Point of support of our entire body with the ground, each of our feet has 26 bones, 33 joints and more than 100 tendons, muscles and ligaments . Our feet make us unique and there are no two people with the same feet, even more so, if we look at our right and left feet, it is more than possible that we can appreciate subtle or even great differences between them. In addition, this part of our anatomy is one of the first to warn us that we have an irrigation or venous return problem.
“The feet are the only point of support against the ground and the way in which it supports it will have a direct relationship with possible injuries in other parts of the body such as the knee, hip or spine . At the muscular level it is also very important, since an important part of the leg muscles has one of its attachments in the foot (anterior tibialis, posterior tibialis, peroneal, etc.) so that the way of stepping or the geometry itself the foot also has a lot to do with certain muscular overloads ”, explains Víctor Alfaro, general manager of Podoactiva and podiatrist of the Real Madrid CF first team.
Our feet are configured so that we can walk, run and jump without the need to wear any footwear. However, as Dr. Ángel de la Rubia, from the Ángel de la Rubia Clinic and member of Top Doctors tells us, “throughout history, man has felt the need to protect him from inclement weather and the aggression of the terrain. Paradoxically, the use and abuse of footwear over the centuries has caused a certain weakening in the muscles of the foot , such as the lumbrical and interosseous muscles, so that many people cannot move their toes freely and independently ”.
So if wearing shoes weakens our feet, wouldn’t it be more convenient to go barefoot through life? Well, as we would say colloquially, “neither bald nor with three wigs”. Podiatrists agree that going barefoot occasionally or even for a bit each day at home and as long as it is not done on hard surfaces such as marble or terrazzo, as it impacts too much on the joints, is beneficial. Alfaro tells us that among the advantages of this practice are to improve the function of the intrinsic muscles of the foot , which is often limited by the use of footwear; of proprioception , which is the sense thanks to which we detect the movement and position of the joints (it helps us to adjust movements such as, for example, when stepping on uneven ground or going down steps), as well as the circulation of the venous return . The latter is achieved especially by walking on the sand of the beach or the grass. De la Rubia makes one last note advising against going barefoot at home if there are alterations in the feet such as fasciitis, metatarsalgia, corns, corns …
Closely related to the above is the minimalist trend , which is nothing more than wearing shoes with little or even no heel. As Víctor Alfaro explains to us, this type of shoe usually has a wider last in the area of the toes, so that they can move freely, as well as a very flexible sole so as not to limit the mobility of the foot. Ángel de la Rubia does not agree very much with this trend and is that, in his opinion, the use of land, smooth, firm and hard, such as the sidewalks we walk on, requires compensating with a certain height of heel, between 2 and 3 centimeters. According to the podiatrist, with this height we are able to balance the percentage of loads or support between the forefoot and the rearfoot or heel. “It is usually the height of classic men’s shoes.”
Alfaro goes further and is that minimalism is also very present in sports practice. The Real Madrid podiatrist tells us that it is common to see certain runners wearing minimalist footwear, although he points out thatnot something suitable for everyoneand that, in any case, requires a long adaptation period. “Going from running using a shoe that incorporates, for example, a 1.5 cm heel height (technically called a heel height).drop) to run barefoot suddenly can be very harmful since this decrease indropit entails a significant increase in muscle tension in the entire posterior pulley of the leg: Achilles tendon, calves, soleus and hamstrings ”. The specialist’s recommendation is that,If you want to start minimalism, do so by lowering the height of the drop very progressively and “listening” to the muscles. “If we lower the heel height by 0.5 cm and we see that our calves, for example, are overloaded excessively, it should be done more gradually. At the same time, it is very important to establish a correct pattern of stretching to help us in this progression ”. And he gives his opinion: “In my opinion, for most people,the ideal is to use a shoe that incorporates some drop and some cushioning and it would be very good to alternate that use with minimalist footwearor even exercise barefoot for a few minutes a day ”. These exercises include walking barefoot for a few minutes a day, standing barefoot on one foot, standing on tiptoe, and “catching” a towel with our toes. Of course, if you have any pathology, you should consult a specialist first.
On the opposite side to minimalist footwear we would find high-heeled shoes. What happens when they are used continuously? “Biomechanically it forces us to walk through short steps, with semi-bent knees, increasing lumbar curvature (hyperlordosis) and favoring the appearance of metatarsalgia, pain in the anterior region of the foot and the appearance of bunions and claw toes, apart from problems in terms of to the deficit of the venous return and the appearance of varicose veins. Let’s not forget that the foot behaves like a true peripheral heart ”, Dr. Ángel de la Rubia explains to VERY. If you want to wear high-heeled shoes, the height limit would be between 4 and 5 centimeters and the heel should be wide, never needle .
Are there the ideal footwear?
At the beginning of this text we commented that, if even a person’s feet are not exactly the same, it is quite complicated, if not impossible, that there is an ideal footwear that suits us all. “There is no ideal shoe for all citizens, since its structure should start from a personalized last , which takes into account, in addition to the length of the foot, the width and height of the instep, to optimize the fit and avoid translational movements within of the shoe, ”says La Rubia. If we focus on a physiological or anatomical footwear, the doctor says that “it should be made of natural leather, breathable, with adjustment by means of a cord or velcro, with a blade wide enough to allow the free mobility of the fingers and a buttress that firmly grips the foot. heel, to avoid ankle instability injuries. The sole must have non-slip properties, with good grip, traction and cushioning, rubber in the winter months and a breathable sole for the summer months ”.
The expert restricts the use of sandals to the beach and the pool. However, as these shoes are very popular in the warm months, De la Rubia recommends that they wear different fixings or anchors, both anteriorly and in the heel and midfoot. On the contrary, the podiatrist welcomes the use of boots in winter since they are ideal for people with unstable ankles. Recommend that they be made of natural leather, with a rounded toe and a heel height of between 2 and 3 centimeters.
“Footwear must have a balance between two fundamental concepts, cushioning and stability , so that a shoe that is very soft and comfortable a priori, can become a problem for a lax foot, or flattened and, on the contrary, a very rigid shoe. it can limit the natural movement of a heavily bridged or poorly mobile foot. We must acquire the shoe in the late afternoon , which is when our feet are most dilated ”, recommends De la Rubia. In addition, he tells us that “as a general rule we should buy shoes taking as a reference the largest foot and the longest toe and always keeping between half and one centimeter between the longest toe and the toe of the shoe.”
And about that of ‘taming’ the shoes, the podiatrist says that those that are light, moccasin type or casual , do not usually require any adaptation period. A different thing is a shoe that is made of pony skin, which does need that ‘taming’ time to be comfortable.
Let’s talk about sneakers
Sports shoes deserve its own section and there are already specific shoes for almost every activity that comes to mind. It is inevitable to ask ourselves if we really need to wear specific shoes depending on the sports activity that we are going to do or if it is the work of marketing. Or, in other words, are brands staying with us to sell us their product?
The doctor de la Rubia highlights footwear as a fundamental piece of sport, as it is the element that puts our locomotor system in contact with the ground. In his opinion, each sports specialty carries a specific type of footwear . “It would be a mistake to run with tennis shoes or play golf with paddle tennis shoes, not to enter sports that require even more specific footwear, such as soccer, track athletics, etc.” And it illustrates: “Normally the ‘magic’ of the sports shoe is found in what is not seen, the sole and the midsole. The midsole contains the most valuable technical elements that each manufacturer uses to give their shoes personality and character. Therefore, we must not let ourselves be carried away by what is seen, which is nothing other than the cutting material, where the manufacturer’s logo is usually printed and whose importance, which has it, is much less ”. Clearly the beauty is on the inside.
“Sports footwear has evolved a lot in recent times and the fact that it is becoming more technical means that the indication of use of each type of sports footwear has to be more precise,” explains Víctor Alfaro to VERY. “ If we talk about runners, the shoe model will depend on parameters such as the way of treading, the weight, the surface on which we are going to run, the distance, the running technique, the speed at which one runs, among others. In long distance races we advise to include a little more cushioning. We have to understand that in the gesture of running we can load on the supporting foot between three and four times our weight, so we end up carrying many tons of load on our feet. The so-called ‘flying’ shoes, which are used for shorter tests where speed is the key, incorporate much less cushioning since when we run fast it is only the front of the foot that rests against the ground ”.
Alfaro has an impact on what De la Rubia says and that is that, although we practice sports occasionally, we must choose footwear related to the specific sport practice. “For other sports that are very fashionable such as crossfit, it is necessary to wear specific footwear. In this case, they are stiffer soles so that they do not give way when the gesture of lifting weights is performed, for example. Each sport has its peculiarities and sports shoes are designed based on these particularities ”.
Latest innovations in podiatry
In recent years the advancement of podiatry has been meteoric, especially with regard to diagnostic technology and the design and manufacture of custom insoles .
In Podoactiva they have a system called baropodometry or pressure platforms , which allow analyzing the behavior of the foot in both static and dynamic situations. “It is a kind of mat full of sensors that capture the information of the foot when it is stepped on,” explains Víctor Alfaro. In sports podiatry, it is possible to perform 4D analyzes that allow to quantify very precisely not only the movement of the feet but the relationship of the way of stepping with other structures such as the knee or the hip. “We no longer only obtain a video image, but certain sensors placed on the patient give us objective and quantifiable data on the patient’s movement (angles, angular velocities, trajectories, 3D location of each segment, etc.)”.
If we talk about templates, we can forget about the way in which it was worked before, that is, when they made you a plaster mold or when you had to step on a foam in which the footprint remains. Now podiatrists have 3D scanners . “The fact of being able to have 3D images gives the process greater precision since it allows to design the treatments by applying engineering techniques such as finite element calculation and reverse engineering, allowing to predict the operation of the template before manufacturing it”, we says Alfaro.
How could it be otherwise, artificial intelligence has landed in the field of podiatry. Podoactiva clinics are pioneers and apply it to design personalized templates. Víctor Alfaro tells us that “ each template is designed taking into account the accumulated experience in treating more than 500,000 patients . The AI system is responsible for locating patients very similar to the one in front of us who have already been treated successfully. This allows all the podiatrists who work in the structure to benefit from the accumulated experience. In health, it is usual for each professional to learn based on their own experience. Artificial intelligence allows us that the experience of each of the team members serves to improve the experience of all the others. This knowledge management allows us to continuously improve our work ”.
To finish, Alfaro tells us about an intelligent insole called Smart Insole Podoactiva , one more step in the personalization of podiatric treatments. “It is a personalized template for a specific patient that is equipped with a layer of sensors and the electronics necessary to continuously monitor the patient’s progress. This information is transmitted to the patient’s mobile phone and from there to the Podoactiva cloud, where it is processed in real time and returns the necessary information to both the patient and the professional in charge of treating said patient. We are applying this technology in different fields: athletes, neurological patients, geriatric patients … This allows us to study what the patient does outside the consultation and to be much more precise, since the study is carried out in the real situation of use of the patient: sports, work use… ”.
Podiatry does not stop innovating. What will be next? We will continue to inform.
