE medicine" Here's an article that supports that.

"Footwear plays an integral role in force distribution on the lower extremities, and choosing appropriate footwear is one of many strategies people can use to manage knee pain caused by joint disorders. When footwear is properly fit, force and stress can be shifted away from weaker parts of the knee, and the leg stabilized. This may lead to a significantly better quality of life for patients with knee problems, such as osteoarthritis (OA) and patellofemoral pain syndrome."

http://lermagazine.com/article/the-effect-of-footwear-on-the-management-of-pain-caused-by-disorders-of-the-knee-joint

Should you rotate your shoes?

Rotate your shoes more often? Maybe not, if you are concerned about plantar pressures. But do increased plantar pressures actually cause injuries? That is the million dollar question, isn't it?

from this paper:

• Footwear characteristics have been implicated as a cause of foot pain (1)
• Ill fitting footwear has been associated with foot pain.(2)
• Individually fitted sport shoes were found to be effective in reducing the incidence of foot fatigue.(3)
• There is an association between using inappropriate footwear and injuries.(4) 
• An association between injuries and the age of sport shoes has been reported. (5)
• The recommendations are that running shoes need to be changed every 500 - 700 kilometres as they lose their shock-absorbing capabilities.(6)
• Elevated plantar pressures cause increased foot pain in people with cavus feet.(7)

"Walking plantar pressures in running shoes need to be investigated. There are no pedobarographic studies in the literature that compare new with old running shoes. We hypothesized that old running shoes transmitted higher plantar pressures as compared to new running shoes. If so, are old running shoes detrimental to our feet? The purpose of this study was to see whether the mean peak pressures & pressure-time integrals exerted at the plantar surface of feet were higher when using old running shoes as compared to new running shoes.

Plantar pressure measurements in general were higher in new running shoes. This could be due to the lack of flexibility in new running shoes. The risk of injury to the foot and ankle would appear to be higher if running shoes are changed frequently. We recommend breaking into new running shoes slowly using them for mild physical activity.

 Rethnam U, Makwana N. Are old running shoes detrimental to your feet? A pedobarographic study. BMC Research Notes. 2011;4:307. doi:10.1186/1756-0500-4-307. link to FREE FULL TEXThttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228510/

references:

1. Grier TL, Knapik JJ, Swedler D. et al. Footwear in the United States Army Band: Injury incidence and risk factors associated with foot pain. Foot (Edinb) 2011;21(2):60–5. [PubMed]
2. Burns SL, Leese GP, McMurdo ME. Older people and ill fitting shoes. Postgrad Med J.2002;78(920):344–6. doi: 10.1136/pmj.78.920.344. [PMC free article] [PubMed] [Cross Ref]
3. Torkki M, Malmivaara A, Reivonen N. et al. Individually fitted sports shoes for overuse injuries among newspaper carriers. Scand J Work Environ Health. 2002;28(3):176–83. [PubMed]
4. Taunton JE, Ryan MB, Clement DB. et al. A prospective study of running injuries: the Vancouver Sun Run "In Training" clinics. Br J Sports Med. 2003;37:239–44. doi: 10.1136/bjsm.37.3.239.[PMC free article] [PubMed] [Cross Ref]
5. van Mechelen W. Running injuries: A review of the epidemiological literature. Sports Med.1992;14(5):320–35. doi: 10.2165/00007256-199214050-00004. [PubMed] [Cross Ref]
6. Fredericson M. Common injuries in runners: diagnosis, rehabilitation, prevention. Sports Med.1996;21(1):49–72. doi: 10.2165/00007256-199621010-00005. [PubMed] [Cross Ref]
7. Wegener C, Burns J, Penkala S. Effect of neutral-cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet: a crossover randomized controlled trial. Am J Sports Med. 2008;36(11):2139–46. doi: 10.1177/0363546508318191. [PubMed] [Cross Ref]

More on Rockered footwear and Hallux Limitus

Rockered footwear is for more than Hallux Limitus..

To go along with yesterdays post on Hallux Limitus... In case you missed it, click here

In other words, footwear with more "drop" in the front lessens the need for forefoot rocker (otherwise known as 1st metatarsophalangeal joint extension, or "the ability to bend your big toe backward)

“Most people have to wear MBTs a little at a time until they gain strength and stamina, so we recommend wearing them an hour a day for the first few days and to increase gradually until they feel strong enough to wear them for a full day,”

...sounds an awful lot like our mantra "skill, endurance, strength"...

A great read here. Keep this one around for reference...

http://lermagazine.com/article/rocker-bottom-footwear-effects-on-balance-gait

#rockeredshoe #rocker #footwear

Tomorrow we lecture on Minimalistic Footwear and its impact on runners on onlinece.com and chirocredit.com. Join Us. Biomechaics 318; 8PM Eastern, 7 Central, 6 Mountain, 5 Pacific.

All the cool people will be there and if you attend, you will know why barefoot is not the same as minimal

Join us this Wednesday evening, 5pm western, 6 PM mountain, 7PM central, 8PM eastern, at:  online CE.com for a lecture on minimalistic footwear and its impact on runners called Biomechanics 318. Drop, motion control features and a host of other subjects will be addressed.

Another IFGEC Certification granted:

Here’s what Mark Small has to say

“The National Shoe Fit Program is beneficial to many fields/disciplines including, but not limited to, coaches, personal trainers, athletic trainers, physical therapists, podiatrists, and chiropractors (I would say MD’s, but it doesn’t come in a pill), as well as those who sell shoes.  The program offers tools to help us understand individual differences and their effects on gait and performance.  Some of the material includes:
    •    Foot anatomy
    •    Anatomical Landmarks
    •    Foot types
    •    Pathologies
    •    Basic biomechanics
    •    Shoe fit functional testing
    ⁃    Static and dynamic tests to assist fitting
    •    Finally shoe selection
    ⁃    Picking the best shoe for your client/athlete/patient

Some of these topics may be a good review for some of the advanced disciplines listed above. What the program is able to do, even for them, is to link everything together in a methodical, step by step, detailed approach, that applies what we have learned into something predictable and usable. We are often looking for ways to increase performance, decrease pain and get people to move better.  I, for one, believe that much of bad movement, pain and dysfunction have to do with inappropriate footwear, this course is a starting place to help correct that problem.  I am looking forward to Level 2 & 3 certification programs, but more importantly, I am looking forward to applying what I am learning with the people I serve.  I’m not a Gait Guy… more like a gleam in the gait daddy’s eye, but I’m working on it.”

Congratulations, Mark!

The Gait Guys

Take a  look at these dogs

Take a good look at these shoes. Notice the wear at the heel counter. Did you notice the varus cant  of the rear foot. Good! Did you carefully inspect where the upper was attached to the midsole? Now did you notice that upper is canted in varus as well? This person DID NOT have a rear (or forefoot) varus.

Hmmm. Maybe the varus canting of the upper caused the wear on the outsole? We doubt it; most likely it was the other way around.

What sort of  symptoms so you think they had?

Do you think medial or lateral knee pain?

 Could be either.

• Lateral; knee pain from stretch on the lateral side of the knee at the lateral collateral ligament or
• medial from compression of the medial condle of the femur and medial tiibial plateau.

Anything else?

How about pain on the outside of the hip? Canting the foot laterally has a tendency to externally rotate the lower leg and thigh. This may cause shortening of the gluteals (max and post fibers of the min); difficulty accessing the gluteus minimus (its a medial rotator), shortening of the deep 6 external rotators, difficulty accessing the vastus medialis (external rotator when foot is on the ground), and the list goes on.

What’s the fix?

New shoes. Pay attention when you buy shoes. Put them up on a counter at eye level and inspet them closely. We can’t tell you how many defects we see on a daily basis; too many to count. One time at a shop, we needed to go through 10 pair before we had a good right and left.

The Gait Guys. Bald. Good looking. Smart. Increasing your “Shoe IQ” every day.

 Want to  know more? Take our National Shoe Fit Certification Program. It’s the only one of its type and the only one certified by the International Footwear and Gait Education Council. Drop us an email at: thegaitguys@gmail.com for more details or go to our payloadz store  (click here) and download it today.

All material copyright 2013 The Gait Guys/ The Homunculus Group.

Another IFGEC Certification Granted

“With more than 2 decades in the fitness industry, and a MS in Exercise Physiology, I’ve learned that there is so little that I really know.  I am constantly looking to improve what I can do to help the triathletes and runners that I see.   As an endurance coach and clinician that focuses on preventing injuries, optimizing performance, and avoiding reoccurring injuries, the IFGEC Shoe Fit Certification is going to be a keystone (much like the Navicular Bone) to my screening process of athletes and clients.  Making sure they are fitted properly in shoes, working with their movement patterns, teaching them running form skills, and then building on all aspects from there.  What I have learned from "The Gait Guys” has already made an impact on what I do, but it’s at a whole new level now.  This is not just a “online course”  this is real education that stays with you for life.  This is a true Ground Up approach to helping and is something that every running shoe store, coach, and medical professional that deals with runners and triathletes needs to learn.“

Ryan Smith, MS is owner of the Personal Impact, LLC and The Runners’ Clinic in the Cincinnati, Ohio area.  He is a USATF Level 1 Coach, Newton Natural Running Form Coach, & ACSM-CPT that works with runners and triathletes helping to prevent and recover from injuries that athletes deal with.  More information on Ryan Smith, visit his site at.  http://ryansmithfitness.com

Want to get certified or learn more? Email us at thegaitguy@gmail.com

Shoe News You can Use…

The Heel Counter- the back of the upper

This is the back of the shoe that offers structure (just squeeze the back of a shoe. this is the rigid part you feel between your thumb and 1st finger, unless of course, you are using your teeth). This is often part of or integrated with the upper.

A strong, deep heel counter with medial and lateral support is important for motion control; It offers something for the calcaneus (heel bone) to bump up against when as it is everting (moving laterally) during pronation. Look at folks that have a bump on the outside of their heel (particularly the ladies(sorry, true); this is often called a “pump bump”). Now look at the inside of their shoes. See that worn away area on the inside of the back of the shoe? Now you know where that worn away area is coming from!

Lateral support especially for people who invert a great deal or when you’re going to place an orthotic in the shoe which inverts the foot a great deal.  The lateral counter provides the foot (or orthotic) something to give resistance against.  The lateral counter needs to extend at least to the base of the fifth metatarsal, otherwise it can affect the foot during propulsion. A deep heel pocket in the shoe helps to limit the motion of the calcaneus and will also allow space for an orthotic. The heel counter should also grip right above the calcaneus, hugging the Achilles tendon.

We know you want to know more. We can help. Take the National Shoe Fit Certification Program. If you like, sit for the exam and get certified as well. Email us for details thegaitguys@gmail.com

The Gait Guys. We’re your heel counter!

all material copyright 2012 The Homunculus Group/ The Gait Guys. All rights reserved. If you want to use our stuff, please ask. If not, Captain Cunieform may pay you a visit…

Hey Folks

You know we are big Altra Fans. Check out their new commercial!

We are sure your keen eyes have picked up on the midfoot pronation at :17 and forefoot pronation at :28. This brings to mind a question we often get asked: How much pronation is too much pronation?

Some pronation is necessary, as it is one of the 4 shock normal absorbing mechanisms

1. midfoot pronation
2. ankle dorsiflexion
3. knee flexion
4. hip flexion)

We do not believe there is a perfect answer, but rather the ideal is: How much pronation can your (neuro and bio) mechanics control? Too much in one individual may be not enough in another. It has to do with foot structure, muscle competency, neuromuscular control, and a host of other things.

Remember the mantra: Skill, endurance, strength… in that order! Work to control the pronation you have and expand on that range.

The Bald Headed, Good Looking, Bringing you the facts Gait Guys.

all material copyright 2012 The Homunculus Group/The Gait Guys (except the commercial of course, which is property of Altra). If you want to use our stuff, ask nicely : )

Wouldn’t want to walk a mile in these shoes….

Read all about it here: http://www.dailymail.co.uk/femail/article-2041188/Top-teen-model-Lindsey-Wixson-takes-tumble-Versace-shoes-blame-her.html

Have a great Friday

Ivo and Shawn

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Dr Mark puts succinctly what we have been saying all along; it is the rare person that can begin the barefoot or minimalist running journey with out proper education, sufficient skill, muscular endurance or appropriate strength.

Promoting gait literacy…..We ARE the Gait Guys….

The effect of footwear and sports-surface on dynamic neurological screening (click for link)→

Shoes make the man, or in this case, the athlete. This study shows that shoes (much like skis) allow us to perform faster than our brain is able to compensate ( in other words, we lack the skill) and allow us to sometimes stretch our  abilities, often at the cost of an injury. We must remember that technology must keep pace with the rate of neural learning, not the opposite.

J Sci Med Sport. 2010 Jul;13(4):382-6. Epub 2010 Mar 15.