Changing your Shoes Decreases Knee Pain

If you're suffering from knee pain or osteoarthritis then you need to rethink your wardrobe and how it is affecting your foot health. If you haven't been paying attention to how your choice in shoe can affect how much torsion and pressure is put on your knees, then you are doing your body a severe injustice.

When you wear shoes with a "positive" heel you are doing the equivalent of wearing a heel. (Yes, that is correct. Even if you are a man you could be wearing a heel!) Positive heeled shoes have a large wedge underneath the heel and cause our weight to be shifted forward over the pads of the foot and the toes which aren't meant to be the load bearing structures in the feet. This can lead to foot pain, plantar fasciitis, bunions, and some pretty gnarly looking feet! (Yes, I said gnarly and no I don't want to show you pictures of some of the feet I've seen walking into my office.) In addition, the weight shifting on the front of the foot can cause excessive loading over the arch in the foot and lead to fallen arches due to weaken muscles that have spent their lifetime encased in restrictive footwear with no where to stretch and no use for them to move. But the real reason you stopped in today was to learn about how shoes can affect your knees, so I'll get back on track.

When you wear these positive heeled shoes they can also increase the amount of pressure put on the joints in your knees and lead to premature degeneration, pain, muscle imbalances, and even osteoarthritis. All of which are not fun by the way. So you need to lay off the positive heeled shoes and switch to either negative heeled shoes or flats. I personally love and highly recommend Earth Shoes because they have incorporated this negative heel technology of 3.7 degrees of a heel in the front of the shoe to keep your weight back on your heel. I have four different pair in different colors and styles to compliment my wardrobe and go with almost any outfit. I also find them very comfortable because not only do they put my weight over the load bearing ankle (where it should be) but they also have a large toe box (the width of the shoe where your toes go) to minimize pressure and rubbing that can also disfigure your feet. I've also had much experience with the fact that wearing these shoes all day long does NOT cause foot pain or knee pain while the gazillion other shoes I have in my closet do. There's also a few other more sporty brands that I'd recommend including Vibrams, Zemgear, Sockwa, and I've even seen that Nike and New Balance have come out with some as well.

Recent research from the University of Sao Paulo has found that wearing minimalist shoes which are shoes that lack supportive structure, arches, and thick heel padding can also decrease the loads on the knee in patients with osteoarthritis. In addition, their newest research has shown that these minimalist shoes also decreased the load on the knee even when climbing up and down stairs, which is usually the worst issue for osteoarthritis patients. Want more info on the study? 

So what can you do to decrease your knee pain?

1) Switch to a negative heeled shoe or a flat shoe.
2) Let your tootsies out of their shoe cages at least 2 hours or more a day. Make sure that you spend this time walking so you can move those joints and stretch out the muscles associated for happier feet.
3) Strengthen the supportive muscles of the knee joint to make sure that you lessen the load on the joint. If you're not sure what kind of exercises to do or not sure which muscles are weak, please make appointment with your biomechanically inclined doctor to get some advice and guidance. If you need a hint on this one think chiropractor, physical therapist, or orthopedist.
4) Get your feet adjusted by a chiropractor! I've had quite a few patients come into my office with knee pain and are amazed by the fact that an adjustment can correct the mechanics of the foot and leg and even decrease low back pain. If you need a chiropractor, I just happen to know a local one that fills the qualifications for #3 and #4 on this list. 

5 Things You Need to Know Before You Go Barefoot

People are joining the barefoot movement everyday in an effort to end chronic pain and injuries sustained while active doing everything from running to hiking up a mountain. So why is this movement so popular? Is it because a Harvard Professor says "Barefoot is Best"? For some, yes. However I think this trend is beginning to truly grow due to the fact that people that have gone barefoot are beginning to learn the biomechanics behind how their bodies were designed to move and embracing it. Many barefoot researchers only look to the foot mechanics in an effort to tote that one type of foot strike is better than the other, however they are again ignoring the mechanics of how our bodies were designed to move together from the head to the feet. As a result their study findings have NOT been incredibly earth shattering because they are ignoring the rest of the leg and pelvis!

So let's take a quick tour of your pelvis and lower leg to see those biomechanics in action. While your leg bone is in fact connected to your hip bone, the biggest key to this articulation working how it was designed has to do with making sure that your hip and your pelvic floor muscles aren't too tight. When your hip flexors are too tight they tend to rotate the femur outward in that joint and can cause strain on the hip as well as causing rotation and buckling at the knee and ankle that can make you prone to injury in the hip, knee, and ankles. On the flip side of that coin when the pelvic floor muscles are too tight they tend to tilt the pelvis forward which will put excessive stress on the low back to cause injury, pain, and even degenerative conditions that can lead to vertebral fractures. Scary right? Guess what, your solution to this is in #3 so keep reading!

In order to have a neutral position while walking or running, the knee joint should be facing forward with no rotation of the femur. How do you check this? Well by having someone help you find your knee pits! (Yes, its true you have a second set of pits that you haven't been paying attention to.) I'll refer to my best friend Katy Bowman for a quick video on how to find your knee pit and fix the rotation. Check out the video in #4.

I'm going to talk about foot strike pattern now to introduce the concept of how your foot should be striking depending on what activity you are doing. For example, I've heard many runners say that you should land on your heel while running and other say that's all wrong and you should land on your forefoot. So who is correct? Well is depends on what activity you are doing and there are also variables from person to person when it comes to running as well. So before we run, let's walk a bit while I show you the normal foot strike pattern for walking. Check out the picture below for the three phases of gait. Contact is the heel strike, midstance is the flattening of the foot, and propulsive is the toe push off to get you moving again. This is all find and dandy, but what's the issue for most people? Due to restrictive footware, heels, and slip on clogs or flip flops most people don't get the full motion in the joints of the foot and they usually stop at midstance before picking up their foot to begin the gait cycle again. This can lead to pain in the bottom of the foot and toes, degeneration in the joints, weak intrinsic muscles of the foot, and even knee pain. Check out tip #3 below for some tips on fixing your walking gait.

So what about running you say? There is an ongoing argument between biomechanists, running enthusiasts, and scientists that gait pattern shouldn't change with running. Some recent studies have looked at shock and forces of impact on joints with heel landing and forefoot landing during the contact phase. They found that more force is transferred into the foot, ankle, and even up to the knee with heel strike during running than with forefoot landing. Their argument stands that "proper" running technique should begin with minimalist shoes so runners land on their forefoot for more cushion and less shock transfer into the foot and knee. Read more on Harvard's Daniel Lieberman's foot strike study here. Another study conducted by Dr. Lieberman looked at running injuries and how they compared between heel strike and forefoot strike gait patterns during running. Over the course of a few years he looked at injury patterns of 52 NCAA cross country runners and found that those with a heel strike running pattern were injured at twice the rate of the those with the forefoot strike running pattern. This statistic may lean people to view heel strike as a downfall in runners, however the study completely avoided analysis of anything from the ankle up in the comparison in these athletes. 

I think that further study and comparisons are needed in injury rates and alignment between ankle, knee, and hips due to the fact that rotation at any of these levels can put unnecessary torsion not only on the joints of the pelvis and lower leg but also lead to chronic re-injury rates in this same population. I think the debate will go on, but I think those that have jumped into the barefoot phenomenon need to look at bone structure and basic biomechanics of the body before touting that one strike pattern is better for the next. Check out #5 for more info.

If you are still confused what I am talking about, don't worry I'll still give you some info on what to know before jumping on the barefoot bandwagon. Check out the rest below.

**Do not begin an exercise program before consulting your doctor. If any of the exercises or tips in the numbers below cause pain, discontinue them immediately and consult with your doctor.**


1) You need to condition your body for barefoot. Yes that is correct. You can't just wake up one morning after wearing hard soled shoes for 20 years that allow for no foot flexibility or movement and just strap on a pair of minimalist shoes with no support and total flexibility. You will need to do some stretches to prepare the feet and joints for flexibility and some strengthening for your muscles of the foot and ankle to be able to support your weight while walking. Need some tips? Check out vibram's website for the foot training program. Check out some of the other stretches and tips below for more ways to prepare your body for barefoot.

2) Don't be surprised if your legs, knees, ankles, or feet are a bit sore after a long walk. These muscles aren't used to being relied on while walking and you just gave them the workout of a lifetime. I recommend beginning your barefoot walking regime on softer surfaces like grass or dirt rather than cement. Many runners have been getting shin splits and stress fractures due to minimalist shoes due to the fact that the shock is transferring up their shins from the cement and the muscles are causing excessive strain and pressure on their insertion points on the bones. This is due to the fact that they aren't starting slow and conditioning their body for barefoot.

3) Stretching the muscles of the hip and pelvis are essential. There are three main stretches that can be done daily to help stretch these muscles out in order to support a more biomechanically "correct" posture. These stretches are designed to target the problem areas for most, however if you're experiencing pain or tightness in other areas please consult with your doctor. The first is the butterfly that will open up your pelvis and give a little stretch to the inside leg and pelvic floor. The second is the pelvic tilt which will help train your body to knowing where correct pelvic posture is and also strengthen the abdominal core. Obviously you'll have a bit more tissue that Mr. Skeleton in the pelvic tilt picture, but you'll need to tense your abs to tilt that pelvis backward and you may notice the arch in your low back will disappear when you tilt the pelvis. The third is the forward lunge which will stretch the front of the hip and thigh. Notice that his body is upright and his knee doesn't extend forward over his foot.

4) Find your knee pits and get them aligned! Correctly aligned knee pits will allow for your knees to bend correctly and lead to less knee injury and degenerative joint disease Watch the short video below to learn how to be a pro.

5) Adjust your foot strike pattern while walking. Based on the paragraph above I introduced the concept of three steps in the gait cycle. Most Americans and even Europeans don't use the joints under the ball of their foot and as a result get a lot of pain. So what I recommend is to practicing walking barefoot through the three steps of gait a minimum of 2 hours everyday and 4 hours if you walk in heels. This means that you are going to have to bend your foot while walking to push off with your toes.