The Truth Is Out There - But Finding It Is Another Matter!

The one seeming constant pertaining to all cases of children born with TEV is the assurances given to the child's parents - "not to worry, it can be corrected." Besides being patently a false statement, both in terms of what the long-term realities are still likely to be for the child, and in terms of the statement prima facie, it is also a very subtle form of distancing. Let's look at the last part of this statement first - "it can be corrected,"referring, of course, to the foot or feet so affected. Not "your child's feet can be corrected," but "it."

Of course, this means "the deformity." By de-personalizing the problem - de-linking it from "your child," it helps both the doctors and the parents see the TEV as an affront, and invasion, an alien artifact that can, and will, be eradicated, and thus, allow "your child" to live a normal life. I would contend it is this de-linking that permits the pediatric medical community to blithely proceed treating TEV as merely a positional deformity that can be "fixed" with no concern for looking more closely, at long-term outcomes, and how they may better inform pediatric treatments for future generations, and at the yet-to-be-explored elements of TEV that suggest there are more than mere positional elements involved with TEV. It is those non-positional questions that, in my view, come in to play later in life, that contribute to increasing pain, joint breakdown, muscle weakness, and a host of biomechanical compensatory mechanics that are playing havoc with many post CF people's lives.

TEV cannot be de-coupled from the child and adult who suffer from it. We live with it's effects every day. Are some luckier? of course. But the percentages that still suffer with the long-term outcomes are significant, and have been seriously disenfranchised by the medical community by the impact of this idea that our feet were "corrected" as children. This is a lie, and a damned lie, at that. Our feet may have been reconfigured, they may have been re-positioned, but they are not "corrected." It is time this term is fully dropped by the pediatric TEV practitioners out there, to stop lying to parents, who, by being so mislead, pass that lie on to the child, who when they do begin to experience problems as an adult, are often made to feel it is their own fault, that they somehow "broke" what the doctors had "corrected." The psychological impact of this practice hurts the child, the parent, and in my view, the entire medical community. The medical community is harmed by this practice because it causes them to have a false sense of power, a badly misguided approach to deepening the knowledge and research and improve the outcomes such children deserve.

The words we use about something matter, and this is the best example of this truism I have yet to find. While I understand the rationale behind the choice of this word, it is a patently false, and thus, harmful basis for continuing its use. Will parents be less convinced to proceed with treatment suggestions? I doubt that very much. Giving parents an honest appraisal of their child's future outlook will permit them to feel better prepared for any eventuality, and that, in turn, will help them better prepare their child for their more possible future options.

That the statement is prima facie false should be obvious, but only if the medical community really starts to do the substantial research required. recent research that shows there are significant changes to the muscles of the lower leg suggest that research needs further exploration. Does this change extend to the upper leg? Does this cellular degradation, grossly manifest in the atrophy seen in nearly all cases of TEV, bear any resemblance to other conditions? This question is especially pertinent in the face of newer knowledge about the chromosomal links to other conditions, and to the presence of TEV in other disorders such as spina bifida, as just one example. Until this research is done, the medical community cannot with any certainty dismiss the idea that TEV is far more than a positional abnormality, and thus, use of the term 'corrected" remains false on its face.

I call upon the medical community to begin this necessary work. Until then, I demand that this much-abused term "corrected" be dropped, that the truth be told - that "we do not with any certainty know what your child's long-term outcome will be. We can only speak of odds, not facts."

It is time to "correct" this problem.

Adios, Sue, Farewell, Lucia

Clubby-dom has lost two very special members over the past few months - Sue Tourle, of Bournemouth, UK, and Lucia Almeida, of Brazil. Both were strong advocates for better recognition of clubby needs through better disability rights and broader medical research and treatment options. And both made every effort to reach out to other clubbys, to share their own life stories, their humor and most of all, their compassion for others. Both have also made many contributions to this blog, and for that among all other reasons, I am grateful to have known them, despite never meeting in person.

Their loss has made me realize that the Web has extended our own personal boundaries across the entire planet, has made us neighbors in a sense that was not possible just ten years ago. That so many clubbies have now come to meet others like themselves, often for the first time realizing they are not alone with their suffering and their struggles, and having a completely new idea of who they are in this world because of this realization. Sue and Lucia, by extending themselves so much to other clubbies, made it so much easier for others to do the same. That is how a community grows, like virtual pot-lucks, virtual quilting bee's. We share our lives, and grow closer in the process.

That is why it hurts so much when we lose a member of our community. It took us so long to find each other, and then, too suddenly, we are asked to let them go.

Peace to them both, to their families, and peace to clubbies, everywhere.

May is World Foot Health Month

May has been selected for many years now as World Foot Health Month. But unbeknownst to the powers that be, for clubbies, foot health is a daily issue. We think about our feet far more frequently than most people, not because we like to, but because we are forced to. pain, poor footwear choices, physical limitations - these and more tend to keep our feet foremost in our thoughts. And sometime this can be quite annoying, right!? But there it is - our feet, our lives.

But this does not necessarily mean we are all equally good at taking care of our feet. How many of us have issues with nail fungus, or athlete's foot (tinea pedis)? As we age, do we know how to deal with chronic swelling, or edema, effectively? Do we all know what compression stockings are, and how to choose the right sort for our particular needs? How about selecting the best shoe gear, or how to know if we would benefit from orthotic inserts? Or even if the orthotics we do have are doing the best for us? If we are also dealing with diabetes, do we have the best handle on watching for the early development of ulcers, or what to do if one actually begins to develop? How about hyper hydrosis - very sweaty feet?

Foot health does not occur by accident - you have to seek the right information, and apply it properly. Consult with your podiatrist or chiropodist regularly. If you don't have one, seek one out, develop a long-term relationship with that specialist. The better they know your feet, the better they will be able to help you keep your feet healthy for the long haul.

Remember - you've miles to go before you sleep - might as well do it on happy feet!

Looking Ahead - Options For Clubbies

Aging has it's own downsides, without adding another disability to the mix. But when a clubby faces the normal aging issues on top of their decreased muscle strength, their increased joint arthritis, and other elements of their post-club foot/feet issues, then the situation becomes far worse. Mobility issues, the ability to remain in the work force or the need to find alternatives to the work one has done for many years, increased medical interventions - these and more become additional baggage we have to carry.

We will need to look at various types of health aids - grabbers, canes, wheelchairs, scooters, etc., etc. And how to deal with the difficulties these changes will bring to our relationships with family and friends. But most importantly, how to deal with what these changes do to our self-esteem, self-image, how we change our responses to what other people throw in our paths. None of this is simple - but we are clubbies, and that almost goes without saying, right?

So, if you are finding yourself heading in these directions already, what are you doing about them? How are you dealing with these changes? Please share them here for other clubbies - we need all the help we can get.

Another Plea For Your Help

Well, its that time of year again, where I, illustrious poster of blogisms, ask you, illustrious reader of posted breakfast snacks, to contribute your knowledge to the clubby universe! As always, nobody gets paid - least of all moi - but everybody gets rich!! All you have to do is contribute a few items of wisdom, such as:

>Shoes - where do you get yours? Are they custom made? How do you like them? How much do they cost? How reliable and consistent is the facility where you get them?

>Orthotics - where do you get yours? How well have they worked for you? How much did they cost? How many times did you need adjustments made until they were comfortable?

>Doctors - who do you see, and what are their specialties? Do they always try non-surgical options with you first? What options do they offer?

>Other - Where do you live - country, city? How far, on average, do you have to go to get the help you need? What groups do you belong to - locally, and on the Web? Do you get the support that you need?

So, there you go - we aren't asking for your money, your passwords, your waist size, or your inner-most secrets - and we don't really want them, well, maybe the money - ;-) All we want is to build up the available resources for other clubbies. Hey - nobody else is making clubby life any easier, so us clubbies will have to do it for ourselves.

Starting, of course, with you!!

Correction - There is No Such Thing As "Correction"

When it comes to talipes equino varus, the big lie told by the medical profession to parents is, "Don't worry, they can be corrected." Now, what the parent hears behind this word is "cured" and "fixed." The implication is that by altering the position of the foot, all will be right. Your child will be "normal." And this of course brings relief to the minds of the parents, and they put their trust in the folks in the white coats. But there's a problem with this situation - a big problem, in fact.

Whether surgical or non-surgical, older methods or Ponsetti, the re-positioning of the foot is merely a reconfiguration, not - listen carefully here - a "correction." To "correct" means to put right, to return something to it's original or intended state. CF treatments do not do this - they do not return something to its original state (with a child born with CF, that IS the original state,) and they do not "put right" such feet to their "intended state." If this was the case, then the atrophy attendant with CF would resolve. There would be no residual joint misalignment that become increasingly pathomechanical over the years. The child would not grow up, in more than 68% of the cases, to have painful arthritic changes before they are fifty, sometimes even sooner. (This is just one estimate, from the Dobbs study. There are differing estimates, but the best is from the Ponsetti study that shows there is still a 15% probability of a poor long-term outcome.)

So this persistent use of the term "corrected" is not merely a lie, but a damned lie, as it misleads parents, others in the medical profession, government policies, and especially, the child, into feeling anything to the contrary is untrue. This makes government policies based on falsehoods, parents misleading and disbelieving their own children, other medical professionals unsure of who to believe, or whether their patient is merely malingering, and the child growing up to feel that anything that goes wrong is their own fault, that they somehow "broke" what the surgeon's claim to have "corrected."

This must change. We must demand that the pediatric orthopedists and podiatrists who work with talipes children cease using this term. They are in fact re-aligning, reconfiguring these feet, and that is what they should be calling it. Until they truly figure out a real cure, they need to stop claiming such. And we post-clubbies need to hammer that point home, again and again.

It is the medical profession that needs to be "corrected."

So, What's Up With Those Orthotics, Eh?

If we think of the shoe and it's two primary components between your foot and the ground, namely, the insole and the outsole, as "translators" between your feet and the ground, then orthotics are the equivalent of a translator of a new language. This is because they alter the relationship between your feet and the ground in more significant ways than the flat surfaces of the insole and the outsole of the shoe. Where your feet apply too much pressure, orthotics redistribute that pressure, and the forces that cause the pressure, so that both your weight and the forces - shock, or impact; and torque, or rotation (with it's sidekick, shear forces) - are supported and modified toward a more efficient set of actions. One of the primary goals of functional foot orthotics is to reduce excessive pronation where that pronation is causing pathology, while another is to improve the posture of the foot during heel strike and through mid-stance phase of gait (when the foot is fully on the ground.)

But these are not the only aspects of a functional foot orthotic as they might be applied to someone with post-club feet. With PCF, it is seldom possible to approach the biomechanics of such feet the same way one approaches less pathomechanically defined feet. But the tools can still be used even if the outcome is often significantly different. The primary consideration should be around three factors: sufficiency of range of motion of the subtalar and midtarsal joints; degree of arthritic changes present; and degree and duration of inflammation or edema. Too little motion available reduces the functional effectiveness; significant amounts of arthritis suggest the need to reduce motion further, not enable more; inflammation especially long standing strongly influences the nature of the surface of any orthotic as to how the foot responds to pressure. A hard device will be less well tolerated than a softer one, or at minimum, a softer material on top of the more rigid material of the orthotic itself.

This brings us to the function of materials as they apply to both the devices and to the foot. You can easily suspect I will frame this in terms of a trade-off, and you would be correct. Materials have to be considered on the basis of their strength, their moldability, their longevity, and their memory. Lets talk about this last item first - memory.

In materials, memory speaks to how well a material will return to its original shape after each "deformation." Think of the pillow you sleep with - when your head lays on the pillow, it "deforms," that is, it conforms, or moves away from, the forces applied to it by your head - it's weight and its shape. When you take your head off the pillow, it returns (depending on the material used to fill that particular pillow) to its original shape. The speed of return, and the degree of return, are both components of the material's memory. If it did not return to that original (or closely) shape, it would rapidly become harder and less comfortable, and you would wish to replace it much sooner than you had been led to believe you would have to. Likewise, if it took several days to return to the original shape, the results would be nearly the same, as far as your comfort and your expectations. These issue apply as well to the materials used to cover and to form your orthotics. They must show a high degree of memory if they are to be worth using.

Longevity is a property of memory, as well, but it also is dependent on other aspects such as chemistry and heat. The environment inside our shoes is fairly tropical, and often quite acidic, as well. Our body generates heat, and the friction of our feet inside our shoes generates heat and moisture. A part of the moisture is sweat, and sweat has many chemical components, salt being one of the more corrosive. all the materials inside your shoes - whether shoe or orthotic - are subject to these chemicals and the moist heat. And one of the side effects is the intrusion of fungal infections, that also contribute to the in-shoe environmental impacts. The other two components affecting longevity of materials are one's weight, and one's biomechanics. So you can see that, tradeoffs are inevitable - there is no such thing as the perfect material, no matter what the advertising might say.

Moldability, or the tendency of a material that permits it to be molded into a new shape, through heat and pressure, and then to retain that new shape with little long-term deformation, is critical for most materials used to make orthotics. We can differentiate materials that can alter their shape through heat and pressure from materials that are shaped via mechanical means, such as graphite, which uses a chemical process, or milled plastics, which start as a block of raw material, and then are shaped by a milling process. Both of these last two approaches have gained in usage over the past decade, but heat molding is still used for many orthotics.

Strength, as you might imagine, is a product of all of the above. Strength refers to the original material's characteristics to resist change, and to how that resistance changes after the material is shaped into the final device, as well as the environment the material must deal with every day. It also refers to the material
s ability to resist tearing, or breaking under a load.

So consider how difficult it is to achieve the right set of trade-offs - there are anywhere from 3 to 4 different materials in use in any given pair of orthotic devices. There is the primary formable material - plastic (of many different types, depending on the approach desired by the doctor) or carbon graphite. Then there is the post, or heel stabilizer material, and the top cover material, and possibly additional material for the extension to allow for a plantarflexed metatarsal head, for example. Each material chosen for the given part of the overall device must be chosen based on how the various parts are supposed to act. The top-covering material must be the best at resisting moisture and acidic conditions, as well as being somewhat resistant to fungus. It must be able to conform to the curvature of the heel cup portion of the body of the orthotics, and it must have a decent longevity. It must offer some cushioning without taking up too much space in the shoe. And it must not contain chemicals that some may be allergic to, such as latex.


More Than The Sum of Its Parts

An orthotic device is more than its material composition - it must also be designed and formed properly, and it must fit within the shoe properly. If the device, once ensconced inside the shoe, makes the shoe too tight to allow the foot to fit inside with comfort, it won't do you much good, so the shoe and orthotic must be considered as a whole. And the type of shoe the device is worn in has a significant impact on the success of the orthotics, as well. if you want to wear 4 inch heels, well, good luck with that - they most likely won't fit in the shoes, your feet definitely won't fit in them, and the position of your feet will make the devices useless, which pretty much wastes everyone's time and effort in that particular project.

So picking the right shoes, if you don't require custom-made shoes, is a matter of several factors - extra depth for the inclusion of the orthotics; good toe room; a stable insole material that will support the orthotics and your feet without breaking down quickly; a well-balanced outer sole; and a good closure system - laces, or velcro, or straps - loafers and other types of slip-on shoes will have a less effective outcome because the foot will likely slip off of the orthotics inside the shoes. For some, who may require better ankle support and who need to control their subtalar motion better, a high-top shoe will be a better choice. Which brings up the perpetual issue of fashion.

Anyone with significant foot problems, CF or otherwise, would most like to be as much like everyone around them as anyone else does. Who wants to call extra attention to the source of one's pain? But there are realities that cannot be avoided - what makes some shoes fashionable is what makes them problematic for people with significant foot problems. Again, it's about tradeoffs, pure and simple. For me, it has always been about comfort over fashion. I tend to think people look best when they are happiest, not because they have the latest fashion trends writ large. A person wearing the latest fashion, yet walks in such shoes in great discomfort, tends to cause any beauty they possess to go missing. IMHO, that is.\

Hopefully, this brief overview of orthotics and the considerations that must go into their construction and their use has given you more tools when communicating with your doctor and/or orthotist. It helps to know what to ask, and how to explain where things could have gone better in your previous devices, so as to get improvement from one pair to the next. Us clubbies, unfortunately, should not expect a perfect pair the first, and likely as not, even on subsequent pairs of devices. We have a very difficult set of conditions compared to people with lesser foot problems, and therefore we are often more the expert on our own feet than most doctors are. That, as they say, is just the way it is.

Side-Steping - It's Not Just About Forward and Reverse Anymore!

So - tired of moving forward? Good - that can get quite boring, right? But don't think that just because you're feet are moving forward they aren't also moving side-to-side. Well, it's actually a lot more complicated than that. Unless you want to walk strictly like a robot, that is. You see, we humans have evolved to move in many directions, but especially forward - how else do you expect to get away from a sabertooth? You have to be able to run both fast, and possibly, for quite a while. This means you had better evolve in several directions - for strength, for speed, and for efficiency - energy efficiency, that is. You wouldn't want to run out of steam at the last second, would you? because that might be really bad - for you, not for that big pussy-cat!

Just as the foot needs to be able to adapt to the changing surface of the ground heel to toe, so does it need to adapt laterally and medially. The foot, in fact, is essentially an adaptable triangle, with the heel being one apex, and the first and fifth metatarsal heads being the other two. It is the job of all the other bones, joints, muscles, ligaments and nerves to make those two adaptable triangles work as efficiently as possible to keep the entire organism they support moving as smoothly and efficiently as possible. But for that to happen, they need to be interact properly with the other mechanisms proximally - that is, above them - so, the ankle, lower legs, knee joint, femur, and, most critically, the hip/pelvis/sacral components. Each plays a role that both affect and is affected by the joints above and below them.

And besides needing to interact according to some pretty basic mechanical concepts, they need to do so with a fairly high degree of symmetry - the right and the left have to work in near-mirror opposition. They have to do this with the nervous system firing in efficient and repetitive sequences, over and over, for your entire life. If just one part fails to work properly, however, the entire shebang can go off-kilter pretty quickly - just look what happens when you do something pretty basic like bang your shin on the coffee table!

First, you will hop on the un-banged side until you can sit down and rub the new contusion. When you are finally ready (no matter how reluctantly) to attempt to get back on your feet, you will try to put less weight and motion on the affected side, and thereby, limp. Limping is the most basic form of compensation - no, not like a paycheck, sad to say, but compensation as a method to relieve the temporarily impacted part. Now, odds are, you won't be limping very long, so unless you already have your back out of joint, this type of compensation - by limping - won't have any long-term negative impacts, and will only involve a few joint segments. But for this brief period, your body will still follow some basic rules until it is able to move without pain. At which point, you will go back to your "normal" way of ambulation.

Now, note I said "unless you already have your back out of joint," above. If you are already compensating for some other asymmetrical musculo-skeletal defect, then adding another level of compensation can have a decided impact on the pre-existing levels of compensation, possibly making the original issue, in this instance, your back spasms, much worse, which can really muddy the waters when the body works to deal with the new reason for additional compensation. But again, the basic rules apply - inner ear balance, and a level visual horizon.

But regardless of the reasons, compensation is largely an unconscious response and reaction to anything that modifies the symmetrical nature of human gait. It might start off conscious, as in the limping example above, but that is usually only the case when you respond to immediate trauma. The matter is, however, quite different when the asymmetry is from a birth defect, disease process, or early-infancy etiology (cause). Then, compensation is slow and steady, and can be influenced by a variety of other factors as to the degree of compensation, how many levels of the body it impacts, and what compensatory-related pathomechanics may result over time.

For our concern right now, lets just consider what happens when one foot is slightly different in the range of motion than the other. Say, your first ray - the first metatarsal and the big toe, or the Hallux. If you have a higher range of dorsiflexion and plantarflexion of the first ray on one side than the other, that side is likely to have a higher degree of pronation than the opposite side does, and this extra amount of pronation can have some pretty complicated compensatory reactions. (Dorsiflexion is movement upward, or toward the joints above the joints in question - plantarflexion is motion downward, toward the ground. So when you raise your big toe, or Hallux, you are dorsiflexing it, and when you point your Hallux downward, you are plantarflexing it. Just another little service we supply here at Definitions-r-Us!)

OK, next time, we will follow this problem in greater detail. Why, you ask? Why do I need to be confused by all this detail? Well, if you want to understand your own feet, and you don't want the medical professionals you have to deal with to hold all the cards, having a working knowledge of how your feet work - or don't - will put some of the power back in your own pocket. The aim is to enable you to understand your feet, your footwear, your orthotics, and why they work, or don't, and what you can do to make sure they do work better. And you should definitely consider asking questions - having more knowledge helps you ask better questions.

Even if it's just to fluster the doc!

Your Shoes, Part Deaux - Translation and Mediation

To continue with the sole and heel a bit, it helps to think of the foot from the point of view of the ground itself. You leave a real impression on it, you know. Well, at least when it's the bare earth. But there are several things that occur when you take a step, besides what your body appears to be doing. First, there is the force of gravity. When your foot hits the ground, it does so with motive force (that's the part you put into it,) and gravitational force (that's the part gravity's force upon your body adds to the mix.) You might think the earth doesn't notice such an insignificant force as your stepping on it, but in fact, it does so through something called the "ground reaction force." Essentially, this is the effect of you pushing on the earth and the earth pushing back. And it is this ground reaction force that helps propel you on to your next step, as well as contribute to the responding shock wave that occurs as your foot impacts the ground. Various factors can amplify or reduce the degree of impact - body weight, shoe materials, heel height and shape, and your specific biomechanics.

It helps to view the heel and sole of your shoes, and, when they are included in the mix, your orthotic devices, as mediators or translators between the shape and composition of the type of ground you are walking on, and your specific bio- or patho-mechanics. That is, these interceding materials (sole, heel, orthotic) either reinforce the interaction, or change it. Think of what happens when you walk on a sidewalk that is tilted toward the street, as most are (to varying degrees.) If the street is to your right, then your right foot is lower than your left relative to perpendicular - you are no longer walking at 90 degrees to the earth, but offset by x-degrees. And, because you are bi-pedal, it forces one leg into a longer relationship with the ground, and the other leg into a shorter one. Of course, you could try to walk at 90 degrees to the tilted sidewalk, but that is not a simple proposition (I'll explain this more later.) The altered shape of the sidewalk has changed your entire biomechanics - temporarily, of course. But for the most part, our bodies can adapt to such a (relatively) short-term change - we are an adaptive animal. And it is the way our bodies were evolved to deal with uneven surfaces that makes us unique among bi-pedal creatures.

But here's the problem - we walk on uneven surfaces less frequently than on hard, flat, unyielding surfaces due to the modern world's obsession with paving and other materials to "manage" our interactions with the planet we walk upon. So that great adaptive mechanism of our body deals less with continually changing forces and more with repetitive forces. Concrete, wood, tiles, etc., all produce more direct and harsh ground-reaction forces than the bare earth ever does. And, we pay a price for this with every step we take. When we add to this mix poor biomechanics, as we clubbies are pretty good at doing, we have even more negative impact - on joints, muscles, tendons, ligaments - and this can lead to early arthritic changes due to this "translation" of force and response. But what it we insert something between our feet and the ground? Let's start with our shoes.

As I said in the last post, the heel raises your rear foot higher than your forefoot. It therefore changes the relationship of your body's center of gravity (COG) relative to the ground - it shifts the COG forward. This causes your body to make certain adjustments, all quite subtle, but clearly measurable. First, you bend your knees slightly, which per,its your pelvis to settle back a bit, thereby keeping your spine aligned perpendicular to the ground. If your body didn't make these adjustments, you would feel like you were always falling forward. Obviously, that would be hard to tolerate for very long. It turns out there are two things the body must maintain according to their specific original designs - our inner-ear balance, and our visual horizon line. If the visual horizon appears un-level, we will always adjust our posture and gait to restore this visual perception of the horizon - side to side, as well as forward and backward. That 90 degree relationship to the ground is critical to our being able to function in relative comfort, so the body is designed to compensate in many ways to maintain that relationship.

As for our inner ear - if you've ever had the misfortune to have an inner- ear infection, and get vertigo, you will understand quite easily why it is so important. If our "vestibular balance" is thrown out of whack by vertigo, we cannot properly perceive where the ground is from one step to the next. So too should our biomechanics get off-kilter, and we will adapt, or compensate, in order to eliminate this imbalance. So by changing the relationship between the ground and the body, via heels, orthotics, or via the shape of the ground, our body uses this idea of compensation to mediate that relationship.

Try this little experiment - tape some materials, say, some stacked cardboard, to the sole of your shoes - same amount, both shoes, but not to your heels. Use enough to make the soles higher than the heels. Now, walk around the room a few minutes. What do you notice? Your knees? Your hips? Your back? How about your balance - what happens there? What this does is to reverse the usual experience of having your shoe's heels higher than the soles, and now you can see the demands any change to your relationship to the ground makes on your body. But don't continue this experiment too long - it will actually cause your kees to "hyper-extend" and can cause some real issues over time. back in the 70's, a shoe called the Earth shoe tried to convince everyone this was a better way to walk, just because that is how your foot acted when you walk on the beach. But how much time do you actually spend walking on the beach?

OK, next time, we'll look at what happens when you alter the relationship between your body and the ground side-to-side. For now, you have enough information already to do your own experiments -  observe how you walk, and try to get a sense of how one side of your body might respond differently than the other side - more impact at heel strike, more or different muscle use on one leg as compared to the other. Observe your pain - is it greater in one area on one foot than on the other. If you are a uni-clubby, this should be an easy experiment, compared to us bi-clubbies, but even with bi-CF, there will be some differences. See you soon.

Are those Shoes on Your Feet, or Are You Just Fixin' To Dance?

OK, here we go with another "what the heck IS that, anyway" post. Most people think of shoes as something they buy at a store, or on-line, and to make themselves acceptable in mixed company - or not, depends, I suppose, on one's particular proclivities. For some, its all about the sexy, while for others its all about the function. That's one of the things that makes shoes somewhat problematic - we want them to "do" things they can only do in our imaginations. But the bottom line (an obvious pun when we speak about shoes) is the issue of utility and function. We'll leave the sexual aspects for another post (and then, only if you ask real nice.)

Until about midway through the Roman Empire, shoes were essentially not much more than flat sandals, of moccasins, or mukluks - somewhat climate-defined coverings to protect the foot from the harsh touch of the earth, and the often harder touches of cold and wet conditions. But sometime in the middle of the Roman Empire, some wise fella had a brainstorm - if he added extra material under the heel portion of the sandal, thereby elevating the heel a small amount higher than the rest of the foot, those hearty and bloodthirsty Centurions could out-march pretty much every barbarian horde in the known world, and be less fatigued by the time they needed to raise their swords and lop off some body parts. This was the first known shoe modifications with a clear, and quite effective, functional outcome.

Now, history shows that shoes began to really go to absurd lengths, er, heights in the Middle Ages, with some shoes recorded as high as 20 inches - the original platform shoes. And even today, the high heel remains one of the mainstays of fashion, and as fraught as ever with sexual subtext. But the raised heel has also become something even more utilitarian, and depending on design and basic shape, can provide significant advantages for people with a wide array of foot problems. They can also, as we will see, create foot problems, and we will explore this, as well, in future posts.

The heel, being named for the part of the foot where it is most closely aligned, serves not merely to elevate the rear part of the foot over the level of the sole, but also serves to either increase or decrease the shock wave of the heel when it strikes the ground. It can do this based on shape and on the materials from which it is made. The primary problem is, it can do one or the other really well, or it can do both, but less well. But it can seldom do both really well. This is because there is a trade-off, between the need to cushion against the impact, and the need to remain stable side-to-side so that the foot is not unbalanced as it transfers the load of the body from the heel, to the midfoot, to the forefoot, and then allows the heel to leave the ground in preparation for swinging through to the next phase of gait. Too soft a material will cause poor stability; too hard will transfer more shock. Therefore, a trade-off is the primary determinant for the design of the heel.

Next time, we will look at materials, used to make the heel and sole of shoes, and how various materials impact functional outcomes. And remember - if you have any questions, just post them in the Comments section. Till then, don't forget to dance!