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12/15/2020    Howard E Friedman, DPM

Twistable Running Shoes Help Build Strong Muscles: NY Podiatrist (Dieter J Fellner DPM)

I have been following the series of posts
regarding the suggested benefit of "twistable
running shoes" which I understand to refer to
lightweight flexible shoes and their effect on
foot strength. This is a topic I have been
interested in and have followed for several
years. I am glad that at this point in time most
podiatrists will accept the proven fact that the
size of foot intrinsic muscles will increase in
response to less supportive footwear rather than
more supportive or robust footwear or the use of
foot orthotics. This fact has been proven
multiple times and measured both with ultrasound
and MRI studies.

Dr. Fellner requested in his post evidence that
increasing foot intrinsic muscle size, which is
associated with increased strength is correlated
with reduced injuries. His request is timely as a
new report proving a relationship between
improved foot strength and reduced injuries in
runners was published this year in The American
Journal of Sports Medicine by Taddei, et. al:
'Foot Core Training to Prevent Running-Related
Injuries'. This level 1 randomized controlled
trial shows that runners who performed foot core
strengthening exercises had a 2.42 fold lower
rate of running related injuries after a period
of 4-8 months of exercises.

Even almost a decade ago there were reports of
the relationship between improved foot strength
benefits in the elderly population and improved
balance. The paper 'Foot and Ankle Strength,
range of motion, posture and deformity are
associated with balance and functional ability in
older adults', was published in Archives of
Physical Medicine and Rehabilitation in 2011 and
demonstrated in a cohort of adults over 65 years
of age that improving foot strength, specifically
hallux flexor and ankle inversion and eversion
strength led to an improvement in a battery of
balance, posture and sway tests.

I do not deny that many of our patients require
added arch and biomechanical support whether it
comes from supportive shoes or foot orthotics.
And I am not claiming that foot exercises will
prevent bunions or plantar fasciitis. However, I
am taking the position that weakened foot
musculature in many instances can be strengthened
and this can often lead to improvement in
function. Furthermore I am coming around to
believe, but cannot prove, that feet that are
braced over many years will probably have
weakened intrinsic muscles and decreased

Our role as podiatrists should be to determine
which patients require bracing and if they do,
for what length of time. In my practice I
encourage appropriate patients to try and
strengthen their feet by teaching them a series
of simple foot strengthening exercises. And when
appropriate I will try to wean patients from
depending on their orthotics. This model is not
dissimilar from many other medical conditions. A
patient has an acute episode, requires
intervention but then undergoes rehabilitation to
build strength. This occurs in cardiac patients
and in most orthopedic injuries. In most plantar
fasciitis patients however, the model seems to be
to diagnose the problem and then prescribe
orthotics for life. I understand if a patient has
severe biomechanical issues that approach could
be appropriate. However many patients with
plantar fasciitis have a one-time episode of
acute inflammation and may do well with temporary
bracing followed by a period of foot

I am not proselytizing that there is one
treatment path for all patients and I agree that
many patients are just fine with lifetime use of
orthotics in the same way they accept wearing
glasses and moreover are not interested in doing
foot exercises. I am however taking the time to
share that there is a growing and emerging body
of research showing that improving foot strength
is attainable, is associated with improved
function and can be a viable option for many of
our patients.

Howard E Friedman, DPM, Suffern, NY

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