Tuesday, April 29, 2008

Knee Pain Isn't Inevitable

Knee pain isn't inevitable as you age. Barring injury, how you use your knee with each step determines how wear and tear of use affects your body. The knee is a hinge joint designed to bend in a straight line. Knee strains and pains occur when the arc of the bend becomes twisted. The beginning of a twist starts with the foot pronating (or rolling inwards on the big toe side). Twisting the foot results in twisting the ankle which carries the stress to the knee. The knee will rotate inward. Repeating this movement throughout the 10,000 steps you take in a day can result in a repetitive strain injury.

If you're sedentary you take less than 10,000 steps per day. If you have a job that requires walking like a nurse or postal worker you'll be taking even more steps.
So what can you do to protect your knee as you walk?
  • Bend your knees slightly (keep a soft knee) with every step and while you stand.
  • When you're walking, concentrate on keeping your heel on the ground as long as possible (this discourages toe walking).
  • When you walk, concentrate on keeping your foot pointing straight ahead with every step and keeping the direction of your knee bend straight over the foot.
  • Keep your hips loose and rotating with each step.
  • Look for shoes that are stable such as an athletic shoe or walking shoe that bend easily in the forefoot.
  • Foot Orthotics help to guide your foot so that it doesn't pronate.
All of this may sound a bit complicated. At my clinic I coach clients to walk and stand so that they protect their knee joints. If you are unable to find a gait training specialist in your area, I suggest you find a friend to video you walking straight towards the camera and from the side. When you watch yourself on the video check the alignment of your leg bend and foot position.

Wednesday, April 23, 2008

Ask Randall: Generic Insoles

April 16, 2008 11:45 AM

Hi Randall, I was wondering if you can tell what elements are needed for a generic insole that would bring comfort to a shoe wearer. What material would you use? By the way your blog is amazingly full of facts and I am enjoying reading each post. SA

Dear SA,

In the shoe industry, the term generic insoles refers to what's also called a sock liner, contoured insole, or generic orthotic.
  • Sock liners are generally a flat cushion layer, sometimes removable, but usually glued into the shoe.
  • Contoured insoles are formed from molded foam to fit the shoes interior and cup the the mid-foot and heel around the edges. Generally this insole has little to no anatomy.
  • Generic orthotics are formed from molded foam or/and other materials. It is like a contoured insole, but has actual arch contour and more anatomy.
Here's what I think are the best choices in each category:
  • Sock Liners: Multi-density foam layers. One layer that forms to the foot layered over one resilient layer that springs back to the original shape.
  • Contoured Insoles: The same as a multi-density sock liner, but with the upper layer being a molded foam shape.
  • Generic orthotics: Typically an after-market product, sometimes they are actually built into a shoe such as a Birkenstock. The most important thing is that the contour doesn't offend the user's foot contour.
The object to orthotic contours is to guide the foot to it's optimal use. The closer the contours are to the foots natural contours, the higher the performance of the orthotic. Peoples feet are different, therefore a mass market product will only address one type of foot over another.

The optimal high performance is a custom orthotic. Because this option isn't available to everyone, the next best thing is to try on a multitude of generic orthotics to seek a good match.

Note: I offer consulting to manufacturers and designers seeking information about foot contours, orthotic shapes and materials. In the past I've patented two systems relating to this research.

Tuesday, April 22, 2008

3 Things to Know Before You Buy Slip-on Shoes

Slip-on shoes are so convenient that they are a popular segment of the shoe market. People love to put on or take off their shoes without bending over. Despite the apparent comfort and convenience of a slip-on shoe, unless the shoe is a perfect fit, it is a compromise. To fit the tight spots, other places on the shoe are too loose. This isn't a problem if your feet are perfect and you don't have any pain, but if you have any problems at all, proper shoe choices are crucial.

Slip-on shoes often don't have adjustability. Or if they do, they must often be too tight to slip in and out of easily. This can effect your gait, promoting shuffling and toe gripping, which can lead to foot problems. If you must wear a slip-on shoe here are the things to look for:
  • Choose a slip-on shoe that fits high onto the foot (towards the ankle).
  • Elastic stretch panels.
  • Adjustable straps or laces.

Friday, April 18, 2008

Foot Arches - Two Per Foot

The arch is one of the founding principles of architecture. It is also one of the strongest shapes as an arch spreads the load it's supporting to the 2 foundations on either side. The arch of your foot uses those same principles of architecture. The two foundations of the arch of your foot are the heel and the metatarsal joints (the part of your foot where the toes attach to the foot).

A big surprise to most people is that each foot has two arches! The arch on the medial side (the inside, big toe side) of your foot is the arch you commonly think of, but there is also an arch on the lateral (the outside, little toe side) of your foot. The lateral arch is much lower and is structurally simpler and more aligned with the leg bones.

The big error a person makes is thinking that they have to support their medial arch by putting something under it that contacts it so that they can lean onto the arch. An orthotic that only contacts the medial arch but doesn't address the presence of the lateral arch will hurt like crazy.

A proper foot orthotic offers full contact with the medial arch but does not "support" it with that contact. The architecture of the foot moves during the gait cycle. When you're standing still, you don't have that movement, so it's impossible to guage if the orthotic will work rather than just "feel good". The correctly made foot orthotic guides the force upon the foot into the orthotics valley on the lateral side. The valley is the contour the foot sits in with every step. Walk in sand and you'll notice that the foot slices into the sand on the lateral (little toe) side leaving the deepest impression.

With proactive efforts from the wearer to step correctly (knees softly bent, feet straight, hip rotation), the foot orthotic will guide the foot. An orthotic alone will not usually alleviate arch pain. The combination of the custom orthotic, gait training and proper fitting of the orthotic into a appropriate shoe for the person's foot are necessary for the best result.

Monday, April 14, 2008

Plantar Fasciitis Heel Pain

The most common repetitive strain injury I see in my clinic is Plantar Fasciitis. The symptom that indicates a possible diagnosis of Plantar Fasciitis is pain in the heel on the bottom of the foot especially when taking the few first steps in the morning or after resting. Micro tears and resultant inflammation in the tissue at the connection point between the plantar fascia and heel bone are responsible for the pain. Resting at night, the plantar fascia repairs a little bit, then tears again in the morning with those first steps.

Most of us take 10,000 steps per day. Those steps constantly irritate the plantar fascia. The plantar fascia is part tendon and part soft tissue, the only structure like this in the body.

Though the pain of Plantar Fasciitis is felt in the heel, putting weight on the heel (or a strong heel strike) is not the cause of Plantar Fasciitis. Mistakenly, most people treat the problem with heel cushions. Though a person may feel relief with heel cushions, the true problem won't be addressed. The usual gait compensation is to walk on the toes. This causes a shortening of the calf muscles and more toe walking, creating a vicious cycle, resulting in chronic cases of plantar fasciitis. I've seen people in my clinic that have had chronic plantar fasciitis for years.

The true problem is a strain on the entire plantar fascia along the bottom of the foot. To reduce the strain, it's important to keep the heel down during the stride and to let the entire foot linger on the ground with every step, rather than walking primarily on the forefoot and toes.

Full foot orthotics and proper shoes along with gait and stance training will alleviate the strains that caused the Plantar Fasciitis. With the proper care and attention to gait, most cases improve dramatically in 6 weeks.

If you keep doing the same thing over and over, ten-thousand steps a day you will get the same result. Step by step, changing the habits you've developed in your stride, along with an excellent foot orthotic will promote healing of the plantar fascia.

Tuesday, April 8, 2008

Hip How-To: Learn to Walk Well From Your Hips

Bio-mechanics is the science that explains how the structures of the body function mechanically. Each joint in your body has a design that moves optimally certain ways. The joint may also allow types of movement that the joint is not best designed to handle.

For example, your elbows and knees are hinge-joints. They bend back and forth in the same direction. They don't allow much rotational movement. If you do over-rotate those joints you'll often incur a sprain or more severe injury.

The hip joint is different from the knee in that it is a ball and socket joint that allows your hips to move both rotationally and as a hinge joint. Here's what you need to know: Your hips are designed to move best as a rotational joint. If you walk, hike or run and don't rotate your hips adequately, your hips move like a hinge joint. Too much of this type of movement in the hip joint causes over-use injuries/damage.

To practice what a rotational movement of the hip feels like, do the Hula. Really!
  • Stand with feet shoulder width apart and knees gently bent.
  • Rotate your hips in circles, first clockwise, then reverse directions.
  • Now, walk backwards slowly and notice how the hips automatically rotate, taking the leg back.
  • Slowly walk forwards, seeking to maintain the sensation of hip movement. Remember to keep your knees slightly bent.
When you use your hips as a ball and socket joint, you are using the joint optimally. This is very important if you are running or walking as correct use, reduces (and sometimes, eliminates) hip problems and pain.


Thursday, April 3, 2008

Custom Shoes & Personalized Shoes: What is the Difference?

Custom shoes are not all the same. Cowboy boots are a good example. You can go to a custom boot maker and they'll trace your foot and make a boot. Sure, it's "custom" but it's not enough. People mistake being able to choose the leather colors and trims with the attributes of a comfort fit shoe. The shape of your foot is only a piece of the shoe-fit picture.

A good shoe conforms to the outline of your foot and supports the bio-mechanics of your foot, including:
  1. Structural elements such as rocker-toe, heel counter, heel height.
  2. Medial & lateral support.
  3. Degree & type of shock absorbing cushion.
  4. Compatibility with orthotics.
The solution for most people is a personalized shoe. At Footform Performance, we combine our knowledge with a select grouping of shoes we sell that are hard to find in mainstream shoe outlets. Personalizing involves how your foot is fitted to a shoe, considering the length, width, shims, stretching, grinding and custom orthotics. Our shoe selections offer unique features such as comfort, fit, durability, quality, function and compatibility with orthotics that other brands simply cannot provide. We pride ourselves on our ability to deliver a personalized fit that will feel like a custom shoe.