Chiropractor Chandler AZ
As healthcare providers, we encourage our patients to make exercise part of a healthy lifestyle. Both running and walking are relatively inexpensive and can be done either inside on a treadmill or out of doors. Unfortunately, many people, especially those new to physical activity, purchase shoes that either don’t fit properly or don’t offer adequate support. Both can lead to musculoskeletal injuries. Helping your patients understand how running/walking shoes should fit and determine the proper amount of support will keep them moving injury-free.
Individuals accustomed to snug-fitting dress shoes may not understand the need for a roomy toe box in exercise shoes. A person’s foot will swell up to ⅛ of a size during exercise. Therefore, the shoe should be snug through the heel and “waist” of the foot around the arch, but roomy in front, with at least half a thumbnail length beyond the longest toe. In addition, the sole of the shoe should fully support the foot. If a person has a wide foot, it is common for B-width shoes (women) or D-width shoes (men) to lack the necessary width in the forefoot. Many athletic shoe companies including Brooks, Asics and New Balance offer their popular models in widths for this reason.
To determine how much support the person needs, you will need to perform a quick gait analysis. Ask the person to stand in their bare feet with the feet shoulder width apart. Look at the feet from the back. When the patient performs a half squat, do the arches collapse or do they continue to support the foot?
Now ask the patient to walk or run back and forth across a 50-yard area. You are looking for the angle of pronation: the angle created by the arch of the foot collapsing in during the transition from landing to toe-off. Ideally this angle should not be greater than 5 degrees. If you notice that the person is rolling in excessively, he or she may need a stability or motion control shoe.
Pay attention to where the person lands. Most people are heel strikers, but you may encounter the occasional forefoot striker, particularly athletes who have participated in ball sports such as football, soccer and rugby that involve a lot of sprinting. In general, these people are best served by a neutral cushioned shoe, no matter what the foot structure.
In addition, take a look at the patient’s Q-angle: the angle from the hips to the knees. Men will tend to have a narrower Q-angle than women, and persons with a relatively long torso and shorter legs will tend to have narrower Q-angles than those with long legs and shorter torsos.
Why is this important? A common mistake in gait analysis is to limit the evaluation to foot structure, assuming that a person with flat feet will need a great deal of overpronation support. However, a person with a wide Q-angle may land more neutrally than their foot structure would indicate. In this case, putting the person in an overly supportive shoe could lead to problems with the IT band, or the bursae on the lateral side of the knee.
Running shoes offer three types of support:
Neutral cushioned shoes simply cushion the ride and in some cases offer a modest amount of arch support. This type of shoe is ideal for a person who either has a neutral gait pattern or who underpronates (also known as supination).
Stability shoes offer moderate pronation support.
Motion control shoes offer maximum support for persons who are heavy overpronators.
Another common mistake is to assume that a person who is large-framed or overweight needs more pronation control in their running or walking shoes. This is simply not true, and too much support can lead to injuries as serious (if not more so) than too little.
Silly as it might sound, blisters can derail a person’s exercise program as easily as a torn ligament, particularly if this person is new to exercise. Blisters can be a serious health hazard for diabetic patients with peripheral neuropathy who may or may not be aware of skin lesions, increasing the risk for infection.
The best way to prevent blisters is with moisture-wicking socks, available at running specialty stores. These come in a variety of styles: the sock that feels best to the patient is the best choice.
The athletic world has embraced compression socks and calf sleeves as an easy method to add extra support for the foot and lower leg, enhance blood circulation and shorten recovery time after hard workouts. Consult your local running specialty store to learn more about available products.
Athletic shoes have limitations: a big one being that they cannot correct for two feet that don’t move in the same way. This is often the case when a person has a functional leg length discrepancy, or has had a serious musculoskeletal injury that permanently altered the function in either the legs or one of the feet. Patients who have undergone joint replacement surgery will often have changes in biomechanics that result in two feet that act differently during walking or running.
In this case, the best “fix” is a custom orthotic insert. By custom, we do not mean an off-the-shelf insert available at a running specialty store. These work well for persons who need additional arch support, but they cannot correct for two feet with different types of motion during ambulation.
Custom orthotics are expensive, and are often not covered by insurance, so it’s important to establish a relationship with a provider you trust. Podiatrists and some physical therapists fit orthotics. A good place to find recommendations is the local specialty running shop.
In addition to correcting for footstrike abnormalities, custom orthotics can be helpful for individuals suffering from peripheral neuropathies (e.g. T2D). In this case, an endocrinologist who is in-network with most insurance providers is a good source for references.