Barefoot Science, General

Foot Drop Recovery | A New Approach to Reconnecting to your Foundation

If you’re unable to lift the toe end of your foot off the ground, you could have a condition known as foot drop. Foot drop itself isn’t typically considered a disease. Rather, it’s the symptom or side effect of a bigger issue.

Foot drop is typically characterized as an abnormal gait. A case of foot drop (or “drop foot”) is where the forefoot drops due to irritation, weakness, or damage to the nerves or muscles of the lower leg. Learning what causes it and how to treat it is essential to getting better.

Understanding Foot Drop

If you suffer from foot drop, or drop foot, you will struggle to lift up the front part of your foot. As you walk, it may even drag the ground. This usually leads to a “stepping gait” in order to compensate, which is when a person lifts their knee higher in order to bring the foot fully off the ground–as if climbing stairs. This gait may lead to your foot slamming against the floor as you put your leg down.

The cause of foot drop will influence a lot of factors associated with your case. For instance, foot drop can sometimes appear very suddenly or, in some cases, it’s a condition that gradually worsens. Regardless of the cause, ignoring foot drop can lead to the underlying condition worsening with time.

Depending on the cause, foot drop can affect just one foot or both of them. You may find that the skin on your toes or top of your foot feels numb. It can be temporary or permanent. A physician will likely prescribe a brace in order to hold your foot in the proper position as you walk and move around.

What Causes Foot Drop?

Foot drop occurs when something happens to the muscles responsible for lifting the front of the foot. These muscles can become weak or even paralyzed due to certain conditions, including the following.

The Peroneal Nerve

The peroneal nerve is responsible for controlling muscles to lift the foot and injuring it is surprisingly easy at any age. The peroneal nerve brances out of the sciatic nerve. The peroneal nerve wraps around from the front of your shin to the back of your knee. It’s close to the surface of the skin, which makes it easy to damage.

It’s so easy to injure that you may suffer from damage while playing sports or even during childbirth. Many other activities can also put you at a higher risk of peroneal nerve damage. If you have damaged your peroneal nerve, you’ll likely experience pain or numbness on the front of your shin all the way down to the top of your foot.

Nerve Compression and Injury

Most commonly, foot drop gets caused by compression of the peroneal nerve in the leg. For instance, damage can occur to this nerve during hip replacement or knee replacement surgery. Additionally, you may suffer from a “pinched nerve,” which is an issue that occurs in the spinal region, and experience foot drop as a result.

However, other risk factors are much more common. Simply crossing your legs habitually can put you at a higher risk of foot drop because this can compress the peroneal nerve in the upper thigh region. So, too, can prolonged kneeling or squatting. Laying tile, picking berries, and other occupations that require you to do so frequently could heighten your risk.

Finally, you might experience foot drop after wearing a cast on your lower leg. If you wear a plaster cast that runs from below the knee to the top of your foot, it can put pressure on the peroneal nerve, which could lead to foot drop.

Muscle or Nerve Disorders

People with diabetes are at a particularly high risk for nerve disorders that can cause foot drop. Additionally, muscular dystrophy is an inherited disease that can lead to foot drop. This disease causes progressively weaker muscles and, in turn, ends up weakening the muscles needed to lift the front of the foot.

Polio and Charcot-Marie-Tooth disease can also cause foot drop. This is why having any case of foot drop addressed is a necessity–it could clue you in to a much more serious condition.

Brand and Spinal Cord Disorders

Any disorder that affects the spinal cord and/or brain can lead to foot drop. This includes ALS, or Amyotrophic Lateral Sclerosis, along with stroke, multiple sclerosis, Cerebral Palsy, and other conditions.

How to Treat Foot Drop

Foot drop is not always permanent. The type of treatment your doctor pursues will depend on the cause of your foot drop. However, addressing the problem early will always give you a greater chance at speedy recovery.

A doctor may suggest a lightweight brace to hold the foot in its proper position. This is the most common treatment route. Alternatively, they may suggest physical therapy to help strengthen weakened muscles in the leg and foot. A physical therapist may also use a device that stimulates nerves in the leg.

In severe cases, your doctor may suggest surgery in an attempt to repair a damaged nerve or decompress it. If a case of foot drop gets diagnosed as permanent, they may suggest surgery to fuse the ankle joint to the foot or they may attempt to improve stability and gait by taking tendons from stronger muscles and transferring them into the problem area.

More commonly, doctors will suggest orthotics to address foot drop.

How Can Orthotics Help Foot Drop?

Regardless of the cause, foot drop treatment almost always involves an ankle foot foot-drop-splint-250x250orthosis (AFO) for bracing. These braces provide stability and toe clearance to help normalize the gait. They come in many different forms.

Understanding how AFOs work is essential to learning how such a product could benefit you. To do so, it’s important to realize that the ankle joint sees two standard forms of motion. These motions are plantarflexion (to describe downward movement) and dorsiflexion (to describe upward movement).

Plantarflexion is the motion of the ankle joints when your toes point downward. Dorsiflexion is the motion of the ankle joins when the foot points upward. As you lift your foot off the ground, dorsiflexion needs to occur so that your toes don’t drag the surface. Typically, foot drop results from weakness or paralyzation of the muscles responsible for dorsiflexion in the ankle joint.

There are multiple types of AFOs your doctor may suggest in order to address your foot drop.

Orthotics with a Short Leg and Fixed Hinge

The first is a “short leg” AFO. This design is shorter in height and features a fixed hinge. This AFO fits easily into most shoes and is fairly light. It gives you more control over your foot and it’s great for foot drop and flat feet.

This AFO works to position the foot at a 90-degree angle to the leg and keep it there. This also helps to control inward foot rotation, which is common in patients who have foot drop as a result of a stroke or Charcot-Marie-Tooth.

With the fixed hinge, however, this brace does not allow for plantarflexion or dorsiflexion. That means the gait won’t be as natural as some other braces may allow. Additionally, taller individuals (over six feet) will struggle with this brace because it is short.

Orthotics to Assist Dorsiflexion

Some AFOs are actually designed to assist dorsiflexion and are aptly named Dorsiflexion Assist Functional AFOs. They feature a hinge reminiscent of a spring. This hinge works to promote dorsiflexion (raising the foot) when you lift your foot off the ground. In other words, it mimics the motion you would naturally make when walking.

As a result, this AFO produces a more normal gait pattern. This design is ideal for someone with mild to moderate foot drop and it can also benefit a person with a generally flat or unstable foot. However, this design typically won’t work for tall people (over six feet) or people who weigh more than a certain amount (typically 225 pounds or more).

Orthotics to Stop Plantarflexion

This AFO design concentrates on preventing plantarflexion in the foot. In other words, it does not allow the foot to point downward, thereby preventing toe dragging. It features a hinge to enable normal dorsiflexion. This design tends to be a bit bulkier than some others but it can be effective for those who suffer from a severe case of foot drop.

Energy Return Orthotics

This AFO is perhaps one of the best designs as it is extremely lightweight in construction and provides immense control. There are usually different sub-models that vary depending on how severe a case of foot drop is. In general, an energy return AFO will use the natural flex of the AFO material itself in order to assist dorsiflexion.

Typically, you will find this type of AFO is actually constructed of carbon graphite materials. This makes them both lightweight and very good at providing dorsiflexion assistance.

Traditional Orthotics

Traditional AFOs are also known as posterior leaf spring AFOs. These orthotics have been around for years and are still effective today. However, newer designs allow for more comfortable usage and are typically lighter.

With that said, a physician may still recommend a posterior leaf spring construction for someone who has both foot drop and knee instability. There are also modern designs made specifically for those with foot drop and unstable knees.

Orthotics for Unstable Knees

Most often, a physician will suggest a “solid AFO” if you have both unstable knees and foot drop. This design will stop plantarflexion and also limit or stop dorsiflexion. If you have an unstable knee alongside a complete loss of dorsiflexion strength (or severely limited strength), this design may work best for you. While bulkier than others, it gives superior control while moving around.

How Textured Insoles Are Beneficial for Foot Drop Braces

In the likely event that your physician recommends an AFO brace, it’s important to also conconsider the role of textured insoles as part of your treatment. This is because textured insoles add the added benefit of stimulating the skin on the bottom of the feet, brining increased neurostimulation.

OLYMPUS DIGITAL CAMERA

Naboso 1.5 Insole

Naboso™ Textured Insoles are the perfect option. Designed by Podiatrist Dr Emily Splichal, Naboso™ Textured Insoles are specifically designed to enhance proprioceptive stimulation of the feet.

What Is Proprioceptive Stimulation?

The skin on the bottom of your foot is home to plantar proprioceptors, which are critical to proper balance, posture, motor control, and human locomotion. However, all footwear blocks the necessary stimulation of the plantar proprioceptors to some degree. The result is a delay in communication between the ground and the nervous system. In turn, this delay can lead to poor balance, inefficient movement, and joint pain.

Proper stimulation of the plantar proprioceptors is essential to whole body wellness and, especially, to supporting healthy movement. Dr Emily Splichal designed Naboso Insoles in a way that they are able to uniquely stimulate the plantar proprioceptors.

With advanced research, Naboso Insoles have shown that they can improve gait patterns and balance. As such, Naboso Technology offer a range of insoles all of which benefit not only medical conditions and athletes, but for people of all ages.

The Benefits of Medical Orthotics

Properly designed orthotics are beneficial to everyone, but they play a special role in recovery or management for those suffering from foot drop and other mobility issues.

Textured insoles do more than support the foot or arch. With all of your weight bearing down on your feet, textured insoles work to alleviate pain that resonates through the foot, ankle, leg, and back. The right insert will help you to correctly align your feet and legs naturally, leading to better posture and improved balance.

By supporting the arch and heel of the foot, textured insoles help to absorb shock and distribute the immense pressure felt by your foot across your entire sole. The design of a properly fitted textured insoles will also help to prevent bunions, calluses, corns, and ulcerations thanks to the evenly distributed weight, which helps to prevent and alleviate pressure points.

All of these things typically promotes greater mobility, allowing people to stay on their feet for longer and be more active while eliminating pain and other impacts they used to suffer from when moving around.

The Importance of Proper Fit

You should never just pull a pair of generic insoles off the shelf and expect them to benefit you. The key to effective orthotics is proper construction and fit. A prefabricated option can work wonders, so long as you properly measure your foot bed to ensure that the fit is right.

If you choose an insole too small or too big, the placement of the arch support and the general shape of the insole can be uncomfortable and even worsen joint pain and other conditions. As such, you should always check size guides and ask for help when needed.

When in doubt, ask a professional for guidance and assistance in choosing the right textured insoles for your needs. If you pair your AFO with the right textured insoles, you will experience immense relief, greater stability, improved mobility, and better results as a whole.

Finding The Right Textured Insoles

Once you have spoken to your physician about addressing your drop foot, seek their guidance in finding the appropriate AFO for your needs. With that information, you can then proceed with looking for the right textured insoles that will enable you to get the most out of your rehabilitation or management program.

If you need help finding the right textured insoles, look no further than Dr Emily Splichal and Naboso Technology. Take a few minutes and learn more Naboso™ Textured Insoles

Advertisements
Standard
Foot Function & Fascial Lines Series

Peripheral Neuropathy | Enhanced Sensory Stimulation May Improve Balance & Stability

Feeling pain, tingling, numbness, or weakness in your hands or feet may be a sign of foot_neuropathy_pain_-_istock_4bb60646-139e-4584-94b5-896d91e8982d_1200xperipheral neuropathy. This condition damages your peripheral nerves. They allow your brain and spinal cord to communicate with the rest of your body.

Peripheral neuropathy is a common condition. More than 20 million Americans suffer from it. While it can affect people of any age, it’s more common in people over 55.

There are many types of peripheral neuropathy, each with a different cause. Treatment for this condition depends on finding what has damaged the nerves. Unfortunately, the cause sometimes remains unknown. Also, even when doctors do discover the cause, the treatment may not reduce all symptoms.

The good news is that the peripheral nerves have an incredible ability. They can regenerate themselves. When they do, the symptoms may disappear on their own or after treatment. But not all types of peripheral neuropathy have a cure. This means some people have to live with their condition.

Learn more about peripheral neuropathy, its symptoms, causes, and treatment options. This information can help you manage your condition and reduce its impact on your life and well-being.

What Is Peripheral Neuropathy?

Peripheral neuropathy is a disorder that affects the peripheral nervous system. This is one of the two components of the nervous system. The other component is the central nervous system (brain and spinal cord).

How the Peripheral Nerves Work

The peripheral nervous system is made up of peripheral nerves. They reach all parts of your body apart from brain and spinal cord. These nerves control how you sense touch and feel pain and temperature. They also control your muscle strength and coordination.

The peripheral nerves carry information to and from the central nervous system. They allow your feet, arms, and organs to send information to your brain. For example, they tell the central nervous system that you feel pain when you step on a tack, or that your hands are cold.

In turn, the central nervous system uses the peripheral nerves to send signals to your body. These signals are “orders” to your muscles and organs. That’s how you’re able to move, breathe, and maintain your balance.

Damage to Peripheral Nerves

The peripheral nerves are fragile. Whey they suffer injury, they can no longer perform their function well.

Damage to peripheral nerves affects how the central and peripheral nervous systems communicate. Damaged communication between the two can lead to loss of sensation. For example, you may become unable to feel a burn from hot water. Or, damaged nerves can lead to loss of function, like being unable to maintain balance when you walk. This, in turn, increases your risk of injuries and falls.

Often, peripheral neuropathy can cause discomfort, numbness, and tingling. It may also lead to weakness in the feet, hands, legs, and arms. Sometimes it causes pain. And some neuropathies may limit your mobility. Your condition might make you unable to enjoy simple everyday activities. Even walking can become difficult.

All these symptoms can disrupt your life. But not all types of peripheral neuropathy are crippling. And treatment is available for many neuropathies. To prescribe the right treatment, doctors first need to discover the cause of the disease.

Causes of Peripheral Neuropathy

Peripheral neuropathy is a very common condition. It affects about 6 percent of the U.S. population, or more than 20 million people.

It can have various causes. The most common is diabetes.  About 60 percent of people with diabetes will develop peripheral neuropathy. That’s because high blood sugar levels can damage the nerves.

Another common cause of peripheral neuropathy is nerve injury or trauma. This can result from auto collisions, sports accidents, medical procedures, and more.

For example, all of the following can cause injury to nerve tissue:

  • Bruising
  • Stretching
  • Cutting or tearing
  • Electrical injury
  • Gunshot wound

Not only injury but also compression can harm the nerve tissue. For example, the carpal tunnel syndrome is a type of compression peripheral neuropathy. It affects the hands. Its cause is repetitive motions that put pressure on a nerve.

Other causes of peripheral neuropathy include the following:

  • Alcoholism
  • Autoimmune disorders
  • Heavy metal exposure (for example, lead poisoning)
  • Exposure to toxic chemicals, such as solvent
  • Infections (including Lyme disease, AIDS, and hepatitis C)
  • Vitamin deficiency (for example, B1, B6, B12)
  • Kidney disease
  • Hypothyroidism
  • Metabolic disease

Peripheral neuropathy is also a side effect of certain types of medication. One example is chemotherapy drugs.

In rare cases, peripheral neuropathy runs in the family. This means that parents can pass it to their children. Inherited peripheral neuropathy includes the Charcot-Marie-Tooth disease.

Doctors can’t always find the cause of peripheral neuropathy. In one-third of cases, it remains unknown. This makes prescribing treatment difficult. When doctors cannot identify the cause of this condition, they call it idiopathic peripheral neuropathy.

Types of Peripheral Neuropathy

More than 100 types of peripheral neuropathy exist, says the U.S. National Institute of Neurological Disorders and Stroke.

According to one classification, there are three main categories of peripheral neuropathy:

  • Motor neuropathyaffects motor nerves. The central nervous system uses these nerves to send orders to all the muscles in the body. They allow you to walk, talk, move your fingers, and catch a ball. Damage to motor nerves can cause muscle weakness, cramps, and spasms. It can also make walking or moving your arms difficult.
  • Sensory neuropathyaffects sensory nerves. They send information from your muscles to your central nervous system. They allow you to sense temperature, touch, and pain. Damage to sensory nerves can cause numbness, tingling, extreme sensitivity to touch or temperature, and even pain.
  • Autonomic nerve neuropathyaffects autonomic nerves. These control bodily functions like heartbeat, breathing, digestion, sweating, and blood pressure. You can’t control most of these functions. Damage to autonomic nerves may cause your heart to beat faster (or slower) or cause you to be unable to sweat (or sweat too much). It may also lead to problems with digestion, urination, and sexual functions.

Here are some examples of peripheral neuropathies.

  • Diabetic neuropathy: It affects all three groups of nerves (motor, sensory, and anatomic). And it damages nerves throughout the body.
  • Alcoholic neuropathy: Excessive alcohol use damages the peripheral nerves.
  • Guillain-Barré syndrome: This is a rare disease in which the body’s immune (defense) system attacks the nerves.
  • Bell’s palsy: This disorder affects the nerves and muscles of the face.
  • Ulnar neuropathy: Its cause is the compression of the ulnar nerve, located in the arm.
  • Chemotherapy-induced neuropathy: Nerve damage can be a side effect of using chemotherapy drugs to treat cancer.
  • Carpal tunnel syndrome: Repetitive movements (such as typing on a keyboard) put pressure on the nerve and tendons in the forearm and hand.

Most people with peripheral neuropathy have more than one type at the same time. The term for this condition is polyneuropathy.  If you have only one damaged nerve, you have mononeuropathy. Each type of neuropathy has its own set of symptoms.

Symptoms

The symptoms of peripheral neuropathy range from mild to severe. Some can be disabling and even lead to paralysis. Pain may or may not be present. In fact, according to researchers, pain is a symptom of half of all cases of polyneuropathy.

The symptoms may appear suddenly, or take months or years to develop. Their onset depends on the cause of nerve damage. For example, the symptoms of diabetic peripheral neuropathy develop slowly and get worse over time. On the other hand, those of acute peripheral neuropathy develop suddenly.

Peripheral neuropathy symptoms may vary depending on which nerves have suffered damage. But some of the common symptoms of many peripheral neuropathies include the following:

  • Tingling, burning, or prickling sensation in the feet, legs, hands, or arms
  • Weakness and numbness in the limbs
  • Inability to feel that something is too hot or too cold
  • Noticing no pain when you step on something sharp
  • Burning or freezing sensation in the hands or feet
  • Extreme sensitivity to touch
  • Extreme sensitivity to heat or cold
  • Sharp, shooting pain in the limbs
  • Loss of balance
  • Difficulty walking
  • Poor coordination
  • Dizziness
  • Loss of reflexes
  • Muscle twitching
  • Loss of mobility

This list of peripheral neuropathy symptoms does not include all the signs of nerve damage. Specific types of peripheral neuropathy may have other symptoms that are not on this list. If you notice any of the above symptoms or others, speak to your doctor.

Who Is More Likely to Develop Peripheral Neuropathy?

Peripheral neuropathy affects between 5 and 8 percent of people in the world.

People of any age can suffer from peripheral neuropathy. But, according to an article in Handbook of Clinical Neurology, older adults are more likely to develop this condition than are younger people.

Also, men are more likely than women to develop almost all types of peripheral neuropathy. There is one exception, though. Carpal tunnel syndrome is more common in women than in men.

Many medical conditions can cause nerve damage. Individuals suffering from a range of conditions may be at a higher risk than others to develop peripheral neuropathy. These include:

  • People who have nerve damage from a previous injury or illness
  • People with diabetes, immune diseases, vitamin deficiencies, or AIDS
  • Alcoholics — according to German researchers, between 22 and 66 percent of people with chronic alcoholism have peripheral neuropathy
  • Cancer patients who had chemotherapy — between 30 and 40 percent of those who have received chemotherapy drugs develop peripheral neuropathy, says the National Comprehensive Cancer Network
  • People who have suffered poisoning from exposure to heavy metals, toxic chemicals, or radiation

Diagnosis

If you are one of the people with an increased risk of peripheral neuropathy, go to the doctor for regular check-ups. Also, speak to your physician if you believe you may have peripheral neuropathy symptoms.

Your doctor will examine your symptoms, your posture and coordination, and perform a physical exam. They may ask you about your medical history. Also, you may need to answer questions about your family’s medical history. Your answers may be important, because some types of peripheral neuropathy are hereditary (run in the family).

Your doctor will use this information to assess if you have an increased risk of neuropathy. Then, they might check your reflexes, and your ability to feel temperature and pain.

If necessary, your physician will request a neurological examination, blood and urine tests, as well as other medical exams. These will reveal if you have diabetes, hypothyroidism, vitamin deficiencies, or other conditions that can cause peripheral neuropathy.

The outcome of these tests will help your doctor discover whether you have a neuropathy. If you do, they’ll try to identify the causes of nerve damage. For this, they might recommend further exams. They may ask for a nerve biopsy (take a sample of nerve tissue to examine), MRI (magnetic resonance imaging) scan, or CT (computed tomography) scan.

As you might have realized, diagnosis of peripheral neuropathy is often difficult. Many diseases can affect your nerves and muscles. That’s why your doctor will likely need to collaborate with other specialists to diagnose your condition. So, arm yourself with patience. Be ready to undergo several medical exams before you can receive a diagnosis and treatment for your condition.

Treatment

The treatment options for peripheral neuropathy depend on its cause. Once your doctor diagnoses your condition, they will be able to recommend the appropriate course of treatment. Follow the treatment your doctor prescribes.

The information in this article gives you an idea about what treatments exist.

Addressing the Cause

The therapy for peripheral neuropathy aims to treat the cause of nerve damage. For example, if the cause is a pinched nerve, the doctors may use surgery to release the nerve. Or, if the cause of your peripheral neuropathy is diabetes, your doctor will aim to control it.

As peripheral nerves have the ability to fix themselves, some of the symptoms may disappear following treatment. Or, they may go away on their own.

Not all nerve damage can be undone, though. In some cases the nerve cell is dead, and no treatment can reverse this. Also, unfortunately, some types of peripheral neuropathy have no known cure. This is the case of inherited peripheral neuropathies. It’s also the case of diabetic peripheral neuropathy.

This is a common type of neuropathy in America, affecting about one in two people with diabetes. Diabetic peripheral neuropathy can cause pain, sensory loss, foot sores, and gait instability, reducing the quality of life. Though no known treatment can reverse nerve damage due to diabetes, there are treatments that may improve the symptoms. One example is transcutaneous electrical nerve stimulation.  This is a noninvasive intervention (meaning it doesn’t require surgery) that might relieve pain.

Reducing the Symptoms

When doctors can’t treat the cause of peripheral neuropathy, the treatment may focus on managing symptoms. In other words, doctors will recommend methods to reduce specific symptoms.

Different types of damaged nerve require different therapies.

  • For sensory neuropathies, medication might help control chronic pain. Your doctor will recommend appropriate pain-control medication. Examples of drugs for neuropathic pain include steroids, anti-seizure medicines, opioids, and antidepressants.
  • For motor neuropathies, doctors may recommend braces, orthopedic shoes, splints, or other mechanical aids. These aim to improve function, and reduce physical disability and pain. They may also allow the nerves to heal.
  • For autonomic neuropathies, doctors may recommend how to cope with neuropathic pain. Massage, certain medications, and psychotherapy techniques can help you cope with pain.

Not all people need medication for managing their peripheral neuropathy symptoms. On the one hand, pain is not a symptom in all cases, as mentioned earlier. On the other hand, some kind of neuropathic pain can be mild. Your doctor can show you ways to manage it.

When medication to control pain doesn’t work, doctors may recommend surgery. Usually, this works only for mononeuropathy (only one nerve is damaged). For example, pinched nerves usually require surgery. This releases the compression and allows the nerve to heal.

Surgery doesn’t usually work for neuropathies that affect more than one nerve.

Other treatments for peripheral neuropathy can help you manage your symptoms and prevent them from getting worse. One example is physical therapy. It includes exercises to improve the body’s ability to maintain coordination, agility, and balance — or proprioception.

Other treatments include occupational therapy, relaxation therapies, guided imagery, biofeedback, and acupuncture.

Managing Peripheral Neuropathy

For some types of peripheral neuropathy there are no therapies. And some neuropathies have no known cause. So, many people have to live with this condition.

Fortunately, not all types of peripheral neuropathy are crippling, and some symptoms are mild. Also, peripheral nerve cells grow throughout your life. This means that some nerves may regenerate. If they do, symptoms might resolve on their own. Not all symptoms lessen or disappear over time, though.

The goal of managing your peripheral neuropathy should be to maintain and restore the function of your peripheral nervous system. Managing peripheral neuropathy involves making healthy lifestyle choices. It also requires taking preventive measures and focusing on restoring function.

Choosing a Healthy Lifestyle

Making healthy lifestyle choices can improve nerve health, as well as helping you cope with the symptoms of neuropathy. Here are some examples of healthy lifestyle choices you can make:

  • Maintaining an optimal weight
  • Eating a balanced diet
  • Avoiding exposure to toxic chemicals and heavy metals
  • Not smoking
  • Avoiding alcohol
  • Exercising
  • Using relaxation techniques

Compensating for Loss of Sensation

When you have a neuropathy, you have to do more than lead a healthy lifestyle. Consider taking measures to counteract the loss of sensation that your condition can cause. You need to pay particular attention to your hands and feet. Loss of sensation can make it hard or impossible to notice pain, extreme temperature, or injuries to your hands and feet.

Take measures to prevent injuries that loss of sensation may cause. Here are some of these measures:

  • Wear gloves when you handle heavy equipment, work outdoor, or do repairs
  • Be extra careful when you use sharp objects
  • Avoid extreme temperatures
  • Keep your feet and hands warm in cold weather
  • Use oven gloves when you handle hot dishes or pans
  • Use a water thermometer to check your bath water
  • Choose footwear that fits properly
  • Ask your doctor if they can recommend therapeutic shoes

Also, if you have problems with balance, there are things you can do to prevent falls. For instance:

  • Use a walking cane or another walking device.  Speak to your doctor if you need help choosing the right walking aid.
  • Sit down when you do some activities you would normally perform standing up (like brushing your teeth).
  • Consider installing handrails in your bathroom.

A New Approach to Improving Mobility and Restoring Function

Making lifestyle changes is only one part of managing peripheral neuropathy. You also have to work on maintaining, or restoring, your motor function. People living with peripheral neuropathy often suffer from balance impairment and mobility problems. Improved mobility will allow you to enjoy walking your dog, running, or playing with your grandchildren.

To help stimulate the nerves on the bottom of your foot, you need to do more than just Naboso Insoles Texture 3wear properly fitting footwear. A new option to stimulate your foot’s nerves is to use textured insoles specifically designed to improve movement and function.

Naboso Technology proprioceptive insoles accurately and precisely stimulate the foot’s nervous system. The small nerves on the bottom of your foot are sensitive to different stimuli.

These include vibration, texture, touch, and pressure. The foot’s nerves receive this information and use it to help you maintain balance and posture. They also use it to control your muscles.

However, wearing shoes — even minimal footwear — blocks some of the stimulation the plantar foot receives. This results in a delay in the central nervous system that can affect balance and movement.

But walking barefoot is not always possible. Also, for people suffering from reduced foot sensitivity due to peripheral neuropathy, walking barefoot may increase the risk of injury. That’s why doctors may advise people with neuropathies to avoid walking barefoot, even around the house.

So if you can’t walk barefoot, what can you do to ensure the foot’s peripheral nerves receive proper stimulation? Fortunately, Naboso Technology has developed a solution for this exact problem: textured insoles that you can insert in your everyday footwear.

Research studies have shown the benefit of textured insoles for people with chronic neurological conditions. At Naboso Technology, we have built upon texture research and surface science to create our proprioceptive insoles. These insoles are ideal for people with decreased sensitivity of the feet. Inserting them into properly fitting shoes has been shown to improve posture, balance, and mobility.

The benefits of Naboso Technology insoles for people with peripheral neuropathy include the following:

  • Increased foot stimulation, which increases the sensitivity of the foot
  • Improved gait, which reduces the risk of falls
  • Enhanced peripheral nerve stimulation, which promotes nerve function and regeneration
  • Improved posture and balance, which help you regain your confidence in your ability to walk and stand

The Naboso Technology insoles are a safe and effective way to promote optimal connection between the foot’s nerves and the brain. Therefore, they can play an important role in neuro-rehabilitation programs.

Beside insoles, Naboso Technology material is also integrated into proprioceptive training mats. They can help ensure your foot’s nerves receive proper stimulation when you exercise barefoot.

Maintaining good balance, coordination, and movement is important for everyone. But it’s key to your wellness when you live with peripheral neuropathy. Increased mobility and balance can help you maintain your quality of life.

Conclusion

Damage to peripheral nerves can cause peripheral neuropathy. This is a condition that can affect anyone, though it’s more common in older people. There are many types of peripheral neuropathy. Their symptoms range from mild to severe. Treatment depends on the type of nerve damage. Unfortunately, no known cure exists for some kinds of neuropathies. When doctors can’t find the cause of this condition, therapies aim to ease its symptoms.

Do not let peripheral neuropathy take control of your life. Take measures to manage your condition. Follow your prescribed treatment and make certain lifestyle changes to improve your mobility as well as your foot’s sensitivity. Wearing Naboso Technology insoles in your everyday shoes can improve your balance and stability. With renewed confidence when walking or standing, you’ll be able to continue enjoying your favorite activities and independence.

Standard
Foot Function & Fascial Lines Series, General

Are you doing short foot correctly? | Clearing the confusion

I think it goes without saying that I have a passion for sharing the power of foot activation and how it fascially connects to central core stabilization.  My go-to for foot activation is none other than – short foot!

Considered by some as merely of foot-specific exercise and not one that is integrated or applicable to total body function, I think it’s time to clear the confusion around this exercise – and foot function in general!

Having taught short foot to professionals, patients and athletes all around the world for over 10 years, I’ve seen it all.   I’ve literally taught short foot to over 25,000 people and have seen every confusion, mis-cueing, compensation pattern and foot type.

Because I understand the power of proper short foot activation, I get a little let’s say passionate when I see and hear professionals cueing short foot incorrectly.

What gets me even more worked up is that those that are cueing short foot incorrectly are professionals who are being followed and trusted as “experts” in the industry.

The Dunning-Kruger Effect

Having thousands of Instagram followers and posting cool pictures that favor natural foot function does not make one a foot expert.   Yet what these professionals are posting and saying is being taken as gospel, possibly because they are being stated with such confidence it must be correct.  Right?

Sadly most of the posts and statements that are being made are black and white concepts.  The foot is supposed to do X and therefore Y.    I wish it was that easy, but the human body is far too complex to be X = Y.    There is a lot of grey when it comes to programming, cueing and yes – overall foot function.

What is the risk of posting pictures and statements or teaching concepts that are black and white or X = Y?   People can get hurt.   Trust gets broken.   Confusion gets created.

Clearing the Confusion on Short Foot

It’s time to set the record straight.    I”m going to go into the proper way to cue and execute short foot.    My cueing technique is backed by anatomy, science and a deep understanding of true foot function.    No conclusions are being made based off of associations.

Disclaimer:   After reading this, if you realize that have been doing short foot incorrectly. It’s okay!   This is not an attack on anyone or a criticism to any professional out there – even to the ones that are cueing short foot incorrectly.   I just want short foot to be represented in its true form so that we get the optimal benefits and reduce the risk of injury. 

Step 1 – Teach 1 foot at a time. 

I usually cue to go into a split stance so that you can focus on just the front foot initially.

Why we want to teach one foot at a time is that the mind-muscle connection of executing short foot bilateral is too high for many clients.   To start with one foot allows the focus to be centered on a more local foot engagement.

Step 2 – Slightly bend the knees to unlock them 

When we do short foot we create a locking mechanism up the lower extremity.   If you do short foot on a fully extended knee you are essentially locking a locked joint.   This can create shear to the meniscus and create injury to our clients.

As the Hippocratic Oath states “thou shalt do no harm” – so I kindly remind you to slightly bend the knees.

Step 3 – Place the foot in neutral and find the foot tripod

foot-tripod-bottom-points

Ensuring the rear foot is not pronated during short foot is critical – reason being is that a pronated foot is unlocked and unstable with the muscles in a lengthened position.    This makes in ineffective to engage short foot.

After the rear foot is put into a neutral position, then it’s time to find the foot tripod.  This means to center body weight under the 1st metatarsal head, 5th metatarsal head and heel.

Disclaimer: This is NOT to be confused with the foot staying on the tripod throughout the exercise – or to push the tripod down during short foot. 

Step 4 – Lift the toes, spread them out and place them on the ground 

To further complete the base of support and centered foot position we need all digits to be spread wide and long.    We will shortly see that the true action of short foot is in the digits which is why this is going to be an important aspect of the short foot cue.

Step 5 – While exhaling, push the tips of the toes down into the ground 

The true cue for short foot is in the long flexors (FHL, FDL) which insert into the plantar, distal aspect of the toes.   These muscles anchor or root the tips of the toes (think toenails) down into the ground.

img_7139.jpgThe pushing of the distal tips of the toes into the ground not only activates the long flexors but it also engages the plantar fascia via the reverse windlass mechanism.   Both the action of the long flexors and plantar fascia is to increase the arches of the foot (longitudinal and transverse) which ultimately lifts us off of the ball of the foot.

What we should see when we push the tips of the toes down into the ground is that the 1st metatarsal head lifts off of the ground.

Now to be clear, I don’t want YOU to lift the 1st metatarsal head off of the ground – I want it to be a reaction of the contraction.

If YOU lift the 1st metatarsal head off of the ground, chances are you are going to over engage short foot and can create too much hypertonicity.

Now this is where the cueing goes wrong!

Many – I repeat – many professionals are cueing short foot as pushing the 1st metatarsal head down into the ground.   This is wrong.  This is incorrect.  This does not transverse to function.   This is a literal translation of the foot tripod and a gross misrepresentation of true function of the foot.    (More on this soon!)

Step 6 – Incorporate the pelvic floor 

The final step we want to integrate with short foot is the deep core.   To be truly integrated we need the entire Deep Front Line to be a part of this short foot exercise.  This means that as we exhale, we want to focus on lifting our pelvic floor and pushing the tips of our toes down into the ground.

The result?

All of the central domes in our body stack.   The arch, the pelvic floor, the diaphragm – and technically our palate all lift during activation.

Clearing the Confusion! 

So now that we know the proper way to cue short foot.   It’s time to clear the confusion how short foot.   The most common incorrect cue that I hear is pushing the 1st metatarsal head down as the activation.

I am not sure who started this trend but it is wrong.

Yes we do start by finding our foot tripod – but that doesn’t mean we should literally push into the foot tripod as the form of foot activation for foot stability.

DFL

So why not?     We need to defend our reason of why not!

Answer #1 –  Deep Front Line.    

Short Foot is a Deep Front Line activation.  Remember the true purpose of activating our feet is to get them to “talk to” our core or center.

If we look at the Deep Front Line, the muscles of the feet that we see are the Flexor Hallucis Longus, Flexor Digitorum Longus, Posterior Tibialis and Anterior Tibialis.

As mentioned earlier, the cueing I use for short foot is to push the tips of the toes down into the ground.  The reason?  Because this is the action of the flexors!

When we push the 1st metatarsal down into the ground we are activating the peroneus longus muscle.

Do you see that muscle in the Deep Front Line?   I don’t either!

Answer #2 – 1st Ray Plantarflexion & the 1st MPJ

To further understand the purpose of 1st metatarsal plantar flexion (or pushing the 1st met down) we need to understand the true functional reason behind this action.

When does our 1st metatarsal FUNCTIONALLY want to plantar flex?

During push-off!

The action of 1st metatarsal plantar flexion is to allow the 1st MPJ to dorsiflexion – an action that occurs during push-off.   When we take a step, run or jump our great toe dorsiflexes to create a rigid lever for forward (or vertical) progression.

I did a whole blog series on the 1st MPJ where I went into the actions of slide, glide and jam but essentially one of the most critical steps in dorsiflexion of the big toe is 1st metatarsal plantar flexion.    However.   We must pause there.   This 1st metatarsal plantar flexion is actually not DOWN but rather it is BEHIND us.

1st mpj

 

If you see in the image to the right, 1st metatarsal plantar flexion is actual BEHIND us as
we shift our COG forward, this is how we truly dorsiflex the great toe.

How does this relate back to short foot?  This means that to train the 1st metatarsal to literally push down into the ground has no true functional transfer.

Answer #3 – Sesamoids 

The final reason of why I do not cue pushing the 1st metatarsal head down has to do with the sesamoids.   The sesamoids are two small bones that sit within the Flexor Hallucis Brevis tendons and sit directly under the 1st metatarsal head.

Like the patella (knee cap) the sesamoids are not intended to be passive weight bearing bones but rather ones that transfer force during functional movement.

sesamoidThe image to the left shows that the sesamoids are the lowest bones in the foot and if there is intentional 1st met plantarflexion into the ground (due to a miscue of short foot) then there is increased force to these small bones.

This can greatly increase the chance for sesamoiditis and sesamoid fractures – two conditions that are a b*#! to treat.

In addition, some of the clients and patients being cued to push down into their 1st metatarsal head during short foot may actually have a functional plantarflexed first ray which can be exacerbated with improper short foot cueing.   The negative impact of a plantar flexed 1st metatarsal (ray) is functional hallux limitus, which can lead to a myriad of compensation patterns during walking.

Did I confuse you more?

If the above was a little like “what the hell is she talking about” then good!   This is is how confusing the foot is!

It is not black and white.   It is not X = Y.

It is grey with a lot of exceptions with any cue or exercise.   This is why I created the Barefoot Training Specialist® Certification and have trained a very niche group of qualified Master Instructors under EBFA Global.

Are you more of an auditory learner?

Tune in below for a video summary I did on this exact topic.

Still confused?    Email me!     dremily@ebfafitness.com

In summary, honor the power of the foot.   Consider who you are using as your sources.   Ask questions.   And don’t take anything anyone says as gospel.   Ask for the WHY?

Stay #barefootstrong

Dr Emily Splichal, DPM, MS, CES

 

Standard
Barefoot Science, General

Toe Walking and Tactile Input

Walking on the toes as a child may be considered a normal phase of learning to walk, however in the child past 3 years old the absence of heel contact at initial contact is not normal.

According to Williams et al. (2010) an average 7% of children present with a toe walking toe walkinggait.  Any child walking on their toes should be assessed for medical causes of the gait pattern.

Some of the most common causes of toe walking include:

  • Equinus (structural limitation is ankle dorsiflexion)
  • Upper motor neuron trauma (cerebral palsy)
  • Neurogenic factors (autism)

But what if all of the above possible causes are ruled out?

What could be the driver of the toe walking?

This is where the diagnosis idiopathic toe walking (ITW) comes into play.    ITW means there is no known cause for the child’s gait pattern and absence of heel strike at initial contact.

Treatment Options for Toe Walking

If there is no known cause for a child’s toe walking it makes treatment options difficult. For ITW, most practitioners focus on ankle mobility as the most addressable option.

This means treatment options for these children include:

  • Physical therapy and manual release work
  • Stretching and night splints
  • Botox injections to calves
  • Achilles tendon lengthening

All of these treatment options have downsides including skin irritation, compliancy and invasive risks of infection and scarring.    Specialists are now looking for new treatment options for these children.  Treatment options that are simple, non-invasive and will have increased compliancy.

New Treatment Options for ITW

Researcher Dr Cylie Williams of Monash University in Australia has been exploring new treatment options that look specifically at the tactile input in these children.   It is proposed that by changing tactile input through the feet, one could change the neurological input and potentially influence the gait pattern.

Dr Williams’ initial exploration into this topic was related to whole body vibration fullsizeoutput_1805(WBV).   In her prior research she has noted varying vibration threshold in children who are idiopathic toe walkers and those with a normal heel toe gait.   The benefits of WBV are promising to this pediatric population however the only downside is that the effect is short term, temporary and requires a WBV platform such as Power Plate.

Dr Williams is seeking new tactile stimulation methods and has turned to Naboso Neuro Insoles.   Starting early 2019 Dr Williams will be researching the effects of Naboso Insoles as a simple, non-invasive intervention for ITW.

Sensory Seeking Children

As the inventor of Naboso Technology and our sensory products, my interest is of course in those children who are sensory seeking and the possible role the Naboso Insoles and Mats can have on the behavior and movement patterns in these children.

Lane et al. (2009) has identified three main types of sensory processing disorders in children with autism:

  • Sensory sensitive (covering ears to loud noises, restricted food preferences)
  • Sensory under-responsive (failure to react to pain)
  • Sensory seeking (rocking, hand flapping, noise-makingchildrens insoles

Due to the correlation between autism, sensory processing disorders and toe walking the possible application of Naboso for these children is exciting.    As the research around ITW and tactile input continues to be explored we will hopefully have new data to share on this topic.

In the mean time we encourage any professional working with ITW children to consider the possible role of Naboso Children’s Insoles and our Naboso Textured Mats.

In health,

Dr Emily Splichal, DPM, MS 

Citations:

Lane, Alison et al. (2009) Sensory Processing Subtypes in Autism. J Dev Autism Disorder 40: 112 – 122.

Williams, Cylie et al. (2010) Idiopathic Toe Walking and Sensory Processing Disorder. J Foot and Ankle Res  3: 16

 

Standard
Foot Function & Fascial Lines Series

Tapping into Torsion | The Rotational Power of the Achilles Tendon

Power lies within the transverse plane.

We have all heard this concept at one point or another throughout our education or training career.  

javelinFrom the rotational moment of the trunk to generate power when throwing a javelin to the torque created from supination of the foot into the external rotational power of the glutes – rotational moments are in every aspect of human movement. 

The closer we look at the fascinating human body and the fascial system, the more we can find that spirals and rotations are everything and EVERYWHERE!

I want to take this time to explore an area of the body where rotational or spiraling properties are often under appreciated or perhaps not even know – within the human Achilles tendon.  

The Achilles Tendon

Enter the largest, strongest tendon in the human body – the Achilles tendon.   Formed by the gastrocnemius and soleus tendons (and sometimes plantaris), this fascinating structure is able to generate most of the elastic energy return during dynamic movement and from an evolutionary perspective is a critical structure in the spring-mass theory of movement efficiency. 

Now there are a few unique characteristics of the Achilles tendon that must be Achilles Rotationappreciated when training or rehabbing this structure.  All of these characteristics are emphasized in all trainings through EBFA Global:

  • The Achilles tendon is not one tendon but rather a stacked tendon 
  • 2/3 of the Achilles tendon is made of soleus fibers 
  • The Achilles tendon medially rotates toward its insertion
  • This rotation places the soleus fibers to the medial calcaneus 
  • While the MG / LG insert towards the lateral calcaneus

How cool are these facts?   But what does the above functionally mean?  

Functional Application #1 – Soleus Equals Power 

Since 2/3 of the Achilles tendon is soleus fibers this means that most of our elastic recoil and plantarflexion torque is coming from the fascial tension and loading of the soleus muscle and fascia.   

When you are training the elastic recoil of the Achilles tendon remember to incorporate soleus focused eccentric deceleration and acceleration training while the knee is bent or while transitioning through a knee flexion pattern.  

Functional Application #2 – Resupination of the Foot through Plantarflexion

The rotation or torsion of the Achilles tendon provides increased tensile strength IMG_9349and assists in fiber sliding during elastic movement.    In addition, due to the placement of the soleus fibers of the Achilles tendon plays a key role in thresupination action of the rearfoot during the push-off phase of gait.

This coupled concept means that when training jumping and push-off power drills emphasize a from the ground up approach the utilizes total ankle plantarflexion.   In EBFA Education we do this through teaching jumping by pushing off all 5 digits and envisioning a follow through with all digits (see image to the right) 

Functional Application #3 – Restriction of Blood Supply 

I must add that as much as torsion adds a rotational power to the Achilles tendon,  there can be a downside to this feature.   This rotation of the Achilles tendon fibers causes a disruption to the micro-circulation or blood supply to the Achille tendon. 

The area with the greatest compromise in circulation is called the watershed area and lies 2 – 6 cm above the Achilles insertion.   The mid-tendon or watershed area is the site of most Achilles tendon ruptures (especially as we age) and is the location of tendon degeneration.   

By appreciating this compromised Achilles circulation, professionals should ensurefullsizeoutput_1805 to properly warm up the elastic properties to the Achilles tendon and in those with a history of mid-tendon tendinitis to avoid movement patterns that increase stress to the watershed area of the tendon.   

In my office, I use the PowerPlate to increase micro-circulation to the Achilles tendon in my patients with a history of Achilles injury or degeneration.   Research has shown that 10 min of whole body vibration can create increased skin perfusion and decrease arterial resistance, both beneficial to tissue healing.   

Functional Application #5 – Non-Uniform Achilles Stress by Pronation

The non-uniform division of the Achilles tendon fibers with 2/3 being soleus, coupled with medial rotation of the tendon fibers there is a non-uniform stress placed on the Achilles tendon.  

Gils et al. has demonstrated that the soleus fibers are under the greatest stress with most Achilles tendon pathology occurring to the medial aspect of the tendon.   It was found that pronation increased this non-uniform stress to the soleus tendon fibers especially during the midstance phase of gait.  

Professionals who appreciate this concept can better assess how foot type and/ or a lack of foot stability can contribute to Achilles tendon pathology.    Foot strengthening and in some cases orthotics may be advisable for the prevention and management of medial Achilles tendon stress.  

To learn more about the fascinating functional foot please visit www.ebfaglobal.com or check out my book Barefoot Strong.    

Until next time, stay #barefootstrong 

Dr Emily 

www.dremilysplichal.com

Standard
Barefoot Science, General

NeuroRehabilitation with Naboso Technology

Balance impairment and gait instability are common symptoms in patients living with Parkinson’s Disease (PD).   From an increased fall risk to reduced independence, compromised dynamic stability can place a heavy emotional burden on these individuals.

When developing a balance and fall reduction program for PD clients, research has OLYMPUS DIGITAL CAMERAshown that stimulation of the foot with texture shows promising results.   Study after study has demonstrated that the seemingly simple intervention of texture is actually quite powerful in its postural effects.

Why the Plantar Foot? 

Our hands and feet are some the most sensitive sensory gateways of the human body and allow us to connect our visual and vestibular systems with the exteroceptive (external) world.

The skin on the plantar foot is packed with unique nerve endings called mechanoceptors or touch receptors.   There are four main mechanoceptors found on the bottom of the feet.

SAI – which is sensitive to two-point discrimination & texture (Naboso!)

SAII – which is sensitive to skin stretch

FAI – which is sensitive to low-frequency vibration (walking impact forces)

FAII – which is sensitive to high-frequency vibration (running impact forces)

Texture & the Plantar Foot 

Texture such as that of two-point discrimination (Naboso) have been shown to improve posture and sway in those with Parkinson’s Disease.

A 2011 study by Hatton et al. showed that pyramid-like textures had the greatest efficacy on reducing postural sway in PD patients.   This was both the eyes shut and unstable environment.

A 2013 study by Qui et al. compared the effects of smooth versus textured insoles on balance and stability in those with Parkinson’s Disease.  Qui et al. found that the greatest effect was with textured insoles on unstable surfaces with eyes open and eyes closed.

A 2017 study by Silva et al. showed that continuous use of textured insoles over a one week period not only improved gait but also improved foot sensitivity and sensation.

Naboso Textured Insoles

Insole Pic 2To date, Naboso Insoles are the only commercially available textured insoles that are designed to enhance posture, improve gait and reduce falls in people with neurological conditions such as Parkinson’s Multiple Sclerosis, neuropathy, and post-stroke.  There is so much exciting textured insole research but until Naboso none of this information was commercially applicable to these PD patients.

At Naboso we are so excited to see that the effects of Naboso Insoles match that of the research!    Below are a few videos of just how powerful the Naboso Insoles are at improving gait in those with Parkinson’s Disease!

Coming Soon! – Naboso Clinical Insoles 

With these exciting results above Naboso Technology is working on a new version to their already existing Insole line – NabosoNeuro.   These clinical insoles will be specific to the enhanced somatosensory demands of Parkinson’s Disease, Multiple Sclerosis, diabetes (neuropathy), post-stroke + more!

To learn more about the benefits of Naboso Insoles in neurorehabilitation please click HERE

To carry Naboso Insoles in your office for patients and clients please contact Naboso Technology for our wholesale rates – orders@nabosotechnology.com

Standard
Barefoot Science

Foot Strength & Arch Stiffness in Relation to Minimal Footwear

GladSolesTrail1Earlier this week one of my master instructors shared an interesting article with me on the relationship between foot strength and stiffness in those who chronically wear minimal footwear.

For those who study barefoot movement and integrated foot mechanics, the association between minimal shoes and stronger feet may seem like an obvious finding but I wanted to delve into this article a little bit more for those readers who may not be as adept to some of the terminology.

Foot strength and stiffness are related to footwear use in a comparison of minimally- vs. conventionally-shod populations – February 2018

 

Concept #1 – Foot Stiffness is a Positive Characteristic 

I want to start off by explaining that anytime you read about foot stiffness or leg stiffness running-1in relation to barefoot running or minimal footwear – this is a GOOD thing!    The term stiffness does not mean rigid or non-flexible and is not synonymous with how we may say “I woke up stiff this morning”

During dynamic movement, the concept of stiffness is actually a fascial response that is used to help efficiently load and unload impact forces.   Think off stiffness as transient rigidity as a means to increase stability.   This stability is achieved through integrated isometric contractions which influence the surrounding fascial tissue and muscle compartment pressures.

In the above-referenced article, Holowka et al. found that those that chronically wear minimal footwear have higher arch stiffness upon foot contact.   This can be interpreted to mean that in minimal footwear the intrinsic foot muscles are more responsive and adapted to help stabilize the foot and absorb impact forces.

This finding further demonstrates that traditional footwear can actually make our feet weaker and less responsive to impact forces, quite possibly to the point that eventually we become dependent on the footwear to absorb impact forces.

Concept #2 – Minimal Footwear Increases Intrinsic Muscle Size 

Repeated use of any muscle will result in hypertrophy of that muscle, this includes the intrinsic muscles of the feet.    If the chronic use of minimal footwear is associated with increased foot stiffness this means that those feet are engaging and strengthening their intrinsic foot muscles with every step they take.

abductor-hallucis-strain220In the above study, Holowka et al. demonstrated that in those that chronically wear minimal footwear there was a noted 2mm increase in abductor hallucis diameter.   Now, 2mm may not seem like a lot but when you are dealing with small muscles of the feet, 2mm is considering statistically significant.

If you are unfamiliar with the abductor hallucis muscle, this is the intrinsic foot muscle that is responsible for controlling the lateral longitudinal arch.   Originating on the plantar medial calcaneus and inserting on the medial aspect of the proximal phalynx of the hallux, the abductor hallucis runs under and supports the navicular bone.

In the picture to the right, you can appreciate that the navicular bone is the highest point calcaneonavicular-ligament_blogof the medial longitudinal arch.   By strengthening the abductor hallucis and controlling how much that bone drops during dynamic movement is essentially saying there is control of the medial arch.

Chronic use of minimal footwear and the strengthening of the abductor hallucis muscle is demonstrated to be an effective way to build foot control and resist the stress of flat feet and over pronation.

Concept #3 – There Are Exceptions to Every Finding 

As a Functional Podiatrist, I must end by saying that the findings of the Holowka et al. study are very exciting and definitely do build the support for the use of minimal footwear.  Having said that, there are exceptions to every finding.

As we take these findings and use them to make footwear recommendations for our clients and patients we cannot forget that there are still a few patients who minimal footwear may not be appropriate for.

Some of these may include:

– Accessory navicular

– Posterior tibial tendinitis or PTTD or post tib tear

– Hypermobility of the 1st Ray

– Flexible flatfoot with symptomatic post tib tenditis, plantar fasciitis, sinus tarsi syndrome

– Rigid flat foot with arthritic changes to the midfoot or rearfoot

All feet should be assessed by a qualified professional before transitioning to minimal footwear and all transitions to minimal footwear should be coupled with a barefoot foot-strengthening program, such as that created by EBFA and our Barefoot Training Specialist® Team

To learn more about foot types and the power of barefoot science please visit http://www.barefootstrong.com or http://www.dremilysplichal.com

Kindly

Dr Emily Splichal

Founder EBFA Global & Naboso Technology

 

Standard