Proper footwear key to avoiding foot injuries in runners

col-liesThe key to avoiding foot injuries may be sitting right under your feet – your shoes. Choosing the proper footwear can go a long way toward preventing foot injuries in runners. Here’s a quick way to find out the right shoes for you:

Know Your Foot Type

The key to making sure you find the correct shoe for you and your running endeavors is first, knowing your foot type. The most important aspect of foot type in selecting a proper fitting shoe is the front to back arch (medial longitudinal arch) of the foot in weight bearing and how it changes while walking. The midfoot motion is responsible for movement of the arch of the foot during gait with the navicular bone being the most important factor in this mobility. This bone is positioned at the apex of the arch on the inside of the foot, and there are three key structural elements that help to maintain the navicular position and arch height during standing.  First, the anatomical positioning of the bones of the midfoot along the transverse arch (travels across the foot from inside to outside) supports the foot much like a bridge, with compression making the foot more stable.

Second, the “windlass mechanism” refers to the relationship of the plantar fascia along the bottom of the foot and its influence on elevating the arch while walking. Because the plantar fascia runs from the bottom of the toes back to the heel, as we push off of our toes in walking and our heel rises, this creates tension along the plantar fascia and helps to elevate the navicular. And lastly, the tibialis posterior muscle begins along the back aspect of the lower leg and inserts into the navicular. Therefore, proper function and contraction of this muscle aids in elevating the navicular and maintain arch height during walking.

The above listed foot biomechanics can work properly or improperly resulting in the three main categories of foot type. First, in the “normal” arch, biomechanics function properly and the individual has an evident arch in sitting and in weight bearing. Although, a minimal loss of arch height when in weight bearing is still considered normal.

A pes planus foot, or low arch foot, has a breakdown in some or all of the above listed biomechanics for any number of reasons. This person may have an evident arch in sitting but the arch collapses as the person puts weight on the foot. Or, this person may not have an arch present in sitting or standing.

Finally, a person may have a pes cavus foot type, or excessive arch. This person has an abnormally high (medial longitudinal) arch that, due to the anatomical positioning of bones in the midfoot, does not change much when moving from non-weight bearing to weight bearing. Individuals with this foot type will bear weight more on the outside of the foot and therefore may be more likely to turn their foot in and sprain the outside of their ankle.

What Is Navicular Drop?

The term navicular drop refers to the loss in arch height as a person moves from sitting (non-weight bearing) to standing (weight-bearing). A normal loss of navicular height from this transition is 6-9mm. If the loss of arch height is much more than this that person is considered to have a pes planus foot type. If the loss of arch height is mush less then this, they can be considered to have a pes cavus foot type.

The Right Shoe For You

The “normal” foot type has a good balance of stability and mobility in their foot and generally does well in a neutral shoe. This shoe type provides enough cushioning for the high impact demands of running without providing too much arch support for a foot type that generally supports itself!

The “pes planus” or flat foot type is described as having too much mobility in their foot and needs a more supportive shoe. Stability and motion control shoes help to provide the arch support where this individual lacks it. A stability shoe will be appropriate for a runner with a mildly excessive navicular drop. A motion control shoe will provide even more stability and is necessary for individuals with more severe navicular drop, or pes planus. The “pes cavus” foot type is considered to be extremely supported and almost rigid. Therefore, this person generally does better in a minimalist or neutral shoe type with extra cushioning to provide mobility where the individual lacks it.

Each name brand of running shoe manufacturers generally makes shoes in each of these three main categories. It is important to try on various brands of shoes in your category to find the optimal comfort in other variables such as width, weight, etc.
In some cases of pes planus and pes cavus it may be necessary to seek alternative forms management through physical therapy and/or shoe orthotics to help achieve the desired amount of stability or mobility needed.  Physical therapy is effective in instructing proper exercise and providing manual therapy techniques to facilitate increased mobility and stability where appropriate. This can be beneficial to rehabilitate current aches and pains one might have with running and to prevent future ailments from arising as you up your mileage.

At Professional Rehabilitation Services, we treat a wide variety of musculoskeletal conditions using the latest in evidence based therapies provided by highly credentialed physical therapists.   In addition to being licensed physical therapists, our providers have additional specialty certifications and training in orthopedics, manual therapy, sports, strength and conditioning, vestibular treatment, and dry needling. For further information on this or other related topics you can contact Richard DeFalco, DPT, OCS, CSCS, CWcHP at Professional Rehabilitation Services (Myrtle Beach) (843) 839-1300, Brian P. Kinmartin PT, DPT, MTC, STC, OCS, CWcHP (Pawleys Island) (843) 235-0200, Richard A. Owens, MPT,OCS, Cert.SMT, CWcHP (Surfside) (843) 831-0163, or Kristen Lies, DPT (Murrells Inlet) (843)314-3224, or visit our website at www.prsrehabservices.com where you can learn more about the company and even download a referral form for your physician to fill out. You can also call and schedule a free 15 minute consultation.

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