Armstrong Podiatry & Sports Health's Blog

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“Springing” away from foot health

 

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Not this type of spring!

In this third installment of this continuing blog series about shoegear (read the first and second installments), another unnatural characteristic of shoegear will be examined-the toe spring.  Though not as obvious as the heel lift, the toe spring can lead to joint dislocation and  joint pain, leading to total body compensation.

The toe spring can be defined as the upward slant of the toebox of a shoe.  If you look at any shoe from the side, you will notice that the tip of the shoe does not touch the ground;  it is more pronounced in running shoes.  The necessity of the toe spring is due to the stiffness of the sole of shoegear.  Since the sole is difficult to bend and flex, shoes artificially create a “bend” in the toe area to allow proper motion of the foot throughout a normal walking cycle.  The concept is similar to the  “rocker bottom” shoes which are so popular today, i.e., “Shape Ups” and MBT.

Toes should be down, not up!

The resultant position of the toes by the toe spring negates their natural activity of grasping the surface when weightbearing.  The toes are placed in one position with limited ability and need to provide motion.  And following classic maxim, “If you don’t use it, you use it.”, the joints respond by becoming stiff, leading to the surrounding tendons and ligaments to also become stiff and tight.  This could lead to such things as hammertoes and clawtoes, and most importantly, limited big toe range of motion (hallux limitus).

Hammertoes from years of shoegear usage

Another consequence of the toe spring is the increased pressure on the ball of the foot.  Since the toes are minimally weightbearing, the ball of the foot (capsule) assumes the major weightbearing responsibility, leading to capsulitis.  The previous blog article about the heel lift also talked about this capsular pressure, so it seems like both of these shoegear characteristics direct pressure on this area. A common treatment I have used for pain caused by this capsular pressure involved decreasing the heel height and causing a straightening of toes to increase their weightbearing status.  This is done by insole modification and has been effective in most of my patients in my attempt to make shoegear more “natural”.

Perhaps the most devastating aspect of the toe spring could be the formation of limited big toe range of motion (hallux limitus).  The big toe provides a major force during walking/running and any disruption of its motion will cause compensation throughout the body, i.e., ball of foot calluses, capsular symptoms, increased knee bending, increased hip bending with lower back pain. 

Lack of motion of the big toe affects the entire body!

The destructive nature of the toe spring has multiple consequences which overlaps with the consequences of the heel lift.  In the next installment, the curved last shoe will add the final piece of the nature of shoegear.  Please feel free to contact me if any questions.

Happiness and good health!

February 16, 2011 Posted by | Uncategorized | , , , | 8 Comments

The unhealthy “lift”

    

 In my previous blog post, I talked about the destructive process of shoegear and its resultant changes on our bodies.  Three major methods that shoegear causes these changes were identified:  elevated heel, toe spring and narrow toe box/curved last.  This installment will focus on the elevated heel.

     Many people have heard that high-heeled shoes are not “healthy” to wear.  But the question really is, “How high is too high?”; “One inch?  Two inches?  Four inches?”  My contention is that any height is not healthy.  Any shoe with an elevated heel (which is, in fact, ALL shoes) will cause increased forefoot pressure, joint changes, muscular tightness, knee and lower back changes.

Even casual shoes has a heel lift!

      Take a close look at any of your outdoor shoes.  The heel is always higher than the forefoot no matter which shoe, i.e., sneakers, casual shoes, dress shoes.  Now look at your bare feet from the side.  It certainly appears that there is ground contact on the ball of the feet and the heels.  Now go up on the balls of your feet and you have virtually eliminated the pressure on the heels and increased the forefoot pressure.  This is what high-heeled shoes can do and it has multiple consequences to the feet.  It exposes the joints (capsules) and nerves around the ball of the feet to increased trauma, leading to increased inflammation (capsulitis and neuritis); it causes tendons in the toes to tighten, leading to hammertoes; and it reduces the usage of the calf muscles, causing shortened, tight calf muscles.

All the pressure shifted to the forefoot!

     The changes from high-heeled shoes can continue further up the body also.  Due to the lack of movement of the calf muscle, the knee and hip must work harder to lift the leg off the ground while walking.  This can lead to not only increased knee pressure, but overuse of the hip muscles which are prone to tightness.   Finally, as an attempt to maintain balance, a shoe-wearing individual must attain a curved lower back posture, which can lead to lower back problems. 

What a difference some heels make!

      All these changes throughout the body occur over time with usage of shoegear.  This gradual process, I believe, can be directly linked to why the elderly today suffer from disfigured toes, calluses and back and knee pain.

      Unfortunately, this is not the end of what shoegear can and has done to our bodies (Yes, there is more!).  The next blog post will explore the destructive feature of the toe spring in shoes. 

     Happiness and good health!

January 21, 2011 Posted by | Uncategorized | , , , , | 1 Comment