You might think your shoe is doing more to control motion of your foot than it is actually doing.

You might think your shoe is doing more to control motion of your foot than it is actually doing.

"The measurement of rearfoot kinematics by placing reflective markers on the shoe heel assumes its motion is identical to the foot’s motion."
The results of this study revealed that "calcaneal frontal plane ROM was significantly greater than neutral and support shoe heel ROM. Calcaneus ROM was also significantly greater than shoe heel ROM in the transverse and sagittal planes. No change in tibial transverse plane ROM was observed."

It is easy to underestimate the calcaneal ROM across all planes of motion. Motion is going to occur somewhere, hopefully you can help your client control the excessive ROMs that are occurring and causing their symptoms. But just do not think that a shoe is going to markedly help, it might, but let your interventions and your client's feedback on pain lead you.

Calcaneus range of motion underestimated by markers on running shoe heel.
Ryan S. Alcantara'Correspondence information about the author Ryan S. AlcantaraEmail the author Ryan S. Alcantara
, Matthieu B. Trudeau, Eric S. Rohr
Human Performance Laboratory, Brooks Running Company, 3400 Stone Way N, Suite 500, Seattle, WA 98103 United States

Pincer toe nails.

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Pincer Toe nails: You've seen them; did you know what they were and how they got that way? Or, did you dismiss them?

We think Hitomi’s hypothesis is correct. Here is why (this is paraphrased from our blog post on subungal hematomas and our revolutionary thinking on why they occur and it seems to fit well with pincer nail formation as well).

… when the skin is pulled at a differential rate over the distal phalange (from gripping of the toes rather than downward pressing through the toe pad) there will be a net lifting response of the nail from its bed as the skin is drawn forward of the backward drawn phalange (there is a NET movement of skin forward thus lifting the nail from its bedding). For an at-home example of this, put your hand AND fingers flat on a table top. Now activate JUST your distal long finger flexors so that only the tip of the fingers are in contact with the table top (there will be a small lifting of the fingers). There should be minimal flexion of the distal fingers at this point. Note the spreading and flattening of the nail. Now, without letting the finger tip-skin contact point move at all from the table, go ahead and increase your long flexor tone/pull fairly aggressively. You are in essence trying to pull the finger backward into flexion while leaving the skin pad in the same place on the table. Feel the pressure building under the distal tip of the finger nail as the skin is RELATIVELY drawn forward.] This is fat pad and skin being drawn forward (relative to the phalange bone being drawn backward) into the apex of the nail. Could this be magnifying the curvature of the nail and not offsetting the “automatic curving and shrinkage” function of the nail ? We think it is quite possible.

We have more to say on this topic, the above is just an excerpt of our blog post. More here, in the link below

https://thegaitguys.tumblr.com/post/127638788139/pincher-nails-who-knew-written-by-dr-shawn?fbclid=IwAR06ol516n9WF2Qh5TadlKd8esXrH5pVviycT_7QiMeScL0UJ3H9r1FF_OQ

Posture doesn't matter, until it does.

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Awareness is key. Does this person know they are doing this ?  Do they have pain? If they do not have pain or awareness is it a problem and does it need addressed ? These shoes did not make this person load like this, the person broke the shoes into this pattern.  There is something going on, the question is what drove this ?  Most likely, this is not a footwear problem, this is a person problem in the footwear.

What we see is not the problem most of the time. We are seeing their strategies , coping mechanics and their ultimate failure to load more cleanly most of the time.

There are people out in the fields that are saying posture doesn't matter, that your next posture is your best posture. This is a bit curious to us.  Sure, if you are not in pain then is a given posture a problem? One could argue that, but not with a strong argument, we believe.  Take this foot-shoe posturing for example, is this a problem if it is not painful ?  Do we leave it alone if it is not painful? Or do we "head this one off at the pass" before possible pathology or pain presents itself? There are certainly no guarantees, however, one can use some educated and calculated logic and make some reasonable decisions that things are going to go off the rails at some point (or in this case, the heel is going to actually go off the shoe!).  Same for the anti-posture nazi's out there who say posture is not a factor in people's lives.  We are not going to call out people on there personal beliefs, but for us, that is just too extreme thinking. The concept gets some great social media attention, but if you are slouched 90% of your day in a chair or standing at a job, those postures might carry over into other activities and thus matter in time, carrying into aberrant tissue loading.  In our minds, posture does matter, because movement on postures that foster challenging mechanics, lead to challenging loading responses on tissues, and over time, that means change.  Change can be good or bad, sometimes it is how you drive the bus.  Posture can matter in many cases, dismissing if fully is foolish.

So, are you going to change this person's footwear ? Bring it to their awareness ? Look for problems in there body mechanics locally and globally? Or are you just going to say, "foot posturing doesn't matter". Saying it is not a problem, until it is a problem, seems awfully negligent, doesn't it?