With its 33 joints, the foot is as complex a mechanism as the hand, yet most of the shoes we wear keep it from functioning right.
That was the message delivered by structural therapist Derek Gardner as he stood barefoot in the Community Room at the Forbes Library in Northampton on a recent Tuesday evening.
“Our hands would start atrophying if they wore gloves as stiff as shoes,” he said.
Gardner was speaking to about a half-dozen people who turned out for his talk on the connection between footwear and health at the library. When feet can’t move properly, he told the group, muscles, tendons and joints in the leg can’t adequately react. The body is strained.
Gardner, who is also a licensed massage therapist in Northampton, practices a form of bodywork, like rolfing, that targets specific points of the anatomy experiencing musculoskeletal pain or dysfunction. If he had his way, most people would go barefoot whenever possible, and when circumstances demand shoes, the footwear would be spare.
“You don’t want your shoe to break your foot in,” he said. Shoes, boots and sneakers should allow feet to feel the surface beneath them. When feet can feel the terrain, he said, the rest of the body can adjust more easily to a hazardous change underfoot — a piece of ice, a forgotten toy, a protruding tree root — and better maintain balance.
The trouble with heels
Displayed on a table behind Gardner were several pairs of boots, shoes and moccasins, all with little or no heel. He had worn one of the pairs of boots to the library. The moccasins belonged to one of his children. Both the soft-soled sheepskin boots and the running shoes with a foot-shaped toe area were from his wife, Beth-Marie Gardner, who was at the workshop as well.
The boots, she said afterward, are handmade. “I love them. I can feel every crack in the sidewalk.”
Heels on shoes pose a particular problem, according to Gardner. They throw off the body’s natural alignment, he said, which can lead to knee, hip, and even neck problems.
“Walking with heels is like constantly falling forward,” he said. “I’ve even noticed subtle whiplash motions with people’s necks.”
To demonstrate, he placed a Styrofoam tube in a boot to mimic the action of a leg. As he slowly lifted the back of the boot off the floor and the boot pitched forward, he pulled the tube back, a motion he said our legs make to keep us from falling forward. Then he placed a second tube on top of the first, to mimic the movement of the body’s torso. As he raised the boot heel higher and higher and the back of the boot rose farther off the ground, the tubes pitched farther forward and Gardner juggled to pull them back so that they would not topple over.
That, he said, is how the body reacts when its natural balance is thrown out of sync with shoes. Joints, muscles and tendons are constantly overcompensating in an attempt to re-align the body.
“It’s a lot on your body to walk around like that for eight hours a day,” he said.
Alignment versus posture
Alignment, Gardner explained, is not the same thing as posture.
“Posture is something that achieves a certain look,” he said. “When most people are told to stand up straight they throw their shoulders back as if getting ready for a military salute.”
When someone is walking in alignment, he said, it almost looks like they are leaning backward.
“The posterior of the body, not just the legs, but the posterior of the arms as well, does most of the work,” he said. Our bodies should be straight, like we are paddling with an oar. The feet should be centered under the hips. When we are standing still, we should be able to lift our toes off the ground without losing balance, he said.
In Gardner’s view, picking the right footwear and retraining ourselves to walk are keys to good health.
The wrong footwear, he said, can lead to several ailments, including bunions, folded toes, heel spurs and plantar fasciitis.
Scattered on the rug in front of Gardner were several balls of various sizes, textures and density that he uses to help his clients massage their feet. He placed his foot over one of the balls and moved it back and forth, massaging the base of his foot, and the arch of his instep.
“See how many of those 33 joints you can use while walking. The idea is to explore movement with your foot,” he said, by putting pressure on it at various points. “Essentially, you’re waking up your foot.”
Gardner passed out a few pieces of Styrofoam shaped like half domes. Placing the flat parts face down on the floor, he asked those at the workshop to place their toes on top of the domes, and then lean forward a little to stretch out their calf muscles.
“All calf stretches will help,” he said. Shoes with heels don’t allow calf muscles to stretch out as much as they would when barefooted. Strengthening the calf muscle is important for walking properly, he said.
Shoe size is another factor, he said. People often buy shoes that are too small. High heels, he said, are commonly too small for a woman’s foot, often by as much as an inch.
Dr. Khanhmei Wong, a podiatrist at the Atwood Health Center in Northampton, which is affiliated with Cooley Dickinson Hospital, agrees that proper footwear is important, but stops short at condemning all heels.
“Foot problems are very complicated,” she said in a telephone interview a day after Gardner’s talk. “It’s really important to choose the correct shoes.”
Most of the patients she sees are seeking treatment for bunions or plantar fasciitis, she said. Bunions — bony bumps at the base of the big toe that form when one toe pushes against the next — are largely genetic, but can be made worse by improper footwear.
With frequent use of high heels, the Achilles tendon becomes shortened over time, Wong said. “The elevated heel creates extra pressure at the back of the foot, while the pointed toe box offers inadequate space in the front of the foot,” she said. That can lead to bunions and arthritic joints.
But Wong says that some shoe support is needed, especially on the soles of the feet, which can get cut or callussed, which in turn can lead to infections. Plantar fasciitis — an ailment common among long distance runners — is an inflammation of the fascia, the connective tissue that runs along the base of the foot and connects the heel to the toe. Wong said many of her patients who have developed that condition are males who wear barefoot-type running shoes that offer little support.
Wong pointed out that people’s feet are not all alike. Each has specific needs, she said. Some require more space for their toes. Others have a high arch, or almost no arch at all. And tweaking one problem, such as a flat foot, can cause another problem somewhere else on the body, such as the knee joint, or hamstring, she said.
“Our feet our alive,” said Wong. They are constantly changing, developing, and adjusting to our routine. Our body is very good at helping us. Over time, it will overcompensate for poor footwear.”
Wong says orthotics can help, particularly for those with flat feet.
“Orthotics help put the foot in correct alignment,” she said. They prevent your feet from rolling inward.
But while orthotics can stabilize someone’s condition, she continued, they cannot fully reverse it.
“They’re like glasses,” explained Wong, which enhance, but don’t change a person’s eyesight.
Foot care is key
Gardner concedes that orthotics can help, but he sees them as a temporary solution. He’d rather see people focus on retraining their gait.
He says walking with less cushioning and heel allows the body’s natural resilience to build back up.
“When the bones and muscles develop their own integrity,” Gardner said, “support becomes less important.”
That, however, doesn’t happen overnight. It has taken years for our bodies to lose their proper alignment, he said, and simply switching shoes, or changing our way of walking too quickly, can strain our legs, feet, and joints, and even cause injury. “You have to retrain everything else in your body, along with (changing) your footwear,” he said.
As a therapist, Gardner said, he helps clients achieve that.
“I practice structural therapy because it’s the most effective bodywork I have yet come across to help muscles, tendons, and bones,” he said. His treatment combines several elements, including movement, stretches as well as choice of footwear.
Gardner and Wong agree that proper foot care is important to overall health.
“When the whole body does better, the whole body does better,” said Gardner.
Wong suggests massaging feet daily, even for 30 seconds or so. Pay attention to them now, she said, before ailments creep up and get worse. “The livelihood of our feet is our livelihood as well,” she said.
(Originally appeared in the Hampshire Gazette.)