Happy Feet!

Yesterday's event was a tremendous success! Rebecca from Foot Levelers was booked all day long, and we were able to start bringing relief to a lot of people with foot, knee, and back problems.

Sportsmens of Litchfield also came through in a big way, providing not only discounts at the store for people who came to get their feet scanned, but also some very nice swag for everyone. Water bottles, bags and t-shirts -- many thanks to Jay and Michael at Sportsmens, for being such good sports!

Teresa did her usual fine job of managing things from the front desk, unsnarling bottlenecks and being everywhere for everyone simultaneously.

As for me, one of the things that I really enjoyed about the day was that it brought in some patients whom I haven't seen in a while. It was a real treat to catch up with people, and reminded me once again what it is that I really like about what I do.

Sure, I enjoy the detective work of being a good diagnostician, unraveling the myriad causes of a patient's health problems. And practicing the physical skills required of my profession, manipulating joints, inserting acupuncture needles, or doing hands-on soft tissue work, is a pleasure as well.

But above it all are the relationships I have with my patients: The give and take, hearing my patients' amazing stories, and telling a few of my own.

That, more than anything else, is what I look forward to when I unlock the door to the office every morning.

Show Notes — The Secret Is In The Feet

My new podcast is up, you can download it here, or even better, subscribe to the podcast by clicking on this feed. Or, as usual, you can always go to iTunes and subscribe there. For more information about the March 12 Free Digital Foot Scan, go here.

The laboratory website is www.footlevelers.com.


Journal of Manipulative and Physiological Therapeutics (JMPT), Volume 23, Issue 3,point prescription 168-174

Effects of orthotic intervention and nine holes of simulated golf on club-head velocity in experienced golfers

David E. Stude, DCa, Jeff Gullickson, DCb

Received 7 April 1999




0bjective: This study was an initial investigation evaluating the effects of orthotic intervention on club-head velocity (CHV) among a group of experienced golfers before and after 9 holes of simulated golf. Setting: Northwestern College of Chiropractic, Bloomington, Minnesota. Participants: Twelve experienced golfers were included in the study. Method: CHV was measured with a device used by many Professional Golf Association and Ladies Professional Golf Association teaching professionals before and after wearing orthotics and before and after completing 9 holes of simulated golf. Subjects wore custom-made, flexible orthotics daily for 6 weeks and then were retested with the same objective measurement parameters. Outcome measure: CHV (swing speed in miles per hour) was measured in all subjects before and after wearing custom-fit, flexible orthotics for 6 weeks and before and after completing 9 holes of simulated golf. Results: There was an approximate increase in CHV of between 3 and 5 mph, or a relative increase in CHV by up to 7%, after subjects had worn custom-made, weight-bearing, flexible orthotics daily for 6 weeks. A 5-mph increase in CHV is equivalent to an approximate increase in golf ball travel distance of 15 yards, a significant increase for the tour player for whom small increases in performance can reflect large position changes on the roster board. In addition, the use of these custom ofthoses eliminated the effects of fatigue associated with playing 9 holes of golf (relative to CHV) and therefore may improve the likelihood for more consistent golf performance. Conclusion: The use oftbe custom-fit, flexible orthotics in this study had a positive influence on CHV in experienced golfers. (J Manipulative Physiol Ther 2000;23:168–74)

Sports Med. 1985 Sep-Oct;2(5):334-47.

Running shoes, orthotics, and injuries.

McKenzie DC, Clement DB, Taunton JE.

Running is the most visible expression of the continued interest in regular physical activities. Unfortunately injuries are common, primarily due to overuse, and a number of aetiological factors have been recognised. Of these, training errors can be responsible for up to 60% of injuries. The training surface, a lack of flexibility and strength, the stage of growth and development, poor footwear and abnormal biomechanical features have all been implicated in the development of running injuries. A thorough understanding of the biomechanics of running is a necessary prerequisite for individuals who treat or advise runners. Clinically, the configuration of the longitudinal arch is a valuable method of classifying feet and has direct implications on the development and management of running problems. The runner with excessively pronated feet has features which predispose him/her to injuries that most frequently occur at the medial aspect of the lower extremity: tibial stress syndrome; patellofemoral pain syndrome; and posterior tibialis tendinitis. These problems occur because of excessive motion at the subtalar joint and control of this movement can be made through the selection of appropriate footwear, plus orthotic foot control. The runner with cavus feet often has a rigid foot and concomitant problems of decreased ability to absorb the force of ground contact. These athletes have unique injuries found most commonly on the lateral aspect of the lower extremity: iliotibial band friction syndrome; peroneus tendinitis; stress fractures; trochanteric bursitis; and plantar fasciitis. Appropriate footwear advice and the use of energy-absorbing materials to help dissipate shock will benefit these individuals. Running shoes for the pronated runner should control the excessive motion. The shoes should be board-lasted, straight-lasted, have a stable heel counter, extra medial support, and a wider flare than the shoes for the cavus foot. For these athletes a slip-lasted, curve-lasted shoe with softer ethylene vinyl acetate (EVA) and a narrow flare is appropriate. Orthotic devices are useful in selected runners with demonstrated biomechanical abnormalities that contribute to the injury. Soft orthotics made of a commercial insole laminated with EVA are comfortable, easily adjusted, inexpensive, and more for-giving than the semirigid orthotics which are useful in cases where the soft orthotic does not provide adequate foot control. A review of injury data shows an alarming rise in the incidence of knee pain in runners-from 18% to 50% of injuries in 13 years.

Barefoot Running

A reader brought to my attention the growing trend of barefoot running, given fuel recently by this study:

Foot strike patterns and collision forces in habitually barefoot versus shod runners.

Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y.

Department of Human Evolutionary Biology, 11 Divinity Avenue, Harvard University, Cambridge, Massachusetts 02138, USA. danlieb@fas.harvard.edu

Comment in:

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

It's an interesting idea, and certainly has its appeal, falling in line with other fitness trends such as functional strength training and the naked warrior concept. I've known people who have been running barefoot since the mid-90s.

But I suspect the faddishness of the trend, and I see some real problems with the research. The first is that it was not until last fall, with the Wolf study, that a decent examination of the consistency of lower extremity kinematics was even performed (to my knowledge, at least). Without that base consistency data, drawing conclusions from a comparison of shod versus barefoot kinematics is perilous. How do we know that the data from the Lieberman study (and others) even falls outside the range of normal variation? The fact is, we do not. So to to make conclusions about technique from such studies is rash.

While the research does show some force reduction at the joints, from that data the researchers are *presuming* a reduction of injury. There are not any studies which actually show a reduction of injury, and it is quite possible that none will be found. Lieberman admits this limitation in his study. What is most probable is that barefoot running may tend to reduce the risk of certain types of injuries, while increasing the risk of others, and as I note below, the benefits are likely to vary widely based on individual biomechanics. There truly is no such thing as a free lunch.

Similarly, performance has not been evaluated. The argument held forth thus far is the "Ethiopian runners do it and they are the best," which is an argument beset with obvious problems, from cardiopulmonary functioning to femorotibial ratios. Until I see some good studies, I am inclined to dismiss barefoot running performance claims.

Interestingly, the kinematics of shoeless running point to the fact that, in all likelihood, the runners who do benefit most from shoeless running are those that are free of foot dysfunction in the first place. Which makes sense.

It is important to note that the foot scans I'm providing are not with the intent to provide a rationale to fit every athlete with orthotics, but more to detect those individuals whose foot dysfunction or pathology tends to increase their risk of injury or hinder their performance. For such individuals, there is absolutely no data to suggest that they would benefit from barefoot running and a wealth of research to suggest that custom orthotics would be beneficial.

I'm not a one-size-fits all kind of doctor, and I may happily recommend seemingly contradictory advice to two different patients with the same (apparent) problem, because I think that any protocol needs to account for the huge individual variability in physiology and biomechanics. It is one of the core ingredients missing in most of mainstream medicine.

So I'm not going to utterly dismiss barefoot running out of hand, because it may have some genuine utility for some people. But the majority of runners, I suspect, will continue to benefit from a well-made shoe and proper foot support.

Free Digital Foot Scan, March 12

I'm very happy to be able to do this. For 15 years, I've been putting my patients into custom orthotics for a variety of reasons, most typically chronic low back or knee pain. I have also used them quite frequently on my athlete patients, as the research has found that custom orthotics can curtail the risk of training injuries.

And in the case of at least one sport -- golf -- there is research that shows that using custom orthotics actually increases performance! Yep, you read it right. Slip these things in your golf cleats and strip a couple of strokes off your game. Can't beat that with a stick (so to speak).

Having made a short story longer, here's the point: I've arranged for the orthotics lab that I've been using for the past 15 years, Foot Levelers, to bring in one of their technicians. She will be spending the day on Friday, March 12, doing digital scans of people's feet to see if you need orthotics. Did I mention that this is free?If it turns out that you do need orthotics and you order them that day, I'll give you 15% off.If you order two pairs, you get 30% off. Sweet.

Here's a linky that takes you to a pretty web page about it.

You can always check out my website to read much of what you've read here, only with more formal wording.And, as always, if you have questions, email me, or call me at (860)567-5727.

Do this. It's free, and it will make you so happy.