Joint pain affects a huge chunk of the world’s population, but the solution could be simpler than you think. Two foot experts tell Harry Bullmore the easy ways to nip some injuries in the bud
Sixty per cent of us will suffer from lower back pain at some point in our lives, data suggests. Foot pain will also hit one in three, while millions more suffer with knee and hip discomfort. These things can feel like a potentially lifelong affliction but the good news is that your footwear could be the root of the problem, according to Dr Courtney Conley and Dr Milica McDowell, authors of the bestselling book Walk: Your Life Depends On It.
“Your shoe should be shaped like a foot,” Dr Conley tells me. It sounds obvious, but when I look down, I realise the front of my shoe is tapered and my toes are somewhat squashed.
By preventing the toes from splaying for balance, many shoes stop the muscles of the foot from activating as they should, contributing to conditions such as achilles tendonitis and plantar fasciitis, Dr McDowell says.
“Your balance is better when your toes are spread,” she continues. “Your fall risk is reduced, and your ability to create propulsion and push yourself forward is improved.”
Over time, inactive foot muscles become weak and dysfunctional. This impacts the body from the ground up, often contributing to pain elsewhere.
This doesn’t mean you should walk less; quite the opposite. Both authors believe walking – with efficient technique – is one of the best things you can do to build a robust lower body and combat pain. In the meantime, they urge people to attack the true root of the problem, starting with your shoes.
The problem with modern shoes
“Shoes were originally used for protection from the elements and variable terrain,” Dr Conley says. But in the medieval period, fashion interrupted function and narrow-toe styles like the poulaine became popular in certain circles.
“One study looked at the skeletal remains of humans, and that’s the time when they started noticing bunions,” Dr Conley says. “We’ve been warned and warned ever since, but we still haven’t learned.”
Modern shoes not only constrict our feet, but they also do a lot of our hard work for us. This might sound like a positive thing, but it can have detrimental effects over time.
“If I were to go to a shoe shop and say that something hurts in my foot, they would probably suggest a shoe with a lot of cushioning and a rocker [a curved sole helping you roll through each stride],” says Dr Conley.
“It would feel great at first but it makes things too easy and you pay the price. Your foot continues to get weaker, and the reason you went in there in the first place – your foot pain – is not being addressed. It’s just being masked.”
The same applies to knee, hip and low back pain, Dr Conley adds. Cushioned shoes change the way and rate at which the foot hits the ground, which can exacerbate dysfunctional movement patterns. Plush soles also make it harder to feel the ground under your feet. This can compromise feedback for your body and impact your balance, leaving you more likely to land heavily and walk inefficiently.
“Shoe companies are selling you features, and those features keep getting bigger and fluffier and stronger,” says Dr McDowell. “But if you’re not spending time barefoot or in shoes that aren’t over-engineered, your feet aren’t doing any work. The muscles in your feet are going to get smaller and they’re going to become deconditioned.”
There is an easy way to find out if your feet are weak. “There are certain things people should be able to do,” says Dr Conley. “Toe dexterity is one of them. It’s as simple as being able to lift your big toe separately to your other four toes.
“If you can’t do that, you have poor awareness of your foot, which means you can’t balance as well and have less stability.”
The footwear solution
Wearing shoes that are shaped like feet: widest at the toes, narrower at the heel is a non-negotiable with Dr Conley when advising patients.
In certain situations, she also recommends a minimal heel-to-toe drop – the difference in height between the heel and the toe – and only enough cushioning for the job at hand.
“There’s a shoe spectrum,” says Dr Conley. “There is traditional footwear, functional footwear with a wide toe box (brands such as Inov8 and Altra), then minimal footwear with a wide toe box, no heel-to-toe drop and a thin, flexible sole – Vivobarefoot is the best-known example.
“If you have weak feet and you want to walk long distances, you can help yourself out by wearing a shoe that’s going to help you. But there should also be a conversation around getting you into ‘less shoe’ sometimes. This way, your foot and ankle can work a little harder, you have the opportunity to put more load through your muscles, bones and tendons, and you can start to fix what is happening rather than masking it.”
You should not flip from your regular shoes to minimalist footwear immediately, however. The latter takes time to adjust to and should be introduced slowly into your weekly routine.
“You have to earn the right to wear minimal footwear all day,” says Dr Conley. “This is a hard shoe to wear for people if their feet are weak and they have mobility problems, because it allows the foot to do what it’s designed to do. Most of us don’t have the capacity to do this yet, so we have to build up to it slowly.”
A good way to start is to head to a grassy area and walk barefoot for five minutes. After doing this a few times and finding it feels comfortable, you might progress to 10 or 15 minutes. This, Dr Conley says, sounds counterintuitive for people with knee, hip or back pain – but it can help rebuild foot strength and mobility, easing your discomfort.
After a while, you can look into buying minimal footwear and begin wearing it for incrementally longer periods. But this progression should still be cautious and gradual to allow your body time to adapt.
How to combat back, knee, hip and foot pain
“I was a ballet dancer and I was a triathlete, and I had a lot of foot pain,” says Dr Conley. “I developed a personal quest to figure it out because I know that, when your feet hurt, the last thing you want to do is go for a walk.
“But in the book we look at low back pain, hip pain and all of these conditions. When you look into the research on what helps, it’s walking.
“Back pain is a global epidemic, and it is often treated with rest and medications,” Dr McDowell continues. Foot pain, on the other hand, is usually treated with an orthotic. If that fails, surgery can be the next port of call.
“But research from the last 20 years has counteracted that. It says we need to keep people moving,” Dr McDowell says. “None of this is a quick fix, and you can take pain medication to feel better temporarily, but this isn’t solving the usual overarching problems: a lack of mobility, a lack of strength, bad habits and too little activity.”
Total rest is rarely the answer, Dr McDowell argues. The more you move, the more you can restore range of motion in the working joints and rebuild strength in your body. Improving these factors will contribute to reduced pain over time, so long as you keep moving in a way that is accessible to you.
This is why Dr Conley describes walking as an “easily accessible, underutilised treatment that many of us are not taking advantage of”. Your body is becoming stronger by moving a load (you), but walking is still a low-impact activity that involves a medium range of motion in the working joints, making it safe for most people.
Source: The Independent
