Minimal Shoes, Support and Orthoses

Minimal Footwear, Orthoses and Supportive Footwear 

 

There can be some controversy on custom foot orthoses and some statements that they weaken the feet. There is a belief that minimalism is one approach and the other is to believe in supportive and durable footwear. My goal is to provide information on both to allow one to make the best decision for their individual health needs. 

 

The reality is that some activities which require repetitive movement, such as walking or running, on a regular basis, can lead to tissue overuse. People who wear minimal shoes have come into my office with injuries and those who run in minimal shoes still do end up with injuries.

There have also been people who wear supportive footwear and still end up coming into my office with injuries. The point here is that footwear is part of the puzzle and not the entire puzzle. Strength and rehabilitation of the entire kinetic chain, along with footwear will yield better results, than footwear or orthoses alone. 

To break things down from a treatment approach, when there is an injury, the ability to maintain some relative load on the tissue is part of rehab. Allowing this to take place by also dissipating the amount of complete load on the tissue can be mitigated by taping, orthoses, supportive footwear or bracing.

What support and orthoses can do is help one maintain a quality of life or continue their life to help lessen the load on the injury so it can get stronger from exercising and maintaining some load on the area. Orthotics do not zap the strength out of the foot, In fact,  there are studies that suggest strength is improved when orthotics are  combined with exercise. 

 

What the Research says :

The study “Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: a randomized controlled trial”, found orthoses combined with short foot exercises increased the strength in the toe flexor and abductor hallucis. This proves that orthoses do not diminish foot strength.

In another study orthoses used in isolation without strengthening does not strengthen the feet. Which I do agree with. Orthotics alone are not meant to strengthen the foot. They are meant to help unload forces on an injury in conjunction with strengthening. 

Some injuries are quite severe, but for most conditions suitable for orthoses, pain reduction is possible. For those who work on their feet all day, or an avid active person who can resume exercise with a reduction in pain, an orthotic can be a great option for them. 

An example of a study which demonstrates how runners benefited from an orthotic was a study “ Effects of foot orthoses on Achilles tendon load in recreational runners”. 

The results indicate that running with foot orthotics was associated with significant reductions in Achilles tendon load compared to without orthotics. The unloading allows the runner to continue their activities while they rehabilitate. This should be weaned off in time.

Also, if one stayed in that device long term there would be changes that could in fact weaken the area and shorten it. So another part of the puzzle is to properly use the devices and have the proper prescription for the injury and foot type.

If someone was injured I would not advise them to continue standing, walking or running for prolonged periods of time in a minimal shoe. That being said, when strengthening the foot I would advise being barefooted or in minimal shoes. There is a time and placenfor minimal footwear. The longer the high load activity there is, muscle and physical failure happens and that is where injuries are most likely to arise. 

I think minimal footwear is great for deliberate strengthening, or the odd time running on the grass or sand. However, pounding the pavement, rehabbing an injury or setting personal bests may not be best sought out in minimal footwear. 

 

How you can try utilizing support prior to getting orthotics:

 

An easy way to see if you would benefit from support when combating an injury is to try some taping and padding. We can provide this for you. Over the counter insoles can also be used to see if there is any small improvement. There is generic support in these and they are not custom with posting or specific prescriptions needed for certain injuries, but can provide some help. 


To summarize, I am not against minimal footwear. Track spikes are very minimal. I do think some minimal footwear for deliberate proprioception/ foot strength is okay to wear. However, for prolonged walking, standing and running, especially when injured, can benefit from more supportive and protective footwear tools.  

Foot and Ankle Tendinopathy Treatment Toronto

Tendinopathy and Treatment

 Not all tendon pain is the same and depending on what stage someone is at, their progress in rehab can be catered to their individual needs. For instance, someone who has very recent tendon  pain, is treated differently than someone who’s had tendon pain for over three months. It is very important to have a thorough examination done in order to determine the root cause of the issue as well as a proper diagnosis.

Type of Tendon Injuries

Tendons can have different types of injuries and pathologies. For instance, there can be a reactive tendon, which is usually within the acute phase and that normally is within the first few weeks of onset. 

A reactive tendon is called reactive due to the cellular response going on within the tendon.

Reactive tendons can also be one in which there is  a direct blow to the tendon.  An example would be if someone hit the Achilles tendon on a bike pedal. Reactive tendons are injuries brought on by a sudden increase in load beyond what the tendon can tolerate. 

 

Degenerative tendons are those where that reactive phase has gone on for a longer duration of time. This is usually the type of pathology that goes on when a tendon injury is longer than 3 months time. The cellular response that occurs in the reactive continues which causes disruption to the tendon matrix, making it degenerative in nature. On a cellular level there are actual physical changes to the cells in the tendon. They become flattened and this makes pockets of degeneration within the tendon. The good news is that there are still healthy tendon cells around those areas of degeneration, which can be loaded and help maintain the health of the tendon. 

 

The other type of tendon injury is not in the actual tendon, but located in the structure around the tendon. This is the tendon sheath called the paratenon.. This is differentiated by pain that’s brought on by movements that would cause a lot of friction but not loading. An example of this would be cycling for a prolonged period of time. That is because the flicking movement of the ankle can cause friction gliding at the paratenon to the tendon causing pain and swelling. It is very important to know the difference because if treated the same way as a tendon, that can actually increase the severity of one’s symptoms. Paratenon is treated quite differently from tendinopathy. 

 

Paratenon Irritation and pain is not brought on by load, it is brought on by friction. If someone went out for a run with a tendon injury,  normally that pain warms up and starts to feel better during and then tends to feel worse after. With a paratendon injury pain can happen with Running from the friction movement of the ankle. It would get worse as a run progresses.

 

Treating a tendon sheath injury is complete rest and offloading. That would also include a chunky heel or wedge heel lifts in order to mitigate how much friction happens. With a tendon injuries and we don’t really want to completely unloaded we want to 

progressively load it in a manner that the tenant can tolerate.The only time complete rest is needed is when there is a complete tendon rupture. 

 

Typically things to note about a tendonapathy is that it can handle heavy and slow loads.  It cannot handle what will provoke pain and make it worse which is fast movement and explosive movements, which requires energy storage and release. Those type of movements would be if someone really goes through calf raises completely fast.. With that being said, energy storage and release movements will have to be rehabilitated later on in the phase of treatment in order for someone to return back to the activities that require those type of movements.

 

Isometrics are great to start with for pain relief and improving the strength in the muscle and tendon. Isometrics of movements where there is no change in range of motion. It is a sustained contraction.The duration of time that is recommended is 45 seconds to 1 minute followed by five repetitions with anywhere from 1 to 2 minute rest between.

Isometrics can be tolerated daily. Then within time one gradually goes through full range of movement. Those type of movements we call concentric and eccentric movement.

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Things that can help  tendon pain include anti-inflammatories, exercise, load modifications,  orthotics let’s and supportive footwear. Things like extracorporal shockwave is also great to help as a modality however it does not take the place of a progressive treatment program.

Load management can be modified so that a person can still maybe do the exercise hey like doing,  but finding a happy medium of what the tendon can tolerate. So that may be a run walk program or walking shorter walks splitting up walks of two shorter durations in a day or taking rests during the walks. 

 

I hope you have found this helpful. A kind reminder that you do not have to struggle and I would be more than happy to help you conquer your tendon injury.