Above is a picture of my foot between my hiking boot and a fashionable shoe from a local store.
Which one would you want to wear all day?
Americans seem to have a sort of foot fetish. A study by the American College of Foot and Ankle Surgeons of 1000 women found that 80% of them were wearing shoes too small for their feet! As if smaller feet are the keys to more success in life and love.
This does not seem dissimilar from the barbaric ancient Chinese practice of binding women’s feet to make them appear “appropriately” tiny, and not incidentally, I think, to keep them from being able to be fit and active and even run away if necessary.
High heeled, pointy toed shoes seem to mimic the bound feet look. And as you can see from the picture above, some men want to prove they can be “styling” too.
Feet look the way they do because they evolved for function, not style.
Maybe fashionable people don’t want to look like they ever have to use their bodies, so they wear dress shoes to make their feet look slim and trim, no matter what they actually look like, and no matter what they need in order to support them physically.
How feet are supposed to work:
The arch of the foot is our primary shock absorber. A thick membrane on the bottom of the foot called the plantar fascia connects the heel to the toes, most significantly the big toe. When we take a step we lean forward and the big toe bends up and tugs on the plantar fascia, pulling the heel forward and raising the arch into a position from which it can absorb shock effectively. In that sense the big toe is the key to successful walking.
The effect of pointy, too-narrow shoes
(If you don’t care about the biomechanics, skip down to “What constitutes a good shoe?”)
If your shoe, like many shoes do, compresses your big toe and bends it toward the other toes, it won’t bend up at the right angle, your arch won’t raise up optimally and be able to absorb shock efficiently, and the shock of each step will be transmitted up to your knee, your hip, your low back, and even your neck.
It gets more complicated. If your big toe doesn’t drag the heel forward by the plantar fascia as it should, over time the plantar fascia stretches out and the arch collapses. At that point your body assumes a stressful posture whenever you are standing.
For many of you I have demonstrated this situation with you in your physical examination by having you rotate your knees to the outside, simulating what your body would be like with better-functioning arches in your feet. In most cases, you find that your neck relaxes.
The situation thus revealed is called foot hyperpronation, and that is the most common reason I prescribe custom-made foot orthotics. Hyperpronation can change the angles of your shins over your feet, stressing your ankles, and your thighs over your shins, stressing your knees. Ultimately more stress is placed on your hips and low back, and your head compensates by moving forward, causing chronic contraction of your neck and shoulders.
But hyperpronation is not the only effect of cruel shoes.
Shoes that are too narrow, and that bend the angle of your big toe in, tend to compress the metatarsal heads, what we call the ball of the foot. The metatarsal heads evolved to sit in the form of an arch in the forefoot, but tight shoes and hyperpronation can both flatten out the metatarsal arch and mash the metatarsal heads together. There are nerves between the metatarsal heads that work fine when the bones are in their arch, but can be irritated when the arch collapses and the bones rub together. Sometimes the nerves swell up and create a painful enlargement called a neuroma.
Regardless of the narrowness and pointiness of your shoes, the higher your heels, the more pressure is placed on the ball of your foot, and the more your foot will tend to break down and create hyperpronation and metatarsal compression.
What constitutes a good shoe?
I’m sorry if what I describe doesn’t sound like high fashion.
A biomechanically appropriate shoe needs to be shaped enough like a foot that your foot can wear it without being bent out of shape. There needs to be enough room in the front, or toebox, so your metatarsal heads aren’t jammed together. The big toe side of the front of the shoe should be straight enough so your big toe won’t be bent toward your other toes. The widest part of the front of the shoe should be where your bunion joint is. Ideally, when you are standing in the shoe there should be a half inch of space between the ends of your toes and the front of the shoe.
Heels should have modest height and not place added stress on your forefeet. They should fit snugly enough not to ride up and down when you walk.
The hiking boot in the picture above is made by Topo. I have seen other biomechanically appropriate shoes made by Altra, Keen, SAS, New Balance, and several other companies. Some stores sell them as “Eurocomfort” or just “Comfort” shoes.
Properly made custom orthotics can be life-changing
Once your arches have collapsed into hyperpronation, which is, sadly, somewhat common, properly made custom foot orthotics can make a dramatic difference in your posture and your level of pain throughout your body.
I say properly made because I have a collection of rigid thermoplastic orthotics (even one of stainless steel) that have been given to me by patients who spent a lot of money for them but who didn’t receive the relief they had hoped for. All of these people ended up more satisfied with the flexible orthotics I made them.
For technical reasons too complicated for me to go into here, I disagree with the methodology many doctors use to cast and manufacture those rigid orthotics. Ultimately the proof of the validity of my disagreement comes when I test them on patients. They invariably make the wearer’s neck muscles tenser while they stand in them, while I require that the flexible orthotics I prescribe make people looser and more balanced.
If I haven’t done it already, I will be glad to evaluate your shoes, your feet, and your orthotics, and their effect on your gait and your total body health and function.
To find out more, call us at 303-394-4204.