Excerpts from Dan Empfield's "Shoe Height and Ramp Angle"

http://www.slowtwitch.com

http://www.slowtwitch.com/Products/Running_Footwear_by_type/Shoe_Height_and_Ramp_Angle_1948.html

Written by: Dan Empfield
Date: Tue Mar 15 2011

The following are exact quotes taken from Dan’s article on the slowtwitch.com website.  This is a very good article. Please read his entire article in the posted link above, so that we do not take something away from the hard work and writing of Dan.  We take zero credit for this work, it is all Dan’ Empfield’s. Thanks for the great work Dan and www.slowtwitch.com  Visit them both !

“Ramp Angles
What we’re talking about here is the distance your heel sits off the ground versus your forefoot, when you’re standing in the shoe. In order to calculate an angle, you’ve got to solve a right triangle equation, specifically, in a size-9 shoe, the distance from the heel to the forefoot is a right triangle’s long arm, the delta between heel and forefoot height is the short arm, connect these two arms via the hypotenuse, the slope of the hypotenuse is the ramp angle (or, just look at the image furthest above).
Who wants to calculate that? Not me.

So, let’s just talk about heel height, forefoot height, and the delta between them. Typical of today’s conventional running shoes is a 24mm heel and a 12mm forefoot. The delta between them is 12mm. This number is much easier to get one’s arms around, so, from here on in I’m going to talk about Ramp Delta (a metric of my own invention—if you’ve got a better term, lay it on me, maybe I’ll abandon mine and adopt yours). The complaint with a large ramp delta is this: If I’m a midfoot striker, can I midfoot strike without that propped-up heel getting in the way? Probably so if we’re talking 10mm, maybe 12mm, but 15mm? (Which is not by any means unheard of.) That’s questionable.

A bigger problem yet: Once I midfoot strike, the heel will touch down almost immediately—how much will the rear of the shoe compress? If it doesn’t sufficiently compress, am I plantar flexing (pushing off) with an achilles tendon not sufficiently elongated?
Part of this depends on how firm the shoe is in the heel. If the midsole is less dense, the shoe may compress to a point where the shoe functions as if it had a smaller ramp delta.

Are traditional shoes made for heel strikers?
This is a contention I hear over and over again, with greater regularity. The running boom has spawned a lot of runners who didn’t get the proper running technique memo (the narrative goes) and companies like Asics and Brooks have accommodated their overstriding, heel-striking, overpronating technique with shoes perfectly made for this inefficient method of running.
I buy this line of reasoning up to a point. I have some problems with this line of thinking and we’ll get to these, but, here’s an experience related to me by a shoe designer, Dave Jewell of Zoot, from a bit earlier in his career:

"We cut all the competition up with a band saw. We wanted to see what the midsole heights were. What we found was rather astounding. Yes their stated midsole heights were fairly correct but their overall height was rather outrageous. We found shoes that were stated as 25mm heel and 13mm forefoot. The total height was 34mm heel and 22mm forefoot. People were still buying them but it seemed to us like they were too tall.”  Dave does not rail against companies that make shoes with a taller heel, or a larger ramp delta. Rather, he offers this observation from the latest Hawaiian Ironman:

“The race up front is won by folks who can run in anything but choose the shoes with the smaller delta—say, 10mm or less. But those finishing the race from 3 hours behind to 10 hours behind tended to run in a shoe that has a 12mm delta. Are all of these people running in the wrong shoe? Clearly they are running in what’s most appropriate to their running style. Running shoe companies for years have offered different shoes with different deltas. In the past the shoes with the low delta were racing flats.”

Does a low ramp delta require a low overall shoe height?
Some believe ardently that a firm connection between the foot and the ground is a must. Danny Abshire (founder and owner of Newton Shoes) believes this and offers the following rationale: There are thousands of nerve endings in the foot responsible for proprioception, and a loss of communication between the ground and these nerve endings interrupts the proper interaction between nerves and muscles. Adding distance between the foot and the ground interrupts this communication.
Newton’s shoes are known for an exceptionally low ramp delta as well as generally low shoe heights. Still, Dave Jewell notes that, “Now there are shoes with a low delta and thicker overall midsoles that are getting some traction.”

Does a low ramp delta necessarily mean a neutral shoe?
This is where the natural/barefoot/minimalist guys lose me. Yes, no doubt you’ll overpronate less if you don’t overstride. But in my experience, it’s dangerous fiction to flatly state that an overpronator can, and should endeavor to, “teach” himself to run in a neutral shoe through engaging in exercises to strengthen his feet.“

Part 2: Progressing out of orthotics.

another Facebook Q. Is there a point during, or post treatment when the foot intrinsics perform and maintain their function without the exercises? Is it shuffle gait and moonwalk for life? and…. Are there any foot conditions that require ‘orthotic therapy’ to be maintained long term?

The Gait Guys answer:

Over time (about 3-6 mos avg, sometimes longer in our experience) the neural pattern becomes ingrained through neural adaptation and collateralization. As long as the exercises become a habit and ingrained into the motor pattern, then it is automatic; but think about how many layers of compensation are present and how long the problem took to occur. It takes time to restructure the nervous system and those pathways. The key here is adaptation of a new motor pattern; then life becomes rehab. There are many other exercises as well; keep an eye out for our new site launch and watch for some of them there. We have a DVD on the works as well.

When a person is UNABLE to function normally (ie they lack the ROM, muscle capacity, anatomy, neural drive IOW an anatomical problem) they MAY require an orthotic to make up for those ROM’s or mechanics they lack. An example may be an uncompensated FF varus where they lack the ROM in the 1st ray, or the individual with a loss of ankle rocker due to trauma, an arthrodesis, or some other anomaly.

The key is, if you are doing your job, their prescription should change and become less and less. This is one reason we sometimes use orthotics constructed of EVA, because they are easier to modify.

Believe it or not (LOL), some people won’t do the exercises you prescribe or aren’t willing to make the changes to be independent of them; these individuals will often need to wear them indefinitely.

Attempting to progress out of orthotics.

From our FACEBOOK PAGE…….The Gait Guys here is a dialogue i had with a doc in the field today.
Q: At what point do you ditch the exercises and need to go to an orthotic? Eccentric arch exercises are great, don’t get me wrong, but with any endurance/postural exercise it takes lots of repetitions and time to retrain the pathway. Unfortunately, most patients aren’t quite patient enough to let the exercise work or diligent enough to follow through with their HEP. On my end, since we see insurance patient with visit caps and financial caps, I usually give it 3-4 weeks and harp on the home program to be done daily. No or limited progress and I’ll consider the orthotic device. What’s your call?

A:we do isometrics, eccentrics, concentrics and dynamic variations. In our opinion it takes more attention and focus than reps. Skill first, endurance second, strength third. Reps help, but they have to be slow….yes, up to 7 seconds…..perfect progressive loading into and out of the proper mechanics……less can be more if done right. It has taken Ivo and I 35+ years to put this together, but we have a formula that works well now, finally. It has been exhausting. Yes, some patients want a silver bullet, i tell them to get the bullet elsewhere most of the time, because most of those patients have adaptive troubles to the proper orthotic and that means time in the grinding lab in our offices. That isnt productive time. Most people can be convinced since most of them have waited several months to get in to see me. Heck, i had a marathoner drive from NY to Chicago to see me 3 weeks ago! That is a sad comment on the state of this small area of problem focus. She had 8 pairs of orthotics if i recall correctly. Bad skill, and strength on bad skill. Collapsed arch, weakness abundant, frontal plane cheating, multiple saggital plane deficits. After 3 weeks of homework she already has less plantar pain after just one visit. It is about doing it right. If we give an orthotic, it is prescribed as orthotic “Therapy”. We insist on the exercise progression to either allow us to downgrade the orthotic in our grind lab, or remove it completely in a few months once they champion the change. I rarely see someone more than once every 2-3 weeks…..so i draw care out long and far over just a few visits. But there is work to do for them in between visits. They must come back with perfect form and progress, and most do. We do “Donald Trump” some clients if they don’t want to do the work. There is always someone waiting who wants to learn it.

Who are The Gait Guys?

An overall combined 35+ years of clinical experience, teaching, and lecturing experience heavily weighted in biomechanics, neurology, orthopedics, manual medicine, acupuncture and advanced gait and running knowledge. Dr. Ivo Waerlop and Dr. Shawn Allen are finally bringing whata has long been needed to the information/web age, enough knowledge and experience to clarify the truths and dispel the myths that are abundant on the internet and in seminar halls.
Dr. Allen and Waerlop have consulted for major corporations and institutions like Vibram USA on the Five Fingers Shoe and numerous smaller companies to help educate them on various topics encompassing gait, running, shoes, foot, orthopedic and neurologic issues, biomechanics and human movement as they relate to a companies bottom line, to R&D assistance, product review, product placement and sales.
We are proud to keep our views and opinions on various products truthful and unbiased for the sake of searching for the facts, uncovering the truth and dispelling myths put upon consumers.