Shoes

I read a very interesting article written by a podiatrist about feet.  In the article the author did research on indigenous peoples who do not wear shoes.  He found that 3% of those people had foot problems.  Then the same study was done on modern society.  He found that 78% of the people had foot problems.  I think of the 3% as equal in both populations – these are foot problems that are present from birth; club foot, flat feet, etc. (this is a statistical amount that would be roughly the same in any population). If you subtract the indigenous 3% from the modern society number you have 75% of the population that has foot problems.  That is due to the only thing that differs in walking between you and I and an indigenous person – modern SHOES.

Shoes are made around a form called a last.  The last time that the (shoe) last was significantly re-engineered was over 150 years ago.  Thus, we are a bit out of date with our thinking.  Make no mistake, shoes are designed for fashion, not function.  Fashion sells shoes.  It amazes me how much pain and discomfort people will put up with to “look good”.  There are a few companies, mostly start-ups, that do something different.  They sometimes make a small dent in people’s thinking, but then are bought by the larger companies and “assimilated”.

If you read the book “Born to Run” (Christopher McDougall, 2011) you will notice that the book strongly suggests that we did not really have problems when people ran with shoes on until the 1970’s when the first running shoe came on the market.  Those shoes changed the way the foot strikes the ground and that lead to problems.  The design of running shoes overall still has not changed.  The problems still persist.

One thing your shoes should not do is be straight along the inner edge.  If you look at a babies feet, their big toe is a bit to the middle (medial) from their heel when the foot is straight (it looks a bit like an ape foot).  They can also move their big toe more like a monkey (they can move it toward the middle/midline).  This is normal.  When you start wearing shoes, the muscle that allows this motion of the toe (called abduction) gets weak (atrophy).  After a time it simply can’t move the toe to the middle anymore – it does not have the strength.  This is due to the end of the shoe (the toe box) pushing the big toe against all of the other ones.  Over years the abductor muscle weakens and the adductor muscle (the one that moves the big toe toward the others) gets stronger (it has no opposition).  This pulls the end of the big toe toward the others and the joint (the ball of the foot or the metacarpal/phlangeal joint of the great toe) begins to move toward the middle – away from the other toes.  We call this a bunion. Notice the cause of the bunion – SHOES.  Shoes that work with your feet (rather than against them) will not try to make the inner edge of your foot straight, but will allow it to make the natural curve that nature intended.  This is actually pretty hard to find in a shoe.

Contrary to popular belief, the human foot (when it works correctly) is a self-supporting structure (as in it requires no outside help – you can walk barefooted with no pain).  Thus, arch supports are NOT required when the foot mechanically works as it should – they are not a long term solution to foot pain.  My first recommendation is to get your feet treated by someone who is skilled at getting the bones, ligaments and muscles to work correctly  (which is about as easy as finding a unicorn in your backyard).  

There are 26 bones, roughly 100 muscles, and 144 ligaments in each human foot.  As stated before, when all of these structures work correctly, the foot is self-supporting.  Foot pain in almost EVERY case comes from a lack of motion in one or more of these foot structures – they don’t move and for that reason it hurts.  In my years of experience, you can’t stretch, massage, heat, ice, put an ointment on, use foam rollers or any other device and correct the mechanical problem (many patients have tried).  This includes bunions, flat feet, turf toe, Morton’s neuroma, metatarsalgia, high arches, etc.  

Podiatrists, at least the way they are trained currently, do not manipulate feet – they prescribe orthotics, give shots, do surgery or give you physical therapy regimen.  None of these things fix a mechanical foot problem (nothing against the podiatrists).  Most chiropractors do a better job with the feet than the podiatrists, but don’t understand all of the movements required to get a foot functionally correct (I am also not bashing the chiropractors, for there are many gifted ones, just stating my experience).  To get your feet really woking correctly, you need an osteopath who understands feet (or someone who was trained by such a person).  Then, with a few treatments, you can start to restore motion to your feet and the pain will fade and disappear.

Then, once your foot is working correctly, buy shoes that work WITH the foot, rather than against it.  This will keep the foot healthy and moving.  You foot may still get tired if you walk for miles without training, but after a nights rest they will be back to normal.  My personal favorite company for shoes is a small one out of Pennsylvania called Flexible Footwear.  Their shoes are the most comfortable that I have ever owned.  They are custom made for your feet, come in a much larger range of sizes than most shoes, and their customer service is outstanding.

I am also a fan of barefoot/minimalist shoes.  They can work well with the body if you get the right shoe for you.  Just like any other item you interact with, however, if it is not right for you, your body will struggle against it.  I have developed an osteopathic method for selecting and fitting individuals to their shoes.  This method is a very precise way to choose which shoes will work well with your body, why a certain shoe will (or will not) work for you, and which areas will likely become painful from wearing a pair of shoes and how to correct those shoes.  

For more information on shoe fittings or getting your feet treated, please contact the Comella Foundation.

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