Now, for the blog that everyone really wants to read, let’s talk about running shoes. In part 1 of the blog we thoroughly broke down the human foot and laid the foundation of how to evaluate your foot before buying a shoe. Now we need to look at the different parts of a shoe and how shoes can affect the way your foot functions. Hopefully, this blog will be able to streamline the elements of the shoe that really matter, and show you what aspects of a shoe don’t really matter and are just “Shoe Bling”. I want to thank JAX Outdoors for letting me use their shoes as demos in my community presentations and take pictures of them for this blog. If you have never been to JAX, it’s worth a trip to west Ames to check them out for any of your sporting good needs.
When shopping for shoes, you need to have plan for finding the shoe that fits your needs as runner anatomically and functionally (learn more about your foot anatomy and biomechanics in Part 1). For example a runner with a mid-foot strike pattern with a history of ankle sprains that runs daily on cement needs different shoes then a person that only runs on tails, heel strikes, and under pronates. You always need to remember when shopping for shoes, that shoes are tools. Tools help us accomplish tasks more efficiently and help take stress off our bodies; shoes are the same way. But, when all you have is a hammer, and you need a screwdriver, problems will arise. In shoes, the wrong type of shoe can cause injuries and poor fitting shoes will wear out faster too. Shoes can also be used as tools to help change running technique or help protect an injury while it heals.
Humans have been walking on two feet for over 5 million years, but the earliest evidence of shoes only carbon dates back 10,000 years. Back then, primitive shoes where were worn to cover and insulate the feet from the elements. Athletic shoes have a very short history, about 100 years ago with development of rubber; companies like Goodyear started producing “sneakers”. It was not until 1970 that Phil Knight and Bill Bowerman began experimenting by pouring liquid rubber onto a waffle iron, that the modern day running shoe was developed. http://www.holabirdsports.com/running-tech-center/running-shoe-history.html
Runners typically seem to develop a brand loyalty with shoe companies. Unfortunately this loyalty will get the runner into trouble eventually. Running shoe company's top engineers and executives are like NFL coaches. It seems like every year, half the NFL teams switch coaches and very few coaches now days spend their entire career with one team. The same thing is going on in the running shoe industry. If some new engineer comes up with a new shoe design for company X, Company Y will give the engineer a pay raise to quit and work for them and bring the new knowledge. So when this hot shot engineer takes his new job, he is going to change the design of your favorite shoe from company Y. If the companies are not loyal to you the consumer, you shouldn’t be loyal to them, just find the shoe that fits. Another little corporate secret is that most companies only use about 3 different molds to manufacture all of their shoes. Meaning, you are paying extra money for bright colors and “shoe bling” on shoes that have the exact same midsole and outer as the less expensive models.
Starting from the ground up, the part of the shoe that actually contacts the ground is the outsole and is made from a strong dense material. The next layer is the midsole and most of the flexibility and control of foot motion is controlled with in this layer. Typically it is formed from foam, many times different densities and stiffness of foam are used in areas of the shoe where motion of the foot needs to be slowed down. This is called a shoe with dual densities, there may be more than just two types of foam depending how much stability is needed. The layer contacting the foot is the insole, many times this is replaced by an insert or orthotic. An orthotic or athletic insert usually has some type of posting. A posting is anything (foam or plastic) that tries to limit pronation of the foot. Finally, there are the parts of the upper including the heal box, vamp, and toe box. An important measurement that should be addressed in all running shoes is the “drop”. Shoe drop is the delta or change in height from where the forefoot and mid foot are positioned off the ground compared to the rear foot.
There are three basic types of shoes. Each one is designed for an ideal category of foot type. As we explained in Part 1, rarely does the shape of the foot (flat, neutral, high arched) match the actual function of the foot (over-pronated, neutral, and under-pronated). But, shoes are still basically broken down into 3 categories matching the 3 foot types: Cushion Shoes, Stability or Neutral Shoes, and Motion control Shoes. I will add four more categories to this discussion, they are: Minimalist, Hybrid, Toe spring, and Trail running shoes.
-Purpose is to absorb large amounts of shock while not limiting foot movement.
-Designed for the runner who under pronates.
-Typically an under-pronator has a stiff foot, so they need a flexible shoe (many times there will be a break in the midsole between the rear foot and forefoot to promote increased shoe flexibility).
-Have a curved sole to fit a high arched foot.
Neutral or Stability Shoe:
-Propose to provide shock absorption and basic stability.
-Designed for the ideal foot, or a person who wears orthotics.
-A semi curved sole with moderate flexibility.
-Theoretically, the most purchased running shoe.
Motion Control Shoe:
Propose is to provide maximum stability and support of the foot that over pronates.
Very dense, heavy, and thick foam is used in the midsole.
The sole is almost straight and there is minimal motion when the shoe is twisted.
(It should be noted that in several studies, every classification of runner who ran in motion controlled shoes had increased injury rates compared to other types of running shoe test. Please don’t release the Brooks Beast.)
The purpose is to mimic barefoot running while still protecting the foot from the elements.
Extremely lightweight, minimal to zero drop, maximum flexibility, and a large toe box or individual toe capsules.
(You can read more about minimalist shoes in my previous blog)
Purpose is to bridge the gap between a cushion shoe and a minimalist shoe.
A small drop, and high flexibility, light weight, while still providing some shock absorption.
Example: Nike Free
Purpose is to provide artificial big toe flexion and ankle dorsiflexion for individuals who lack those ranges of motion.
A stiff sole with a large arched relief under the forefoot to rock over during gait.
Trail Running shoe:
Purpose is to provide a light weight traction shoe that limits ankle sprains.
Bottom treads that wick away mud, yet provide superior traction.
A low drop with a wide heel to reduce the severity of ankle sprains.
There are more than just color differences between male and female shoes. Anatomically and biomechanically, there are significant differences between men and women. Women have shorter legs (as a ratio of total height), wider hips, and more valgus alignment of the knees (“knock knees” or higher “Q” angle). When it comes to shoe fitting they often have more trouble finding shoes that fit well than their male counterparts. Women have triangular and narrower feet compared to males who have more square and wide feet. Their malleoli (ankle bones) are also lower. Women are also more likely to develop foot deformities such as bunions and need to be fit for shoes that provide adequate toe box room.
Recommendations for Mid foot and Forefoot Strikers:
I recommend a forefoot or mid foot striker wear a shoe with very little drop. Because a high heel/large drop shoe will cause a premature heel strike. This type of runner doesn't need excessive heel cushioning/motion control features, because pronation and shock absorption is basically over when their heel hits the ground. They are often better off with a hybrid or minimalist shoe style. These shoes offer adequate room in the toe box for increased widening of the forefoot on initial contact. If possible a flared heel cuff can be used to add support of the rear of the shoe during contact, taking strain off the Achilles tendon.
In the Shoe Store Tips
· Weight it: heavy shoes usually provide more shock absorption and/or motion control, but they add weight that must be moved in every stride.
· Twist it: does the mid foot flexibility match your foot type needs?
· Bend it: does the forefoot bend where your big toe joint is placed within the shoe?
· Poke it: are there dual density foams in the right areas for your needs?
· Look at it: what is the curve in the sole like? How much of the shoe is “bling”?
· Bring the socks you generally wear running to use while trying on the shoes.
· Try on shoes later in the day or right after a run so your feet will have swelled.
· Shoes should feel great when you put them on, don't buy them thinking you will "wear them in."
· If you have wide or narrow feet, look for a brand that has multiple widths to fit your feet.
· Find a different shoe if any part of your foot feels like it is rubbing
· Do not shop when you are in a hurry. Be sure to walk/run around the store for a few minutes on a hard surface.
· NEVER buy “seconds” shoes online, these shoes may save you $20 initially, but in the long term they can cost you much more if you are injured. The reason many shoes are sold at a discount online is that there is a manufacturing flaw within the shoe. Would you by a powertool or a car that had a mechanical defect?
(In part 3, the last of the Shoes 101 blog, there will be a discussion about the cause of different running injuries and different shoe strategies to help heel and prevent future injuries)
The goal of these next blog posts is to remove some of the mystery of how to find the right running shoe for your specific foot. For the average consumer, shopping for a good pair of running shoes can be daunting. There are thousands of different models and styles of shoes to pick from. It doesn’t help that most costumers are influenced more by TV commercials about the shoe and how the shoe looks esthetically, than how it actually functions on their foot. I like to use the analogy that shopping for running shoes is like buying a $100 lotto ticket. It’s exciting when you are purchasing the ticket, but there is often buyer remorse when you get home and you realize the ticket was not a winner. Even more frustrating if you do find a winning ticket, you can never play the same numbers again because the shoe companies are always changing their shoe designs. Hopefully, after reading this blog, you stop feeling like you’re always playing the lotto at the shoe store, and your shoes always feel like a million dollars!
This blog will be 3 parts long. It will start by discussing what goes into a shoe first, that being your foot. The shoe must match your foot, not the other way around. Then in the second part, it will breakdown shoe anatomy and the different types of shoes and how they can help improve function and decreases injuries in runners. There will be a brief discussion in this part on running style/technique and the type of shoe that suits the runner (I will post more specific blogs on running form and technique in the future). Finally in the third part, I’ll post about several injuries that occur while running and how to prevent and aid in healing specific injuries with specific shoes.
Getting to know your own Foot:
Humans started to walk bipedal (on two feet) anywhere from 5 million to 10 million years ago, depending on which archeologist you ask. The transition from ambulating on all fours to bipedalism may actually have been one of the most important evolutionary developments in mankind. There are two theories on why we started to walk up right. The first is that by walking only on our feet, we freed up our hands to use tools. The second idea, and most accepted theory is that by walking on two feet, human beings became more efficient. Ancient humans were able to walk/run for greater distances; which improved their ability to hunt. Bipedal man could literally chase his pray to death because of the improved efficiency. Maybe this why modern man still has the deep desire and love for running long distances?
To make the physiological change to bipedal locomotion, some major adaptions had to take place in the human body. First our posture changed to a more vertically erect posture, we developed a lumbar lordosis/mobile lumbar spine. The shape of our pelvis changed and many of the muscle of our pelvis had to change their function compared to other primates. I believe this is why so many injuries can be related back todysfunctional hips in modern man. Finally, our feet had to change in shape and function. We ask more out of our feet than any other animal on this planet. Our feet act as a stable platform for when we need to stand for hours, they act as the first line of shock absorption and they also transform into ridged levers when we need to push off in running.
The human foot is composed or 33 different joints and 26 bones. The structure of the foot articulations give the foot the ability to be very mobile and then stiffen depending on the position and contraction of muscles. Speaking of muscles, there are two types of muscles that attach to the foot, a short group called the “intrinsics”that are found within the foot, and then there are longer muscles that start at the leg bones (tibia/fibula) and then attach to the bones in the foot. The muscles and ligaments hold together the arches of the foot. Yes, I wrote arches, with an “s”. There are actually three different arches in the foot, the medial arch that most people think of when they think of a foot arch runs between the base of the big toe to the inner heel. The longitudinal arch runs along the outside of the foot, and the transverse arch runs across the forefoot. Together, these arches create a triangle or tripod within the foot. It doesn’t matter if you have really high arches or a “flat” foot; everyone needs to support themselves on the three points of the foot tripod. The most common deformity that occurs when there is a dysfunctional foot tripod is a bunion. When the tripod point at the base of the big toe becomes dysfunctional, the angle of progression changes when you walk (over pronation), forces are distributed unevenly, and muscles that usually anchored from that tripods point become weak. If this occurs over several years, the forefoot will widen and the joint of the big toe with start to deform.
As I mentioned previously, the foot needs to be a mobile shock absorber, for 5 million years humans walked barefoot on uneven terrain (it was not until the last few hundred years that humankind made everything flat with cement and concrete). This ability to keep the joints of the foot loose and adaptable is termed “pronation”. Pronation gets a bad rap; really, it is one of the most important motions in your foot. As a runner I would take a foot that slightly over pronates any day over a foot that doesn’t pronate enough. The motion of pronation is complicated when you breakdown the motion of every bone in the foot, but for the sake of simplicity, think of pronation as the foot “collapsing or rolling in”. Supination is the exact opposite of pronation, it is the mechanism of making the foot a “ridged lever”. As we walk or run, after we have adapted to the ground, absorbed the shock of impact through pronation, we transfer our body weight over and past our foot by pushing off through supination. It would not be very efficient to push off if the foot was still a “loose bag of bones” as it is in pronation. During supination, the muscles and tendons of the foot and leg bring the foot downward and inward, causing the bones of the foot to lock (windlass effect).Some rights reserved by sportEX journals
Bio-mechanically, there are differences between running and walking. Walking can be described as a pendulum motion, where the rotation of the different parts of the body preserves momentum. In walking, the foot is in contact with the ground 60% of the time, and both feet are touching the ground simultaneously at different parts of the walking gait cycle to preserve the momentum used to propel walkers. Running uses principles more related to a spring. Running relies on the elasticity of the muscles and tendons to propel the runner forward. In contrast to walking, most of running is done in the air (40% foot ground contact time) and only one foot is ever in contact with the ground at one time. During running, pronation occurs during 70% of the ground contact period, and supination comprises the rest of the time the foot touches the ground.
So what’s the big deal about “over pronation”? As stated previously, pronation is essential to human movement and actually helps prevent injuries then it causes. But, when pronation occurs at a speed or rate that your body can’t control, you can have complications that lead to injuries and decreased performance. I use a slingshot analogy to explain the concept of over pronation. I can pick up a pebble and toss it to someone; they will be able to catch it without difficulty because of the predicable slow speed of the toss. However, if I take that pebble and load it into a slingshot and fire it at someone, they will not be able to control and stop the pebble without some type of shield, or they will become injured. The shield in this analogy is a shoe or an orthotic that slows down the pronation. The worse type of over pronation is one that only happens in one foot, and not the other. In this case there is an asymmetry in the body that travels up the kinetic chain. (over pronation causes the lower leg to rotate in, the knee to twist down and in, the thigh rotate causing the pelvis to tip down and forward, leading to a curve in the lower back and a compensation in the middle back, dropping and rounding one of a shoulders).
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So what’s the big deal about “over pronation”? As stated previously, pronation is essential to human movement and actually helps prevent injuries then it causes. But, when pronation occurs at a speed or rate that your body can’t control, you can have complications that lead to injuries and decreased performance. I use a slingshot analogy to explain the concept of over pronation. I can pick up a pebble and toss it to someone; they will be able to catch it without difficulty because of the predicable slow speed of the toss. However, if I take that pebble and load it into a slingshot and fire it at someone, they will not be able to control and stop the pebble without some type of shield, or they will become injured. The shield in this analogy is a shoe or an orthotic that slows down the pronation. The worse type of over pronation is one that only happens in one foot, and not the other. In this case there is an asymmetry in the body that travels up the kinetic chain.
The best story of this relationship between the foot and rest of the body comes from baseball. In 1937, Dizzy Dean was pitching in an All-Star game. The batter hit a comebacker that hit Dean’s foot, fracturing his toe. While still nursing a sore foot, Dean resumed pitching. The soreness caused him to change his foot position and his pitching mechanics, leading to shoulder and arm problems. Dean was never able to overcome his shoulder injury, leading to his early retirement. His quote ““Fractured. Hell, the damn thing’s broken!”.
Is There an Ideal Foot?Image from www.dukehealth.org
Many people make the mistake of only looking at their foot when are trying to determine if they under or over pronate. The assumption is that if your foot is “flat” you must over pronate. This is a myth, if a person with a flat foot uses their foot tripod effectively, they may not have a pronation problem at all. Actually, a person with a flat foot can have a very stiff and ridged foot and may need a completely different type of shoe compared to what it looks like they should wear. The best example of this is the fastest man in world, Usain Bolt. Did you know he has flat feet? I don’t think I remember watching him run at the Olympics in heavy motion control shoes. Sadly many people with flat feet with normal foot mechanics are improperly fit into a motion control shoe or an orthotic. This causes them to complain the shoes are uncomfortable due to the artificial arch that presses into their underfoot. Actually, people with high arches that have very mobile and loose feet are more likely to become injured because their body can’t control the rate in which their foot collapses at a greater distance because of their high arch starting point.
Much like the stereotyping of flat feet, there is an assumption that people with high arches need a cushion shoe because it is assumed that their foot is very stiff and they supinate more than they should. And the person with a “normal” looking arched feet (what ever normal is?) should be ok in a stability/neutral shoe. The moral of the story here is that looks can be deceiving. I can look at a door and assume I know how it moves, but until I physically open it, I never know if the door moves easily or is locked/jammed. The best way to tell how a foot moves is to have a professional palpate the motion of a foot and then analysis the foot when walking/running. Palpating your own foot or trying to self-analysis your gait can be tricky. The easiest way to tell about your foot tendencies during your gait cycle is to look at the wear pattern of an old pair of shoes. I call this “arch”eology (sorry it’s a lame pun).
The two other variables in foot function that become very important when fitting shoes are:
1. Where and how much your big toe bends in relation to the shoe. You may have never realized the ramifications that people have different sized toes, and the joints of the toes don’t always match where the shoe bends (can you say turftoe?). Typically in an athlete the big toe should bend up in the air 65 degrees when standing flat. There is also specific group of people that have a Morton’s foot, this is easy to distinguish because in a Morton’s foot the 2nd and maybe 3rd toes are longer then the first toe. This causes an alteration in toe off when they run and special attention needs to be paid in fitting them into a shoe that bends in the forefoot at the proper location.
2. How well your ankle flexes (dorisflexs) is also really, really, really important in runners and all other athletes. The number one reason we lose our ability to flex our feet are ankle sprains. If you severely sprain your ankle and never properly rehab after, the ligaments on the side and back of the foot scar down and you end up losing the ability to flex the ankle. In a runner ankle dorsiflexion should be between 20 and 30 degrees. Anything less will shorten the stride length and put excess stress on the soft tissues of the plantar fascia, Achilles tendon and the calf musculature.
The last point I’ll make before we start to break down shoes in the next blog, is that there are these things called legs that attach to your feet. In an ideal world there would never be anything wrong with the legs above the feet that could cause concern about shoe fit and function. But, we live in the real world, not an ideal world. For example, if people have knees that are bowed out or knocked in, special consideration needs to be made in shoe choice. Sometimes function may call for one type of shoe, but that shoe will not work with the individual because the shoe makes a condition in the knees or hip/back worse. This is when compensation needs to be made in shoe choice and professional help should be sought out.
To Fill a Missing Void in Ames Healthcare: Ames, Iowa is a highly educated community and with the 6th lowest unemployment in the country. Those two factors alone make Ames an Ideal place to start a business. But, as I talked to people around the town, I began to hear some of the same issues over and over again about healthcare. The four statements below comprise the foundation of how I plan to build my practice and find my niche in Ames:
1. To my knowledge, none of the current conservative care providers (physical therapist, chiropractors, and massage therapists) currently offer the total package to their patients. The PT’s don’t adjust, the chiropractors don’t adequately do soft tissue work or rehab, and massage therapist cannot diagnose.
2. Few Healthcare providers are willing to work with individuals who are hurt and still trying to exercise. Most providers tell their patients to stop exercising completely and rest.
3. It’s difficult to find a practitioner that formulates a specific plan to treat a condition or injury. Telling a patient to come 3 times week for 3 months, is not a specific plan.
4. Runners in Ames are limited in their local options for running specific healthcare needs and have difficulty finding adequate running shoes locally.
Bring Life Back to an Old Structure:
My practice is located within a 100 year old train depot. The outside of the building is the original brick with a lot of character
in the old awnings and cast iron support beams. The inside of Suite 104 needed a facelift when I first looked at it. With the help of Dotey Construction and Nelson Electric, we were able to repurpose the space while preserving some of the historic charm. For example, we kept the interior walls low to let the beautiful original windows flood the space in natural light. The interior design of the space is not complete yet, but my goal is to mimic some of the traditional finishing’s used during the era of the depots construction, while maintaining functionality for my practice. I built the large reception desk with a mission style to match the look and function I envision for the finished space.
Just like the old depot, my patients all have histories that lead to their present day condition. My philosophy is to never hide the past, but work with what history has given us and marry it with modern day function to achieve a desired goal. In my office, I’m able to preserve the charm and character of the original depot architecture, while providing my patients a warm and comfortable space to heal and recover. Professionally, I use the same principals in my patient care. I assess the patient’s body for structural issues and build an understanding of what caused their problem through their health history. Then we work together to develop a plan to allow their body to regain a new level of function to meet their goals.
Provide Economical Healthcare:
Healthcare is actually one or our nation’s largest industries. Healthcare costs continue to sky rocket and insurance rates rise at the same speed. I believe we are creating an unsustainable future for our nation, because healthcare is not readily exported or imported, it’s mainly a service. Through my experiences in mainstream medicine I have observed the various middlemen that raise the cost of the simplest surgical procedures and greed of large healthcare corporations that push their doctors to make large profit margins. The current healthcare model is ethically and economically flawed. I vow to make Team Chiropractic and Rehabilitation of Ames affordable without affecting the quality of care. First, my prices are fair for the average consumer. Even though most of my services are covered by insurance, I still feel it’s important that an average citizen of Ames should be able to afford my care if they were paying cash. I don’t bill insurance companies hundreds of dollars for a simple office visit, because that is what is driving up this nation’s healthcare costs.
Another problem that the citizens of Ames have expressed to me is that they are being copaid to death. For example, a person with a shoulder problem currently has to go to their primary care provider for a diagnosis, and then they go to PT for several weeks to learn exercises to improve the range of motion and strengthen their shoulder. They also end up visiting a traditional chiropractor to get adjusted because it helps with middle back/neck mobility leading to better shoulder function. And finally, this person with a shoulder injury has to see a massage therapist on the side to help improve the soft tissues surrounding the shoulder. That’s a lot of wasted time running to different appointments and money spent on separate medical bills. My goal is for that individual to walk in my door and receive the correct diagnosis, hands on care to correct the joint and soft tissue dysfunctions, and a progressive rehabilitation plan to restabilize the shoulder and prevent future injury.
Small is the New Big: My goal is to keep my overhead low and the quality of care high. Another reason I started Team Chiropractic and Rehabilitation of Ames was to have control over my schedule and my overhead. Those two items are directly related in the numbers game of healthcare. The higher the overhead, the more patients a doctor needs to see, and I believe quality of care goes down with high daily patient loads. I have worked in settings where I treated 40-50 patients in one day, I know my attention to detail and thoroughness suffered in that situation. At Team Chiropractic and Rehabilitation of Ames, my overhead is ridiculously low, so my attention to care can be at its highest. I have the perfect amount of space to effectively treat patients, my rent is affordable, and I don’t have expensive X-ray machines or gadgets that I need to payoff. Meaning, I have a clear head and can take my time with patients to help produce the results we both want.
Dr. Chris Feil