The Minimalist- Proper Footwear

Modern Day Minimalist Footwear

A very smart doctor by the name of William A Rossi once stated “Natural gait is biomechanically impossible for any shoe wearing person. It took 4 million years to develop our unique human foot and our consequent distinctive form of gait, a remarkable feat of bioengineering. Yet, in only a few thousand years, and with one carelessly designed instrument, our shoes, we have warped the pure anatomical form of human gait, obstructing its engineering efficiency, afflicting it with strains and stresses and denying it its natural grace of form and ease of movement head to foot.”. (Podiatry Management, 1999)

Outdated Thinking on Foot Support

Most health professionals, who are taught to promote footwear with stability, arch support, cushion, and pronation in an effort to remove as many natural stressors as possible, would probably consider Dr. Rossi to be completely insane with his above statement. Yet, in spite of our advanced footwear, recent statistics report that 75% of Americans experience foot health problems at some point in their lives and 65% of runners will develop a foot or leg problem within the first year of running. Could it be that Dr. Rossi was on to something?

While I too was taught the importance of shoe stability and support, my time spent working as a Chiropractic Sports Physician has indicated that Dr. Rossi was quite accurate in his assessment of the modern-day shoe. Just as walking around in a back brace all day would eventually result in a weakened core and possible back injuries; constantly moving around in overly-supportive footwear can severely weaken foot structure. In addition to overly supportive footwear, problems can also arise as a result of heel elevations (or high heels in women), shoes with tapered toes, and other features added for the sake of fashion and comfort.

Because I see such a strong link between lower extremity function and common injuries among my patients, I include a gait analysis as part of my thorough orthopedic exam, and in many cases will also examine patients’ shoe wear patterns, structure and stability. These examinations allow me to collect valuable information regarding each patient’s biomechanics and often provide the clues needed to help me understand why patients’ knees, hips, and lower back may be causing pain.

One can quickly see how ineffective our overly supportive footwear is when visiting other cultures where conditions such as plantar fasciitis, bunions, hammertoes, and footwear-induced low back pain are almost none-existent among people who spend their days shoeless or wearing minimalist styles of footwear. If one were to examine the feet of those who haven’t been exposed to years of unnatural shoe confinement, they would find a much different foot shape than the average American’s. You see, at birth the widest part of the foot is at the ends of the toes which are spaced and independently strong and flexible. However, after years of confinement, our feet actually deform so that the widest part of the foot is at the ball with the toes becoming scrunched toward midline and chronically extended. With these adaptations we develop chronically tightened dorsiflexors, stretched and weakened plantar flexors, and a fat pad that is raised and pointed anteriorly, (rather than being under the metatarsal heads, where it would protect the bones and nerves).

Before throwing out your current athletic shoes, there are a few steps that I highly recommend when transitioning to the minimalist style of footwear. For those upgrading to a more functional shoe, the key is to opt for a style that is flat with no heel elevation, wide through the ball and the toe areas, and flexible to simulate the natural movement and flexion of the bare foot. When transitioning into your new footwear, it is vital to first reestablish the “natural” structure and integrity of the feet by stretching the chronically-tightened dorsiflexors and Achilles while retraining the intrinsic muscles of the feet to activate, thus creating the natural arch support. Yoga and walking barefoot in sand or grass are great ways to “train” the feet for this transition. Standing on uneven surfaces such as a Bosu Ball, wrestling mat, or a Dyna-Disc will help to strengthen and activate the proprioceptors required to prevent injuries while the feet are adjusting. Lastly, (and most importantly) I recommend decreasing the degree of arch and stability gradually while slowly increasing time the range of activities performed in the new footwear.

Remember, the feet (and body) function best when allowed to work as nature intended. It seems that once again, our Paleolithic ancestors had it right all along.

-Jason M. Kremer, DC, CCSP, CSCS


From the Doc Paleo Magazine

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