I’d like to share some insight with you on how I’ve come to recommend certain shoes for many of my patients.
When the sudden rupture of my left Achilles tendon occurred, the medical literature could only suggest that it was because I was over the age of 40 (I wasn’t), or that I was overweight and out of shape (maybe).
But I knew that didn’t tell the whole story.
When it happened, I had just come back from a 10 day driving trip to Quebec. It was November and so, November weather being what it is, there weren’t a lot of outdoor activities on that trip. There was a lot of driving, though.
On top of this, for most of the trip I’d been wearing a pair of stiff hiking boots.
In retrospect, it now seems quite plain that I had essentially put my foot in a cast for 10 days.
A few days after our return, I decided to play basketball. It was just the third or fourth run down the court when suddenly the left Achilles tendon popped and completely ruptured.
I tell this story to emphasize a key point: modern medicine does not have good answers for why a lot of the things that happen to us, happen to us. It’s pretty good at figuring out what’s wrong once something is plainly wrong, but why things happen is often far less clear, and is often thought to be irrelevant at that point.
I see a lot of people with various types of what I call “nontraumatic foot pain,“ and I learned in my training how to diagnose conditions like plantar fasciitis, metatarsalgia, heel spurs, and Morton’s neuroma. Ultimately, all of these diagnoses were fairly unsatisfactory in that there aren’t a lot of effective treatment options out there.
If we often don’t know why it happens, or how to treat it when it does happen, what can we do about foot pain?
First, you have to be walking, every day, as much as you can. It’s probably only too much if you’re walking more than a couple of hours a day! Most of us don’t get close to that. Keeping the feet strong with healthy activity, in my experience, reduces foot pain 90% of the time.
Second, one wants to give the foot lots of different types of steps, with sometimes a little bit more pressure on one aspect compared to the other: so, it seems logical to me that walking barefoot on grass or on sand would provide this variability and strengthen all the little muscles of the feet. Given that walking on grass or sand barefoot is not really possible for most of us on a daily basis, and given that many of us are exposed all the time to concrete and other hard surfaces like tile and even hardwood floors, it stands to reason that our feet could only get so strong before ultimately yielding to the strength of these hard surfaces.
So the best thing would be neutral, so that means flat, protection against those hard surfaces that allows a normal walking stride (normal means that you land with your heel and push off with the balls of your feet and toes).
So there we have it: the best shoe would be cushioned, flat, and flexible. I would propose the skateboarding shoe as the ideal shoe, though a lot of people have trouble with the toe-box area, so this can require some creativity and perhaps money, and the willingness to shop a bit more. But these shoes are out there, and I will start to post some suggested brands on our website, so that you can take a look for yourself at what kinds of options are out there.
I now wear flat and neutral shoes, meaning no heels at all and not much structure (such as arch support or heel cupping). I recognize that we need to work the muscles of the feet, not to mention the calf muscle that inserts into the Achilles tendon, in order to keep things limber and flexible. I know now how important footwear can be for preventing Achilles tendon rupture.
I never needed surgery on my tendon, or at least I didn’t agree to surgery, and instead I tried what was called an early rehabilitative protocol. Slowly, I could feel the Achilles tendon reattaching, and in a way that made me confident week after week that it would never happen again if I stuck to the right footwear.
90% of the people that I see for nontraumatic foot pain find that their pain improves, no matter what the underlying diagnosis, 90% of the time within the first few weeks.
Your feet may not be used to walking like this, as many of us are used to rigid shoes and boots, or worse, flip-flops that really don’t help you land with a heel-strike properly because they fall off. But, if you allow time for your feet to adjust to this simple intervention, you could be in the 90% who will find your pain improving.
