An Osteopathic Physician’s Perspective
Shoes are not designed to mold to the shape of our feet. Instead our feet are forced to mold the shape of your shoes. Over time, our feet lose their pliability. The interesting thing is that when pliability is lost, it becomes more painful to walk without shoes. Some people interpret this as evidence that walking barefoot is not good for them. Any time the distance between attachments of muscles is changed, weakness takes place. As humans, we abuse our feet a lot. Society has determined that high-heels and the unnatural gait they produce are “sexy.” Overall we are more concerned about fashion than we are about our overall health. As an osteopathic physician, I want to describe some strains that I have found almost universally on my patients. Upon research, I have determined that there certain designs in most shoes that are strongly to blame.
- Compressed Toes: Look at your toes. Do you have space between all of your toes? Chances are you probably do not. Over time people develop toes that overlap or have indentations of their toes if they separate them. This also leads multiple problems including bunions as your big toe is chronically bent towards the middle of the foot. The feet of those who never wear shoes naturally have space between their toes. The rest of us have our toes crammed by our shoes. Shoe makers make shoes pointed at the front because “it looks better.” As your toes become compressed, they become less functional. Most people cannot curl their toes without getting foot cramps. I find Correct Toes to be the best spacers to help this problem along with wide-flexible shoes that have wide toe boxes like the Vivobarefoot brand.
- Narrow feet: A wider base is more stable than a narrower base, but wider shoes are not considered attractive. Therefore, we wear shoes that are narrower than our feet. Over time the small muscles between the long bones of the feet, the metatarsals, become permanently contracted. In addition the small bones, the tarsals, in the foot become compressed and lose their range of motion. The result is that we end up with narrowed feet that lack pliability. I have found that releasing the tension (view article for instructions) in the small muscles between the metatarsals helps to restore some range of motion to the tarsal bones, relax chronically tight calf muscles, and sometimes even into the sacroiliac (SI) joints.
- Diminished heel range of motion: Because shoes produce a heel striking gait, the heel absorbs the shock of each step. The heel is not designed to absorb shock. Driving your heel into the ground with each step causes the heel to not only become compressed upward into the ankle, but also driven backward. Over time, the heel can get struck like that permanently. A problem at the joint between the heel bone and the foot bones can refer pain to the bottom of the foot which can mimic and is often misdiagnosed as plantar fasciitis. In addition, the heel has attachments for the plantar fascia and the calf muscles via the achilles tendon. Therefore a dysfunction at the heel will lead to chronic tightening of any muscles associated with it including the calves and problems further up.
- Tight plantar fascia: The plantar fascia is a tough connective tissue from the toes that anchors into the heel. Because the plantar fascia is associated with the toes and heel bone, it responds to the dysfunctions associated with them like muscles by contracting. Therefore, the more the foot changes its shape, the more the plantar fascia will tighten. In addition improper use of the heel by heel striking can irritate it and lead to inflammation which can be another cause of plantar fasciitis. To make things worse, the arch supports in shoes abnormally stretch the plantar fascia irritating it further.
- Dropped metatarsals: If you ever watch a woman walk in high-heels, you’ll notice that with every step the balls of the feet are driven downward towards the ground and the toes driven upward at an abnormal angle. Over time this permanently changes the joints at the balls of the feet. What happens is the balls of the feet drop, becoming exposed and painful to walk on. This is called metatarsalgia. This is much more pronounced in high-heels but also occurs with most shoes. If you rest your shoe on a flat surface, more often than not the tip will angle up. This is because shoes, including sneakers, are so rigid and immobilize your feet therefore the shoe is built with this “rocker” effect. This feature pulls your toes upward constantly when you are wearing shoes and can produce metatarsalgia.
The solution to most of these problems is to work to maintain pliability and strength at your feet and specifically at the structures mentioned above. Chronic shoe wear leads to specific changes in the foot that cause it to lose pliability and function the way it was originally intended to. This can lead to many foot ailments that are blamed on other things. Besides the ideas mentioned above, I have found that many of these changes have to be addressed with very specific osteopathic treatment.