Foot Care Overview

Who has foot problems and why?

“Over 66% of North American’s feet hurt on a regular basis”
– American College of Foot and Ankle Surgeons (ACFAS)

“More women (74%) than men (57%) surveyed said their feet hurt, and more women (75%) than men (39%) said their feet hurt when they wear certain shoes.”
– American College of Foot and Ankle Surgeons (ACFAS)

“High heels and improperly fitting shoes are to blame for 90 percent of foot deformities and ankle injuries suffered by American women,” said Dr. Schuberth. “High heels place undue pressure on the forefoot and have been shown to lead to bunions, hammertoes, heel pain, and other ailments.”
– American College of Foot and Ankle Surgeons (ACFAS)

“75% of North Americans will experience foot health problems at one time or another in their lifetimes”
– American Podiatric Medical Association

“About 19 percent of the US population have an average of 1.4 foot problems each year”
– American Podiatric Medical Association

“…an estimated eight out of ten people in the U.S. have undetected gait problems that cause sore feet, aching backs and hips, and pains in the leg and neck.”
– Gait Analysis Steps Into New Fields, Mechanical Engineering

“Less than 3% of habitually barefoot populations exhibit foot-related problems and almost none of these are debilitating.”
– Shulman S., Survey in China and India of Feet That Have Never Worn Shoes.

“All writers who have reported their observations of barefooted people agree that the untrammeled feet of natural men are free from the disabilities commonly noted among shod people – hallux valgus, bunions, hammer toes, and painful feet.”
– Stewart SF., Footgear—Its History, Uses and Abuses, Clinical Orthopaedics and Related Research

“In unshod communities the foot muscles get freedom for exercise and the joints remain supple. This is why functional disorders of the foot are so rarely seen in such people.” I sometimes like to look upon closed shoes as braces …which takes up the work of muscles causing them to atrophy from disuse and make the joints stiff.”
– Sethi PK., The Foot and Footwear. Prosthetics and Orthotics International

“Natural gait is biomechanically impossible for any shoe-wearing person. Natural gait means the pristine, ideal state; the ideal form and function stemming from nature itself.

Conventional footwear is designed around “Normal” foot function ideologies that are based on the accumulated observations of shoe-wearing populations. “Normal” being an accepted standard, means, or average.”
– William A. Rossi, Podiatrist

“Unfortunately, my profession, which initially arose to treat the problems caused by shoes, has largely focused on the shoe rather than the foot. We are brilliant at mitigating some of the adverse effects of shoes, and of course treating the pathologies & deformities which shoes inevitably cause! I only realized about two years ago that most feet can function perfectly well, in fact actually function optimally, without shoes. The medical and scientific evidence spanning over 100 years proves that shoes not only damage feet, but increase the risk of pathology in ankles, knees, hips & backs.”
– Steve Bloor, Podiatrist

Historical Views

More than 500 years ago, Leonardo da Vinci asserted, “The foot is a masterpiece of engineering and a work of art.” His statement stands in stark contrast with the prevailing view, widely promoted by footwear, insole, and orthotic marketers, as well as many health care professionals, that the foot is poorly designed and requires artificial support and/or cushioning to function properly.

The “foot is poorly designed” theory first surfaced in the mid-1800’s, accompanied by foot function “NORMS” as defined by practitioners of the day. These hypotheses have remained virtually unchanged over the years, sustained by a mountain of white papers and journal articles. In 2000, the Journal of the American Podiatric Medical Association challenged the reliability of these articles, noting that only 1% of the 322 articles reviewed displayed consistent, reputable, and scientific evidence-based information. The authors concluded that the majority of these published articles focused on generating rather than testing hypotheses.

The structure of the foot and its biomechanical function have been commonly referred to in medical journals, studies, and in consumer publications as being of poor design and function, therefore susceptible to injury. Another common statement is that most foot dysfunctions and resulting pathologies are hereditary. These two myths have been perpetuated within the medical community simply by their repeated exposure in these mediums, notwithstanding the fact that there are very few scientific studies to support these hypotheses. In fact, an abundance of research demonstrates otherwise.

There is much debate about what constitutes normal foot function and how “NORMS” are determined. It is important to note that the currently accepted “NORMS,” as defined in most medical literature, were derived from studies on foot function and gait conducted mainly on sample populations that have worn shoes since childhood. For the most part, these NORMS have been one of the “tools” used to identify the causes of various pathologies and have traditionally formed the foundation of associated treatment options. Furthermore, they have played an integral role in the development of footwear designs and orthotic devices.

Significantly, the NORMS derived from studies on predominantly unshod populations show drastically different trends with respect to foot function. The difference between NORMS derived from shod vs. unshod populations is similar to comparing function and range-of-motion between:

  • a limb that has been immobilized by a splint or cast for several years, and
  • a limb that has experienced unfettered movement over the same period of time.

It is obvious, even to a layperson, that the chronically restricted limb would be weaker and exhibit joint stiffness with an associated limited range-of-motion. Additionally, the restricted limb would be incapable of many of the tasks that would be easily managed by an unfettered limb.

Therefore NORMS, with respect to foot function and upon which the efficacy of standard therapeutic practice is based, are themselves biased. As a result, the accuracy and applicability of a majority of current foot care research is questionable.

For example, most textbooks, journals, and studies refer to the terms “pronation” and “supination” when describing foot function NORMS.

The foot’s weight bearing or stance phase of motion is most commonly described as consisting of pronation in early stance in association with lowering of the medial longitudinal arch, followed by a progressive supination in association with raising of the arch. The foot has been described as behaving much like a twisted plate, in that the arch rises or lowers according to counter motions of the rear foot and forefoot segments. According to Hunt, et al., “…these commonly defined NORMS are largely speculative, as they are based on the application of static experiments or unquantified observations. Furthermore, they have been applied to the motion of foot segments and bones, although no data yet exists to provide a description of typical inter-bone motion during walking.”

Common Foot Care Myths

Cushioning reduces damaging shock and stress.

Orthotics correct faulty foot biomechanics.

It is important to wear good supportive shoes.

A Closer Look at Human Physiology

To better understand foot function, we must first examine how the feet should ideally function from a biomechanical/neuromuscular perspective. Once this is clearly understood, the negative environmental influences that lead to a disproportionate number of pathologies in shoe-wearing populations can be examined in context. Preventative measures can then be developed and new, more effective treatment options can be implemented.

Healthy and unhealthy foot function, like the function of all parts of the body’s physiological structure, is defined by the tenets of human physiology. Human physiology is separated into subcategories that cover a vast amount of information, including:

  • how the organs and systems work within the body,
  • how these systems work together for healthy function and survival, and
  • how the body adapts to different environments.

From a physiology perspective, the major biological systems that are principally involved in human body movement are:

  • The Musculoskeletal system, which includes the skeleton, muscles, tendons, ligaments, cartilage, and connective tissue. The skeleton, cartilage, and ligaments provide form and support for the human body; the muscles and tendons affect the skeletal movement and stability; and the connective tissue helps to support and bind the aforementioned together.
  • The Nervous system, which is divided into two parts: the central nervous system (brain and spinal cord) which combines information for the entire body and coordinates body activity; and the peripheral nervous system which includes all of the nerves that branch out from the brain and spinal cord and extend to all parts of the body, including muscles and organs. Both parts of the system play a vital role in how information is communicated throughout the body, including information related to the senses, memory, emotion, movement, and thought.

Integral to, and synergistic with, the nervous system is the body’s innate intelligence – the natural protective reflex mechanisms that protect the body from harm.

The Musculoskeletal and Nervous systems work in synchronized harmony when controlling the movement of the body and its parts. Collectively, they are called the Neuromusculoskeletal system.

While the circulatory, digestive/excretory, and respiratory systems are responsible for “fuelling” the Neuromusculoskeletal system, their functions are outside the scope of this discussion.

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