Podiatric Sports Medicine Recommendations

Regarding shoes, biomechanics, and training techniques

Dear Friends and Colleagues,
In the past some of you have asked me podiatric sports medicine recommendations regarding shoes, biomechanics, and training techniques. I have decided to do a brief news letter on a quarterly basis to keep you informed on what’s new in the world of podiatric sports medicine. I hope you find this helpful. I promise to keep it short and sweet.

While there is no single best shoe, all my athletes have different needs. There are several key questions that I ask them about their training and running history. I also want to know height, weight, their basal metabolism rate if they know it. I also want to know exactly how much running they do and on what terrain they run on, how often they train and at what intensity they train. If they are having any type of injury or pain, I want to know if they’ve changed anything in their routine such as a shoe, a course of run, a type of surface, increased speed, anything that can give me a tip on why things are going wrong.

The athlete’s lower extremity biomechanics are a huge part of the process that I use for shoe selection and injury evaluation. I have seen three basic foot types in my practice. I classify these basic types through the medial longitudinal arch and its relationship to the transverse arch. I describe the longitudinal arch as the relationship for the rear foot to the mid foot and the transverse arch as the guide post for the mid foot to fore foot. There are three basic configurations. The rear foot arch could be in a high or elevated position or a low position. This is usually determined by clinical examination or by x ray evaluation of the calcaneal inclination angle. The calcaneal inclination angle is a bisection of the calcaneas on a lateral x ray view. This is measured, any angle which is over the normal 18 to 21 degrees is considered, in my opinion, a high arch rear foot. If you do not have access to an x ray this foot type can be noted by non weight baring position, the foot remains in a high arch position in the medial longitudinal arch and when you weight bare the foot remains in a similar position showing high arch rear foot and high arch fore foot. This foot type requires maximum amount of shock absorption and excellence I biomechanics in running. These athletes usually require a technique coach or a movement specialist to help decrease the shock that goes through their body.

The next foot type is the most common type that we see in the United States. This is a low arch rear foot and a low arch fore foot. Any angle measured through the calcaneas under 18-21 degrees is a relatively flat foot or pes planus foot type. These foot types absorb shock very well because they are flexible but they have a very hard time re supinating or becoming rigid for propulsion. This is where their problems develop. These foot types usually require some type of orthotic device, performance enhancement device, or just a stability or motion control running shoe.

So those two foot types comprise approximately 90% of all foot types that we see in athletics and in the general population. The tricky combination is the high arch rear foot and low arch fore foot because that athlete requires shock absorption on heel strike that can be provided through a neutral shoe but on take off or propulsion he needs stability. What does this all mean? This means he has a supinated rear foot and a pronated fore foot. This foot type will always give you trouble in diagnosing and in treatment. They may return to your office or training room for multiple issues. One problem resolves and another problem begins. We should be highly suspicious that an athlete has this specific foot type once they enter your training room for multiple problems in different sports. This foot type can be detected if you have the athlete seated, non weight baring on your training table and it appears that they have a high longitudinal arch. Once you place the athlete in a weight baring attitude the fore foot will appear to collapse and the heel may go into an everted or valgus position. This is the case that I described as a high, low foot type. Supinated on contact, lacking of shock, and pronated in take off. With this foot type we usually recommend a neutral cushioned shoe for shock absorption of rear foot and a custom made insole device for the control of pronatory forces in take off phase of gait.

Hope you find this helpful in your practice.