Unfortunately there is no secret best running shoe! They are all good. Every runner is different. Every runner has a different foot type and structure. Every runner has a different running style. Every runner has different needs. Every running shoe make and model has different design features all designed to achieve different things and meet different characteristics. The secret (if there is one) is to match the characteristics and needs of the runner to the correct running shoes. Theoretically of you get the match wrong, there is a potential for increased injury risk and decreased performance. If you get the match right, then there is possible a decreased injury risk and a potential for increased performance. The challenge in running shoe prescribing is to get the match between the two right. It is not an easy task and best left to the speciality running shoes stores.
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There has been a lot of controversy around the Vibram five fingers shoes lately given the barefoot or minimalist running trend. Part of the controversy surround the hype and exaggerated claims about how barefoot running can reduce the injuries when it’s becoming increasingly clear that this is not the case (see: Vibram FiveFingers Cause Metatarsal Stress Fractures?; Why are barefoot runners getting so many injuries?; Vibram Five Fingers).
Vibram Five Fingers are a novelty item and should be treated as such. Those contemplating Vibram Five Fingers are well advised to follow the advice of the barefoot running advocates and transition slowly and carefully over a long period of time. Just don’t fall for all the hype and exaggerated claims about the alleged benefits.
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Medial tibial stress syndrome is a common overuse injury in the legs of athletes. There are many theories and ideas as to what it exactly is. Equally, there are many theories and ideas as to exactly what causes or increases the risk for medial tibial stress syndrome. One idea that is gaining increased popularity is that it is due to higher bending moments in the tibia. These can be reduced with the use of medial wedging under the foot. See this discussion on medial tibial stress syndrome.
Golf is a popular sport or activity for participation and for competition. It attracts millions of dollars in sponsorship and prize money (and a few controversies!). There are a lot of golf forums on the web for discussion of golfing and related issues. Foot orthotics for golf do raise some issues when they are indicated. On the one hand you need a fairly supportive foot orthotic to control the foot over the long distances that get walking during a game of golf (and unless you are a pro, you have to carry or pull the extra weight of the golf clubs). On the other hand, the rearfoot area of an orthotic for a golfer needs to be reasonably flexible to allow for the side to side motion that happen in stance during a golf swing. Just what needs to be done to help the golf biomechanics is always going to be one of compromises between these two competing considerations.
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Cyclists bring a particular challenge to podiatric practice. Running and other sports have a swing phase to gait when the foot is off the ground and not weight bearing. Cycle “gait” does not really have a swing phase and the foot is constantly “weight bearing”. This makes for an unusual injury risk profile due to the constant “stance phase”. Added to that is the relatively tight cycling shoes that cyclists tend to wear means that there is not a lot of room in the cycling shoe if foot orthotics or some sort of in-shoe modification is needed. The set up of the cycling for efficient biomechanics is the first step. Cycling foot orthotics can be challenging but when they are needed, they are needed. Given the distances and days that cyclists compete over, the risk for overuse injury is high if the mechanics are not set up properly. You often learn more about the problems of cyclists on cycling forums than cycling on podiatry forums.
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Asics running shoes seem to some of the more popular on the market today. They are responsible for a number of technical innovations such as the Asics space trustic system that is claimed to enhance the windlass mechanism of the foot. The Asics running shoe company has sponsorship deals with a number of sports medicine organisations around the world. Some of the popular models in the Asics running shoe range include the Asics Gel Kayano, the Asics Gel Cumulus, The Asics Gel Nimbus and the Asics Gel DS trainer. There are many shoes in the Asics running shoe range and it can be a bit hard at time to keep on top of them all, let alone the range of shoes from all the other companies.
Plantar fasciitis has got to be by far the most common musculoskeletal problems of the foot. It also gets commonly mislabelled as a heel spur which are not a problem. The problem is the plantar fascia inserting into the heel bone. The key symptom of plantar fasciitis is plantar heel pain after arising from rest, especially getting out of bed in the morning. This pain after rest for the first few steps is almost diagnostic of the problem. Plantar fasciitis is due to too much load in the long ligaments that supports the arch of the foot (the plantar fascia). This load can come from higher levels of activity, being overweight and having tight alf muscles. As this is a load issue, then the only proper way to manage plantar fasciitis over the long term is to reduce the load in the plantar fascia. This can only be done with low dye strapping and certain foot orthotic design parameters. All other treatment modalities (eg shockwave, ultrasound, accupuncture, etc) are really aimed at helping the tissue heal that are damaged as part of the plantar fasciitis. They are not going to be very helpful if the load going through the plantar fascia is not addressed.
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Low dye strapping is a strapping technique that is used as a short term measure to treat foot pronation or support the arch of the foot. It was first described by a Podiatrist, Dr Ralph Dye. PodiatryOnline.TV has many video clips on how to apply low dye strapping.
A really neat thing to do to test low dye strapping is to have the patient standing, then do Jacks test to see how hard it is to dorsiflex the hallux. Then put the tape on; then do Jacks test again. It is often remarkable how ‘loose’ the hallux is, which gives a big hint as to how and why the tape works.
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How do foot orthotic work in Achilles tendonitis? It always used to bug me how so many claim a pronated foot can cause Achilles tendonitis and you should use foot orthotics for it. I could never understand the rationale behind how a pronated foot could cause achilles tendonitis. There is no doubt that foot orthotics do help Achilles tendonitis (and there is at least one study showing that). Achilles tendon treatment is obviously multifactorial and involves a lot more than just foot orthotics, but I finally understand that rationale for foot orthotics. The soleus muscle that attaches to the Achilles tendon is a very power supinators of the foot (as the Achilles attaches medial to the subtalar joint). Several studies have showed the reduction in the ankle inversion or supination moment with inverted foot orthotics. Foot orthotics reduce the force that the soleus muscle has to contract with and lessons the load on the Achilles tendon. Problem solved.
