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How to make friends and influence people (at least about their feet)

22nd Jun 2007 , Ed

Anette Thompson, practicing podiatrist, chair of the SA Podiatry Association’s sub-committee on footwear, consultant to the SA Footwear and Leather Industries Association, and a member of Michelle Footwear’s research, development and marketing team, says retailers and shop assistants don’t need degrees to take better care of their customers. All you need to do is stock well-designed footwear and follow some of the following advice. Your reward? A sale and a customer who will come back again.

Leonardo da Vinci, who was as skilled at anatomy as he was at art, observed that “the human foot is a work of art and a masterpiece of engineering”. Unfortunately, while most babies – not all – are born with ‘normal’ feet, all too often retail shop assistants see feet, of all ages, that are anatomically defective (poor shape) and functionally deficient (don’t work so well) – and usually, footwear is to blame.
Every experienced shoe person knows that every off-the-shelf pair of shoes fitted is a compromise of some type. But that should not stop us (personally and for our customers) from trying to find the best fit.
Dr William Rossi, podiatric advisor to the American footwear industry, said that the only truly normal feet, anatomically and functionally, are found mostly among the nearly one billion people on earth who never wear shoes (because they can’t afford them); who stand, walk, run and work daily, mostly on natural earth. Bushmen are an obvious example, but the vast majority of that one billion are rural peasants. Their strong, mobile feet hardly have even minor deformities and rarely show distress symptoms throughout a lifetime. Nor do they suffer from fungal infections like athlete’s foot. Hardly any of them suffer from diabetes-related foot problems either, but that’s mostly a dietary issue.
In general, however, the footwear industry has a lot to answer for. By comparison, scientific studies show a 75% to 88% incidence of foot problems among people who wear shoes!Why is this? What is it about their footwear that produces this result?
In a nutshell: shape and function. Their shoes don’t match their foot shape or the function of their feet. When shoes fail to fit they can cause abrasions that develop into painful corns, calluses, hammer toes and bunions. Why are shape and function so important? What can you in retail advise and recommend?
A little background information is needed before that question is answered. Most people, including some medical practitioners, assume that the five toes, especially the four lesser ones, are simply ‘minor’ add-ons to the foot. Most people would never say that those toes are vital for foot function and stability.
But of the 19 muscles and tendons that have their origins in various parts of the foot, 18 are attached to toes (a similar pattern exists in the hand). These 18 muscles and tendons insert or are attached to the toes for various functions. There are 13 additional muscles and tendons that originate in the leg, some of which are also attached to the toes. Think about the following: if your fingers were tied closely together and held fast, your hand functions would become extremely limited. Yet that is what happens to the foot inside most curved footwear designed with a 6 degree in-flare of the forefoot and a tapered toe box. X-rays of the foot inside a traditional shoe will show this clearly. When we ignore foot shape and foot function in making, selling and purchasing shoes, there are consequences because, in effect, we ‘paralyse’ muscle function. If foot and leg muscles can’t operate because of limitations or alterations imposed by the shoe, then functional efficiency will be lost. When we alter or limit movement of the foot, plus add in pressure from constriction (too tight), this can re-mould the entire foot so that it is no longer a truly normal or natural foot.
In other words: faulty shoe fit leads to poor function of the foot and ankle. No matter how well a shoe is made, unless it is a good fit, it will cause the wearer discomfort and foot pain or trauma. A shoe that is a poor fit will soon lose its shape and since the weight of the body is not equally distributed, will wear out quickly at some given point.
Poor fit leads to muscle inaction. Muscle inaction results in poor gait (walking pattern). This, in turn, sets up a chain of further muscle imbalances. Muscle imbalances will put more load on some parts of the foot/knee/hip/spine than others.
This picture of structural imbalances affecting structural function is known as biomechanical imbalance. Faulty biomechanics of the foot and leg are the cause of most corns, calluses, toe deformities, ankle imbalances, faulty gait propulsion patterns, knee and hip pain – to name just a few.
The main objective in fitting functional shoes is to find shoes that allow full muscular action and complete foot freedom without pinching, binding or restricting at any point.
A shoe should be long enough to leave approximately the width of the wearer’s thumb between the end of the longest toe and the end of a closed shoe. From 8mm for infants, to 14mm or more for adults is absolutely necessary to avoid a closed shoe being too short for “foot travel” in walking. For an open toed shoe, provided it is sufficiently wide at the tip, the longest toe of the foot should not extend beyond the insole.
If the purpose of the shoe is for running or a ballistic (bouncing impact) sport, then the foot “travels” more inside the shoe and the toe allowance should be greater than 14mm.
The inner joint (where bunions occur) should be directly over the point where the sole of the shoe begins to swing under the arch of the foot. If this big toe joint rests beyond (in front of) that point, the shoes are definitely too short (in their heel to ball length) and will often cause wrinkles in the shoe directly under the inside arch. Check the customer’s old shoes for telltale signs.
Wrinkles in the upper directly under the inside arch can also be an indication of excessive in-flare curvature present in the last. As a person walks, the heel acts as a rudder that guides the rest of the foot straight ahead of the centre of the heel. This ‘rudder guidance’ takes place in 3-D along the longitudinal foot axis. When the foot is held fast in a shoe that has an inward swing in the region of the fifth toe, this guidance is interfered with. Add to that the traditional but scientifically now outdated 6 degrees of in-flare of the forefoot, and the result is a torsion (twisting) action on the forefoot. The foot undergoes torsion because it attempts to still travel along the straight axis. Hey presto…wrinkles on the shoe’s inside vamp and overhang on the outside vamp!
Wrinkles on an upper are unfortunate. Not so easily remedied is what happens to the actual foot over years of this torsion effect… Corns and callus are caused by pressure and friction as the foot’s natural function “fights” against the constraint. Ankle and midfoot over-supination (the foot is held in supination in a curved or in-flared last) can result in compensatory over-pronation….and can lead to shin splints, plantar fasciitis, heel spurs, tendinosis and knee pain.

A shoe properly fitted will hug the foot firmly and snugly throughout the arch and the heel but at the same time allow ample room for the toes and the ball of the foot to stretch out comfortably – which allows free movement of bones and muscles when the foot goes into action.
The secret of proper fitting is to distribute the weight of the body equally from the heel to the toes. If properly fitted, a person should be able to walk out of your shoe store with a new pair of shoes on his feet and find them entirely comfortable the moment he or she starts to wear them. The heel of the foot should fit snugly in the heel of the shoe. Since the heel is the part of the foot that first strikes the ground and absorbs impact shock, it should be well seated in the shoe. There should be no gaps or wrinkles in the topline of the quarter.

Remind your customers that backless or slip on styles do not offer as much support for the foot and can cause foot fatigue since additional muscles in the toes, midfoot and leg have to work to keep the shoe from falling off the foot. Backless styles are not suitable for children because they can lead to developmental imbalances. Backless styles are also not suitable for seniors since their reflexes are slower and they are more at risk of falling out of a backless shoe.

The ball of the foot should be in the ball of the shoe. A mismatch or bridging of the heel to ball means that the foot is unsupported as it should be by the shank curve. In heeled shoes, women would complain of a burning sensation after a while – this is due to the muscles under the arch having to constantly contract to hold the foot. After a while the constant contraction puts the muscles into spasm and a burning pain soon follows.

Allow proper width to fit the normal expansion of the foot without pressure. In the ball of the foot area, there should be enough room for the foot in action.
By feeling the shoe at the ball of the foot and running your fingers over to the outside edge of the shoe, one can easily see whether a shoe fits too tightly or too loosely. You should be able to imagine a thin pencil’s thickness slipping in under the vamp.
If the width fitting is too tight, bones will be cramped, nerves and tissue pinched, circulation retarded and the shoes will provide incorrect balance when standing or walking.

Allow sufficient toe room to fit the toes without crowding them. Crowding of the toes causes distorted toes, hammer toes, ingrown nails, corns and many other foot problems.
Watch that the toe box shape matches the shape formed by the toe profile – some people have a tapered shape, some have a square shape, some are spatulate.
For infants, best choices are highly flexible and light booties made of thin unlined nappa leather or similar. These are merely for protection of feet from the cold when outside of the home environment. At home, definitely for the first four years, barefoot for infants is best as the bare sole of the foot then has the best chance of transmitting all the sensory information needed for optimal coordination, balance and development.
Between birth and age 2, it is entirely normal for a baby to be bow legged and for their feet to appear as if they have flat feet. The flat foot appearance is caused by a pad of baby fat that fills in the undeveloped arch area.
Between age 2 and age 4, as the leg bones undergo normal development, it will again be absolutely normal for the child to show a tendency to knock knees. By age 5 and approaching age 6, a child should have completed this leg bone development of alignment and have reasonably straight legs.
Any child over the age of 6 that shows pigeon toes, bowlegs, knock knees, misshapen or curly toes, misshapen toenails or does not walk or run easily, should be referred to a podiatrist (foot and ankle specialist) for assessment. There are many forms of conservative treatment which do not involve surgery. Call 0861 100 249 for details of your nearest podiatrist.

Footwear for seniors – what’s in and what’s out? Ageing generally tends to bring about diminished vision, less peripheral sensation, less strength, less reaction time and changes in posture. Footwear for seniors, just as for children, should be fastened in two important places – across the top of the foot and behind the heel. This applies to both men and women – so any style of shoe that is low cut like a women’s court shoe, or slide, or a men’s sandal that has no back strap, or slippers that have no back to them, or slip slops or thong footwear without a back strap – are associated with risk.
A person over age 60 wearing a backless shoe, sandal or slipper is an accident waiting to happen.
Slippers are particularly dangerous if they are of the floppy soft toweling sort that does not have a firm fit against the foot. Properly shaped felt or fabric slippers that are firmer and have a heel counter are preferable. Heel height should not exceed 25mm in this age group as wearing shoes higher than this has been shown in studies to promote bunions and calluses. Heel style for a woman: stable block style heel that is not narrower than 50% of the width of the heel itself. Wedge heels are much better than block heels for stability.
Soles should be firm, thin and flexible at the ball joint. Soles should be thin so that the floor surface can be better judged by the senses. Internal cushioning in the shoe is preferable to thick soft soles. Studies show that thick soles which do not bend easily are implicated in falls much more than thin soled shoes.
Interestingly enough, whereas podiatrists encourage parents to allow babies, children and young adults to walk barefoot as much as possible for good foot development, in older people studies have shown that the risk of falling indoors is greater when the senior is wearing just socks or going barefoot. So, older people at risk of falling should rather wear shoes indoors where possible.
Are there exercises that can be done to help?
Here is an example of an exercise you can recommend to customers to strengthen the quadriceps muscles (needed for sitting, getting up, standing and walking). It can be done while watching television. When a commercial comes on, straighten the right leg and hold it straight with the foot off the floor until the commercial is over. When the first television commercial ends, lower the right leg, straighten the left leg and hold until the second commercial is over. The right leg is raised for the third commercial and so on until the commercial break is over and the programme resumes. This sequence should be performed for every commercial break during a 1-hour television programme. – Anette Thompson, B Tech Podiatry (Wits) [Tel: +27 (0)31 450 0233, e-mail: anette.thompson@iafrica.com]




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