ORIGINALLY Published Thursday, 14 June 2012 

I find myself often asked to help assess my patients' footwear and what I might recommend for their next purchase.  So, in an effort to simplify a process that has way too many things to think about, I am sharing my secret.  When buying shoes today, especially training or running footwear - the single most important feature that I look for, is how the sole of the foot integrates the ground force during movement.  

Traditional thinking recommends postural correction of the arch (whether too high or fallen), in addition to correction of any rotation (pronated or supinated foot alignment).  This is commonly accomplished by inserts, altered uppers in the shoe, or orthotics.  In my opinion, these corrections are used under the wrong premise.  

Thinking the foot needs to plant in a neutral, stable position makes sense in theory, and is how most people make their selection.  The problem with this approach, is that it does not take into account how the patient's joint receptors interpret the force entering the body.  Healthy proprioceptive input from the ankle-mortise joint through receptor activation in the tibio-fibular ligament is vital.  This is how our motor cortex knows what type of surface we are walking on, and what muscles need to be activated or de-activated in accordance to our environment.  In addition to moving with power, speed and efficiency, this circuit is a major source of brain power (neural fuel).  

Therefore, the better the fuel delivery or the more pure the neural activation from this receptor pool, the better the muscles will fire to absorb force through the foot.  And the greater the ability to absorb force the instant it enters the body, the lower the chance of injury.

Now to the secret:  We can test this integration by muscle testing the patient in a standing posture while wearing the footwear they are interested in purchasing.  If the muscle tests with a weakness or delay - it can be ascertained that the footwear provides for very poor integration. If the muscle tests with strength and speed of contraction - I am in full support of the purchase.  I usually suggest if a patient is in the market for a new pair of sneakers to purchase 3 or 4 pairs and keep all the receipts.  And next time they come in, we spend 5 minutes determining what pair provides the best integration. This has become an easy and effective way to recommend footwear for my patients.  I love the objectivity.

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