Problems of the sole!
New Shoes. Old Shoes. Good shoes. Bad shoes. What’s the difference?
Whether it is stabbing pain under the foot or aching pain of the heel, these problems can truly make each step memorable in the worst kind of way. With most injuries the first port of management is offloading the area. The difficulty when dealing with feet is you are always using them. This means taking it easy, reducing the stress on the tissue and letting the body heal before strengthening the area back up to the demands of the required activity, can be quite the challenge. While it is definitely possible to offload the foot completely (crutches, boots etc) it is often not practical with patients busy life schedules.
Most foot problems result from a combination of tissue overloading and poor foot biomechanics. Typically, pain presents at the bony-tendon junction due to micro tears following a sharp increase in weekly activity. At this time the demand on the tendon struggles to cope with the increasing demands placed on it. Combine this with poor foot biomechanics due to a lack of sufficient intrinsic foot control and we make the perfect storm for conditions like plantarfascitis or achilles tendinopathy.
This is where proper supportive footwear comes in. However modern footwear comes in many forms, shapes and styles often built for a purpose or certain aesthetic.
So what should you look for when it comes time to buy?
While not an exhaustive list, three areas you should consider when you have foot pain are:
Heel Raise - The purpose of a heel raise is offload the achilles tendon which attaches at the base of the calcaneus, also know as the heel bone. The heel raise elevates the back of the foot relative to the front of the foot, placing the calf in an advantaged position by preventing repeated end-range positions that put the achilles tendon on full stretch. This is important to consider for runners than are experiencing any on-going foot pain.
Cushioning - Often overlooked, cushioning is more than just the feeling of walking on a pair of clouds. If we take a deeper look, cushioning is instead a reduction in the ground reaction force or force applied to the heel when the foot contacts the ground, also know as heel strike. By increasing the time over which this force is applied (i.e. the cushioning effect) the foot is better equipped to absorb the incoming force and reduces tendon loading.
Arch Support - possibly the most important aspect in footwear for supporting your feet. The arch of the foot is comprised of fascia, muscles, tendons and ligaments which maintains its function. When the foot rolls in the arch flattens. Now flattening of the arch is not a bad thing, it is a function of the foot, it acts, like a spring, to load up the foot to create efficient propulsion. The problem is when arch remains flatten due to strength deficits causing continuous stretch to the underlying tissues. Arch support does exactly what its name implies, it supports the arch of the foot. This in turn stops the foot from continuous rolling in, flattening the arch and stretching the structures that need to be temporarily offloaded. Now this may sound simple enough but many footwear styles do not offer arch support, like thongs or heels, and others are lacking. Orthotics are great option to bolster up your footwear of choice, but should only be used as a short term solution.
Tying it all together
In summary proper footwear ultimately is a great tool that offers relief and support when foot pain does occur and is a simple solution to offloading tissues of the foot allow them to heal.
If any of this pain does sound familiar to you and you are uncertain about how to fix it, or if you want to discuss what footwear is best for you, book in with one of our physiotherapists to have an private consult. This will include a biomechanics and gait assessment to identify the problem areas and a targeted strengthening and stretching exercise program to get you back to pain free movement and performance.
Written by:
Michael Ward - Physiotherapist