Health

From the Bottom Up

May 27, 2014

bottomUp_featOver my 17 years as a trainer, and drawing on my own personal experience (my feet), I can’t give enough emphasis to how important and good pair of shoes are. I still remember when one of my personal training clients came to see me 16 years ago.

One of his complaints, soon after he got started with his daily walks (we started with 6 minute walks 4 times a day as his level of fitness was incredibly low and he was carrying a lot of weight) was that he was having lower back pain that hadn’t been there before. I looked at his shoes before anything else and he told me that they were about three years old. That same day, he replaced them and within 48 hours, those aches and pains in his lower back disappeared.

Not long after, Mendel joined my program. He also was very heavy but began walking 15 minutes twice a day. After 10 days of his routine, his knee started hurting. My first check was, again, his shoes. And they too were old and worn. He quickly purchased a new pair and his pain also disappeared.

Although we tend to think of back pain, hip pain, knee pain and ankle pain as local problems, in many if not most cases, the problems all come from the bottom up—from your feet. Shulamit had lower back pain and discomfort often, she got new shoes and also started wearing custom fitted orthotics in her shoes and her lower back has been fine ever since.
Every time our feet hit the ground, a chain reaction of force begins. There are 5 stages to each step we take:

  1. Heel Strike
    The heel strike phase starts the moment when the heel first touches the ground and lasts until the whole foot is on the ground (early flatfoot stage).
  2. Early flatfoot
    The beginning of this stage is defined as the moment that the whole foot is on the ground. The end of the stage occurs when the body’s center of gravity passes over top of the foot. The body’s center of gravity is located approximately in the pelvic area in front of the lower spine when we stand and walk. The main purpose of the “early flatfoot” stage is to allow the foot to serve as a shock absorber, helping to cushion the force of the body weight landing on the foot.
  3. Late flatfoot
    Once the body’s center of gravity has passed in front of the neutral position, a person is in the late flatfoot stage. This stage of gait ends when the heel lifts off the ground. During “late flatfoot” the foot needs to go from being a flexible shock absorber to being a rigid lever to propel the body forward.
  4. Heel rise
    As the name suggests, the heel rise phase begins when the heel begins to leave the ground. During this phase the foot functions to move the body forward. During this phase of walking the forces that go through the foot are quite significant often 2-3x a person’s body weight.

    This is because the foot creates a lever arm (centered on the ankle) which serves to magnify body weight forces. Given these high forces and considering that the average human takes 3,000-5,000 steps per day (an active person commonly takes 10,000 steps/day) it is not surprising that the foot can easily develop chronic repetitive stress related problems.

  5. Toe off
    The toe off stage begins as the toes leave the ground. This is the final stage when breaking down walking. The defining difference between walking and running is that during running there is a period of time when both feet are off the ground. Also because running is associated with greater speeds the forces that go through the foot when it lands can be substantially greater than during walking, often 4-5 times body weight during running and even up to 6-7 times body weight during sprinting.

    When anything interrupts the natural walking process—high arch, flat feet, etc.—your feet, ankles, knees, hips, pelvis and lower back become out of line and that is where problems begin. Pains in any of those areas and shin splints are common.

  6. ORTHOTICS
    Having the right shoes is usually enough, but many people have flat feet or high arches and although the proper shoe goes a long way toward helping them, they need more of a correction than the shoe can take care of. They need orthotics, and good quality, custom-casted are the type I am referring to. After breaking in your orthotics your walking gait will begin to correct itself.

    There are many stories of doctors focusing on the area of pain instead of the looking at the biomechanical picture. Treating the root cause is very important. A good podiatrist who deals with biomechanical problems and is familiar with sports medicine can cast your feet for orthotics and then have them made and fitted for the problem. Once they are broken in, you usually see the problem gradually resolved.

    There are many different kinds of orthotics and there are different ways of casting your feet for them (positive pressure or neutral pressure). Your podiatrist will know which is best for you.

    The shoe that you choose for yourself must be the one that fits you the best. Although there are many top-brand shoes on the market, not all of them are made the same way. You should always stick with a good quality shoe, but make sure it fits you well. When you try on your shoe in the store, make sure it is comfortable. It should be slightly snug without being tight and should give you cushion and stability. A shoe that is too big can cause blisters and can be unstable and something too tight can cause pains and ingrown toenails. A good sturdy pair of proper walking or running shoes is essential and they need to be replaced about every 400-500 miles of walking. For most active people, count on about half a year out of a pair of shoes.

    With all the money we spend on exercise equipment, the one place that you should certainly invest in quality is in a pair of shoes because it is really the only piece of exercise equipment that is essential. Taking care of your feet by investing in the right pair of quality shoes will “add hours to your day, days to your year, and years to your life.”