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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 strength.
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 strengthening.
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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