How strong and healthy feet can influence the whole body.
ON SOLID GROUND
WRITTEN BY SPORTS PHYSIOTHERAPIST
Author: Hege Erichsen
Designer: Clinical Innovation
Cover Design: Helene Morris Michaelsen
ISBN: 978-82-300-2716-5
© Hege Erichsen, 2023
Hi.
I want to say thank you for choosing to read this book. At the same time, I hope it will give you answers to what you're looking for.
I would like to thank Claus for investing in me, a young mother of two, almost 25 years ago and making me responsible for SuperSole Norway - this is where it all started!
I'd also like to thank my wonderful boys Petter and Jørgen - you've put up with having another foot nerd mum telling "silly" stories around the dinner table
You have read, supported and posed for pictures - without you this book would not have been createdlove you.
I would also like to thank my wonderful colleagues, Silje, Erik and Marius - you have read, corrected, discussed and provided input. Thank you so much, you're the best in the world.
Last but not least, I'd like to thank Tor Arne for all his help with photos, editing and finalizing the bookwithout you I would have given up on the project.
INDEX
INTRODUCTION
FEET - A weird PART OF THE BODY
Ourfeetcanwithstandenormous loads andstresses,buttheycanquickly losebothstrength and resilience and then things can start to go very wrong.
How are your feet? Do yourfeet hurt? Are you utilizing the potential of your feet?
We forget about our feet in most contexts, we train everything else to get stronger and perform better, but what about our feet - our "foundation"?
Are there "misalignments" in the feet? Is there one position that is more favorable than others? What about pain and discomfort - what causes them? Can the feet cause pain further up the body? Is there anything we can do ourselves to avoid these pains? You'll find answers to these questions and more in this book.
The foot is an incredibly advanced and intricate part of the body. It consists of many small and large bones, many different joints, muscles and tendons that must work together for your foot to function well.
There's a lot in the foot that needs to co-operate well and function optimally in order for the body to function well in general. If there is too little or too much movement in the ankle joint, or if you have muscles that are too weak or too strong, this can spread further upwards to the knees, hips, back and neck.
If there is a muscle in the foot that is not working properly, this has ripple effects and other muscles have to "take over" the job and end up working more than necessary. This can ultimately lead to overloads and a poorly functioning foot. Some of the muscles in the feet go far up the leg and if one or more of these are weak or malfunctioning, this can cause problems in the knees, hips and back, and even right up to the neck.
HOW TO USE THE BOOK
The book is written for those who either work with patients who have pain in their feet, who have poorly functioning feet or who have foot-related ailments further up the body, or who suffer from such conditions themselves.
The book is based on my own experience of working with feet and foot-related ailments problems for over 25 years.
Many people experience pain in their feet during their lifetime. I believe that you can avoid many of these problems by paying a little attention to your feet and doing some simple exercises to strengthen the muscles in your feet, ankles and calves.
I've been working with SuperSole insoles since 2001, I've also tested other types of insoles, but I keep coming back to SuperSole. The insoles are easily moldable, and they are dynamic - I find that many people actually get stronger in their feet by using SuperSole insoles.
"When I've given various lectures on the subject of feet, soles and exercises, many people ask - "where can we read about this?", but there isn't a book that contains what I'm writing here, you have to look around in different literature.
I've gained a lot of experience in this area, and it's those experiences and stories that I'd like to share with you through this book.
My wish was therefore to collect the experiences of the problems/diagnoses I see most of in my everyday work in this book.
Throughout the book, I will tell you about the various problems, discomforts and injuries that can occur in the feet, ankles and calves. If you work with patients and perhaps insoles, this book will give you tips and ideas on how to treat your patients with foot-related prolems. You will get tips on how your patients should take care of their feet to prevent and avoid certain ailments. You'll also get exercises you can give your patients for specific problems/injuries.
The book also contains many things patients can do themselves, both as preventive measures and "self-treatment".
Chapter 1
SECTION 1
1.1 FEET - THE FOUNDATION OF THE BODY
When I started physiotherapy school in 1993, I was immediately fascinated by the feet, their complex structure, all the muscles that need to work as well as possible for the foot to be able to perform at its best and, not least, how little it takes for our feet to no longer be able to perform at their best.
Why is the position and strength of the foot so important for the foot itself and the rest of the body?
What tests should we perform to find out if the foot is weak or strong? When can we expect children to have developed normal gait patterns? How does the position of the foot affect the rest of the body? What can we do about the most common foot-related problems?
These are also questions I hope to answer in the book. 28 CHAPTER 1
1.2 COMMON PERCEPTIONS ABOUT OUR FEET THAT AREN'T TRUE!
Misaligned big toe - Hallux valgus is caused by wearing shoes that are too tight!
This is wrong. A misalignment of the big toe is a condition that is often inherited. What is inherited? I have had patients who have worn "molded shoes" all their lives but have still developed hallux valgus.
I've written a separate chapter on hallux valgus, where I give you the answer to why it has arisen and what you can do yourself to reduce further distortion. Sometimes these conditions end in surgery, but have you done EVERYTHING you could do yourself before the operation and what about afterwards? We often hear about the big toe becoming crooked again after such an operation. Read chapter 5 for good advice, tips and exercises you can do.
It is dangerous to overpronate. This is wrong - it is not dangerous to overpronate!
However, this is a condition that can cause pain and discomfort both in the feet and up the body. It's important to be aware of the causes of overpronation and which muscles you should train. I discuss the condition and the exercises in several places in the book.
Shoes are shoes - Many people believe that shoe manufacturers make "special" shoes just to increase the price - a sneaker is a shoe you can use for all sports. I think this is wrong. There is a big difference between which sport you do and which shoe you should choose.
Sneakers are produced with different levels of support, cushioning and drop (the difference in height between the forefoot and the heel). All of these factors can be crucial to the health of your feet.
In chapter 9 on running, I go through the different types of running shoes and what you should consider when buying new running shoes.
Chapter 2
SECTION 2
2.1 DEVELOPMENT OF THE FOOT FROM NEWBORN TO FULL GROWTH
What could be more beautiful and delicate than a newborn baby's foot?
The newborn's foot is shaped like a fan with a sturdy big toe pointing straight ahead or often slightly to the side. The child's foot is soft and malleable, some of the bones in the foot are ossified when the child is born, others ossify as late as the age of 20. This means that external influences, such as shoes that are too tight, can have a major impact on the growth of the bones.
This is the main reason why I don't recommend that children should inherit shoes. A shoe that has already been used in or stepped on a little crookedly can help "mold" the feet of our children incorrectly.
The 26 bones of the foot are still "soft" and impressionable. Young children move their ankles and toes as much as their hands and fingers, so it is important that the conditions are adapted to this movement. Tight shoes and socks, or wearing shoes too early, impair motor skills, inhibit the development of muscles and the stability of the feet.
By all means DO NOT use anti-slip socks in shoes - what do you think happens to the tip of the sock when we put our foot in a shoe? The anti-slip layer sticks to the sole inside the shoe and causes the child to curl their toes.
And DON'T wear kicking trousers with feet - the child grows fast and suddenly it's too tight for the toes. Our children won't let us know this; they just curl their toes.
If a child who is still crawling wears shoes, the foot will be pushed outwards, and this can lead to increased stress on both knees and ankles - already at risk of potential foot deformities.
An infant's foot is so delicate and perfect because it hasn't yet been wrapped in a shoe.
Our feet are not fully developed until around the age of 15 for boys and around the age of 13 for girls. This applies to sizes, arches and foot position. Some bones are not fully ossified until the age of 20.
All humans have a fat pad under the heel and ball of the toe that acts as a shock-absorbing organ, this fat pad is located under the arch of young children and therefore most children look flat-footed. The different arches of the foot develop gradually until the age of 79, at which point the fat pad will also lie under the heel and ball of the toe where it belongs, acting as a shock-absorbing organ.
Newborns are usually bow-legged, but around 6 months of age most are less bowlegged. Around the age of 1.5 years, knees and feet should be fairly straight. Most children go through a calf-legged period around the age of 2.5 years and then regain fine alignment. There is a good correspondence between knees and feet around 4-6 years of age, but the most important thing to remember is that during periods of a child's development it is normal for them to be both bowlegged and calf legged. This is due to the growth development of the femur and tibia.
Alignment describes the "lines of the body".
Gait pattern - the rolling movement of the foot during walking - explains more about this in chapter 8.
Around the age of 18 months, all children should walk without support. By 2-3 years of age, foot movement starts to become an integral part of the gait function, and the body weight meets the ground with the heel first and the weight is transferred in a rolling motion to the big toe.
Normal foot movement is not fully developed until the child is around 7 years old, and the rolling movement is not properly established until the child is 10-12 years old.
2.2 SHOES FOR CHILDREN
The foot measures about 10 cm when a child is one year old, but only 5 years later the foot is almost twice as long. This corresponds to almost 14 shoe sizes. That's 14 shoe sizes! This is where we parents need to keep up.
The foot grows about 25 cm in the first 15-16 years. This means that the foot grows about 1-1.5 cm a year during childhood and then about 2-2.5 cm a year during puberty.
Children can easily walk more than 20,000 steps a day, so it's important that children's shoes have both a "slip length" and a growth zone. In my opinion, you should never buy shoes where you can't remove the sole from the shoes, because then we as parents have little opportunity to check whether the shoe still fits. When was the last time you checked the size of your children's shoes?
I think parents should measure the foot every 3 months for children aged 1-6 years and every 4 months for children aged 6-10 years. The internal dimensions of the shoe should be 12-15 mm longer than the foot's longest toe and 8 mm wider. Remember that in some children and adults, the second toe is the longest, not always the big toe. The second toe must also have a slip space and a growth zone.
When my children were small, I left them on cardboard sheets the night before I went shoe shopping, drew around their feet and added the extra measurements, cut out the drawings and carried them in my bag. If I found a pair of shoes that I thought had all the parameters (more on these in the next section) that I think a children's shoe should have, I'd take out the shoe's original sole and put the cardboard sheets into the shoe to check whether the shoe was both long and wide enough for my children's feet. You'll probably get some strange looks when you go to the shoe store with these cardboard discs, but I'd rather that than your kids walking around with shoes that are too narrow. Size "28" is not always 28...
What should children's shoes look like?
The shoe should have the shape of a healthy and natural foot. Always measure your child's foot in the evening, in the loaded position, when the foot is widest and longest. The toe cap should have enough room for all toes to point straight ahead, i.e. when you put the shoes next to each other, the inside of the shoes should be next to each other all the way round and there should be a certain height in the front. So that the shoe does not press the toes together or flatten them. Children should be able to wiggle their toes inside the shoe.
Here is an example of two different shoe tops. Notice the straight shape of the inside of the big toe on the blue shoes compared to the white. The white shoe tip curves more. Such a shape on a children's shoe can help shape the toes of our children. The big toe can easily become crooked in the white shoes.
The heel cupshould be firm, but at the same time rounded and contain a shock-absorbing layer. It should support and guide the foot during walking. The heel should be as low as possible, so that the body weight is distributed in the most appropriate way.
The sole of the shoe should be flexible under the balls of the toes so that the muscles of the foot can work properly. In the back of the shoe, there should be as small an opening as possible so that the foot is supported and prevented from slipping forwards. It's best if the shoes are made of leather or leatherette because these are breathable materials. If your child's shoes are worn unevenly, this is often a sign of incorrect loading.
The problem is that most children do not experience pain or discomfort from wearing shoes that are too tight or too small, so they do not realize that the shoe is too small. The children just curl their toes, or the toes grow crooked!
98% of our children are born with perfectly normal feet, while over 50% of the adult population has minor or major foot-related ailments - that's a wake-up call!
One of my favorite teachers at the School of Physiotherapy in Oslo, Knut Fyrrand, said that -
"Shoes are the showcase of the foot!"
And I completely agree with him.
There's an incredible amount of information we can get from looking at well-used shoes.
3 parameters that children's shoes should contain:
* hard heel cup
* the sole of the shoe should bend easily at the balls of the toes
* the sole of the shoe should be stable and support the foot
RECOMMENDATIONS FOR CHILDREN'S SHOES
When it comes to children's shoes, there are different recommendations for different uses. Shoes should sit well on the foot so that they don't fall off when the child is active, and I think it's best to use elasticated laces, possibly combined with Velcro. This makes it easy for the child to put shoes on and take them off, while also making it easier for those who may have to help the child.
Indoor shoes in kindergarten and school should be a light and stable type of leisure shoe or jogging shoe, not slippers.
The sole of children's shoes should provide cushioning and stability. There will always be a discussion between professionals when it comes to whether children's shoes should have stability or not. Some believe that children's shoes should be completely flat and soft in all directions so that the shoe does not affect the foot in any way.
In my experience, a lot of children need stability in their shoes, but this may of course be related to the fact that the children I see at the clinic usually have some form of problem. I bought stable and shock-absorbing shoes for my two boys throughout their childhood without them having any direct ailments.
Children who choose to walk with their toes pointing inwards and who often trip over their own legs do so because they have weak muscles on the inside of their feet. In this case, my experience is that it very often helps to give children both a stable and shockabsorbing shoe, and in some cases an insole may also be necessary.
Stable shoes will help the muscles on the inside of the foot to work more appropriately and the result is often that children stop walking with their toes pointing inwards.
I'm often referred children by other colleagues, GPs and health centers who want me to assess them for problems with their feet, knees and hips, or because the child walks and runs a bit "strangely".
In many cases, this is because the strength of the muscles in the feet and around the ankles has not quite managed to keep up with the growth of the bones, which can cause pain in the tissue that is stressed or muscles/tendons that have an unfavorable work path. From time to time, children and young people go through growth spurts where they practically shoot up and can grow many centimeters in a relatively short time. It's not always easy for the muscles to keep up with these growth spurts, which leads to an imbalance between stability and strength around various joints.
If children and young people are active in sports at the same time, this can result in strain and discomfort. It can also result in children and young people walking and running a little strangely. The normal foot development and resilience in the push-off are not automated and optimized until the young person has passed the age of 12-14.