Sandals - What You Need To Know

Anyone that has been through a PRI program knows that shoes are extremely important to the success of said program. The Hruska Clinic (the clinic that the creator of the Postural Restoration Institute, Ron Hruska, owns and works out of) puts out a biannual shoe list where they look at hundreds of different tennis shoes, breaks them into categories to help clinicians narrow down the options for our patients, then lists a few shoes in each category (see current shoe list HERE). Having proper footwear can make or break a program. For our patients who present in a pattern (or are not in neutral in one or multiple areas of their body), these shoes can kick start their program instantly getting them in to neutral and saving weeks of work! However, once our patients lift scores get to a 3 out of five or higher, they have some options in terms of footwear. Since spring has sprung and we know that our patients will be wearing sandals at some point regardless of lift score, we wanted to you know what to look for in a good sandal.

1) Avoid a heel. Having any height in your heel will push the weight of your body onto the ball of your foot. We are designed to bear our weight through our heels. When we are forced into an unnatural ankle and foot position, we must counterbalance our weight up the chain so that we do not fall forward. The most typical compensation for this is to lean back in the shoulders accentuating the curve in the lower back and possibly pushing the head forward. This can quickly cause lower back, shoulder, and neck pain. 

2) Choose a shoe that is attached to your foot. When we wear a shoe that hangs on our foot like a flip flip or a mule, we have to work harder to keep that shoe on our foot while we walk. This may include gripping the shoe with our toes, lifting our toes up excessively, or even rotating our hips so that our toes point slightly outward. All of these compensation patterns cause excessive and abnormal muscle use which can irritate many areas including our foot, ankle, knees, hips, and lower backs. Choosing a shoe that straps at or around the ankle will ensure that the shoe stays on your foot while walking and you don’t have to work as hard!

3) Try to find a shoe with heel support. Although this is quite a challenge, it can be done. Many people realize the importance of having good arch support in a shoe for good foot and ankle alignment. However, many do not realize that what really determines the arch’s position is the heel bone or calcaneus. If you are able to find a sandal that encompasses the heel and gives it some support via a more rigid material, your arch will be much more stable. 

4) Feel your arches. As mentioned above, managing your heel position is very important, but it’s still essential to have support under your arches. Try to find a pair of sandals that has enough arch support built into it that when you stand and walk you can feel the material of the shoe supporting your arch. There should not be a gap between your arch and the shoe. Additionally, there should there never be so much build up that it’s painful or you feel as though it’s pushing your weight to the outside of your foot. The ability to sense and feel your arches helps your body to utilize your glut max muscle. This helps to keep your lower back from overworking and can help to strengthen those very important gluts!

5) Go for comfort. Whatever sandal you chose needs to be comfortable. Think about the last time you wore a pair of shoes that gave you a blister. First of all, remember how much that hurt. Second, remember how strangely you walked to avoid rubbing the blister even more? It’s obvious that when you walk oddly to avoid pain, you’re not walking in a biomechanically correct way which can lead to form breakdown and pain.

6) Limit your use. No matter how many of the above boxes your selected sandals check, we all have a limit to what our bodies can handle with less than desirable shoes (aka not tennis shoes). Listen to your body when you wear your sandals. You’ll soon begin to notice how much time or activity you can tolerate in those shoes before your body starts to break down. Have a your tennis shoes at the ready for when you drive home after that wedding or only wear them when you’re going to a nice dinner and won’t be on your feet much. 

Written by Lesley Callaham, MPT, PRC      April 2, 2019

Why Your Orthotics Don't Work

Many of us have had some experience with orthotics. Most of us have purchased a cheap, off the shelf variety that we purchased on a whim or were suggested to us by a shoe salesman. Others of us have purchased the expensive, over the counter, "customizable" variety that you heat up in the oven and step onto as they cool, making a mold around your foot. No matter what route you took to get there, I'm guessing that your symptoms either worsened, lessened temporarily, or moved to another place in your body. 

Why? All of those orthotics are simply putting a band-aid on the problem and may not be any better for your body than if you were walking around barefoot all day. Any time you chose a shoe and what may be going inside of it, your anatomy, your compensatory patterns, and your pain need to be taken into account. Otherwise you're either putting your foot in a different, but still not properly aligned position. This will either increase pain immediately or after some time as your body adjusts its compensatory pattern and develops breakdown.

No matter where your pain is, the position and function of your entire body needs to be assessed to see where the breakdown in your movement is. The site of pain is not always the site of the dysfunction. For example, someone may be experiencing neck pain and headaches because they keep all of their weight on their toes and lock their knees. This moves their center of gravity forward causing their hips to move forward while their shoulders lean back to rebalance themselves. The head will then move forward so that they can see the world in front of them. This places excessive stress on the neck muscles and will lead to pain. 

One major theme to proper position and mechanics of the entire body is the ability to sense and feel where we are in space. Our body must be able to feel where the weight is in our foot in order to tell us where our body is on the ground. Proper positioning of the ankle joint is also essential so that our proprioceptors can tell us, again, where we are on the ground and how we are moving on it as we walk. If we cannot accurately sense and feel where our body and feet are, we develop compensatory movement strategies which eventually lead to pain. 

Cheap, over the counter orthotics are a "shot in the dark." The chance that the amount of arch support that is built into the orthotic is actually the amount we need is unlikely. The "customizable" over the counter orthotics that are heated in the oven simply support your foot in it's improper position. This is also how corkbedded shoes work. They are typically very comfortable, but as they support you in your dysfunction, your compensatory pattern will only worsen and you will eventually experience you pain again. Rigid orthotics do not work because they do not allow your foot to change from a "loose bag of bones" that is needed when your heel first strikes the ground (this is needed for your leg to appropriately absorb the force the ground exerts on you leg at initial impact) to a rigid lever that is needed when you're pushing off of your toe of your back foot. It also doesn't allow your foot to feel and sense and change in pressure as your weight moves in your foot. 

What your body needs is to sense and feel the floor. The first line of attack to achieving this goal is to be sure that you are wearing the approparite shoes for your feet. Some people need more guidance for their foot while others need the motion of their foot to be controlled as they walk. If appropriate footwear will not solve the entire problem (likely to due a structural change in the foot or ankle from surgery, fractures, arthritis, etc), orthotics may be appropriate.

The orthotics made at Integrate 360 are made of a dense foam and are customized to each of your feet. We take measurements of the foot and ankle, pictures of the alignment of the foot in relation to the lower leg, and impressions of your feet. The orthotics are made by Dr. Paul Coffin with respect to your PRI rehabilitation goals. Once you receive your orthotics, they will have been made to support your foot/ankle where they need some assistance and, more importantly, allow you to sense and feel certain areas of your foot as you walk. This is essential as your brain needs to sense where you are on the ground to activate your muscles appropariately. This allows your underactive muscles to turn on, while keeping overactive muscles off. From here, your therapist now has a "blank slate" to help teach your body to use these cues appropriately, strengthen "weak" muscles, and help your body to learn to move in a balanced way again. 

Just by changing either your footwear or orthotic, your body is now able to regain proper joint/muscle position and restore reciprocal movement allowing for perfected mechanics versus putting a band-aid on their symptom. 

Interesting in an assessment to see what will fit your needs? Call Integrate 360 Physical Therapy at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com