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 Foot Rocker Pathology Clues.

Is ankle rocker normal and adequate or is it limited ?  Is it limited in early midstance or late midstance ? How about at Toe off?  Is it even possible to distinguish this ? Well, we are splitting hairs now but we do think that it is possible. It is important to understand the pathologies on either end of the foot that can impact premature ankle rocker. 

Look at the photo above. You can see the clinical hint in the toe wear that this runner may have a premature heel rise. However, this is not solid evidence that every time you see this you must assume pathologic ankle rocker. The question is obviously, what is the cause.

Considerations:

1- weak anterior compartment, which is quite often paired with the evil neuroprotective tight calf-achilles posterior complex to offer the necessary sagittal protection at the ankle mortise.  This will cause premature heel rise from a posterior foot aspect.

2- rigid acquired blocked ankle rocker from something like “Footballer’s ankle”. This will also cause premature heel rise from a relatively posterior foot aspect.

3- there are multiple reasons for late midstance ankle rocker pathology. The client could completely avoid the normal pronation/supination phase of gait because of pain anywhere in the foot. For example, they could have plantar fascial pain, sesamoiditis, a weak first ray complex from hallux vaglus, they could have a painful bunion, they could be avoiding the collapse of a forefoot varus. There are many reasons but any of them can impair the timely pronation-supination phase in attempting to gain a rigid lever foot to toe off the big toe-medial column in “high gear” fashion. And when this happens the preparatory late midstance phase of gait can be delayed or rushed causing them to move into premature heel rise for any one of several reasons.  Rolling off to the outside and off of the lesser toes creates premature heel rise.  

4- And now for one anterior aspect cause of premature heel rise. This is obviously past the midstance phase but it can also cause premature heel rise. Turf toe, Hallux rigidus/limitus or even the dreaded fake out, the often mysterious Functional Hallux limitus (FnHL) can cause the heel to come up just a little early if the client cannot get to the full big toe dorsiflexion range.  

We could go on and on and include other issues such as altered Hip Extension Patterning, loss of hip extension range of motion, weak glutes, or even loss of terminal knee extension (from things like an incompleted ACL rehab, Osteoarthritis etc) but these are things for another time. Lets stay in the foot today.

All of these causes, with their premature heel rise component, will rush the foot to the forefoot and likely create Metatarsal head plantar loading and could cause forces appropriate enough to create stress responses to the bone. This abrupt forefoot loading thrust will often cause a reactive hammer toe effect.  Quite often just looking at the resting nature of a clients toes while they are lying down will show the underlying increase in neuro-protective hammering pattern (increased long toe flexor and short toe extensor activity paired with shortness of the opposing pairs which we review here in this short video link).  The astute observer will also note the EVA foam compressing of the shoe’s foot bed, and will also note the distal displacement of the MET head fat pad rendering the MET head pressures even greater osseously. 

Premature ankle rocker and heel rise can occur for many reasons. It can occur from problems with the shoe, posterior foot, anterior foot, toe off, ankle mortise, knee, hip or even arm swing pathomechanics.  

When premature heel rise and impaired ankle rocker rushes us to the front of the foot we drive the front half of the shoe into the ground as the foot plantarflexion is imparted into the shoe.  The timing of the normal biomechanical events is off and the pressures are altered.  instead of rolling over the forefoot and front half of the shoe after our body has moved past the foot these forces are occurring more so as our body mass is still over the foot. And the shoe can show us clues as to the torture it has sustained, just like in this photo case.

You must know the normal biomechanical gait events if you are going to put together the clues of each runner’s clinical mystery.  If you do not know normal how will you know abnormal when you see it ? If all you know is what you know, how will you know when you see something you don’t know ?

Shawn and Ivo, The Gait Guys … .  stomping out the world’s pathologic gait mechanics one person at a time. 

“Too much tripping, soles worn thin. Too much Trippin and my soul’s worn thin.”

Scott Weiland

Take a look at these shoes which are basically a leather glove for the foot. Look at the wear pattern and how the lines of force travel from the heel, of the lateral aspect of the foot, across the metatarsal heads and out the great toe. To have you wear on the right is due to a left-sided leg length discrepancy.  She has a higher lateral longitudinal arch as evidenced from the absence of where just anterior to the heel.  Looks like she’s getting her first Ray to the ground, Eh?

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…