WARM WEATHER HAS ARRIVED, and inevitably you’ll be seeing more patients wearing sandals and flip-flops into your office. This time of year presents both challenges and opportunities for doctors of chiropractic: Patients’ shoes can either contribute to their health and whole-body wellness or to their misery and musculoskeletal complaints.
Why? With the average American taking 5,117 steps a day, improper footwear can lead to degenerative changes in the muscles, joints and connective tissues in the feet over time. With the body’s foundation compromised, gait, joint movement, circulation and proprioceptive input may suffer as a result. The problem is alarmingly widespread. Seventy-eight percent of American adults over the age of 21 reported in 2012 that they had experienced foot pain or issues.1
Shoes have been implicated as the principal cause of forefoot disorders in women.2
Assess patients’ feet and shoes as part of your normal intake process, and don’t miss the opportunity to talk to patients about proper footwear. Ideally, it should provide support, protection and cushioning for the pedal foundation. If a patient’s shoes are poor in one or more of these categories, not only is the spine exposed to abnormal stresses, but continued usage could also undo your hard work on the adjusting table.
Here’s how to help your patients select healthy, summer footwear.
Look for the Shank
One component of the optimal footwear or sandal is called a shank. A shank is a semi-rigid and semi-flexible material that allows for support and a normal or optimal range of motion when the foot is functional. The typical summer sandal is very thin, not allowing a shank. This will usually result in an unstable pedal foundation.
Insist on Three-Arch Support
Another important component of optimal footwear is the support of the arches — not just the one, but all three: medial, lateral longitudinal arches and anterior transverse arches. Optimal accuracy can be measured from a weight-bearing cast or a functional scan. The height of the arches should be at the relative lowest end of the normal range of motion for that arch. This will allow for normal/optimal motion but block excessive motion, usually pronation.
If the pedal foundation includes a proper shank and all the arches are supported to allow normal motion, it will have a positive effect on the kinetic chain and add to the stability of the entire human frame.
Banish Traditional Flip-flops
Of all the harmful summer footwear out there, traditional flip-flops are perhaps the most damaging. Traditional flip-flops are notoriously flat, offering little support or cushioning to the foot. Not surprisingly, reported rates of heel pain, frequently due to plantar fasciitis, statistically rise in the spring as flip-flop wearers shed their winter footwear in favor of the popular sandal. The problem worsens when the wearer is overweight or sedentary.3
Researchers at Auburn University found that wearing traditional flip-flops can alter gait, “which can result in problems and pain from the foot up into the hips and lower back,” according to biomechanics doctoral student Justin Schroyer, the study’s lead author. “Variations like this at the foot can result in changes up the kinetic chain, which in this case can extend upward in the wearer’s body,” Schroyer adds.4
The Foundation Matters
Encourage your patients to choose their summer footwear carefully — it’s critical to good health. High-quality, supportive footwear, ideally with support for all three of the foot’s arches, gives the body a healthy and solid foundation that is less likely to experience biomechanical problems and is more receptive to chiropractic care. Wearing custom orthotics in every pair of shoes goes a long way toward giving patients the support they need. Consider recommending orthotic footwear and sandals. This helps relieve your patients of the guesswork involved in selecting a healthy shoe, and it offers two-for-one benefits with built-in custom orthotics.
Companies like Foot Levelers offer custom orthotic footwear, including orthotic sandals. Foot Levelers also recently introduced its Seabreeze custom orthotic flip-flop, which offers all the fashion and comfort of regular flip-flops but in a healthier model.
Shoes that don’t properly support the feet can significantly interfere with chiropractic care. I strongly recommend an examination of the patient’s feet and usual shoes. Emerging research shows that custom-made orthotics in conjunction with chiropractic care may be more effective in treating low back pain than chiropractic care alone.4-7
1. “National Foot Health Assessment 2012”; www.ipfh.org/resources/surveys/national-foot-health-assessment-2012
2. Frey, C. Foot health and shoewear for women. Clin Orthop
200; 372: 32-34.
3. Shroyer JF, Weimar WH. Comparative analysis of human gait while wearing thong-style flip-flops versus sneakers. J Am Podiatr Med Assoc
4. Zhang J. Chiropractic adjustments and orthotics reduced symptoms for standing workers. J Chiropr Med
2005; 4(4): 177–181.
5. Fauno P, Kalund S, Andreasen I, Jorgensen U. Soreness in lower extremities and back is reduced by use of shock absorbing heel inserts. Int J Sports Med
1993; 14: 288-290.
6. Schwellnus MP, Jodaan G, Noakes TD. Prevention of common overuse injuries by the use of shock absorbing insoles. Am J Sports Med
1990; 18: 636-641.