When a stability shoe makes things worse.

Look at this video. This is a video of what was a midfoot-forefoot pronator who was fitted into a high stability motion control shoe. This appears to be a Brooks Adrenaline GTS shoe.

You can see that the shoe appears to help limit the pronation at the rear and mid foot but a keen eye will easily tell you that this person is pronating heavily through the forefoot.  This may in fact be a person with forefoot varus.

You need to know your shoe types, foot types and when to pair them up. This pairing actually blocked much of the rear and midfoot pronation but forced it all to occur through the forefoot at an abrupt rate. This abruptness increases the likelihood of metatarsal osseous stress responses and for anterior or posterior shin splints.

This person needs more ankle stability to protect from the degree of ankle valgus and they could also use more hip and knee stability to prevent the genu valgum loading (medial knee posturing) as well as the Cross Over deficits. A little bit of rehab, body awareness and some foot exercises will go a long way here. A more accommodative shoe could help, too. We are not sure of the foot type obviously, but if we have a rigid forefoot varus a medial MET  head post (a Rothbart-type) wedge could help this client immensely. 

There is much going on here, but the big point we wanted to hit home here is that even a high end motion control shoe cannot block all pronation, especially if it occurs in the forefoot. Many orthotics fair to address forefoot pronation as well, merely because the control of the device does not extend into the forefoot. Sure, some can be dampened by changes in the rear and midfoot, but this case should prove that sometimes it is not enough.  

If you want to learn more about proper matching of feet and shoes, our National Shoe Fit PRogram will take you a long way.

Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Shawn and Ivo

The Dual Density Foam Running Shoe.

This goes along nicely with yesterdays post. Note the photo attached. This is a great example of something we all see everyday. A laterally tipped foot in a stability shoe.  Clearly a shoe that has been mis-prescribed for the wrong reason. Or has it ?

This client is clearly tipped laterally in the shoe, forcing supination.  Did this client self fit the shoe themselves in a discount store ? Were they fitted in a retail running store ? Where did things go wrong ? Or did they ?  The initial knee jerk reaction is to say this is the wrong shoe for this client.  Lets go a little deeper and ask some harder questions and see if you are considering some alternatives.

The assumption is frequently one of, “you are a hyperpronator so you need a stability shoe”. In this case is this person a hyperpronator ?  There is no way to know, not in the shoe.  On initial knee jerk observation this looks like a supinator in a stability shoe, a poor match.  But read on …

1. What if this person has significant flat feet, pes planus with severe pronation problems, but they find the stability they need by standing on the outer edge of the foot in the mechanically locked out position (supination).  Perhaps this is a less fatiguing posture, perhaps a less painful posture. This is often a comfort thing for hyperpronators to display.  What you see is not always what you get because there are two types of feet, those that drop or collapse into the weakness and those that fight the collapse and weakness the whole way via an alternative compensation.  You cannot tell by looking, certainly not from this picture of someone in a shoe. There must be a functional assessment and some gait evaluation. 

2. There exists the high arched flexible foot that pronates excessively, quickly and for a long time (this is the flexible cavus foot) and then there is the high arched rigid foot (the equinovarus foot).  The first described foot may need support from a stability shoe even though they have a high arch on presentation/examination and the later described foot can often go right into a neutral non-supportive shoe.  Can you tell either of these from this picture ? No you cannot.

3. Maybe the person in the photo has tibial varum (bowed lower leg) combined with a rearfoot varus and forefoot varus. This could mean they pronate heavily through the midfoot-forefoot and less so through the rearfoot-midfoot. In this case they are still a heavy pronator but not through what is typically noted or detected by significant medial arch collapse.  In this case the dual density shoe is not going to help all that much because the pronation is occurring mostly after the bulk of the shoe’s dual density stability foam has been passed through by the foot. Can this be detected by this photo ? Again the answer is no. The shoe fitter needs to be clinically aware that this type of client needs a forefoot varus posted shoe to help post up that medial tripod (1st metatarsal head).

4. Maybe, just maybe this is a typical rearfoot-midfoot pronating client, excessive mind you, and all they need is some foot and gait retraining to break their old compensation pattern of lateral weight bearing (standing or walking) and with this correct shoe they can then engage a healthier motor pattern. 

Which is it ?

Do you know how to navigate your way through these issues to make the right decision ?  There is no way to know here without seeing the foot naked and moving across the floor, and with a clinical examination to boot.

You can get all these things through our National Shoe Fit Certification program found here.

LINK:  http://store.payloadz.com/results/results.aspx?advsearch=1&m=80204

Email us and we will share the necessary info to get you started.  thegaitguys@gmail.com

Shawn and Ivo, The Gait Guys

Retail/Coach/Trainer Focus: When a stability shoe does not stop gait or running pronation.

This video is unlisted. You will need this link to view it if it does not show up in the player above this blog post:    http://youtu.be/Lt6RbEtALUY

This is a higher end stability shoe. We know what shoe it is and you can see the significant amount of dual density mid sole foam in the shoe, represented by the darker grey foam in the medial mid sole.  The point here is not to pick on the shoe or the brand. The point here is to:

1. not prescribe a shoe entirely on the appearance of the foot architecture

2. not to prescribe a shoe merely because a person is a pronator

3. not to assume that a stability shoe will prevent pronation

4. not to assume that technique does not play a part in shoe prescription

5. not to assume that all pronation occurs at the mid foot (which is the traditional thinking by the majority of the population, including shoe store sales people)

There you go, plenty of negatives. But there are positives here. Knowing the answers and responses to the above 5 detractors will make you a better athlete, better coach, better shoe sales person, a safer runner, a more educated doctor or therapist and a  wiser person when it comes to human locomotion. 

A shoe prescription does not always make things better. You have heard it here and we will say it again. What you see is not necessarily what you get.  This case is a classic example of how everything done for the right reasons when so very wrong for this young runner.

What do you see ?

Pronation can occur at:

  1. the rear foot (we refer to this as excessive rear foot eversion or calcaneal eversion driven sometimes by rearfoot valgus). This can be structural (congenital) in the bone (calcaneus or talus) or functional from weaknesses in one or several rear foot eversion controlling muscles.
  2. the mid foot as is traditionally assumed (this is often referred to as “arch collapse” ).
  3. the fore foot. (possibly many causes, such as a Rothbart Foot variant, short first metatarsal, a bunion , forefoot varus, hallux valgus, weakness of the hallux controlling muscles etc)

So, in this case you might assume that the stability shoe that is designed to prevent rear and midfoot pronation is:

  1. not doing its job sufficiently OR
  2. the pronation is occuring at the forefoot OR
  3. there is a myriad of of issues (yes, this is the answer)

However, the keen eye can clearly see that this is a case of heavy forefoot pronation but there are also mechanical flaws in technique (driven by weaknesses, hence just working on her running form will not solve her issues, it will merely force her to adopt a new set of strategies around those weaknesses !). The problems must be resolved before a new technique is forced.  This is perhaps the number one mistake runners make that drives new injuries.  They tend to blame the injury on new shoes, old shoes, increased miles, the fartlek they did the other day, the weather, their mom, there spouse, their kids…….runners come up with some great theories. Heck, all of our athletes do ! It keeps things amusing for us and we get to joke around with our athletes and throw out funny responses like, “I disagree, it was more likely the coming precession of the equinox that caused this injury !”. 

Although his individual does not have a fore foot varus deformity (because we have examined  her) it needs to be ruled out because it is  big driver of what you see in many folks.  In FF varus the forefoot is inverted with respect to the rear foot. This can be rigid (cannot descend the 1st ray and medial side of the tripod) or plastic (has the range of motion, but it hasn’t been developed).

We, as clinicians, like to assume that MOST FEET have a range of motion that folks are not using, which may be due to muscle weakness, ligamentous tightness, pathomechanics, joint fixation, etc. Our 1st job is to examine test the feet and make sure they are competent. Then and only then, after a trial of therapy and exercise, would you consider any type of more permanent “shoe prescription”.

If the individual has a rigid deformity, then you MAY consider a shoe that “brings the ground up” to the foot. Often time we find, with diligent effort on your and the individuals part, that a shoe with motion control features is not needed.

Sometimes the individual is not willing to do their homework and put in the work necessary to make things happen. This would also be a case where an orthotic or shoe can assist in giving the person mechanics that they do not have.

We have not seen many (or any) shoes that correct specifically for a fore foot varus (ie a shoe with fore foot motion control ONLY). The Altra Provision/Provisioness has a full length varus post which may help, but may over correct the mid foot as well. Be careful of what you prescribe.

Yes, we have been studying, blogging, videoing and talking about this stuff for a long time. Yes, much of it is often subtle and takes a trained eye to see. It is also the stuff that goes the “extra mile” and separates good results from great ones.

We are The Gait Guys. Watch for some seminars on some of our analysis and treatment techniques this fall and winter, and some pretty cool video, soon to be released.

Retail/Coach/Trainer Focus: When a stability shoe does not stop gait or running pronation.

This video is unlisted. You will need this link to view it if it does not show up in the player above this blog post:    http://youtu.be/Lt6RbEtALUY

This is a higher end stability shoe. We know what shoe it is and you can see the significant amount of dual density mid sole foam in the shoe, represented by the darker grey foam in the medial mid sole.  The point here is not to pick on the shoe or the brand. The point here is to:

1. not prescribe a shoe entirely on the appearance of the foot architecture

2. not to prescribe a shoe merely because a person is a pronator

3. not to assume that a stability shoe will prevent pronation

4. not to assume that technique does not play a part in shoe prescription

5. not to assume that all pronation occurs at the mid foot (which is the traditional thinking by the majority of the population, including shoe store sales people)

There you go, plenty of negatives. But there are positives here. Knowing the answers and responses to the above 5 detractors will make you a better athlete, better coach, better shoe sales person, a safer runner, a more educated doctor or therapist and a  wiser person when it comes to human locomotion. 

A shoe prescription does not always make things better. You have heard it here and we will say it again. What you see is not necessarily what you get.  This case is a classic example of how everything done for the right reasons when so very wrong for this young runner.

What do you see ?

Pronation can occur at:

  1. the rear foot (we refer to this as excessive rear foot eversion or calcaneal eversion driven sometimes by rearfoot valgus). This can be structural (congenital) in the bone (calcaneus or talus) or functional from weaknesses in one or several rear foot eversion controlling muscles.
  2. the mid foot as is traditionally assumed (this is often referred to as “arch collapse” ).
  3. the fore foot. (possibly many causes, such as a Rothbart Foot variant, short first metatarsal, a bunion , forefoot varus, hallux valgus, weakness of the hallux controlling muscles etc)

So, in this case you might assume that the stability shoe that is designed to prevent rear and midfoot pronation is:

  1. not doing its job sufficiently OR
  2. the pronation is occuring at the forefoot OR
  3. there is a myriad of of issues (yes, this is the answer)

However, the keen eye can clearly see that this is a case of heavy forefoot pronation but there are also mechanical flaws in technique (driven by weaknesses, hence just working on her running form will not solve her issues, it will merely force her to adopt a new set of strategies around those weaknesses !). The problems must be resolved before a new technique is forced.  This is perhaps the number one mistake runners make that drives new injuries.  They tend to blame the injury on new shoes, old shoes, increased miles, the fartlek they did the other day, the weather, their mom, there spouse, their kids…….runners come up with some great theories. Heck, all of our athletes do ! It keeps things amusing for us and we get to joke around with our athletes and throw out funny responses like, “I disagree, it was more likely the coming precession of the equinox that caused this injury !”. 

Although his individual does not have a fore foot varus deformity (because we have examined  her) it needs to be ruled out because it is  big driver of what you see in many folks.  In FF varus the forefoot is inverted with respect to the rear foot. This can be rigid (cannot descend the 1st ray and medial side of the tripod) or plastic (has the range of motion, but it hasn’t been developed).

We, as clinicians, like to assume that MOST FEET have a range of motion that folks are not using, which may be due to muscle weakness, ligamentous tightness, pathomechanics, joint fixation, etc. Our 1st job is to examine test the feet and make sure they are competent. Then and only then, after a trial of therapy and exercise, would you consider any type of more permanent “shoe prescription”.

If the individual has a rigid deformity, then you MAY consider a shoe that “brings the ground up” to the foot. Often time we find, with diligent effort on your and the individuals part, that a shoe with motion control features is not needed.

Sometimes the individual is not willing to do their homework and put in the work necessary to make things happen. This would also be a case where an orthotic or shoe can assist in giving the person mechanics that they do not have.

We have not seen many (or any) shoes that correct specifically for a fore foot varus (ie a shoe with fore foot motion control ONLY). The Altra Provision/Provisioness has a full length varus post which may help, but may over correct the mid foot as well. Be careful of what you prescribe.

Yes, we have been studying, blogging, videoing and talking about this stuff for a long time. Yes, much of it is often subtle and takes a trained eye to see. It is also the stuff that goes the “extra mile” and separates good results from great ones.

We are The Gait Guys. Watch for some seminars on some of our analysis and treatment techniques this fall and winter, and some pretty cool video, soon to be released.

Shoe Retail Thursday: Today we have a client in some shoes that appear to be a good match, until you look more closely.  See if you can see it.


” Just because the shoe fits, doesn’t mean you should wear it ! ”

– The Gait Guys

First of all, we apologize for the crummy video. But we were scouring through some old stuff while working on our long awaited “Shoe Fit” program and this video just had to be shown. This is a short video, you might get some  vertigo from the nasty camera work. Sorry about that. 

Initially this client looks great from behind. The rear foot looks neutral, no valgus heel collapse into rearfoot pronation and no over burdening of the lateral crash zone (lateral/outside tipping of the shoe into supination).  If anything could be said, they look like there could be a subtle rearfoot supination from the initial shot before they start to walk. 

We are also not sure what shoe this is, we do however know it is a New Balance stability shoe from the video.  This client had purchased these shoes 1-2 weeks prior in a trusted high end specialty running store.  As the client walks away from us everything looks pretty good. We could point out some subtleties but those are not the point of our talk today.  It is not until they come walking back that something is clearly wrong.  Did you see it ?  The LEFT foot is drastically supinating displaying a lateral weight bearing shift all the way through toe off.

Now, on the surface this is a simple case.  (We just shot a concept video last night to take this blog post today to the next level. We will present it next week once we get it edited.) But the points we need you to understand today are :

  1. Just because someone has a flat foot standing in front of you does not mean they need a stability shoe.  We see plenty of folks who are serious walkers, runners all the way up to professional athletes who have flatter, or flattened, medial longitudinal arches but still have very strong competent feet.  There are ethnic groupings that have flat feet.  So just because a foot looks flat does not mean one should reach for a stability shoe or an orthotic or additional foot bed insert.  This client had flatter arches but had competent feet.  They also had some issues of tibial torsion that negated some of the challenges of flatter feet.  So, our point here is what you see is not always what you get, nor what you should fix either for that matter. 
  2. What should happen in a shoe does not always truly happen.  This means you have missed some calculations or you simply do not have enough experiential wisdom to predict the oddities in certain situations or with the given anatomy of a given athlete.  This comes in time, with experience.
  3. Sometimes supination is not really supination. This client has a flatter foot. Flatter feet do not supinate well. Ok, better put they run out of time to supinate the foot because they have spent too much time into the pronation phase. However, they also could have weakness in the supinatory mechanisms to drive it adequately. Remember, some clients will fall into their weaknesses and some will strategize to avoid the weaknesses if they have enough body awareness and strength to do so.  They just do not seem to have the skills to find the more appropriate pattern to correct the underlying issues. But there is certainly something positive to be said to knowing you have a problem and that you are cheating around it rather than being oblivious.

This case was possibly, maybe even likely, one of several problems:

  1. wrong shoe for the foot type
  2. possibly a faulty shoe fabrication
  3. poor strategy to make for a rigid foot structure

This case also draws clinical inquiry into:

  • whether there is weakness of the ankle and forefoot everting muscles namely the peronei and extensor digitorum longus and brevis. * This the topic of the video we are producing because these muscles have huge implications in the cross over gait (which we have senselessly beat you all with in previous blog posts) at the lower end of the limb.

Who are we ? The Gait Guys…… Shawn and Ivo.  The dynamic duo of all things gait.