Caring for Your Feet

Did you know that the most important part of caring for your feet is choosing the right shoes for your feet?

Most foot problems are caused by shoes.  Shoes that are appropriate for length and width by today’s standards often cause deformity within the feet and ankles.

There are few shoes available to consumers that are truly shaped as a foot is shaped, and function as a foot should function.

One of our goals at NW Foot and Ankle is to help you access information that will enable you to make the best possible decisions about the health of your feet and your family’s feet.

To that end we would encourage you to begin learning about shoes and how to achieve a correct fit as a preventive measure against needing the services of a podiatric surgeon or an orthopedic surgeon.

Most foot problems are preventable, if the causes are understood and addressed early in a person’s life.

The primary cause is footwear.  Shoes and boots mostly, but also socks.

The primary driving force for wearing footwear is protection, but the shoes available today far surpass what is required for safe and protected use of the feet.   They actually prevent the foot from developing the strength and flexibility that the unshod foot assumes naturally through prolonged use.

Many shoes conform to fashionable trends that are unsafe and deforming and many people are willing to pay the price to look their best, regardless of the consequences in their posture, joint alignment and balance.

Some perhaps are not aware of the significant effects our shoes play in how we move our bodies and engage in play.

To those who are interested in understanding why foot problems are caused by shoes, this is for you.  We hope that will be a lot of you.

In addition to the suggestions for getting your shoes fit properly, we will provide 4 full length articles written by shoe expert, podiatrist -William Rossi, DPM.  These articles outline what you need to understand about shoes from infants to seniors and why some types of shoes are so troublesome.

One of the most important purchases you will make for yourself and possibly for your family members if you are a parent or a caregiver, is footwear.  You will make this purchase repeatedly throughout your life.  It is a purchase capable of generating a lot of pain and deformity.  But it can also be a purchase that brings joy, comfort and protection.

It is up to you.

If shoe purchasing is approached with respect and understanding, it is not rushed, but given careful consideration. To wear shoes that are too small, too narrow, or shaped in fashionable ways that do not resemble foot shape, is welcoming bunions, hammertoes, ingrown toenails, and a whole host of other foot ills that we wish to spare you from.

We are certain that our humble website cannot possibly reach every shoe wearing person and furthermore, that many reached would not heed the message.  Change occurs slowly.  We hope to change your mind about footwear. 

However, we are also realistic about the likelihood of not being able to change history.

History tells us that humans who wear shoes are more likely to view shoes as a covering that must meet fashion standards or workplace standards, rather than as important pieces of protection for the foundation of the body.

Let us begin by stating that the human foot is capable of much more than we give it credit for.  We are sure of this by our observations of cultures where shoes are not regularly worn.  Did you know that shoeless cultures experience approximately 3% of foot problems, compared to shoe-wearing populations which experience around 75%?

A beautiful example of the capability of strong human feet is the gold medal performance by barefoot Abibe Bikile in the Olympic marathon.  As if running barefoot were not enough of a challenge, much of the course was run over cobblestones.

So why does wearing shoes cause so many foot problems? There are several reasons for this.  First, as was stated above, many shoes available for consumers are not shaped like a human foot.  Second, up to 90% of shoe wearing people wear shoes that are not properly fitted, meaning they are too small or too narrow. This is not entirely the fault of the shoe wearer, since shoe manufacturers have failed to keep pace with the fact that the feet of shoe wearing people have gotten longer and wider since the turn of the century, yet the sizes manufactured and available to the public have largely stayed the same.  The fact that a proper fitting service is no longer employed by most shoe selling businesses is another significant contributing factor to people wearing shoes that are not their correct size.

There are several shoe design characteristics that are unhealthy for the human foot.



Tapering toeboxes

Have you ever noticed the foot of a child?  Particularly a child who has just been born?  The child will have a forefoot that is wider than the rest of the foot. Meaning, the tips of the toes are wider than the ball of the foot and there are natural spaces in between the toes.   Unfortunately, we fail to recognize the importance of these natural findings
and begin to cripple the foot of the child by placing the child’s feet into shoes that push the toes into an unnatural alignment.  It is practically impossible to find a pair of shoes or boots that are manufactured wider at the end of the toes than at the ball of the foot.  On the contrary, almost all shoes and boots, including athletic models, squeeze the toes into a triangular shape that compromises their natural grasping and balancing functions.  We accept this because we have been doing it since people began to wear shoes, but we also accept it because most people do not fully understand the importance of the function of the toes, including many doctors entrusted in the care of them.

The toes are critical for our sense of balance, which is very important when we go onto our toes just before we toe off in the part of walking and running that we call propulsion.  When our toes are not properly spaced and grasping the ground, our legs and upper bodies are forced to make compensations for the instability of our toes and our gait is less balanced and less efficient.  Most shoe wearing people begin to lose the function of their toes early in life because almost all shoes push the toes together and hold them above the ground surface.  We make compensations for our faulty walking, but the cost of these compensations is foot deformity, leg and back pain and abnormal gait.  Thus, it makes sense to find shoes that allow an individual to spread their toes and have the ends of their toes next to the ground.  Unfortunately, there are few such shoes available, and furthermore most shoes have an elevated heel which further compounds the imbalance within the toes of the foot.  A good example of a shoe that would be healthy is a shoe that is shaped like a Birkenstock sandal.

So, how do we go about the task of finding shoes that give our toes the room they need?  I do not have much hope that shoe and boot manufacturers are going to make any radical changes, since fashion and cosmetics have been the traditional motivators in their market.

Consequently, the best recommendation is to find a shoe store that specializes in wide shoes and removable insoles.  To see if the toebox will have adequate room for your toes, it is recommended that you find shoes with removable insoles and stand on them with the socks that you intend to wear, preferably with your toes spread.  If no part of your foot expands beyond the insole, especially your toes, that shoe may work for your feet.  Unfortunately even amongst wide brands you will find that most toeboxes are more tapered, narrow and pointed than the average foot.  So why do we tolerate it?  We tolerate it because we are not educated as to the potential problems associated with this bad positioning of our toes and the front of our feet. And we tolerate it because that is the way most shoes are built.

  Some of the potential problems are: 

BUNIONS
HAMMERTOES
CORNS
CALLUSES
INGROWN TOENAILS
TAILOR’S BUNIONS
HEEL PAIN
METATARSALGIA
ATHLETES FOOT INFECTION
TENDON IMBALANCES
MORTON’S NEUROMA
BURSITIS
FUNGAL TOENAIL DISEASE
BLACK TOENAILS
BLISTERS

These problems occur very rarely in cultures where shoes are not worn, but they are exceedingly common in our shoe wearing culture.

It is interesting to note that the above foot problems include most of the common foot problems that are treated by medical professionals, yet treatment most often does not include education as to how to prevent these problems once they have been  identified.  Worse still, reconstructive surgery is often recommended for some of these conditions, without mention of need to modify the types and shapes of shoes that are worn.

RETRAINING OF THE TOES

If you are fortunate enough to find a shoe that has enough room in the toebox for you to spread your toes, you should assist in retraining your toes to have a natural space between each of them by wearing a digital splint, which is a flexible pad made of soft accommodative material placed between each of the toes.  They are available for sale in the Products section of our website.  If these splints are worn regularly enough in a properly wide round toebox, the toes have been shown in active patients to assume the correct natural space between them, even after removing the splints.  This has been an extremely gratifying experience in our practice, especially when a patient was able to avoid surgery due to retraining their toes to be spread and straight.



Our efforts to help our clients achieve strength within their toes and feet has been augmented with the use of active foot massage and manipulation performed by a licensed massage therapist with experience in foot and ankle rehabilitation.

An exercise to increase the ability of your toes to spread is  placing the corresponding fingers in between each of the toes and holding it until the toes relax and allowing greater space between the toes.



Toespring
Toespring is the next deforming shoe feature that is present on most shoes available to consumers, including athletic shoes.   Toespring is the elevation of the toebox of the shoe above the supporting surface.  Industry standard for most types of shoegear is around 15 degrees.  What does this mean?
It means that all the while we are wearing shoes, our toes are being unnaturally elevated above the supporting surface.  The reason you should be concerned about this is your toes operate on a system of  balanced pulling.  There is a balance between tendons pulling on them from the top, bottom and sides.  When the toes are artificially elevated from years of shoe wearing, the tendons on the top get a bit of a pulling advantage over the tendons pulling on the bottom and sides of the toes.

This sets up a pulling imbalance that, when coupled with other imbalances such as elevated heels or tapered toeboxes, creates a combination of deformities in the toes referred to as CROOKED TOES, or hammertoes. See the website glossary for a more detailed description.

This pulling imbalance also contributes to many of the foot problems mentioned in the section above, as well as participating in imbalances created in the lower leg and knee since the muscles that send the tendons to the ends of the toes, take their origin from the lower leg and surrounding structures.

As if these two previously mentioned negative shoe features were not enough of a concern for those concerned about the health of their feet, elevating the heel of the foot by wearing a shoe with an elevated heel further contributes to the unbalanced pull of the tendons going to the toes since the ankle bones, which sit just above the heel, are the points around which the tendons exert some of their pulling to secure the toes on the ground firmly.   The toes desperately need to be held firmly against the ground, since the entire body is then going to pass over them during the part of normal foot action called propulsion. 

So in case you weren’t previously concerned with those skin covered bony levers attached to the end of your foot, hopefully you will be now and fit them accordingly and comfortably in a shoe that is shaped as the foot and spread toes are shaped.

Heel Elevation

Heel elevation is present on almost all shoes.   

Since we learned to walk, we have been wearing shoes. Some of us even before then.  Our parents wisely wished to protect our feet and were not aware of the limiting effects shoes were having on the development of our feet. Almost all of those shoes had a heel that was elevated above the surface more than the front part of the shoe covering our toes and the ball of our feet.  Consequently, we have ALL developed contracted or shortened lower leg muscles on the back of our leg.

The muscles that we mostly talk about are the calf muscles or the gastrocnemius and the soleus.  There are actually 3 more very important muscles that are also in the back of the leg under the calf muscles that are also extremely important in helping our arch to function properly (posterior tibial, flexor hallucis longus, and flexor digitorum longus) as well as helping our toes perform their natural functions of grasping, balancing and directing our feet forward while we are pushing off of our toes (propulsion).

This is an extremely serious situation considering the fact that the shortened lower leg muscles are now contributing to faulty foot function in a number of ways.  The most significant foot fault caused by elevated heels is that shortened posterior leg muscles pull improperly on the back of the heel to unnaturally increase the amount of flattening the arch will undergo.  Said another way, chronically shortened lower leg muscles increase pronation of the foot and ankle.  Pronation is the sequence of movements that has been given the most attention by foot care providers as being the cause of most foot and leg problems.  If indeed pronation is the prime culprit for most foot and leg problems, it makes good sense to lower the elevation of the heel on your footwear so as to not allow the shoe to further shorten your lower leg muscles and increase your pronation.

Increasing your pronation certainly is cause for concern especially given all the attention to this movement by foot care providers and sports medicine providers, but in this author's opinion, it is only one of many negative effects brought about by wearing a shoe with an elevated heel.

A more significant and potentially debilitating effect of heel elevation is that there is an involuntary stretch reflex built into the posterior lower leg, that can only be activated if the heel is allowed to come close to the ground.  This does not occur in most shoes available to consumers today, EVEN amongst athletic models.

The problem here is that activation of that involuntary reflex is something that should happen with every step to help our forefoot with its most important task of propulsion. 

Sadly most shoe wearing people do not get to experience normal gait and propulsion.

This may not seem like that big of a deal because after all we can still walk and many of us are able to participate in athletic endeavors.  But it is a big deal when you consider that walking and participation in sport can not occur naturally, and our efforts are undeniably hampered by something so seemingly simple as the coverings we put on our feet.  Shoes and their construction have been hypothesized to be the single most important identifiable feature that separates our long distance runners from those who grew up in countries where their feet and legs developed normally.

So next time you are in the market for a pair of shoes, bear in mind the negative features described above and choose accordingly.  Your feet and your whole body will thank you.