I grew up in a very small town in North Dakota, so I don’t think I really knew what a Podiatrist was until I moved to NYC! I came to NYC after Undergrad school with a background in Forensic Science. Just like CSI, I was working in more a criminal justice setting and was planning to go to medical school for Forensic Pathology. Intellectually, forensics is the coolest field but I wasn’t passionate about it.
It was then that I was introduced to Podiatry – and the specialty of Podiatric Sports Medicine. The further I got into the Podiatry field I realized that it was not just medicine per say that excited me but again it was the movement and biomechanics.
Now, 11 years later – I’ve been able to combine my extensive fitness background with my podiatric medical degree and I could not be happier. This truly is what I was meant to do when I grew up!
There are definitely several ways that a person can treat different types of foot dysfunction – sometimes barefoot training and movement corrective techniques are best and sometimes orthotics are best. Although I believe that orthotics can be unnecessarily prescribed in some cases, It is not entirely the fault of the Podiatrist. Sadly the concept of treating foot dysfunction as it relates to total body movement dysfunction is not taught or emphasized in Podiatry School.
The way I approach my patients with an integrated mindset was not something I gained from my Podiatry background – but rather my years in fitness and through returning to graduate school to earn a M.S. in Human Movement. And then more specifically the way I integrate barefoot training concepts is based off of research I’ve conducted, or collaborated on.
Now although I am a barefoot-friendly Podiatrist, this does not mean that I never prescribe orthotics. It’s one of my pet peeves when people say orthotics are like the worst thing out there and they are like a “crutch” or “foot coffins”. For someone to make a strong argument for or against orthotics, I want to hear an educated and intelligent reason why they are bad.
In many situations orthotics are a great option or your only option (besides surgery) at correcting foot dysfunction or minimizing a patient’s pain. The biomechanics that go into prescribing very good and appropriate orthotics is fascinating – and I take great pride in knowing orthotics extremely well and making some kick-ass orthotics.
In my office I see a lot of overuse injuries – whether it be plantar fasciitis, tendonitis or stress fractures. In the acute phase all these conditions must be treated with your typical inflammation control and minimizing stress to the area.
But once the acute phase and pain is more under control then I take advantage of addressing mobility and stability issues both proximally in the hip or core as well as distally in the ankle and foot. The most difficult are patients who have long standing foot dysfunction to the point that soft tissue structures have adapted to the repetitive stress with degeneration, calcification or tears. In these situations, more invasive techniques are required to restore the health of soft tissue structures – after which THEN I will implement the corrective exercise, barefoot training techniques.
So every patient is a little different.
The bottom of the foot plays such an important role in balance and stabilization. From the skin on the bottom of the foot to the contracture of the toes, these mechanisms are blocked or dampened when wearing shoes.
What’s interesting is that barefoot science studies have shown that simply walking around barefoot begins to strengthen the small muscles in the feet to the point that subjects saw an increase in medial arch height. Which is pretty cool! This is often why people who switch to minimalist often feel a great relief in foot, knee and back pain.
The foot is the foundation to human posture in the closed chain (weight bearing) – with most human movements and sports requiring us to be weight bearing. Since the human body is interconnected any imbalance in the foot must impact the lower leg, which travels to the hip and pelvis, and then continues to the thoracic spine and shoulder.
By maintaining proper foot and ankle mobility we can avoid compensating into movements that create improper muscle recruitment, poor joint alignment and excess stress to soft tissue structures. Once foot and ankle mobility is achieved, the focus must be on adequate foot strength. Foot strength is important not only for proper foot posture – but it also how our body absorbs shock. Most foot injuries I see are due to poor dissipation of ground reaction forces – many of which could have been prevented injuries if some sort of eccentric foot strengthening was done.
I think minimalist footwear has a role in the shoe industry. No shoe has brought this much attention to foot health as Vibram Five Fingers and the minimalist category. I do not think minimalist shoes are the be-all to achieving adequate foot strength and function. Those who decide to wear minimalist shoes must still integrate foot mobility and strengthening exercises to their workouts.
From a kinematic (or joint motion) standpoint the minimalist shoes are good because they require you to better recruit the muscles that stabilize the foot. What is still blocked in these shoes, however, is the plantar cutaneous or proprioceptors. They are definitely closer to being barefoot than your traditional sneakers, but from a neuromuscular standpoint are not the same as barefoot.
I do not have a favorite minimalist shoe as each provides a different advantage – I have had many patients who could not wear the Five Fingers due to toe contractures or rotations so in that case I would recommend the Fila Skel-Toes or a traditional style toe box.
After increase foot mobilization, a person will want to wake up the muscles of the foot and ankle. Remember these muscles are used to being in shoes so are most likely under active. Two of my favorite exercises for activating the foot are the short foot and heel raise with a ball between the heels. Both of these exercises should be held isometrically for 8 seconds and repeated 4 times.
Then next step is gaining adequate eccentric control of the foot & ankle. Since a weakness in eccentric strength is where I see most injuries this is one of the most important steps to proper barefoot training. Some great eccentric exercises are reverse heel raises, walking backward on a treadmill and jumping rope – all barefoot.
Everyone can safely benefit from barefoot training. Remember we are not just training the muscles but the nervous system. Different foot types have unique foot imbalances that must be addressed through adequate foot mobilization and strengthening.
I teach in my Barefoot Training Specialist workshops that not everyone should have the same barefoot training prescription. The effectiveness of barefoot training lies in the unique recommendations for each individual foot type.
An exception would of course be those who are in pain or have a severe flat foot deformity.
VCore® Workout is a barefoot balance workout that I created to take the concept of barefoot training to group fitness. Why I created a barefoot workout that is specifically done on one leg, is because the foot is interconnected with the hip and core with every movement we make. By training the foot – and body – in the most functional way will allow the greatest transfer to real life daily activities.
Before I launched VCore® into the clubs I introduced the training concepts with my patients and clients. I saw great improvement in foot posture, glute strength and postural alignment. I knew that so many people could benefit from integrating foot, hip and core exercises into their workout.
I want to end by emphasizing the importance of barefoot training – and foot strengthening techniques – separate from barefoot running. I do not recommend barefoot running as foot strengthening exercise. I treat many barefoot runners and see the benefit of the foot strike pattern associated with it, but for those who are not runners or have no experience in barefoot training – this should not be the direction they go. All barefoot runners still must train their feet and focus on a strong foundation of adequate foot mobility, stability and eccentric muscle strength!