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Shoe advice from The Foot Doctor

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June 14, 2015 by Ville Raivio

Matthew Wohlgemuth is a senior medical student of podiatry with a specialization in foot as well as ankle surgery, and biomechanics along with footwear to boot. He also likes more or less handmade shoes quite a bit, so I’ve taken to calling him The Foot Doctor in this new series of advice on foot health, shoe fit, quality, and overall smartness in shoes. I also like to think he’s just the right man to answer any and all questions podiatric. The good Foot Doctor cordially gave Keikari his time to go through my list of questions. This first post goes through the differences between the hand and the foot as well as the choices between sneakers and welted pairs.

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Ville Raivio: You are currently studying podiatry as well as foot and ankle surgery, so you likely know a few things we common shoe enthusiasts don’t. Our lower extremities handle movement and weight distribution, but how does the human foot differ from the hand?

Matthew Wohlgemuth: The foot is similar in many regards to the hand in that it has main bones of varying shapes called tarsal (in the foot) or carpal (in the hand) bones that are at the start of each foot/hand. Then they have metatarsals (foot) or metacarpals (hand) that are long bones to connect the tarsals/carpals to the phalanges, which are the fingers/toes.

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Credit: The Project Gutenberg eBook of On the Relations of Man to the Lower Animals, by Thomas H. Huxley

 

In this part of general anatomy, the structures are very similar except that the foot has larger tarsal bones than the hand’s carpal bones and the long bones (metatarsals, metacarpals, phalanges) are longer in the feet and gradually start from a higher point and come down on an angle. To further clarify, the bones in the hand go fairly straight, but the long bones in the foot start higher up in the air (forms the instep and arch of the foot) and gradually drop down to the ground as you move forward to the toes. This varies from person to person and that is why some people have high arches/insteps and others have flat feet.

The more functional difference between the hand and foot is due to the hand being used for controlled and precise movements like writing, playing piano, etc. The musculature is generally able to give better control as well as that the proportion of the length of the fingers to the rest of the hand is much larger than the proportion of the toe length versus the rest of the foot.

The foot on the other hand, generally can’t do very precise movements and grasp items (there are exceptions), but the structures need to be able to absorb the pressure of the person stepping on the ground. There is supposed to be an arch of the foot, which will partially collapse to help absorb the pressure more than a solid rigid structure. There is a band called the plantar fascia under the foot that helps this process and many people who don’t get proper arch support in a shoe develop plantar fasciitis, which is now becoming much more prevalent. In severe cases, heel spurs can even form under the foot from the constant tension of the plantar fascia on the heel bone (calcaneus).

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(Credit: Webmd.com)

 

This is why it is important to have shoes that have proper stability and possibly arch support to help hold up the foot to prevent these problems. It is unfortunate that most shoes that men buy are completely flat inside and made with inferior materials that don’t have any rigidity. This is part of the reason why arch supports, insoles, or orthotics have become so common, because they are available to help support the foot and in some cases, help correct biomechanical disruptions when walking.

 

VR: Canvas sneakers, Crocs-like “footwear”, and running shoes are the obvious choices today. The first two lack support and the last one cushions the step greatly. Do these choices often lead to foot problems you’ve encountered in your study cases or patients?

MW: In terms of these alternate types of “footwear” there are both pros and cons.

Canvas sneakers and crocs are both very breathable. The canvas is a light and easy material to keep and the crocs have open perforations to allow air exchange between the inside of the shoe and the outside air. The benefit here is that can help the moisture build-up that leads to fungal infections like athlete’s foot (Tinea Pedis) or fungal nails (onychomycosis).

The con to Crocs is that they don’t give support. Many people will just slip around in the Crocs, which can cause injuries in the future, if they are worn so often, especially in someone who moves around quite a bit for work. They are still somewhat popular as summer shoes at the beach and in the health care field (they are very easy to clean), but more medical professionals are now using clogs, which have a natural arch support and rigidity to help support the foot better. Plus the small increase in heel height is actually good for most people’s foot types. Most people don’t have a heel bone that is at the exact same height as the front of the foot (Anterior Cavus, Posterior Cavus, etc.), so a small heel will actually allow the plantar fascia and Achilles tendon to relax slightly, which can help relieve and even prevent pain, from the heel bone being on the floor for extended periods of time.

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This case is an extreme but shows the concept of having different heights for the front and back of the foot (Anterior Cavus).

 

Canvas shoes, on the other hand, are usually flat for the heel, which is okay for some people, but in many cases can lead to an over lengthening of the plantar fascia and Achilles tendon, which can lead to pain in many patients. Those flat type shoes are usually one of the first things that I correct in patients. There is not a problem wearing them on occasion, but a normal basis is usually too much for most people.

Running shoes are another beast entirely. There are many different families of running shoes so I will just keep this part brief.

There are extremes like minimalist or bare foot running shoes. They are not necessarily bad at all, but they are not a good choice for most people. The purpose of these types of shoes is to feel like you are running barefoot and have complete control of your step, while still protecting your feet from rocks, glass, etc. The problem is that the runner needs to strengthen their lower leg and foot muscles to get the full benefits of them. There are many muscles that enter the foot from the leg and then some muscles that are entirely in the foot. Many of these foot muscles are not fully utilized and that is what these types of shoes will do. They also are quite flat, so they will not work well for people who have these uneven feet that I previously mentioned.

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Vibram’s 5 Finger Shoe is a barefoot style/minimalist shoe

 

Then there are the normal cushioned running shoes that are soft and have added protection for most people. These are the most common types of running shoes and usually do not cause a problem for most people. Yes they are soft, but it gives further protection for whoever wears them, and if the person needs added arch support or even a custom orthotic to correct their gait, these sneakers are great choices. They still have plenty of support if you get shoes that are of high enough quality.

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Asics Gel Nimbus 17 is a top-level cushioned running shoe. It is a comfortable all-around running shoe.

 

The next type is a stability shoe. It does just what the name suggests and gives a more rigid and stable support structure to run on. They usually have some stiffer materials utilized as well as the actual outsole of the shoe has more dense materials used to hold up the collapsing foot. These are fine for most people as well, especially if they don’t want too much cushion. They are also a great option for people who tend to over pronate. Pronating is the process of the foot partially collapsing to absorb pressure. Pronation is normal but many people pronate too much, which is what lengthens the plantar fascia (as mentioned earlier) and can cause foot pain.

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Asics Gel Kayano 21 is a top-level stability shoe. This works well for mild to moderate over pronators.

 

The final major type of running shoe is the motion control shoe. They basically are using the same concept as a stability shoe, but are much more bulky to really hold the foot in the position it is in. They are not recommended for most people, unless they pronate to the level of pain or are very overweight, since these extra additions of dense materials will support the force that the runner’s body places on the shoe.

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Asics Gel Fortify is a top-level motion control shoe for severe over pronators. You can see the very thick outsole and the darker grey in the very dense materials used for the most supportive part of the outsole. This is not recommended for people besides those who are overweight over pronate severely.

 

It is a shame but, at least in the US, one must be willing to buy shoes that have a list price of $100 or more at this time to get a shoe made with the superior materials, and one that will actually last for some time. Most of the lower-priced shoes do not have the full support that they need because there is so much cost cutting, and many of those cheaper pairs are made just for the individual retailers to give budget options. It is actually not even worth buying those cheaper shoes unless you have no foot problems and don’t use sneakers often. If you exercise on a normal basis, it is well worth it to buy the $100+ shoes, just for the more sturdy construction method alone.


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