Although falls are very common among people aged 65 years and over, we know that they are not a natural part of ageing. There is also strong evidence to indicate that many falls can be prevented (ACC, 2012).

Tackling a ‘sloppy slipper’ issue

Slippers, the name says it all really! Research has indicated that slippers, and footwear with at least one undesirable feature (e.g. no fastening), are likely to contribute to falls (Menz & Sherrington, 2003). Interestingly it also appears that going barefoot or just wearing socks may also increase the risk of having a fall (Kelsey et al, 2010).

What is Resonance Podiatry© doing?

Resonance Podiatry© is instigating a ‘sloppy slipper’ campaign in which anybody can ‘trade in’ their unsafe slippers for new, safer, slippers or indoor shoes. Sloppy slippers can include anything from slippers with no fastenings, trodden down backs, worn out soles or just really old slippers.

Although causes of falls are multifaceted, this is one way to raise awareness about falls from a podiatry perspective. Since the most common place for a fall to occur is in the home, including residential care settings, where slippers are commonly worn, it is a good place to start making small changes.

Those who are not sure whether their slippers are ‘sloppy’ should be encouraged to visit their podiatrist to assess whether the slippers potentially could increase the risk of a fall.

Formthotics™

Resonance Podiatry© utilises Formthotics™ to provide extra foot support and biomechanical control. Formthotics were the prefabricated orthotic of choice in a recent study into the ‘effectiveness of a multifaceted podiatry intervention to prevent falls in older people with disabling foot pain’ (Spink et al 2011).

This study demonstrated that the use of Formthotics, along with some other relatively simple interventions, could be effective in reducing falls. It is thought that the Formthotics may have positively affected balance “by improving foot stability and enhancing plantar sensory feedback – and by reducing plantar pressure and foot pain” (Spink et al 2011). Further research into the effectiveness of Formthotics

What else can you do to reduce your risk of having a fall?

Make your home as safe as possible. Below are just a few starting points:

• Don’t leave clutter on the floor or stairs

• Firmly anchor or remove loose mats, or mats with curled up edges

• Install grab rails around the home, especially around steps

• Install night lights in hallways if you get up during the night

Also ensure you have:

• Regular eye examinations

• A medications review with your doctor

• Any foot problems examined and treated by a registered podiatrist

About Resonance Podiatry

Resonance Podiatry specialise in the management of foot, ankle, leg and knee pain, sports injury and rehabilitation. They have a number of practices across New Zealand. To contact Resonance, call 04 233 9110 or find them online.

Further information about falls prevention can be found online by doing a search for ‘ACC preventing falls – information for older people’ or here.

If your medical practice has an interesting case study using Formthotics that you would like to share, please email marketing@footscienceinternational.co.nz, we’d like to hear from you!

References:

ACC (2014) ‘Preventing falls - information for older people’ [Accessed 31 March 2014] Available from: http://www.acc.co.nz/preventing-injuries/at-home/older-people/information-for-older-people/

Kelsey, J., Procter-Gray, E., Nguyen, U., Li, W., Kiel, DP. & Hannan, M. (2010) ‘Footwear and Falls in the Home Among Older Individuals in the MOBILIZE Boston Study’, Footwear Sci. 2(3):123-129

Menz, HB. & Sherrington, C. (2003) ‘An evaluation of footwear worn at the time of fall-related hip fracture’, Age Ageing. 32(3): 310-314

Spink, M., Menz, H., Fotoohabadi, M., Wee, E., Landorf, K., Hill, K. & Lord, S. (2011) ‘Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial’, BMJ, 342:d3411.

The National Strategy 2005-2015 (2005) ‘Preventing injury from falls’, Accident Compensation Corporation.

Understanding orthotics

As a physiotherapist, I recognise the importance of symmetry and keeping your joints and muscles in check. Your body is a complex system, responsible for making you move. I've enjoyed assessing, diagnosing and treating people who have come in with all sorts of injuries, a lot related to biomechanical asymmetry, weakness and lack of flexibility.

The feet form the foundation for the body. They contain 52 bones (not including the sesamoids), 66 joints and plenty of ligaments. No wonder it is important to support this area which takes us around 10,000 steps per day before it gets an overnight rest.

The kinetic chain is an integral part of the human body and shows that fixing one source of problems can effect another part of the body. This is exactly what Formthotics are about, supporting your foundation to lessen the impact of forces through the kinetic chain.

Helping patients (and myself) reach goals

Another part of my profession is to set goals with clients. I can't stress the importance of this. After all, ‘setting goals is the first step in turning the invisible into the visible’ – Tony Robbins. I do this on a daily basis with my patients, and also for myself.

Several years ago I set myself the goal of running my first marathon. I was given an excellent opportunity to run the London Marathon for my chosen charity, The Muscular Dystrophy Campaign.

Fortunately, I was pointed in the direction of Foot Science International and met European Sales Manager, Tim Hiscock. I was then given the golden snitch in the form of my own custom fitted Formthotics.

Success with Formthotics

The marathon was a success. This fuelled the fire to continue to be active, and since then I have completed 15 fair distance races, including the 'world’s longest obstacle race', a race under the midnight sun in Iceland, a half marathon dressed as a crayfish in England, and I beat a steam train in a race just a few weeks ago in Australia. I also conquered the highest mountain in each of Scotland, England and Wales over a five day period.

I am still going strong today and managing to surpass my 10,000 steps a day very easily without a problem, this gives me the confidence to continue to use Formthotics and recommend them to my patients.

Don’t worry were not completely winging this we are both pretty well qualified, I am a Podiatrist and am competing at the Age Group World Triathlon Champs in Auckland later this year. My friend Quinn is a physiotherapist and a well accomplished surf sport athlete and endurance triathlete.

When it comes to foot type I am a true over pronator, training in the very supportive Asics Keyano with heavily modified Formthotics™. It took me a good year of running drills and video analysis to improve my running form; sometimes I do still over stride which over a long distance again is not ideal.

Quinn has more of a neutral foot type, this means her foot doesn’t roll in or out too much. She is however a toey runner from years of soft sand running with surf sport and she tends to have a forward lean. It will be interesting to see how the minimalist shoes affect our running form and how our different foot types tolerate them.

Before I get onto the shoes though there are a few things you should consider before you take to the pavement barefoot;

1. If you have a history of running related injuries or are currently injured visit your local physiotherapist or podiatrist first to get these sorted. A muscle balance assessment to identify key areas of lower limb weakness would also pay off as you can concentrate on strengthening these areas prior to starting to minimise risk of injury.

2. Have a running technique assessment and re-training session – there are a few Podiatrists, Physiotherapists, Personal trainers and Running groups that offer this. Usually this involves teaching you how to hold the barefoot running form, BUT with your shoes on.

3. Don’t expect to be running your usual 10km loop in bare feet overnight, it takes months of slowly building up your sessions barefoot to be able to achieve the same distance. Your body is used to having the support of solid running shoes, you need to train it slowly to not rely on these and build up strength. A good way to start is do the first 5 minutes barefoot and then put your shoes on, slowly upping the time barefoot as each week passes. Doing too much barefoot too soon could be detrimental resulting in injury.

4. Consider progressing through a range of shoes. As mentioned above barefoot running form, one of the main benefits associated with barefoot running, can be achieved in you trusty supportive shoes. Once you have mastered this you could move to a slightly less supportive shoe, and then consider something like the Vibram FiveFinger and eventually bare feet if this is what you desire.

The Shoes…

In this review we included the “true” minimalist running shoe, Vibram FiveFinger, the Nike Free, the Merrell Pace Glove and the Asics Neo 33. We tested all the shoes on and off road for the same distance and also tried Formthotics™ in the shoes they would fit in. We evaluated everything from looks to feel, our results were surprising.

We scored on a scale of 1-5, 5 being excellent. Overall Quinn chose the Nike Free as her preferred shoe and I chose the Vibram 5 finger.

Nike Free

First up is the Nike Free. It was one of the first minimalist running shoes on the market and has been around for a few years now in various models. It’s a very nice looking shoe, available in an array of “pop” colours and is as light as a feather – all very appealing. Getting the shoe on however was an interesting task. The tongue is fastened to the shoe so you have to wiggle your foot into the “one size fits all” hole.

Once the Nike Free was on and we were running they were great; it truly felt like you had nothing on your feet! Quinn loved them. She found them the best for off-road when fitted with Formthotics™, claiming “they made me feel powerful”. The Formthotics made her feel more stable due to their moulded shape providing better feedback from the sole of her foot. Quinn’s only negative feedback was that after a while she started to feel pressure and heat under the balls of her feet. This is a sure sign that the lack of feedback the Nike provided was letting her run on her forefoot rather than landing on her midfoot.

For me the thick cushioned sole unit was a let-down, it masked the proprioceptive feedback you want to experience when running barefoot. Not having this feedback also affected my form, allowing me to over stride. One of the benefits of having a good connection with the ground when running barefoot is that you are forced to take shorter steps. It’s uncomfortable to over stride due to increased shock on landing. I also found sticks and stones were stuck in the sole by the end of my off road adventure which was a pain once back on the road.

For Quinn this was her favourite off road shoe with Formthotics fitted, for me I found them too soft and unstable due to the thicker sole unit. I personally would not use these for running, possibly walking the dog for a short time, but they would be great for a surf athlete pre-race to warm up the intrinsic foot muscles without risk of being stabbed by shells.

Comfort   Style  Flexibility  
Protection  

Vibram FiveFinger

Although the Nikes were a bit of an effort to get on, the Vibram FiveFinger took the cake. Not only did we have to squeeze our feet into the shoe again but we also had to ensure each toe piece matched the corresponding digit – a work out in itself! It quickly became apparent that for those of you with a longer second toe these are not the shoes for you as the toe pieces decrease in length with each digit. Once on these were surprisingly comfortable and felt supportive as they contoured well to the sole of the foot, providing good proprioceptive feedback. Running in them was great, both on and off road; the sole unit had great flexibility and wasn’t too thick, which meant adaptation to uneven terrain was effortless. Our only complaint is when landing on a sharp object you may as well be barefoot as the pain is not masked!

Comfort Style Flexibility
Protection

Merrell Pace Glove

The Merrell Pace Glove is another true minimalist shoe. Again these were nice and light weight and hugged the foot well, like a Glove you could say. Unlike the Vibram FiveFinger the Merrell Pace Glove sole unit was not as flexible; it was one solid rubber piece whereas the Vibram was lots of little pieces providing better flexibility. The Merrell felt more restrictive when running off road, but it provided more protection from nasty sticks and stones and felt good when running on road. This would also be a great shoe for rock climbing.

ComfortStyle   Flexibility
Protection

Asics Neo 33

Asics Neo 33 would definitely be classed as a transition shoe to minimalist running. They are light weight yet still torsionally rigid through the mid sole with a small amount of duo max for additional support. Don’t get me wrong, they are far from the robust nature of more well-known Asics running shoe models, but when compared to the other minimalist shoes they are still quite controlling. The Asics Neo 33 was the most Formthotics™ friendly, which further enhanced proprioception both on and off road. They provided enough rigidity to feel supported but were light enough to make us feel fast. The only negative was that the more cushioning again lead to more heel striking and over stride rather than mid foot striking.

This video of Quinn shows the change in running form between the a true minimalist shoe and a transition shoe (Link to running video of Quinn)

The technique and form gained from running barefoot is the true benefit behind this craze. It will shorten your stride and help you land on your mid foot, much closer to your centre. This should reduce injury and fatigue, and over time increase efficiency. Barefoot running takes time and we would recommend you see this as a long term project. Start with a good transition shoe such as the Asics Neo 33; get some Formthotics™ and some running technique advice from your podiatrist. Remember you are doing this to reduce injuries so be careful!

ComfortStyleFlexibility 
Protection

“The reality is that when you put a well cushioned running shoe on someone, they feel confident about striding out when they run, normally putting their heels down first as they run. This can lead to issues with heel strike, attributing to common runner’s injuries.”

“When you remove those shoes, striking the ground heel first is no longer comfortable or natural, so immediately a shift in running style occurs and your natural running form improves,” Bruce says.

Instead of striding out in front of the body, barefoot runners carry their body weight in a more centred fashion, which improves your overall style and the cadence of your running.

Although this improved form can be achieved through running barefoot, where people will naturally run closer to the mid foot, Bruce says it is not necessary to run barefoot to improve your running posture. Bruce believes you can achieve the benefits from barefoot running without the risks associated with removing all protection from your feet.

In addition to shifting the emphasis away from striking heel first, barefoot running also provides greater contact with the ground. Due to this greater biofeedback through the foot to the rest of the body is achieved, which means the foot can easily adapt to uneven surfaces, terrain and angles accordingly.

Bruce says almost the same level of biofeedback can be achieved by using custom fitted orthotics.

“Charlie Baycroft, the creator of Formthotics, believed it was possible to retain most of that biofeedback by creating a customised orthotic that was snugly fitted to the soles of each individual runner.

“Similar to how sand forms around your foot on a beach, providing a high level of sensory information to the rest of your body, formthotics are designed to fit to all surfaces of your sole.”

For runners who would like to gain the benefits of barefoot running, but don’t want to risk injury from running unprotected on city surfaces, Bruce recommends retraining your running form, ideally in conjunction with a podiatrist who can advise you, and gradually transitioning from a fully cushioned, rigid shoe to a lighter shoe with a lighter orthotic.

You may want to invest in a few different types of running shoe, each with different formthotics depending on the type of training you are doing – ie sprint training vs longer distance or different terrain sessions.

If you are considering trying barefoot running, Bruce suggests you consider these points first:

• Do you have enough foot strength – are your feet strong enough to start running without support?

• How stable are your feet and ankles? Again, are they stable enough to run without support (no existing issues with ankles or weakness)?

• Ideally you need to build up gradually to running barefoot – do you have a plan in place to do this?

• Do you really need to remove your shoes to improve your running form? have you considered other approaches?

• Why do you want to take up barefoot running in the first place? Have you considered all the pros and cons?

• Have you tried retraining your technique, while keeping your shoes on, or changing to a lighter shoe?

• Do you heal quickly? Some people are less prone to bruising and heal more quickly from the cuts and abrasions that are more likely to occur when you run barefoot.

• Consider making barefoot running just a small part of your running time, as a supplement to your main training.

Whatever your decision, it is a good idea to make it in conjunction with a qualified podiatrist who understands the issues around your running form and the possible injuries to your feet, ankles and egs.

Bruce says he sees a number of forefoot stress fractures from clients who are running barefoot, which is a common injury seen worldwide as a result of runners who haven’t changed their running style to adapt to running barefoot, so it is critical to get good advice to help avoid injury.

“The type of sport, footwear and foot type plays the main role in which Formthotics model I choose for an athlete/patient. For cycling I use a lot of the original red, being the firmest density it provides a nice strength/weight option.”

“There were Formthotics in some of our medal winning athletes cycling shoes at both the Beijing Olympics and Delhi 2010 Commonwealth Games. Each sport is has different requirements from the foot.

In cycling I use orthotics to minimise frontal plane motion in an attempt to deliver power to the foot-pedal interface. I find the customising of these orthotics to the cyclist’s individual requirements helps greatly to improve knee tracking issues with cyclists at all levels.”

Symptoms of runner’s knee include pain on the outside or inside of the knee, pain aggravated by running downhill or pain during flexion and extension of the knee.

Runner’s knee, commonly diagnosed as Patella femoral pain, occurs when the patella femoral tendon becomes irritated. The Patella femoral tendon runs from your femur (thigh bone), to your knee cap and inserts in to the tibial tuberosity – it aids in tracking of the knee cap during movement of the knee.

What causes it?
Knee caps are designed to slide up and down while you run, if the leg’s alignment is off, then your knee caps will not track directly up and down because the patella femoral tendon will have a bow in it. The most common reasons for this dysfunction are weak front thigh muscles (quadricepts) and excessive pronation of the foot. Pain on the inside and outside of the knee can also occur due to this as the ligament and muscles connecting here can be over stretched.

Shin Splints

What is it?
Runners who suffer from pain in the front, inner leg often have shin splints, medically known as medial tibial stress syndrome. The pain often starts out as dull but then becomes more pronounced during exercise such as running. Initially this condition affects the muscles attaching to this area of bone but if left untreated this condition can lead to bone changes knowen as periostial reaction which may require surgery.

What causes it?
Shin splints occur most often in new runners or those who have recently changed their frequency, intensity, duration and running surfaces. The new increase in impact can cause the lower leg muscles to become fatigued and overstressed. This leads to inflammation and pain. Some people are more prone to shin splints than others due to existing biomechanical foot conditions (like overpronation) that increase the stress on the lower leg.

Plantar Fasciitis

What is it?
Plantar fasciitis is a condition affecting the plantar fascia: the band of fibres that runs from the ball of the foot to the heel. It usually manifests as heel pain that is most prominent in the morning, when you take your first steps, and may feel like a stone bruise. Generally this pain lessens during the day but is again prominent after sitting down in the evening.

What causes it?
Plantar fasciitis occurs when the plantar fasciia is over strained, becoming inflamed often at its origin in the heel . When the arch of the foot is not supported properly, the plantar fasciia stretches more than it was intended to, resulting in overuse and inflammation. Overpron

ation, which involves the flattening of the arch and a rolling in movement through the ankle and midfoot, is a common culprit in plantar fasciitis. Other factors include tight calf muscles, new exercise regimes and weight gain, all of which can contribute to excessive strain in the arch area.

Others who may be at risk are people who work jobs that require them to stand or walk for hours at a time. Sudden weight gain, including pregnancy, can also cause plantar fasciitis.

Should I be running with plantar fasciitis?

Once you have had your problem diagnosed by a podiatrist, you can begin taking steps towards recovery. Resting your feet is the first step to recovery as running with plantar fasciitis will only exacerbate the problem. Even if pain is only mild, reduce the amount of time you spend running. Remember that even if you do not feel much pain running with plantar fasciitis, the pain will increase once you stop.

How is plantar fasciitis treated?

Often, the most effective way to treat plantar fasciitis is with orthotics. With arch support, your plantar fascia will no longer be over-stressed with weight. Rather, your weight will be dispersed evenly across the bottom of your foot. Plantar fasciitis typically requires between six to eight weeks of treatment before full recovery. Fortunately, the recovery rate is very high especially when dealt with early, so a full recovery is likely.

How is plantar fasciitis prevented?

To avoid the pain of plantar fasciitis, you can take steps to prevent it. The same orthotics that are used to treat existing injury can also prevent future strains by ensuring your body’s weight is distributed evenly. By keeping excessive weight off the plantar fascia, orthotics prevent overuse of the tendon.

Stretching before and after you run or exercise will also help, as overly tight calf muscles can contribute to plantar fasciitis. If possible, try running on softer, more malleable surfaces. Consider dirt trails instead of sidewalks as these terrains put less strain on any one part of your foot.