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The Emperor’s New Shoes

Posted Mar 18 2010 6:52am
The two most important parts of the body for a triathlete are the feet. They carry one’s body weight while running to the water, act as propellers during the swim, provide a platform to pedal, and pound the ground for miles while running to the finish line. And when the race is over they bring you to the podium, car or most importantly, the post-race party!

Realizing this, the knowledge of how to preserve the integrity of one’s feet becomes paramount in getting to the starting line of the next race. Unfortunately, fashion and business have dictated the construction of footwear, which has led to the most common ailments that sports podiatrists see in athletes everyday.

The average person logs over 110,000 miles on their feet while walking during their lifetime. An athlete, particularly a triathlete can exceed this mileage within a year between regular daily activities, and training, with the difference being the force exerted on the foot during activity.

For the athlete it is three to four times the body weight of the individual. This means a 125lb female runner will exert about 500,000 lbs of force, on her feet, over every mile. Add that up over an athlete’s life and the importance of understanding how to care for ones feet is truly exemplified.

Therefore, it comes as no surprise that the body created such an organized matrix in each foot consisting of 26 bones, 33 joints, 107 ligaments and 19 muscles. Still 75% of all people living in the U.S experience a foot injury in their lifetime. This compared to the 3% of the population in countries that do not wear shoes. Why? The answer as Dr. Ray McClanahan, DPM, BS Ed, sports podiatrist and duathlete explains, ‘is directly caused by improper footwear,’ stating that, ‘every shoe available to us on the market is not made correctly.’

Although popular thought differs in the cause of the most commonly seen foot ailments in athletes the injuries remain the same. Dr. Lloyd Nesbitt, DPM, and former President of the Canadian Podiatric Sports Medicine Academy identifies a few of the top ones as being Plantar Fasciitis, Patello Femoral Syndrome, also known as Runner’s Knee, and Neuroma. Practically 80% of all triathletes will have experienced one of these in their career.

Plantar Fasciitis is an inflammation of the ligament that runs from the heel to the ball of the foot. This is typically experienced first thing in the morning or after remaining in the same place for an extended period of time. The pain is generally felt in the heel and at times in the arch.

Runners Knee, or Patello Femoral Syndrome, is the irritation felt under the kneecap as a result of it moving from side to side. Generally, this is experienced only while running, but in severe cases can be the source of constant pain even when walking.

The third, but by no means the last of possible ailments that a triathlete might experience is, Neuroma. This is a pinched nerve that swells and normally occurs in the forefoot (extending to two of the toes). It is experienced by sharp, stabbing pains that are intermittent, (but can also cause cramping, burning, stinging or numbness).

Treatment for all of these is usually the same amongst all podiatrists. The first is to reduce the activity that is causing the pain. For a triathlete, that means you might have too spend a bit more time in the pool or on the bike if running is the problem.

The next step is RICE: Rest, Ice, Compression and Elevation of the affected area. From here the treatments range from footbeds and pads, having orthotics made, to shots of cortisone and in the most extreme cases, surgery. A sports podiatrist is one of the best ways to determine what course of treatment an individual needs.

Although advanced medicine has been able to identify, name and treat these problems, it is the prevention of them that will keep a triathlete staying on their feet for the length of their career. Prevention is a long road with a fork that is very close to its beginning. With the dominant source of information coming from the manufacturers of athletic shoes, it is a simple look at basic human anatomy and structure that reveals how a shoe should really be made.

The idea of ‘heel-striking’ or ‘heel-to-toe’ running may be viewed as the fundamental problem. Dave Scott and Wes Hobson addressed this in their May 5, 2003 online chat on InsideTriathlon, both being in agreement that they do not believe in this philosophy of running. Unfortunately, this is the pretense by which running shoes are made. Dr. McClanahan identifies three major areas in athletic shoes that perpetuate this running style and its associated ailments noting, ‘9 out of 10 foot problems are a result of such design flaws.’ These are tapering toeboxes, toespring and heel elevation.

The tapering toebox is evident in almost all cycling and running shoes and as McClanahan points out, ‘there is absolutely no scientific evidence that supports a tapering toebox has any beneficial biomechanical advantage.’

Examine the structure of a baby’s foot when it is born, or better yet, look at the footprints on your own birth-certificate. You will notice that the span of toes and forefoot is wider than the rest. Toes play an important role in balance while walking and especially running. Squeezing them and the forefoot into a tapering toebox requires our bodies to compensate in other areas which subsequently leads to foot problems such as: black toenails, blisters, bursitis, heel pain and more.

Joe Umphenour, professional triathlete, illustrates this by immediately getting his feet into something ‘with a bit more space’ after a race because ‘they are so beat-up.’

In addition, shoe design keeps toes elevated above the supporting surface of the ground, called toespring, further forcing the ‘heel-to-toe’ running method. This contradicts the natural alignment of our feet and offsets the internal balancing system that the foot’s tendons operate on.

This imbalance can lead to deformities of the toes known as hammertoes, as well as problems in the lower leg and knee. Dave Scott supports this by stating this philosophy of running, ‘puts a huge load along the muscles that parallel your tibia.’

If the tapering toebox and toespring were not bad enough, add in heel elevation, and athletic shoes become a recipe for foot disaster. McClanahan identifies the problem of heel elevation by stating, ‘the most significant foot fault caused by elevated heels is that shortened posterior leg muscles pull improperly on the back of the heel to increase unnaturally the amount of flattening the arch will undergo.’

Essentially, this drastically increases pronation of the foot and ankle, which has been known to induce the majority of foot problems. To compensate, shoe companies created motion-control technology for heel design. Unfortunately, stabilizing the heel only makes the foot weaker and does not allow the ankle to strengthen and develop properly. Think about having your foot in a cast, does all that loss of motion make it stronger? The answer is an easy, No.

Consequently, proper shoe fitting is the most important preventive measure an athlete can take to ensure the integrity of their feet. The first step in doing so as Dr. Nesbitt suggests is to ‘align yourself with a store that employs a knowledgeable fitting service.’

Dr. McClanahan agrees and says your foot should be ‘measured for both length and width.’ This is not only the length from heel to toe but also the length of the arch, from heel to the ball of the foot. He does add that this ‘is only scratching the surface.’

Every athlete should visit a sports podiatrist for a full exam to help identify any deficiencies. But there are a few general guidelines to help find the right fit for your athletic shoes.

For running, you should have a ½ inch space from the tip of your longest toe to the front of the shoe. Also, the shoe should bend at the ball of the foot very easily. Finding a shoe that does not have one of the above-mentioned features will be very difficult and as a result McClanahan performs ‘surgery’ on the athletes shoes that he works with by widening the toebox and grinding down the heel. As a result, his athletes have not only eliminated foot problems but have also increased their performance.

Cycling is a bit different although a lot of the design flaws are the same. Miles Romanow, service manager at Bikehampton in Sag Harbor, N.Y fits between 2 and 3 dozen cycling shoes per week and suggests a (‘comfortable fit’) for riding. ‘A cycling shoe should hold and support your foot, with (about) 2-3mm of space from your toes to the front of the shoe,’ says Miles. Reason being is that while pedaling you do not want your foot slipping back and forth, adding ‘you also want zero heel slippage.’ (Otherwise, make sure that your toes have the space they need.)

Miles has heard a host of foot injuries from his clients and relayed one story in particular about a guy who thought cramming his toes together would produce more speed, but all he saw were calluses between his toes and red feet.

Socks, footbeds and orthotics can also play a role in shoe fitting. ‘Cotton Kills,’ is an old adage that outdoor athletes live by for their clothes, but for some reason does not make it down to the socks. Wicking moisture away from the skin can prevent a host of foot problems from blisters, to fungus, and warts. Cotton socks do nothing but promote an environment for this to happen. A wool or synthetic blend is your best option here.

Footbeds can also help as Joe Umphenour feels that his footbeds allow him to run even though he has a partially fused ankle joint. Orthotics is another option but one really needs to see a specialist to determine their necessity.

Africans are the dominant runners of today and they come from a country that is not a shoe wearing population. As a result they run from the mid-foot and not heel-to-toe. Changing one’s ways can be difficult, especially for an athlete, but preserving foot integrity should be part of training 101.

The persistence of foot injuries today lends no support to the way athletic shoes are made. Only personal experience and specialists who are also athletes can encourage and help change the way shoes are constructed. In doing so, an athlete can that they will stay on their feet for their lifetime.

If a shoe does not fit correctly, even the most technological bells, whistles, straps and snaps won’t guarantee anything—except sore feet. It is difficult to provide a single method of finding the right fit, but there is one iron-clad guideline that all foot professionals espouse. “Make sure that you are fitted by someone who understands the biomechanics of feet,” says Karen Schwartz, a Certified Pedorthist and owner of Sage to Summit, a running store in Bishop, California.
Here are some guidelines for finding a proper shoe that Dr. Ray McClanahan suggests
- Purchase shoes in the evening or post-run to ensure a proper fit. Feet tend to swell during runs and throughout the course of the day.

- Make sure you have a snug heel and instep and that there is plenty of wiggle room for your toes. There should be about one half inch from the

- A good running shoe should bend easily at the ball of the foot.

- Tapering Toe Boxes. Some toe boxes taper so abruptly that they compress the toes together. “There is no scientific evidence that indicates that a tapering toe box has any biomechanical advantage,” says McClanahan. “Our toes play an extremely important role in our sense of balance—especially when trail running.” How to tell: remove the shoe’s insoles and stand on them, with socks that you intend to wear while running. Spread your toes apart. No part of your foot should extend beyond the insole.

- Heel Elevation. Look out for a shoe heel that is elevated above the ground. This can contribute to problems similar to those caused by an elevated toe box.

- Toe Spring. The shoe’s toebox is sometimes elevated so far above the ground that it creates uneven distribution of force between the tendons on the top and bottom of the foot. This leads to unequal strength of the tendons between the two and along with a tapering toe box and heel elevation causes deformities such as hammer toes.

Keeping a low profile- Paul Langer, a podiatrist and running-store owner from Minneapolis, Minnesota, notes, “The foot has better proprioception [the process by which the foot’s tendons and muscles quickly adapt to changing terrain] and stability if it remains closer to the ground. Elevating the foot from the ground increases the risk of ankle sprains and makes the foot less able to adapt to uneven terrain.”


The above article was written by Adam Kelinson, a professional chef, three-time Ironman, and the founder of Organic Performance , a nutrition consulting company.

I worked with Adam's brother for years, and he kept telling me, 'Susan, I
really need to introduce you to my brother ... you have so much in common.' Well, thankfully that introduction was made and I feel very honored to have had Adam submit a guest posting.

Adam has cooked and consulted for athletes, celebrities, and business executives. He has written on diet and nutrition for TrailRunner, Inside Triathlon, xtri.com, Dietwatch.com, and is the Nutritional Director for the Silverman Full Distance Triathlon. Most recently, Adam has written The Athlete's Plate: Real Food for High P erformance , a no-nonsense cookbook that makes it easy to eat well and healthy.

Train hard; stay strong.

Peace.

Susan

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