Fitting the Foot For Performance Joseph Fox, MS, LAT

6/9/2015

Financial Disclosure

• I do not have any financial relationships to disclose

Commerial Bias

• With shoes/brands it is very easy to ask/speak about specific shoe companies

• Please refer a shoe to a shoe type (cushioned, stability, lightweight, minimal) instead of a specific shoe brand or name.

• Thanks!

Course Objectives Following the presentation, participants will be able to: • Describe how shoes are manufactured • Explain when and how to replace a shoe • Identify how to fit a shoe to a given foot • State common mistakes when choosing a shoe • Discuss how shoes help improve/change gait • Recognize the basic anatomy of a shoe • Identify common tests to measure effectiveness of a

shoe

TOP TEN worst sayings about shoes

10.I found these as a bargain for $20 9. My feet haven’t grown in five years 8. My friend has the same pair of shoes 7. My shoes aren’t causing my shin splints 6. But, (insert professional athlete here), wears these shoes…

TOP TEN worst sayings about shoes

5. These shoes won’t go with my outfit 4. I don’t need to tie my shoes, they are

more comfortable loose 3. I’ve had these shoes for three years and

they’re the most comfortable 2. My teammates and I all need the same

shoes 1. These shoes LOOK cool

Pronation vs.. Supination

• Pronation – Dorsiflexion – Abduction – Eversion

• Supination

– Plantarflexion – Adduction – Inversion

• All or none principle – If any one of the

motions is engaged, the segment will automatically do the other two motions.

Not every shoe fits every foot

Shoe Basics

• How to properly fit a shoe • How can a person get the most life out of

the shoe? • How is a shoe manufactured (components

and design) • When does a person need a new running

shoe? • Shoe determination lab

Shoe type Simplification

• Pronator – Motion Control or Stability shoe

• Neutral – ***Any shoe, MC and Stability

• Supinator – Cushioned shoe, possibly stability shoe

…It’s not that easy • Uncompensated subtalar varus

– Cushioned shoe/Stability • Compensated subtalar varus

– Motion control shoe • Uncompensated forefoot varus

– Cushioned shoe/Stability • Compensated forefoot varus

– Motion Control/Stability • Forefoot Valgus

– Cushioned/Stability • Ankle Equinus

– Cushioned/Stability

Shoe Terminology

Outsole

Midsole

Heel Counter

Toe Box

Vamp

Shoe Construction

• Last – Straight (Overpronators) – Curved (Supinators) – Semi-Curved (Neutral Runners)

• Slip – Central Slip – Peripheral Slip

Shoe Construction cont.

• Outsole – Polyurethane (Court shoes) – Blown Rubber (Lightweight Shoes) – High density carbon rubber (High abrasion

resistance) • Midsole

– EVA (Ethyl Vinyl Acetate) – Polyurethane – +Cushioning and Foot Bridges

Shoe Construction cont.

• Toe Box – Length, width, depth

• Vamp – Area where laces are placed

• Tongue • Heel Counter • Insole/Sock Liner

Motion Control Shoe

• Built for Pronation/Overprontation Control • Rigid last • Midsole made from EVA or PU • Dual Density midsole • Reinforced Heel Counter • ***Brick

Motion Control Shoes

Stability Shoes

• Built for a more neutral runner • Semi-Curved Last • Periperhal slip • (EVA/PU) Midsole • Firm Heel Counter

Stability Shoes

Cushioned Shoe

• Built for a supinator • Curved Last • Peripheral Slip • Usually made from EVA • Single Density Midsole, Dual Sensity

Outsole • Cushioning Units

Cushioned Shoes

Side by side comparison

Heel by heel comparison

Last comparison

Shoe fitting basics

• Time of day for shopping – 1-2 PM • Bend in shoe should occur at first

metatarsal head • Width of shoe should be enough to barely

splay toes without painful pressure • From the end of the toe box, shoe should

have 1 thumb width • There should be no bulging of foot in toe

box

Shoe fitting basics cont.

• If woman wants to wear a male shoe, go down by 1-1.5 sizes

• **Do not go on look of shoe, start with comfort, then select appropriate color/size – Walk before see technique – Hard to convince high schoolers to not select

based on design/look appeal • Shoe materials listed on locations on shoe

Shoe Longevity

Shoe Longevity • General rules

– Do not run in the same pair of shoes for simultaneous days (24-48 hour refractory period)

– Lace and unlace shoes before and after each workout – Do not need to “wear in” running shoes – Do not kick off or heel in shoes – Use running shoes for running, not cross training or

lifting – If shoes get wet, do not run in them until completely

dry, wet materials stretch more – Use talcum powder or foot spray to keep shoes

sanitary or dry – Can keep a log of total miles run in each shoe

When To Purchase Shoes • Mile method

– Cushioned Shoe (300-450 miles) – Stability Shoe (Approx 450 miles) – Motion Control Shoe (450-600 miles)

• These are arbitrary numbers and don’t factor in

usage frequency, running surface, running conditions, body weight, usage type, when shoes were made

• Marathon runner – Supinator – Every month – Pronator – Every 2 months

Objective Shoe Wear Tests

• Toe back test • Mid forefoot squeeze test • Flat touch test • Multi-colored rubber test • Table slide test

Subjective Shoe Wear Tests

• Air Pocket/Cushioned Unit collapse • Toe box bulge/rip • Mesh Upper loosening/tears • Excessive Squeaking noise, or rush of air • Outsole/Midsole Flattening • Compression wrinkles • Waffle appearance

Shoe rule of thumb

• When purchasing a pair of running shoes, you get what you pay for – More expensive running shoes have more

expensive research and more dynamic materials

Barefoot Running

• Gimmick or Gimme? – Running barefoot or with limited material on

the foot – Claims include reduction in acute and chronic

lower leg injuries, stronger feet, increases propriception and tactile sensitivity of the foot

– Can everyone (even overpronators) run this way?

Barefoot Running • Barefoot Running:How Humans Ran Comfortably and

Safely Before the Invention of Shoes:Science Daily (Feb 1, 2010) – Barefoot runners avoid heel strike, land on ball of foot – Shod runners have to absorb 2-3 times body weight at heel-

strike • Barefoot runners have less impact at heelstrike • Need calluses to avoid injury

– 75 percent of shod runners heel strike (1,000 per mile) – Modern running shoe developed in 1970s – Need gradual approach; need to develop calf and ankle muscles

before proceeding

Barefoot Running • Barefoot Running:SportScience 2001 5(3)

– Running barefoot associated with lower prevalence of acute injuries of the ankle and chronic injuries of the lower leg

• 4 percent decrease of energy cost when running barefoot – Shoes increase ankle sprains by decreasing

awareness of foot position provided by feedback from plantar cutaneous mechanoreceptors

– Running shoes reduce proprioceptive and tactile sensitivity

– Cons include bruising, lacerations, and puncture wounds

Adapting to Barefoot Running

• Start by running 30 minutes on soft surface (grass, turf, soil)

• Continue increasing time after 3-4 weeks when skin begins to thicken

• Over-pronators may take 6 months to a year to adapt

• Sources don’t recommend doing both shod and barefoot running simultaneously – Reduces the effect of barefoot running