Which Shoes Help Exercise, Fall Prevention, and Ankles?
Tuesday, February 20, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
We are in the cold, damp Tennessee mountains for the rest of the week, teaching at a medical school program of wilderness medicine. It should be warmer than home in the Northeast US where it's snowing, and the Schuylkill River, and water bottle on my bicycle are frozen. I won't have Internet or phone access at the wilderness camp. Unflagging Healthline staffer Carrie Locke is posting the blogs for me all week. Thank you Carrie, once again.
For wilderness treks and hikes, and everyday walking, you need to walk on uneven surfaces without stumbling or spraining your ankles. Expensive shoes, inserts, arch supports, braces, ankle supports, and orthotics are sold on the belief that they are needed to hold your foot and ankle in position. However, this is an expensive fallacy.
You are the one who can hold your ankles in healthy position or let them sag into foot pronation. You don't need, or even want, shoes that hold your ankles straight for you. Without use, your ankle muscles weaken. With shoe support, your ankle doesn't have to work to hold itself. It gets weaker. It forgets how. "Supportive" hard shoes without flexibility are a common source of hip and knee pain. It is the opposite of what is needed.
It is not high top shoes or ace bandages or taping or orthotics that prevent falls and ankle sprains, or prevent ankles from sagging outward (supination) or inward (pronation.) The most important thing you can do for healthy ankles and preventing sprains is to use your own leg muscles, and simply hold your ankles without sagging, the same as any other posture. Think of a beginning skater. At first, they let their ankles bend and sag inward. They do not know how to hold their legs using their own muscles. Eventually, they learn to hold straight, healthful positioning.
Letting your ankles sag inward can press the joints of your arches, ankles, knees, even hips. In most instances, supportive shoes and inserts are no more needed than putting your mouth in a sling to keep it from falling open when you walk around. Thinking that you need supportive shoes to brace uninjured ankles for hiking and walking is a common myth that perpetuates weak, unstable ankles. Many people who use arch supports never learn how to use their own muscles, and are told to never go barefoot. This is an unfortunate and unnecessary restriction to their health.
The post Healthy Knees shows what inward-sagging knee positioning looks like and how to fix it. It is easy to do and makes an immediate and important improvement to your joint health.
Often in wilderness settings, I see hikers in expensive boots. The native mountain guides and pack-bearers are wearing flip-flops or old soft sneakers. This is not just a salary inequality. It is not that the guides don't know ankle and leg health. They know something crucial - the health of your ankles and knees comes from your own muscles. You will save much money by not getting footwear and products that prevent your foot and ankle muscles from working. You will save your knees and hip from the shock and extra loading of hard supportive shoes. Without them, you will get free, built-in foot stretch and leg and foot exercise with every step.
More:
- Read more how to have healthy ankles and ankle support in the book Fix Your Own Pain Without Drugs or Surgery.
- Arch Support Is Not From Shoes
- Are Your Shoes Too Tight?
- How To Treat Ankle Sprains and Prevent Them
- Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
- Supportive Hard Shoes Linked to Knee Loading and Arthritis
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Read and contribute your own success stories of these methods.
Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail" (under trumpet) upper right.
For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. See Dr. Bookspan's Books.
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Read and contribute your own success stories of these methods.
Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail" (under trumpet) upper right.
For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. See Dr. Bookspan's Books.
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Labels: ankle, arches, feet, hip, orthotics, pronation, shoes
10 Comments:
At Monday, February 26, 2007 8:00:00 AM,
Rhiannon Miller said…
The trouble is that it's getting harder and harder to find shoes without filled insteps. I tend to over-supinate rather than over-pronate my feet, so the last thing I need is instep support. (I also have narrow heels and wide toes, which also cuts down my choice of shoes.) I've taken to having my old shoes resoled, but there's only so many times you can do that – and it's almost as expensive as buying new ones.
At Monday, March 05, 2007 6:03:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Rhiannon, you ask good questions with each comment you write. Insteps in any shoes are not supposed to be higher than "neutral" and so, should not push you into any supination (in general, rolling the foot and/or ankle outward). If you supinate, the arch that is built into the shoe would be lower than what you habitually do on your own.
This leads to an interesting point. Many people will roll inward (pronate) or outward (supinate), regardless of the shoe. Many pronators who spend much on inserts and orthotics and arched shoes just continue to slump inward, pronating right over their supports. (Those who do get an arch lifting effect from inserts unfortunately perpetuate their same poor muscle control and pronation problems, because they never develop the simple muscle ability of not rolling inward.) The same for supinators - don't allow your foot to roll outward. Use leg and ankle muscles to prevent it.
Experiment with pushing and pulling your arch into different heights. Let us know what you find.
I hope that your wide forefoot will keep you away from unhealthful narrow toe shoes :-)
Cheap sneakers are often fine. With simple muscle use to position your own foot where you want it, even moccasins and flip-flops without any arch are fine. It's a myth that you need expensive shoes, or that "support" must come from shoes. You support using your own muscles and volition - no different from holding any other body part from slouching.
Enjoy, and save money.
At Thursday, March 22, 2007 11:05:00 PM,
Anonymous said…
I feel that it is important to acknowledge that some do in fact need orthotic supports of some fashion. For all of my life, I was told I needed them by various podiatrists, but refrained because they'd never fit into the "cool" shoes I wanted to wear (though fortunately, these were always sneakers). However, after several years of back problems and needing to buy new shoes with increasing frequency to combat knee and hip pain, I finally broke down and bought a pair of lynco inserts.
Honestly, it's made all the difference - I've noticed a perceptible change in my entire posture in that with the inserts I can stand correctly.
At Friday, March 23, 2007 4:31:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
For anonymous, your own foot and ankle muscles can make the same adjustment as the orthotics. Then you will have the right positioning without them and can wear the shoes you want, go barefoot, and get built-in exercise for your feet and leg.
You also save money spending on something that you can do with your own muscles. It's all good.
At Friday, March 23, 2007 5:09:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
reply #2 for Anonymous -
It is not difficult to position your own feet and change your posture yourself so that you do not need the orthotics, and can then go barefoot.
It is not necessary or even healthy to be locked into shoes to do what your own muscles should be doing. You do not have to have back or hip pain. Try the step-by-step instructions in Arch Support Is Not From Shoes.
Another helpful thing - if the insert is providing a softer surface, that may be a factor to reduce pain. Check how you walk to see if you are banging down heavily with each step. Walking heavily can add to hip and back pain. Instead, walk softly using your own muscles to decelerate - another way to save money instead of buying orthotics.
At Tuesday, October 23, 2007 4:56:00 PM,
Anonymous said…
For the purpose of ankle health I have found that deliberately walking on uneven surfaces every day is quite a "tonic".
I have a long driveway that is partially unpaved (I prefer it that way), with outcrops of bedrock poking out above silt in places about 2 inches, with a sloped face at an angle of 45 degrees or so.
Years ago, having walked on them "accidentally" and noticing some ankle strain, I began including deliberately walking on them (in each direction up and down the drive, so as to "even out" the exercise in both lateral direction) in my daily treks. I made sure to step so as to turn my feet out and up a bit, as well as in and up, again by using different outcrops and changing direction of travel.
In "civilized" places one could simulate this by walking on the edges of a driveway with a slight dropoff, or on gently sloping curbs ... carefully, especially at first.
To my amazement, from then on when I would actually have an incident of "turning" my ankle, like when stepping on an unstable rock that "gives" when in unfamiliar terrain, I would either "get away with" no injury at all when I expect a mild strain or sprain, or I would have only the slightest of strain or sprain when I'd expect a real "whopper".
We most believe that injuries result to us as adults "because of age" (I'm 63). However, it is certainly partly because we stop doing the things we do as youths, like walking on odd surfaces and the like, restricting ourselves to the "civilized" surfaces of engineered-flat pavement.
We (some) get some good exercise by walking up and down hill or stairs, but rarely do we choose to walk along a sloping surface PARALLEL to the slope. Yes, it's "a strain". That is precisely why such situations are "engineered out of" our everyday experience ... and that is precisely why we should go out of our way to do so.
As much as anything, we have been "engineered out of" fitness by "civilization". There is little puzzle that our society both benefits from and suffers from the advent of inventions like the elevator and the escalator. The stairway was a mostly good invention, but could have been improved, for fitness' sake, if they made the steps uneven as in sloping at differen angles from side to side. Not a pretty sight ... but then neither is a black-and-blue ankle! One thing to try, by the way, might be to go up and down the stairs sideways for ankle and knee exercise, come to think of it (but I'd ask an expert about the wisdom of this, first ...).
With ankle injuries probably the most common ones in sports, I have often wondered if anyone includes exercise on uneven surfaces in training. If not, that would certainly improve performance for a team that did. For example, lifting weights standing on slightly uneven surfaces would do two things at once, providing lateral ankle strength as well as whatever else we were lifting for.
At Friday, October 26, 2007 2:18:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Anonymous, beautifully said.
The phenomenon of people who "work on a treadmill or elliptical trainer but sprain their ankle when out walking because they haven't trained balance and stabilization" is in the post What is "Fitness as a Lifestyle?" Two posts get readers started with stabilization positioning and training:
How To Treat Ankle Sprains and Prevent Them
and
No More Ankle Sprains Part II.
More that includes what you thoughtfully wrote was already in progress for Part III. You have contributed wonderfully. Send me your photos and or/mpeg computer movie files and I can post your inspiring story.
There is an entire chapter on training balance and stabilization by walking, lifting weights, jumping, training, and having fun on raised and uneven surfaces in the book Healthy Martial Arts.
At Saturday, March 01, 2008 3:43:00 AM,
Anonymous said…
I have suffered what I thought was a cruel handicap for as long as I can remember. I have a slightly crooked left hip, my left leg is 1/2" shorter than the other, and have severe pronation from having COMPLETELY flat feet. And both ankles are very weak, as my left knee and both of my ankles, and even my back pop incessantly (and painfully) while I'm walking. Simple things such as walking becomes a painful trial, and my personal dream of being able to run has been denied me. I'm only 21 years old, (and 240 lbs at 30% bodyfat, in case that's important) and feel like I'm 60! My family had told me that this was simply a hereditary thing, and I would have to deal with it. But I desperately want to be a boxer like the rest of my friends, and I cannot train with them so long as I have this "condition". You know running, jump-rope, etc. I can't even train right to lose the weight because of it. It's absolutely frustating, and sometimes gives me a God-complex. Even if there are ways to reverse the pronation, won't I still need a lift to compensate for the leg-length discrepency? And will that force me to get orthotics with it? This is the cycle I've been unable to escape, and I want out. Please respond as soon as someone reads this. Thanks in advance :)
At Tuesday, March 04, 2008 3:03:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Dear Anonymous, don't worry, what you describe is not hereditary, and besides that, who says you have to do everything your family does :-)
I have many heavy people who come to me since it hurts to move. I show them how to move better without letting their knees and ankles sway inward, and the pain goes away so that they can exercise for the first time. It will be fun. The leg length may just be how you stand. We do not know that yet and will soon figure it out here, but there is much that we know and can do right now. Let's reframe it for you - You do not have a condition. You just haven't had a chance to get in shape yet. Boxing sounds like fun. Let's get you in shape in fun natural ways, ok?
I am writing you a post with an mpeg video of fixing flattened arches. Until then, do these:
- Read all the comments to this post and see how other readers held their own feet and ankles straight and how quickly that works.
- Read the post Arch Support Is Not From Shoes and do the drills in that post.
- Read the post Healthy Knees.
- Read and try the enormously helpful and insightful info in the comment to this post by the 63 year old (signed Anonymous) on Oct 23, 2007. Follow the links to ankle exercises I put in reply.
Don't worry, have fun by feeling empowered to make your own changes, and keep us posted.
At Wednesday, May 28, 2008 3:36:00 AM,
Airchild said…
Jolie,
Great article here. I want to share my experience to confirm what you said about the arches. Mine "collapsed" when I was in my mid-20s, when I was diagnosed with "flat feet", which was the cause of my lower back pain. At that time I was prescribed orthotics - very expensive ones, and did not walk without them for about 10 years. You can imagine the bills on those orthotics and shoes that had enough room to fit them. Anyway, just over a year ago, I started taking adult ballet classes. Suddenly my arches came back! It must have been the training of the intrinsic foot muscles as well as the deep calf muscles that have rebuilt my arches. Can you tell me the exact biomechanics involved? I am so thrilled about this. And suddenly I realized that I wasn't comfortable walking with my orthotics anymore. That was when I realized I didn't need them anymore.
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