CHAPTER 30

FEET FIRST—

Understanding the Body’s Structural Foundation

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When competing in high school and college, I would sometimes race barefoot. This felt better on the “new” synthetic tracks that were smoother and easier on the feet than cinders. When I ran my first marathon in New York City in 1980, the running shoe industry was manufacturing many good shoes, but that would quickly change due to a change in marketing strategy. Running shoes became laden with all sorts of newfangled cushioning, thick waffle soles, shock-absorption, and rigid heel support. And the gullible running public pounced on this new “more is better” trend, buying shoes that, in reality, contained unnatural foot-bed support systems.

 

 

 

In my own private practice, I began seeing more patients with running injuries. It didn’t take me long to figure out why. Running shoes were crippling runners. It was not unlike cigarette companies promoting “healthy” cigarettes (which, by the way, Big Tobacco did in the ’50s and early ’60s).

I began discussing the running-shoe paradox in my lectures at races—while the shoes were hyped by companies as “injury prevention,” they were doing the exact opposite. In these talks, I cited a variety of published medical studies that provided evidence that shoes often caused significant stress in the feet and legs. To demonstrate this concept to my audience, I would have an athlete run across the stage or up and down the aisle in his running shoes, pointing out the abnormal heavy heel strike that the cushioned shoe sole caused. Then I would ask the volunteer to take off the shoes and run barefoot. To the audience’s astonishment, the athlete’s stride transformed into a beautifully arched and light prance reminiscent of world-class runners.

I also began writing about this topic but encountered heated resistance, especially from running magazine editors. No one wanted to publish articles on the dangers of this new breed of running shoe. Once, I discussed this topic with a long-time editor at Runner’s World; he just kept saying, “there’s no proof, and the shoe companies do research too.” What he didn’t say, and what’s obvious even today, is that running shoe advertisers help pay the bills for his magazine, and in doing so indirectly control editorial.

I never lost my love of barefoot running and would train that way for endurance runs on and off through the years, and especially when I lived near a flat, sandy beach. I also convinced more than a few athletes to run barefoot.

Recently, runners have taken notice of the harm caused by built-up running shoes and are taking the matter in their own hands (I should say feet). The best-selling book by Christopher McDougall Born to Run has influenced this consumer trend toward barefoot running and minimalist, low-tech footwear. Ironically, in 2009, Runner’s World contacted me for a quote about barefoot running, but in its annual shoe review issue published several months after my quote appeared, the magazine featured page after page of new models of thick-heeled, well-padded running shoes. Sadly, the majority of these shoes will cause more harm than good.

While most athletes instinctually know the importance of good shoes, they often take their feet for granted—at least until they start to hurt. Only then do they realize that their shoes were not the best match for their feet. But one’s feet don’t even need to hurt to cause trouble. Subtle muscle imbalances in the foot and ankle, for example, can disturb the delicate biomechanics by putting undue stress on the knee, hip, and spine.

The more we understand about our feet, the better we can care for them and even fix them when their function goes astray. Our feet must last a lifetime. The feet are subjected to more wear and tear than any other body part. Just walking a mile, you generate more than sixty tons—that’s over 120,000 pounds—of stress on each foot! Fortunately, and what’s even more amazing, our feet are actually made to handle such natural stress. It’s only when we interfere with nature that problems arise. Almost all foot problems can be prevented, and those that do arise can most often be treated conservatively through self-care.

From birth until death, our feet are very important in the development of overall fitness and health, but they may be one of the most neglected parts of the body. The feet are our structural foundation. They form the base of our body’s physical stature, and any departure from optimal balance can have significant adverse effects not only locally in the feet but throughout the entire body. These problems are often transmitted through the ankle, an extension of the upper part of the foot. Anatomists technically consider the foot and ankle as two separate areas, but I consider the ankle as a vital part of the foot for ease of discussion. The ankle is a vulnerable area; approximately 25,000 Americans sprain their ankle each day.

While our skeleton is an important part of our structural health, it’s the skeletal muscles that allow us to move. The same is true with the skeleton of our foot—muscle function is a key part of foot fitness and health. The early stages of most foot problems are associated with muscle imbalance. Bone problems, including joint dysfunction, are usually secondary to muscle imbalance. Trauma can cause injury to any component of the foot, including a muscle, bone, ligament, tendon, or joint.

Another important job of the feet is to help balance the whole body. The feet continuously communicate with the brain to regulate the rest of the body’s daily movements, including standing, walking, cycling, running, and other movement. This is accomplished by powerful nerve endings at the bottom of our feet. These nerve endings are developed from infancy and their function is necessary throughout our life. Disturbances of these nerve endings due to trauma, disease, poor footwear, or neglect can lead to further health problems.

The nerve endings at the bottoms of our feet also become a potential source of powerful therapy when properly and specifically stimulated. This approach can be used both preventatively and after some injury is realized. For example, a simple foot massage, even by an untrained person, can be great for your feet and brain.

While many problems in the body are the result of either obvious or hidden foot imbalances, some foot problems themselves are secondary to more primary disorders. When this happens, these secondary foot problems can, in turn, cause other problems, another example of a domino effect.

Examples of problems that cause secondary foot dysfunction include structural faults in the spine and pelvis, muscle imbalance, trauma, shoes that don’t properly fit, over-supported shoes and those with higher heels, and certain diseases such as diabetes, peripheral vascular disease, neuropathy, inflammation, and arthritis.

Foot problems are perhaps the most common type of structural injury athletes develop. And the most typical complaint about the foot is pain. When pain presents in specific areas of the foot, it most often indicates the source of the problem. For example, pain at the top of the foot may indicate a mid-foot fracture, although there may be other causes of this type of pain.

Many foot problems lead to inactivity. An athlete with a foot injury will often experience a complete cessation of training, unless swimming can be used to maintain fitness. Reductions in training, or forced rest, can make an athlete get out of shape fast; it can also lead to changes in metabolism leading to weight gain, circulatory insufficiency, muscle loss, poor coordination, and other more serious disabilities.

Structurally, improper bike and running shoes can alter how the muscles and joints function, not only in the foot but in leg areas above. Knee movement is the best example of this; with improper footwear, the muscles around the knee and the knee joint may move improperly. When this irregular movement continues, the result is some type of knee injury, usually associated with pain.