More shoe foam may mean more problems.

Last night we had a great online teleseminar (www.onlinece.com). The talk was minimialism. Here was 2 of our take home points:

More foam in the shoe is not always good.

“Shoes with cushioning fail to absorb impact when humans run and jump, and amplify force under certain conditions, because soft materials used as interfaces between the foot and support surface elicit a predictable reduction in impact-moderating behavior. ” -Robbins

Basically barefoot feet, and even shoes with thinner foam/soled shoes, tend to judge impact more precisely because there is less foam to dampen proprioceptive input. The more foam you stack under the foot, the more material that must be deformed before a sufficiently rigid surface can be detected by the foot. Think of this, what do we do in rehab ? We stand people on stacked foam to give them an unstable surface (if they have championed balance challenges on a stable surface first, this is an important first step). When the foot cannot find a firm platform it searches for stability and drowns in the instability. This can be what more foam under the foot provides, inability to reference stable ground surface can negatively impact proprioceptive joint and tissue receptors.

2. Impact loading behaviors.

if we know the surface (the shoe or the actual surface/ground) is unstable, we will modify the pending impact loading behavior. In other words, you will jump differently onto a frozen puddle than you would dry ground. Studies have shown that the more foam a shoe has (ie. the more the potential instability from the example above) the greater the reduction of impact moderating behavior.

Humans reduce impact-moderating behavior in direct relation to increased instability.- Robbins

hope to see you in the next online teleseminar in 4 weeks !

shawn and ivo

reference:

BioMechanics April 1998

Materials: Do soft soles improve running shoes?
Most athletic shoes advertise injury protection through “cushioning,” but real world studies have not shown impact moderation.
By Steven Robbins, MD, Edward Waked, PhD, and Gad Saad, PhD

Tonite’s the night folks. The research behind minimalism and minimalsitic footwear; Biomechanics 318. Join us at onlinece.com or chirocredit.com at 5 PCT, 6 MST, 7 CST, 8 EST for all the beef, without the filler.

Tomorrow we lecture on Minimalistic Footwear and its impact on runners on onlinece.com and chirocredit.com. Join Us. Biomechaics 318; 8PM Eastern, 7 Central, 6 Mountain, 5 Pacific.

All the cool people will be there and if you attend, you will know why barefoot is not the same as minimal

Yep, you read it here. Exercise good: Sugar…Not so good for your brain

“Thus, BDNF appears to be released from the human brain, and the cerebral output of BDNF is negatively regulated by high plasma glucose levels, but not by high levels of insulin”

Let us boil it down to two simple equations for you:

Exercise = More BDNF

Sugar (Glucose) = Less BDNF

So what is BDNF? It stands for “Brain Derived Neurotrophic Factor”. It’s the stuff that makes our brain grow.

Neurotrophins are a family of structurally related growth factors, including brain-derived neurotrophic factor (BDNF), which exert many of their effects on neurons in the brain, but also many other metabolic processes in the body.

Brain-derived neurotrophic factor has been shown to regulate neuronal
development and to modulate synaptic plasticity (ie it is a mind expanding compound; literally). Recent studies show that BDNF is also expressed in non-neurogenic tissues, including skeletal muscle. BDNF has also been identified as a key component of the hypothalamic pathway that controls body weight and energy homeostasis and it appears to
be a major player not only in central metabolic pathways,but also as a regulator of metabolism in skeletal muscle.

So, before you replenish those glycogen stores with some simple sugars post run or workout; remember that it may be at the expense of your brain function. Are we saying not to replenish? No, we are saying stick to lower glycemic choices, which yes, will fill the glycogen stores slower, but can help preserve your noggin. Glucose IS the preferred fuel of the brain, but it can make it from fats and proteins as well; remember something called gluconeogenesis from physiology class? Some of the latest studies show that ketosis isn’t as bad as we previously thought, but that is the subject of another post…

We are The Gait Guys and we are all things gait; even those that are peripherally related.



Krabbe KS, Nielsen AR, Krogh-Madsen R, Plomgaard P, Rasmussen P, Erikstrup C, Fischer CP, Lindegaard B, Petersen AM, Taudorf S, Secher NH, Pilegaard H, Bruunsgaard H & Pedersen BK (2007). Brain-derived neurotrophic factor (BDNF) and type 2 diabetes. Diabetologia 50, 431–438.

Join us this Wednesday evening, 5pm western, 6 PM mountain, 7PM central, 8PM eastern, at:  online CE.com for a lecture on minimalistic footwear and its impact on runners called Biomechanics 318. Drop, motion control features and a host of other subjects will be addressed.

Vintage Nike Niobe

I best recall being told that this shoe was worn three times, the third run was a marathon, and as you can see that was its last day on the road.

This is what happens when someone who should not be in a curve lasted shoe, chooses to run in one. The Nike Niobe was a curve lasted simple shoe. It was very light weight, small stack height and narrow ramp from heel to forefoot. This was likely a fast shoe for someone, for the right foot type. 

This person was obviously having some distal toe pain, so they pre-shredded the tip of the shoe to offer some “space”. Perhaps they were sized wrong, perhaps this person had a tender 2nd toe/nail.  But this is not the purpose of today’s blog post.

Today we wanted to bring up shoe LASTS again.

The Last (the part between the midsole and insole)

Strictly speaking, a last is the mold or template for creating the shoe. It defines theshape of a shoe. Remember that men’s and women’s feet are shaped differently. Men (usually) have rectangular feet (the forefoot and heels are wider, or have less difference in width); Ladies (usually) have triangular feet (the forefoot is much wider than the heel). This is why it is important to know if the shoes you are fitting are a men’s or women’s specific last. Many times, the shoes come off the production line and the boy shoes are blue and the girls pink: both made from the same last.

The last determines whether a shoe is  a high, medium or low volume shoe… Pretty important, if they have a high instep or flat foot. Companies like Altra have as many as 6 different, sex specific lasts. This results in a wide range of fit (and thus a bigger market share).

Take off your clients shoes and look at their feet. Note their shape and curve. Lasts need to match that “curve” so they can be relatively straight or curved (this refers to the shape of the “sole” of the shoe: see above). Turn a shoe over and look at the sole. Mentally bisect the heel with a line going to the front of the shoe. If the line bisects the front of the shoe, it is a straight lasted shoe (this corresponds to the axis of the 2nd metatarsal, or slightly lateral to it). If more of the shoe falls medial to this (more of the sole on the big toe side) it has a curved last.

Curved last shoes can vary in the degree of curvature. Curved last shoes are designed to help control pronation, as they provide medial support and slow its rate by causing a relative supination of the foot after heel strike (it weights the lateral border of the shoe for a longer period of time, theoretically allowing less pronation). Curved last shoes can put more motion into a foot, especially one with limited rearfoot motion (it still must pronate, but due to the lack of rearfoot motion, the forefoot must compensate and now must do so in a shorter period of time).The last is the surface that the insole of the shoe lays on, where the sole and upper are attached.    Shoes are board lasted, slip lasted or combination lasted. A board lasted shoe is very stiff and has a piece of cardboard or fiber overlying the shank and sole (sometimes the shank is incorporated into the midsole or last) .  It is very effective for motion control (pronation) but can be uncomfortable for somebody who does not have this problem.  A slip lasted shoe is made like a slipper and is sewn up the middle.  It allows great amounts of flexibility, which is better for people with more rigid feet.  A combination lasted shoe has a board lasted heel and slip lasted front portion, giving you the best of both worlds. 

When evaluating a shoe, you want to look at the shape of the last (or sole).   Bisecting the heel and drawing an imaginary line along the sole of the shoe determines the last shape.  This line should pass between the second and third metatarsal.  If you do this to the Nike Niobe shoe you will see a nice gentle curved line, it is not as much as one would think because the severity of the carved away instep/arch gives it the appearance of a more curved last than it truly is.  Drawing this imaginary line, you are looking for equal amounts of shoe to be on either side of this line. Shoes have either a straight or curved last.  The original idea of a curved last (banana shaped shoe) was to help with pronation.  A curved last puts more motion into the foot and may force the foot through mechanics that is not accustomed to. Most people should have a straight last shoe. Folks who have pronation challenges will do better with a semi-curved to straight lasted shoe.  Few people need a truly curve lasted shoe. A general rule of thumb is: You really can’t go wrong with a straight last. It will work for all feet, especially if you are using an orthotic. This is especially important with people with forefoot abductus, moderate to severe pronators and rigid feet (rear or forefoot). A forefoot abductus and severe pronator’s feet will move laterally in the shoe, often causing crushing, rubbing, cramping and blistering of the little toe against the side of the shoe. A rigid foot, because the foot needs to be able to pronate at the mid and forefoot, will have a similar problem. You can use a curved last with people with mobile or hypermobile feet, provided their pronation is not too severe (clinical judgment, trial and error).

You won’t see any Nike Niobe’s anymore, they are even mere ghost stories even on the internet.  It is cool to see where shoe fabrication logic was long ago, and to see how far it has come. RIP Niobe.  

This was clearly an example of a heavy pronator (note the medial heel blow out) starting at the rearfoot heel contact. They were also likely a heel striker, but that was “the thing” back then.  The gentle curve in this shoe’s last did not do this person any favors, heck this runner was likely crippled for a week with arch pain, tibialis posterior pain and medial knee pain.  A shoe can really tell a story !

Want to learn more about shoe anatomy and how to pair shoes to certain foot types ?  Do you find yourself wanting to know more about a forefoot varus, forefoot valgus, compensated and uncompensated variants of these or rearfoot variances ? Here is where you should start:

Gait Guys online /download store (National Shoe Fit Certification and more) :

http://store.payloadz.com/results/results.aspx?m=80204

Or, other web based Gait Guys lectures: www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Thanks to Wayne  over at Dick Pond Shoes for this little gift 10 years ago. We came across it doing some thinning out of “the herd” of great shoe pathology samples we like to keep.

Shawn and Ivo, The Gait Guys

We always love a video with cool foot action and interesting human movement.  This fella shows very quick coordinated movements to and from rearfoot - forefoot. All dancers have this skill and coordinating it can take time, then you have to put it to music.

Have a great weekend folks.

Shawn and Ivo, The Gait Guys

Today’s Rewind includes an older “Gait Guys at the Movies” clip of Carey Grant! Sit back and enjoy!

Run, Carey, Run?

Lets look at this Hitchcock classic “North by Northwest” and check out Cary’s form.

1^st of all, what an arm swing! Think of all that energy it is sapping from the rest of his muscular system. He must be hiding something, but what? We can only see him from the waist up, so we may never actually know. Did you notice how he initially only turns to the right? Did you pick up on the flexion at the waist? How about that torso bob from side to side? Not much to his hip abductors now are there?

The only thing he has going for him is he is wearing leather soled shoes, which have been shown to have one of the lowest impact loading on the body (yes, you read that right; increased cushioning INCREASES impact forces, but that’s not what we are here to talk about). Oh yea, he actually impacts the ground at the end of the sequence. I guess if his technique was better, he would have hit even HARDER.

Next sequence, we are off to a good start, look at that forward lean to start! This is essential to good technique. He loses that form pretty quickly; we can still see that forward flexion at the waist; certainly costing him energy by not using his core.

Finally, we get a posterior view at the end, but the uneven surface makes it difficult to make an analysis.

We think Cary would certainly give Lola a run for her money. Cary, next time, engage your core and watch your step…

We Remain….The Gait Guys

Holy Hand Grenades! What kind of shoe do I put these feet in?

Take a look at these feet. (* click on each of the photos to see the full photo, they get cropped in the viewer) Pretty bad, eh? How about a motion control shoe to help things along? NOT! OK. but WHY NOT? Let’s take a look and talk about it.

To orient you:

• top photo: full internal rotation of the Left leg
• 2nd photo: full internal rotation of the Right leg
• 3rd photo: full external rotation of the Left leg
• last photo: full external rotation of the Right leg

Yes, this gal has internal tibial torsion (yikes! what’s that? click here for a review).

Yes, it is worse on the Left side

Yes, she has a moderate genu valgus, bilaterally.

If someone has internal tibial torsion, the foot points inward when the knee is in the saggital plane (it is like a hinge). The brain will not allow us to walk this way, as we would trip, so we rotate the feet out. This moves the knee out of the saggital plane (ie. now it points outward).

What happens when we place a motion control shoe (with a generous arch and midfoot and rearfoot control) under the foot? It lifts the arch (ie it creates supination and it PREVENTS pronation). This creates EXTERNAL rotation of the leg and thigh, moving the knee EVEN FURTHER outside the saggital plane. No bueno for walking forward and bad news for the menisci.

Another point worth mentioning is the genu valgus. What happens when you pick up the arch? It forces the knee laterally, correct? It does this by externally rotating the leg. This places more pressure/compression on the medial aspect of the knee joint (particularly the medial condyle of the femur). Not a good idea if there is any degeneration present, as it will increase pain. And this is no way to let younger clients start out their life either.

So, what type of shoe would be best?

• a shoe with little to no torsional rigidity (the shoe needs to have some “give”)
• a shoe with no motion control features
• a shoe with less of a ramp delta (ie; less drop, because more drop = more supination of the foot (supination is plantarflexion, inversion and adduction)
• a shoe that matches her sox, so as not to interfere with the harmonic radiation of the colors (OK, maybe not so much…)

Sometimes giving the foot what it appears to need can wreak  havoc elsewhere. One needs to understand the whole system and understand what interventions will do to each part. Sometimes one has to compromise to a partial remedy in one area so as not to create a problem elsewhere. (Kind of like your eye-glass doctor. Rarely do they give you the full prescription you need, because the full prescription might be too much for the brain all at once.  Better to see decent and not fall over, than to see perfectly while face down in the dirt.) 

Want to know more? Consider taking the National Shoe Fit Certification Program. Email us for details: thegaitguys@gmail.com.

We are the Gait Guys, and yes, we like her sox : )

Podcast 56: Crawling, Neurodevel. & Foot Strike

A. Link to our server:

Direct Download: 

http://traffic.libsyn.com/thegaitguys/pod_57_final.mp3

Permalink: http://thegaitguys.libsyn.com/podcast-56-crawling-neurodevel-foot-strike

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience

1) http://thegaitguys.tumblr.com/post/78470419988/the-hand-walkers-part-2-uner-tan-syndrome-the

Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia.  

“ a re-emergence of the ancestral diagonal QL, and (3) it may spontaneously emerge in humans with entirely normal brains, by taking advantage of neural networks such as central pattern generators that have been preserved for about 400 million years.”

References:

Front Neurol. 2012 Oct 25;3:154. doi: 10.3389/fneur.2012.00154. eCollection 2012. Karaca S1, Tan M, Tan U. Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia.

2)  selectively removing torsions ? bunions ?  

FDA Panel Mulls Technique That Creates Babies Using DNA of 3 People
http://foxnewsinsider.com/2014/02/25/fda-panel-mulls-technique-creates-babies-using-dna-3-people

3) A Crazy Oculus Rift Hack Lets Men and Women Swap Bodies

http://www.wired.com/design/2014/02/crazy-oculus-rift-experiment-lets-men-women-swap-bodies/

4) Is It Harmful To Heel Strike When Running?
http://running.competitor.com/2014/02/injury-prevention/is-it-harmful-to-heel-strike-when-running_95678

5) Neuroscience and Pain Science for Manual Physical Therapists

“Minimum effective dose: Why less is more” - via Farnam Street blog. True for manual therapy, for sure. Lighten up, hack nervous system instead of trying to force structure to comply.http://www.farnamstreetblog.com/2014/02/the-minimum-effective-dose-why-less-is-more/

6) Unpowered Treadmills

http://naturalrunningcenter.com/2014/02/26/running-rhythm-balance-motorless-treadmill/

7) http://www.ncbi.nlm.nih.gov/pubmed/23921096

8) Exercise both body and mind with a different kind of cross-training
http://www.theglobeandmail.com/life/health-and-fitness/fitness/exercise-both-body-and-mind-with-a-different-kind-of-cross-training/article17022151/

When a stability shoe makes things worse.

Look at this video. This is a video of what was a midfoot-forefoot pronator who was fitted into a high stability motion control shoe. This appears to be a Brooks Adrenaline GTS shoe.

You can see that the shoe appears to help limit the pronation at the rear and mid foot but a keen eye will easily tell you that this person is pronating heavily through the forefoot.  This may in fact be a person with forefoot varus.

You need to know your shoe types, foot types and when to pair them up. This pairing actually blocked much of the rear and midfoot pronation but forced it all to occur through the forefoot at an abrupt rate. This abruptness increases the likelihood of metatarsal osseous stress responses and for anterior or posterior shin splints.

This person needs more ankle stability to protect from the degree of ankle valgus and they could also use more hip and knee stability to prevent the genu valgum loading (medial knee posturing) as well as the Cross Over deficits. A little bit of rehab, body awareness and some foot exercises will go a long way here. A more accommodative shoe could help, too. We are not sure of the foot type obviously, but if we have a rigid forefoot varus a medial MET  head post (a Rothbart-type) wedge could help this client immensely. 

There is much going on here, but the big point we wanted to hit home here is that even a high end motion control shoe cannot block all pronation, especially if it occurs in the forefoot. Many orthotics fair to address forefoot pronation as well, merely because the control of the device does not extend into the forefoot. Sure, some can be dampened by changes in the rear and midfoot, but this case should prove that sometimes it is not enough.  

If you want to learn more about proper matching of feet and shoes, our National Shoe Fit PRogram will take you a long way.

Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Shawn and Ivo

It’s a “Dancing Queen” kind of Friday  here on The Gait Guys.  Enjoy !  Shake it like you wanna break it sweetie !

Human movement is a beautiful thing, in any form. So are uninhibited individuals like this sparky lady. Why stand when you can dance ?

“Neural circuits linking activity in anatomically segregated populations of neurons in subcortical structures and the neocortex throughout the human brain regulate complex behaviors such as walking, talking, language comprehension, and other cognitive functions associated with frontal lobes.”

Don’t you wanna become a Gait Guy Geek !?  (come on, you know you wanna !)

Leonard and Sheldon, The Gait Guys Theory

Front Syst Neurosci. 2014 Feb 13;8:16. eCollection 2014.

Cognitive-motor interactions of the basal ganglia in development.

Leisman G1, Braun-Benjamin O2, Melillo R3.

A theory for bipedal gait ? Ipsilateral interference between the foot and hand in quadrupedal gait.

___________________________________________________

Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia: Uner Tan Syndrome, Part 3

* Alert: Before you read this blog post you will do yourself a great degree of mental service by reading our 2 prior blog posts on this video.  There is an important learning progression here. Here are the links:

http://thegaitguys.tumblr.com/post/28332726553/the-hand-walkers-the-family-that-walks-on-all

http://thegaitguys.tumblr.com/post/78470419988/the-hand-walkers-part-2-uner-tan-syndrome-the

Note that in this video there is ipsilateral interference between the foot and hand in this quadrupedal gait. In this diagonal quadrupedal locomotion (QL) the forward moving lower limb is impaired from further forward progression by the posting up (contact) hand of the same side. This would not occur if the QL gait was non-diagonal (ie. unilateral), the forward progression of the lower limb would be met with same time forward progression of the upper limb, allowing a larger striding out of both limbs.  This would enable faster locomotion without increasing cadence (which would be the only way of speeding up in the diagonal QL), at the possible limitation of necessitating greater unilateral truncal postural control (which is a typical problem in some of these Uner Tan Syndrome individuals who typically have profound truncal ataxia).  

As the video progresses one can see that bipedal locomotion IS IN FACT POSSIBLE in Uner Tan syndrome individuals. 

This is the excerpt from the embedded video:

“Two adult siblings from a consanguineous famiy in Kars, Turkey, exhibited Uner Tan syndrome with severe mental retardation, and no speech, but with some developmental differences.. 
There was no homozygocity in the genetic analysis, but the extremely low socio-economic status suggested epigenetic changes occurred during pre- and post-natal
development. 
Quadrupedal locomotion in cases with Uner Tan syndrome exhibit interference between the ipsilateral extremities, and this also occurred in all tetrapods with diagonal sequence QL since this form of locomotion appeared around 400 MYA. 
The ipsilateral limb interference might have been the triggering factor for bipedal locomotion in our ancestors, and walking upright would enhance their chances of survival, because of the benefits in the visual and manual domains. The ipsilateral interference theory is a novel theory for the evolution of bipedalism in human beings, and was first proposed by Uner Tan in 2014.”

As Karaca, Tan & Tan (1) discussed in their article:

“In discussions of the origins of the habitual QL observed in Uner Tan syndrome, it was argued that this quadrupedalism might be an epiphenomenon caused by neurodevelopmental malformation and severe truncal ataxia (Herz et al., 2008). The present work will show that this argument may be untenable, presenting two individuals with QL who do not exhibit ataxia, and who have entirely normal brain images and cognitive functions.”

As we mentioned in our last blog post,

“Tan and Ozcelik mentioned in their recent research, in UTS the obligate diagonal QL was associated with some genetic mutations and cerebellovermial hypoplasia, and was seen as an adaptive self-organizing response to limited balance. On the other  hand, the present work showed that human QL may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years. (Shapiro and Raichien, 2005; Reilly et al., 2006)." (1)

Kind of brings some new "slap in the face” thoughts to the rehab “bird dog” exercise doesn’t it !  Driving a 400 million year old quadruped motor pattern (ya, ya, we know it is a early-window primitive cross crawl infant neurodevelopmental pattern, we have been to Pavel Kolar seminars. Don’t try to argue, just think past all this. Go get a beer or walk in the park and cogitate on this a bit, it is important.)

If you want to dive deeper into this kind of work,  you may want to go and look at some of our recent work on Arm Swing here. But don’t forget to watch this video above again and pay close attention to what we mentioned here.

We received this video on Monday (March 3, 2014) directly from Dr. Uner Tan himself in Turkey. We are very grateful for all that he has been sharing with us behind the scenes and we are grateful for his research and for this budding relationship.  Thank you Dr. Tan !  

Dr. Shawn Allen, one of The Gait Guys

Reference: 

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480821/

If you work in a shoe store, you better understand the real problem behind this frequent shoe breakdown. You have seen it, but do you truly understand it ?

Stripping of the heel counter: a naughty problem. (note the foam break down at the inside heel of the shoe in this photo of an almost new pair of shoes)

Has the inside of the heel counter of your shoe ever looked like this?

Do you know why ? We will tell you why !  * #4 is the lightbulb moment for most people,. 

1. you may be lazy and not tie your shoes and try to slip  your foot into/out of your shoe without unlacing and re-lacing. This will often fold the top of the counter over upon its self and start some breakdown. Kids are lazy, but so are some adults.

2. your laces may be laced to loosely and your heel is excessively slipping/riding up and down on the heel counter foam/material.  

3.  you have a nasty Halglunds deformity that is just so big it is creating too much friction.

4. However, there is often a better and more logical reason and it just so happens that it is the one that no one thinks of or understands.  Loss of ankle rocker (AKA loss of ankle dorsiflexion.  You see, the heel counters job is to gently create counter pressure against the back of the heel/calcaneus so that when the person moves into terminal stance phase of gait (when the heel begins to rise) the heel rise will pull the heel of the shoe up AT THE SAME TIME !  If there is a differential in this time stamp event, then the heel will rise abruptly against a shoe that has not had time to finish forefoot rockering at toe-off through the normal forefoot siping on the outsole.  In other words, if ankle rocker/dorsiflexion is less than sufficient the restricted range will necessitate that the  heel rise BEFORE it is technically supposed to do so, AND thus, before the shoe will reach its build in rocker that enables the heel rise. The two events  have to occur at the same time ! When a person has impaired ankle rocker and thus goes into premature heel rise, the shoe will essentially still be attempting to get to the forefoot rocker built into the shoe (which will lift the heel of the shoe passively). So, if the heel rise is premature, before the shoe gets to the forefoot rocker, the heel will abruptly, yet subtly, slide up the heel counter and shear the foam on the inside of the heel counter. Keep in  mind that once the heel slide and the shoe heel counter engage together the shoe will be suddenly thrust into its (the shoe’s) forefoot rocker. But, you should understand that this is premature forefoot loading response, and it has a host of clinical problems that go along with it (ie. metatarsal stress fractures, premature or excessive forefoot pronation, toe clenching etc). 

* clinical pearl: this problem often presents with the runner having dorsal foot pain across the top of the foot. The runner will naturally think it is the tightly tied shoes, so the natural solution is to lace the shoes looser and looser (or skip lace) until the point they no longer stay on the foot because of the heel counter sliding. Neither one fixes the dorsal foot pain, because the lacing is not the issue. The astute shoe fitter will realize that this dorsal foot pain is directly related to the loss of ankle rocker, but that is a blog post for another time. 

It is natural for runners to try to tie their shoes tighter to stop the feeling of the heel slip but this is not the solution.  Ankle strangling is not the solution.

Either the shoe is:

1. not fit properly matching the person’s natural forefoot rocker phase to the shoe’s natural rocker or

2. they have a narrow heel (and thus also need a more appropriately fit shoe)

3. need to learn to lace the shoes properly (this does not mean strangle the ankle, any shoe that needs to be tied that tightly to prevent this phenomenon is not the correctly fitted shoe).  Shoe tie tension should be modest, comfortable and not constrictive…… ie hardly noticeable.

OR:  

the person needs more ankle rocker !  Which does not necessarily mean more calf stretching. It means EARNING posterior length through anterior strength. Watch one of our solution exercises here  .  Earn the changes you need, no one wants to have to performs stretches before every run for the rest of their lives.  Who has that kinda time ?! 

Better yet, why not take our National Shoe Fit Certification Program and learn the truths about shoe fit and clean biomechanics.  Or, you can leave the pathology alone and support your friendly neighborhood shoe store and local running injury guru more frequently than usual or than is necessary.  Its your money and your time.

Links to the National Shoe Fit certification program:

Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Shawn and Ivo, The gait guys

Sharing the secrets of gait and walking/running biomechanics that you are not taught elsewhere.

Congrats to Coach Cameron! Our 1st Certification in Germany!

Here is what this coach has to say about the IFGEC Certification program:

“I found the National Shoe Fit Program very informative. So much information was presented in a short amount of time, and I have learned a huge amount. Without being able to stop to write and go back to check I had the information clear in my head I would have only taken away a very small amount of the detail required to start to get my head around this subject.

I am a coach, personal trainer and an athlete and will be using this within my coaching here in Germany. After buying so many shoes and seeing Doctors in the past about problems had with running I am amazed that not one person had gone into the detail and really looked at my feet in the way they should have been. I now believe I have been given a short cut to all the basic information and now have a solid platform on with to build more biomechanical information.

Thank you for the course.

Regards Cameron Lamont”

Want to know more? Contact us at: thegaitguys@gmail.com

The Hand Walkers, Part 2. Uner Tan Syndrome, the new research.

A year ago we wrote our first piece on Uner Tan Syndrome. We have always been interested in the neurodevelopmental windows of children and their process of moving through the various movement phases in the hopes of gaining clean upright bipedal gait. In our clinics daily we see many soft signs of sensory-motor pattern aberrancies that result in foot problems such as lack of pronatory control, or torsional long bone abnormalities and failures to protect frontal plane deviations (to name a very small few). In fact, these soft seonsory-motor signs and patterns can be found globally if one knows what to look for.  In our clinics we rarely see the serious neuro-developmental problems but Uner Tan Syndrome (UTS) has always been one of interest to us. We recently received a very kind email from Turkey, from Dr. Uner Tan himself, asking to reference some of our work so this was a serious honor.  The email sparked us to look into his research to look for newer work and we were happy to find it. Before we start into the new research findings, you will want to take a few minutes to read our last blog piece on Uner Tan Syndrome: The Hand Walkers.

http://thegaitguys.tumblr.com/post/28332726553/the-hand-walkers-the-family-that-walks-on-all

This previous blog post discussed much of the research that was current at the time.  The following was from our previous blog post  on UTS  

UTS is a syndrome proposed by the Turkish evolutionary biologist Uner Tan. Persons affected by this syndrome walk with a quadrupedal locomotion and are afflicted with primitive speech, habitual quadrupedalism, impaired intelligence. Tan postulated that this is a plausible example of “backward evolution”. MRI brain scans showed changes in cerebellar development which you should know after a year of our blog reading means that balance and motor programming might be thus impaired.  PET scans showed a decreased glucose metabolic activity in the cerebellum, vermis and, to a lesser extent the cerebral cortex in the majority of the patients. All of the families assessed had consanguineous marriages in their lineage suggesting autosomal recessive transmission. The syndrome was genetically heterogeneous.  

However, some startling new research has recently surfaced and if most are paying attention, they will see the value in our 1000+ blog posts here at The Gait Guys but more so discover Dr. Tan’s most startling conclusion from the Frontiers in Neurology article below. We are currently moving through the most recent research so you will want to check in with us again soon for our follow up blog posts on this topic. 

Here was Dr. Tan’s et al abstract conclusion of his most recent research, and we think it is earth shattering.

Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia.  

Two cases with quadrupedal locomotion (QL) were presented. In both cases, cognitive and psychiatric functions were normal and, no neurological deficits were observed, except for a sequel paralysis of left leg in Case 2. It was suggested that human QL (1) should not be considered as an epiphenomenon caused by neurodevelopmental malformation and ataxia, but (2) may be considered as a re-emergence of the ancestral diagonal QL, and (3) it may spontaneously emerge in humans with entirely normal brains, by taking advantage of neural networks such as central pattern generators that have been preserved for about 400 million years.

We will have more to come shortly, but for now, realizing that the human brain, even when normal, can take advantage of neural networks encompassing Central Pattern Generators (CPG’s) that have been suppressed for 400 million years is startling information in our opinion.

Check back in with us soon.

Dr. Shawn Allen, one of the gait guys

References:

Front Neurol. 2012 Oct 25;3:154. doi: 10.3389/fneur.2012.00154. eCollection 2012. Karaca S1, Tan M, Tan U. Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia.

Welcome to rewind Friday Folks.

Think about all those folks in the Northeast who have been shoveling (OK, the folks in Colorado as well) and their feet being rubber boots!

Here’s an oldie, but a goodie.

Here’s one paper we though had merit (sure, go to Pub Med and search foot odor. There were 119 entries). We think we may try this in the office…

The Gait Guys: Yes, smelly feet are something we have to deal with at the office on a daily basis. One of the pitfalls of being a Foot Geek : )

Make sure to check back later for more on malodorous extremities…                        

 

J Int Soc Sports Nutr. 2007 Jul 13;4:3.

A novel aromatic oil compound inhibits microbial overgrowth on feet: a case study.

Misner BD.

Source

West 1140 Glass Avenue Spokane, Washington, 99205, USA. drbill@omnicast.net.

Abstract

ABSTRACT:

BACKGROUND:

Athlete’s Foot (Tinea pedis) is a form of ringworm associated with highly contagious yeast-fungi colonies, although they look like bacteria. Foot bacteria overgrowth produces a harmless pungent odor, however, uncontrolled proliferation of yeast-fungi produces small vesicles, fissures, scaling, and maceration with eroded areas between the toes and the plantar surface of the foot, resulting in intense itching, blisters, and cracking. Painful microbial foot infection may prevent athletic participation. Keeping the feet clean and dry with the toenails trimmed reduces the incidence of skin disease of the feet. Wearing sandals in locker and shower rooms prevents intimate contact with the infecting organisms and alleviates most foot-sensitive infections. Enclosing feet in socks and shoes generates a moisture-rich environment that stimulates overgrowth of pungent both aerobic bacteria and infectious yeast-fungi. Suppression of microbial growth may be accomplished by exposing the feet to air to enhance evaporation to reduce moistures’ growth-stimulating effect and is often neglected. There is an association between yeast-fungi overgrowths and disabling foot infections. Potent agents virtually exterminate some microbial growth, but the inevitable presence of infection under the nails predicts future infection. Topical antibiotics present a potent approach with the ideal agent being one that removes moisture producing antibacterial-antifungal activity. Severe infection may require costly prescription drugs, salves, and repeated treatment.

METHODS:

A 63-y female volunteered to enclose feet in shoes and socks for 48 hours. Aerobic bacteria and yeast-fungi counts were determined by swab sample incubation technique (1) after 48-hours feet enclosure, (2) after washing feet, and (3) after 8-hours socks-shoes exposure to an aromatic oil powder-compound consisting of arrowroot, baking soda, basil oil, tea tree oil, sage oil, and clove oil.

CONCLUSION:

Application of this novel compound to the external surfaces of feet completely inhibited both aerobic bacteria and yeast-fungi-mold proliferation for 8-hours in spite of being in an enclosed environment compatible to microbial proliferation. Whether topical application of this compound prevents microbial infections in larger populations is not known. This calls for more research collected from subjects exposed to elements that may increase the risk of microbial-induced foot diseases.

The Gait Guys. Bringing you the good, the bad and the smelly….

Another IFGEC Certification granted:

Here’s what Mark Small has to say

“The National Shoe Fit Program is beneficial to many fields/disciplines including, but not limited to, coaches, personal trainers, athletic trainers, physical therapists, podiatrists, and chiropractors (I would say MD’s, but it doesn’t come in a pill), as well as those who sell shoes.  The program offers tools to help us understand individual differences and their effects on gait and performance.  Some of the material includes:
    •    Foot anatomy
    •    Anatomical Landmarks
    •    Foot types
    •    Pathologies
    •    Basic biomechanics
    •    Shoe fit functional testing
    ⁃    Static and dynamic tests to assist fitting
    •    Finally shoe selection
    ⁃    Picking the best shoe for your client/athlete/patient

Some of these topics may be a good review for some of the advanced disciplines listed above. What the program is able to do, even for them, is to link everything together in a methodical, step by step, detailed approach, that applies what we have learned into something predictable and usable. We are often looking for ways to increase performance, decrease pain and get people to move better.  I, for one, believe that much of bad movement, pain and dysfunction have to do with inappropriate footwear, this course is a starting place to help correct that problem.  I am looking forward to Level 2 & 3 certification programs, but more importantly, I am looking forward to applying what I am learning with the people I serve.  I’m not a Gait Guy… more like a gleam in the gait daddy’s eye, but I’m working on it.”

Congratulations, Mark!

The Gait Guys

Thanks for the kudos Coach Smith !

for anyone interested… . . 

1.  Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

2. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

“ I had explosive diarrhea in the middle of a good long run.”

We have always wanted to start a blog post with something dirty like that, but it never seemed like the right thing to do. So, we figured we would save it for on or around the day of our 1000th blog post. We started The Gait Guys blog in 2011 with our first blog post and just a few days ago the trumpets sounded at the 1000th post. How did this happen ? Well, it happened little by little, 3-5 post a week, month after month. It happened just as the gentleman described in the video above on how to make a dry wall, stone after stone.  Our writing has managed to reach into 74 countries with the additional help of our podcasts, teleseminars and social media.  Thus, we wanted to just voice a little thanks to you all for following us, week after week, month after month.  So far this has been a pretty great journey for us and we are happy you have come along for the ride. 

Now back to sphincters and running. 

“ I had explosive diarrhea in the middle of a good long run.”

Think it can’t happen to you ? Here is a true medical literature case study. “A 20-year-old female running the Marine Corps Marathon developed diarrhea at mile 12. After finishing the race she noted that she was covered in bloody stool. A local emergency department suspected ischemic colitis.” This was straight from the Grames study found below. 

Maintenance of the basal tone in the internal anal sphincter is critical for rectoanal continence. Effective evacuation requires a fully functional rectoanal inhibitory reflex-mediated relaxation of the internal anal sphincter via inhibitory neurotransmission.

Ok, What !!!!????

Basically, all that means is that the tone of the anus is pretty complicated and when it works right, we don’t think about it much, and when it shows us signs of things hitting the fan, it prompts an immediate hierarchy of our attention.  However, diarrhea is so much more than what is violently erupting from the opening at the other end of our alimentary tract.

Lower GI complaints such as urgency and diarrhea are not all that uncommon in runners.  Sometimes it is pre-race jitters/nerves, sometimes is too many donuts and coffee before the big sunday team run, sometimes it is electrolyte imbalances or too much beer or Wild Turkey the night before, sometimes it’s aberrant autonomic nervous system stimulation, and in the initial case above sometimes it is ischemia (impaired blood perfusion to the colon).

Possible mechanisms of ischemia in distance runners and others participating in intense exercise may include a combination of splanchnic vasoconstriction, dehydration, and hyperthermia, combined with the mechanical jostling of organs via intense activity. Most of the unfortunate presenting with marathon-running-induced ischemic colitis respond favorably to conservative treatment, but awareness is the first step. However, as in the Cohen et al case referenced below, sometimes the unlucky collapse at the finish line and have other results …  whereafter “computed tomography scanning revealed ischemic colitis of the cecum and ascending colon, which progressed to the development of clinical peritonism after 48 hours. This patient subsequently underwent a laparotomy and right hemicolectomy, with ileostomy formation, on the third day after admission. Operative and histologic findings confirmed ischemic colitis of the cecum and proximal colon.”  

So, there is some anxiety-inducing stuff to think about right before your long run this week ! But lets be realistic. Be smart, watch your diet with a good food diary, think hard about your fluid levels and what those fluids are, be smart about pushing hard during high temperature days, know your usual stool habits, and most of all do not ignore the subtle or obvious signs that things could be going wrong in a race or in training. Unexpected bowel problems in a race may not be only a mere embarrassment, they could be telling you something is seriously wrong. 

In closing, thanks for following our writings for the past 3.5 years, writings amounting to 1000 articles. It has been a fun journey and we have learned right along side of you.  In relation to the video above, our body of work is clearly no novel, but our journey in itself is a story of sorts. A story that has been piecing together all the little nuances of the human frame and its biomechanics, bit by bit. 

(Oh, and for those who feel we should apologize for the video not being about, well, erupting diarrhea in a runner, well, we wanted to make today’s post more about the writing process. If you want THAT video, that is what youtube might be for. Just don’t too much of your day looking for it, try writing a book instead.)

Shawn and Ivo,

Two Gait Guys trying to avoid what sometimes hits the fan.

References:

1) Am Fam Physician. 1993 Sep 15;48(4):623-7. Runner’s diarrhea and other intestingal problems of athletes. Butcher JD.

2) Am J Emerg Med. 2009 Feb;27(2):255.e5-7. Marathon-induced ishemic colitis: Why running is not always good for you.  Cohen DC1, Winstanley A, Engledow A, Windsor AC, Skipworth JR.

3) Case Rep Gastrointest Med. 2012;2012:356895. Ischemic Colitis in an endurance runner.  Grames C1, Berry-Cabán CS.