Unlock Foot Strength Secrets- Paul Langer DPM

Step into the world of the Crackin' Backs Podcast, where we untie the laces of conventional wisdom and walk barefoot through the latest in health and wellness. In this episode, we invite Dr. Paul Langer, a renowned sports medicine podiatrist with a day filled with foot and ankle puzzles, to share his expert insights on a topic that's sprinting into the spotlight: barefoot running. Is it a path to peak physical health or a shortcut to injury? Dr. Langer weighs in on the benefits and risks, helping listeners decide if it's the right fit for their feet.

But we don't stop there. As interest in foot health and strength gains traction, Dr. Langer shares his top exercises for building a solid foundation, from the ground up. Why do we rehab hands with vigor yet often neglect our feet after injury? We explore this imbalance, proposing a more natural approach to foot recovery and the intriguing question of internal versus external arch support.

In a world flooded with footwear options, from minimalist sandals to cushioned fortresses, how does one navigate the shoe aisle? Dr. Langer offers guiding principles to select the perfect pair, illuminating the primary role shoes play in our health and societal performance. Has our understanding evolved from mere protection to enhancing performance?

Tackling another contentious issue, Dr. Langer shares his professional stance on pre-taping the foot and ankle in sports. Is this age-old practice preventative medicine or potentially harmful?

Join us on the Crackin' Backs Podcast for an enlightening journey through the intricacies of foot health, shoe science, and the bare truths behind barefoot running. Whether you're a seasoned marathoner, a weekend warrior, or simply curious about healthier living, this episode promises insights that will change the way you think about your feet and their journey through life. Tune in and step up your health game!

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Transcript

Dr. Spencer Baron: 0:00

Welcome to the cracking backs podcast where we sat down with Dr. Paul Langer, a sports medicine podiatrist. Today, we're stripping down the bare essentials with Dr. Langer to tackle the groundswell of interest in barefoot running. From the natural benefits to the potential risks. we're uncovering what you and your feet truly need to thrive. are we supporting our feet too much? Or not enough? And in the world overflowing with shoe choices, how do you step correctly for your health and performance? Plus, will unravel the mystery of pre taping for sports such as football, volleyball, and basketball? Is it a precaution or just a placebo lace up or rather take them off for an enlightening journey into the foundation of our bodies. You won't want to miss a step of this groundbreaking discussion. Tune in now. Well, thank you, Dr. Paul Langer for being on the air with us. We are looking so far to Ave on the show and, and really just basically talking feet, but a whole lot more. You're and welcome, welcome. Glad to be here to be interesting. You bet. You bet. Let's let's start by I want to I want to kick this off by wanting your opinion on this whole concept of barefoot wear running which you seem to have really taken a special interest with. Can you give us a little idea as a podiatrist, what you deal with and your thoughts about that?

Unknown: 1:46

Yeah, and I'll preface it by saying that I am a fan of it. And the research for it had just keeps getting better and better. Probably like a lot of people. Back in 2009 was when foreign to run the book came out by Chris McDougal. And probably by 2010 2011. I had a lot of patients starting to ask me about barefoot running and and as a podiatrist that I specialize in sports medicine, but endurance sports is kind of what led me into podiatry and was always my special interest, especially running and triathlon. So when my patients started asking me about it, I was like, well, I need to understand this better and I tell people that I tried barefoot running the same way I tried sushi, I had no intention of liking it. And and I was like, this is actually pretty cool. So the the first time I ran barefoot and then I got some minimal shoes like everybody did back then and that was Vibram Five Fingers were kind of the first ones that were big. But once I started running in them and I was lucky in that being from Minnesota, I live on the Mississippi River so I could actually run on dirt and single track right next to the river I didn't have to go straight to concrete or asphalt. So I just spent some a summer basically building up my mileage running barefoot and in minimal shoes and I really liked it and that summer well actually I think the following summer I did about half of my mileage and in minimal shoes, but I didn't just kick off my shoes and go barefoot or minimalist. I spent a long time transitioning. And on the flip side of that in clinic though, I was seeing a lot of patients coming in with metatarsal stress fractures with calf strains with Achilles tendonitis, because they just threw their shoes in the garbage and and went barefoot went minimalist one of my patients, his very first run barefoot he did 12 miles and he had a stress fracture at the end of that 12 miles. So so there was there was a lot of a lot of kind of over enthusiasm I would say for it initially. And you guys probably saw that in practice too. So So then there was a little bit of a backlash like oh, you know, maybe running shoes aren't so bad for us, maybe we need them but the reality was no one was adapted to running in minimalist shoes. And so I would say even today like I never completely gave up my shoes or conventional shoes, I would say but but I rotated in a minimalist shoe. And I still do that to this day I'll run them I just ran barefoot on the beach. The other day three and a half miles felt pretty good. But I've spent a long time kind of building up to that but but that was the problem is that people jumped in a little too enthusiastically and since that time though, now there's got to be better research about potentially how to make a transition. There's benefits to minimalist shoes or going barefoot even just for walking so you don't have to run in them to have a benefit from them. But But this initially it was kind of like all running shoes are bad they make us weak and injure us so therefore we must be all in barefoot or minimalist shoes and not get injured but it didn't work that way we still got injured it was just different types of injuries that were popping up. Because of the different stresses and loads and minimal issues are barefoot running places out of body in contrast to some of the how the stresses of loads are distributed with conventional shoes.

Dr. Spencer Baron: 4:58

What is a minimalist shoe What was the example? I think of the ones with the fingers?

Unknown: 5:04

Toes? Yeah, V room five fingers. Were kind of the first one. And I have one here because I knew that question would come up. But there was a paper done by a couple Canadians, school VA and Waze Dubois and they wrote a paper called The minimalist index, and basically on how to stratify shoes like what's what's the most stiff and supportive shoe versus what's the shoe that's minimalist. Now, this would be an example of a minimalist shoe, this one happens to be vivo, barefoot, a British brand. But minimalist shoes have no cushioning and no support. So I can fold that up into nothing. It's just a thin sheet of rubber and then just something to secure it to your foot. And there's a bunch of different brands now zero, New Balance is bringing back their minimis line of shoes that they had for a while. And then as minimalism kind of died. It's kind of slowly creeping back. But but so the shoe has literally no cushioning, no support. There's a few different brands that call themselves middlemost. But if they had even a little bit of cushioning, a little bit of support to have, it's not going, in the strictest definition be a minimalist shoe. So that that cushioning affects how you move and defects impact and loading things.

Dr. Spencer Baron: 6:19

For your regular patient that's looking to go barefoot, how do you tell them to transition and what to what to be careful of?

Unknown: 6:27

Yeah, and that is one of the questions that that comes up very frequently. Now, I actually use as a reference point a paper, but Sarah ridge and colleagues did at the university, I think at Brigham Young University in 2018. And they just use this for walking. But it's a great way to start. In their studies, actually, they were looking at whether minimalist shoes or barefoot walking, while they use shoes in the study builds flip strength. And so they had a control group that was just doing foot intrinsic strength exercises. And then they had the intervention group that was using minimalist shoes. And what they did was the first two weeks of the study, the subjects goal was to walk 2000 steps a day in the minimalist shoes, five out of the seven days of the week. The next two weeks of the study, they progressed to 5000 steps a day. And then the next two weeks, they did 7000 steps a day. And over the course of the study, they found that comparing them to the group that was doing the exercises, the minimalist group built foot strength just by walking in minimalist shoe, so their feet got stronger, they weren't doing any exercises, they were just wearing minimalist shoes. And they build strength in slightly different ways from the group doing the foot strengthening. So I tell my patients, you should actually do both, you should do foot intrinsic strengthening exercises on your own. But an easy way to get some strengthen and benefit to your feet is just wear minimalist shoes, you don't have to work at it, you just put them on and move around them. So so that study I actually have a little summary of that and a handout that I give my patients on foot strengthening. And it's a great tool. So whether they want to run in their minimal shoes or walk in them, I say you got to start walking, of course, build some strength and then you can start to transition to running and there isn't one universally accepted or studied program I've seen on running but generally it is tell people if you let pain be the guide and do it gradually, like you would for any kind of transition to a running program or higher intensity training. Like I know you guys know, well, then then you should be able to do it safely.

Dr. Spencer Baron: 8:32

You mentioned that you ran on the beach barefoot. I liked that idea. I started running on the beach once once my knees started bothering me from running on pavement. But I made sure I had my shoes on. Would you transition from having shoes on the beach to barefoot on the beach? Because it requires a lot more flexibility? Yeah,

Unknown: 8:58

yeah, you certainly could. And even like one way to do it would be just that way Spencer, like bring your shoes with you. And then maybe say I'm gonna do like five minutes or 10 minutes without my shoes. And then if you start to get kind of sore, he say alright, and I'm gonna put my shoes back on and you could gradually you know, increase how much you're barefoot and how much you're running with your shoes. And again, I don't have any evidence based or studied methods that would say what the ideal amount is, but just like any athlete, he's tend to know what feels good, what doesn't so when you start to get fatigued, you're tired shoes back on and very likely to be able to gradually increase how much you ran barefoot,

Dr. Spencer Baron: 9:34

you know? I'm sure you would caution people about running on the slant on the beach, which is you know, would really throw off your Yeah,

Unknown: 9:47

especially in Florida. I've seen it slow pretty severely in some places. Yeah. So yeah, I was on a pretty flat stretch out here recently but but yeah, those things and as you know, too, you know, heading south it was the slope one way and then heading two So you know, to finish your run back the other way, but But yeah, sometimes you just kind of try to find that flattest surface you can or just make sure you

Dr. Terry Weyman: 10:07

know, I'm glad you brought a foot foot straight, Paul, because, you know, that's one of my pet peeves people will strengthen their hands after injury or to work, but we never seem to strengthen our feet. It seems to be like this loss appendage below the waist. And yet it feeds into the hip. And so yeah, you nobody straightens your feet, they want to cushion them, they want to make them softer, they want to do that. And I see these athletes coming in, and they have no muscles in your feet. And they wonder why they're constantly in plantar fasciitis. Yeah. So what are some foot strengthening exercises that you can recommend? And can you talk about how to take care of our feet and for overall strength and health?

Unknown: 10:54

Yeah, so the the think, even believe it or not, as a podiatrist, there wasn't a lot of information about the small muscles of the feet intrinsics or strengthening when I was a student or starting practicing. And I think that started change around 2015 When there was a paper that came out McKeon was the lead author, but basically, it was called the foot core paradigm. And they they equated the intrinsic muscles of the feet to the core muscles of our pelvis. And basically, you know, saying that these are the muscles that stabilize your foot. So the big muscles can provide movement. But we haven't really understood their function because it's hard to measure what they do. They're so small, and some of them are, so do can't really measure EMG and sudo. Surface EMG. And, but that paper kind of opened people's eyes that, you know, maybe we've been neglecting the importance of the small muscles. And so, since 2015, the awareness has been growing. And the exercise that I've been teaching pretty much all my patients, so I'll, I'll tell them that the evidence for strengthening these muscles isn't just to reduce your risk of injury or help treat an injury, but it also improves sports performance and improves balance in our older patients. So even my patients are in their 70s or 80s. I'll tell them, these exercises will decrease your risk of falling you need to make them a part of your daily routine. But the ones that I typically recommend are some people call them toe yoga or toe piano. But the ones where you press the big toe down, lift the little toes up, little toes down, big toes up. And then like any strengthening program, you know, first you activate those muscles. And you guys I'm sure you've seen this in clinic, where you could have a super fit athlete and they can use their big toe to go up independently or they can't get their little toes to spread out. So like you can take someone's Super Fit say alright, you have to first activate these muscles. So first they do it from a seated position. Once they can do 10 repetitions then they can graduate to the strengthening part of it where you know initially they do it standing then standing on one foot and if you do little hats off of them to gradually make it progressively harder. And then there's also dole meter short foot which I'm sure you guys are familiar with where we're the biggest muscle in the foot is the abductor hallucis muscle and that muscle is weakness of that muscle is associated with a lower arch height with plantar fasciitis, it's significant and bunion deformities as well. And there's evidence in the literature that strengthening it helps align the foot stabilize the foot raises the arch, so first strengthening that one of with short foot and there's also something called the toe spread out exercise and same deal activate then progress progressively strengthened and then keep it as a part of your fitness routine because those muscles will become inhibited and latent as you guys know if they don't stay on top of it. And so those exercises I tell everybody you got to do but then I also just remind them an easy way to keep those muscles strong and active is to make sure that you're using minimal issues at least if you don't like working out and I'm at least use them as a recovery shoe or

Dr. Terry Weyman: 13:56

you give me you know this is a favorite thing of Spencer but now you gave me goosebumps because I love this stuff you because it's so nice to talk to podiatrists that has a thought process because I have tested every every patient first day they come in and make even if they have to shoulder injury and make them take the shoes and socks off. And I go if you were mittens on your hands all day long, he would lose dexterity in your hands that you're at. We wear mittens on our feet all day long. We wonder why we can't control our toes. And I say everything your hands can do your feet should be able to do and I now have an athlete they could they can take do this with his four toes you can separate them and you can take a coin and go across him and and all his ankle injuries and his knee injuries went away. And so my question to you is as a podiatrist, why, what's your thoughts on on these foot strengthening and toe exercises but more of when we come out of a boot whether it's an ankle injury or a foot injury? Why are Are we not? Or what's your thoughts on the old way of doing things, which is like putting them into a hookah shoe and, and, and orthotics and bracing them and all that stuff versus getting them into doing some foot exercises right away? Like with our hands, what's your what's your thoughts on on that and, and to build up these arches, because in my last point is in nature, when you see an urge is never supported by something or Nita supported by a structure. So why aren't we going back to that thought process?

Unknown: 15:33

Yeah, well, and all those tools you mentioned, Terry are, you know, to a certain extent necessary, but that yeah, how do you transition away from those those kind of artificial forms of support and, like, I know that like I've seen some studies show even two weeks, and it can boot causes stiffness of the ankle and weakness as a muscle so so very quickly, there's a negative effect that that cast disease sets in, right, so we've got someone who's recovering from a fracture, severe ankle sprain, I'll have them start the toe yoga, even before they can bear weight. So I'll just tell them, you know, like, I rarely put people in fiberglass or plaster casts anymore for fractures. And partly is because the candidates are adequately protected both stiff rocker bottom boots. And then they can take them off to do little things like mobilizations and activation of their muscles, and maybe sleep better so. So I tell them that as soon as they're paying allows, they need to start doing a little activation of their muscles, even just passive range of motion, Franco can minimize some of the effects of being immobilized. And then in terms of transition back, so that can be a little bit tricky, for example, like some of the athletes that we work with, especially metatarsal stress fractures, like it takes, on average, about nine weeks for a runner to return to running after a metatarsal fracture. So and we work a lot of the college athletes and some of the professional runners in our areas. And so they're itching to get back to it right. So I will have them start to use an insole or a Hoka, because they do reduce bending forces on the metatarsal, but I'll also tell them, this is something that we transition from. So you know, the boot is really acute part of the injury. And then we use other tools to modify the loading of the injured tissue as they start to heal. But then as soon as they're strong enough and stable enough and pain free enough, then we remove that artificial support, while they're building strength to increase their capacity even before their full speed. So, so kind of using all those tools, Terry, like in that stratified approach, from the acute part of the injury back to full return the sport will utilize all of those, for sure, because there is evidence in the literature that that tinsels orthotics and, and and rocker bottom shoes can decrease bending forces, but but again, potentially what is

Dr. Terry Weyman: 17:45

a realistic, excuse me a realistic strategy for return this? Because what you'll see people with plantar fasciitis, that they go, I've been suffering this for years, you know, and then you go, Well, what have you done for it? Well, I just keep wearing the boots, you know, so, and then tendinopathy, they'll say, well, some doctors will say, well, tendinopathy is not really an inflammatory condition is more of a internal tendon, micro tears in deep inside the core of the tendons. So what's some of your, your thought processes on return to sports and strategies and timeframes?

Unknown: 18:19

Yeah, so for soft tissue injuries, I generally follow the pain monitoring principle and Karen silver Nagel developed it specifically for Achilles tendon, but it applies to other soft tissue injuries. So her read her pain monitoring model for the Achilles was basically if, if an athlete's pain is less than a five on a scale of 10 during activity, and they're improving week to week, they can be active on so if their pain though goes above five or above or their progress reverses or plateaus, then they have to modify the workout activity again. So so I'll use that for the Achilles tendon for other types of tenant athletes. And then for plantar fasciitis, I might be a little more aggressive than others. And maybe the reason I say that is because I will put up with plantar fasciitis for 20 some years before my feet had strong enough where it wasn't as much of an issue. But I I tell my patients I never skipped a run because of plantar fasciitis. And there was times when probably like a lot of the athletes you guys treat in case you guys have done it yourself. I'm sure you're just like, I don't care if it hurts, I gotta go for a run today. And I will just do it right. And and I always came out the other side, okay, and it wasn't stupid about it. I wouldn't beat the hell out of my foot five days in a row. But there's times when you want to be out there. So so I've kind of learned in talking to athletes about plantar fasciitis that you know I use that pain, monetary miles, it's a bona fide you're going to move differently you're going to hurt something else and if you're beating the heck out of it five days in a row, that's just not smart. But you don't have to sit on the couch and wait for your pain to go away. So so generally I feel like the one thing with plantar fasciitis is kind of merciful is that usually does warm up and get better with movement right? But then you sort of pay for it later either later that day or the next morning. So I in that context I will use some tools to stay active but but once I started introducing or adding minimalist and barefoot running to my routine, my plantar fasciitis really didn't bother me anymore so, so I might feel it once a while because some of the studies show 30 to 50% of people that get plantar fasciitis are vulnerable to reoccurrence. And I clearly was in that category maybe I still am but but I found that it's much more manageable now that my feet are stronger

Dr. Terry Weyman: 20:38

Have you found this thought process of getting your feet stronger men was shaped barefoot rain is also helped with your patients wishes splints.

Unknown: 20:48

Well, not necessarily shoes was interesting, you bring that up because I'm actually going to participate in a study on that coming up this summer. But it could it could help inches plus with in this way. So when you run with minimalist or run barefoot, you tend to shorten your stride just automatically because our bodies are basically programmed to move in a way that's most metabolically efficient and least painful. And so I even have some video of myself running in conventional shoes and running in my minimalist shoes on a treadmill. Without even thinking about it. When I run in my minimalist shoes, I have a shorter stride and I land with a flatter foot in place. But when I put on my cushion shoes, I have a longer stride and I'm a little bit more of a heel striker. So in the context of shin splints there, there are some studies that show you can reduce shock loading to the tibia by shortening the stride and landing with a flatter foot placement. So So I do tell some of my patients that you can modify your gait. I'm not a big fan of telling people how to run but but if you did it for a short term intervention to help someone run, you can say you can shorten your stride 10% reduce some shock load into the tibia. And there was a study done on it. But it was done by Irene Davis at Harvard. But they did it more on females with tibial with a history of tibial stress fractures. So it wasn't exactly the same but but they did show they reduced shock loading just by shortening the stride and running with a higher cadence. But there was also a study that showed for shin splints that running with a wider base of gait, reduced pain. And there was a small study, I think only about 15 or 16 patients. But the idea was you know the TVs got slight verum to it. And most shin splints is the distal 1/3. And so the thought was with a wider base of gait, that kind of kvt is kind of exaggerated, or I should say with a narrow base of data sort of exaggerated concavity. But if they ran with a little bit wider base of gait, they reduce some of that Varus moment on the tibia. And in in I tried it, it's weird, because when you try to widen the gate, you sort of feel like this. And even even if you only widened, like like, I think the example they used in the study, or maybe I came up with it when I was goofing around myself on a track, like I think the lines on a track are about four inches wide. So I would just try to run with my feet on either side of it. Even that felt too wide, like two inches a little bit wider, decreases some of that that's bending moment on the tibia. So, so I wouldn't tell someone with shin splints that, oh, this is the you know the solution to your problem. But I might look at him on the gate on the treadmill and see if they have a crossover gate because some people do have a crossover gate and you say, hey, just widen. That might make a difference. But that's some gate manipulation we can do. But I always tell patients, if you're going to change your gate, you're going to feel like you're working harder and running slower. And it's because you you're shifting your body out of metabolically efficient movement patterns, one that's less efficient, but it might alter the load enough to help reduce savings up running, as he's temporarily

Dr. Spencer Baron: 23:46

fascinating. It just evaluated someone's biomechanics, and they were so valgum their knees, were knocking into each other. And I go, man, you know, and I didn't even think to tell them to widen their gate. You know, it was, it was quite the dilemma. Yeah,

Unknown: 24:02

I know it. Yeah. Sometimes I battle that too, is like, should I tell him to change your feet? Or should I have to work on something that's going to take longer to change? Right? And, but sometimes I'll tell him, Hey, here's a short term intervention, I might help you get your miles in while we're working on this part of therapy. So you can kind of look at it that way too.

Dr. Spencer Baron: 24:21

Quick question on lately in the NFL, and there's been some Achilles tendon tears. We just had a police officer ruptured the Achilles tendon right off the bone and had to get re reattached. This poor guy I wish I wish I was involved in in the rehab, but the orthopedic you know, wanted him to it was a work comp injury. So you can imagine Yeah, man, he was in a boot for like, seemed like months.

Unknown: 24:56

He didn't get hit have it surgically repaired though. Was it surgery pay less. Yeah, yep.

Dr. Spencer Baron: 25:01

Yeah. Would you have suggested at least some toe exercises? I mean, he had

Unknown: 25:08

nothing. And yeah, I mean, some of that stuff. Yeah, it's easy enough to do just to move the toes without loading the Achilles. Right. So yeah, but but they that's definitely a kind of a long recovery as you guys know, that's a big tendon and, and sometimes to repair it and it's like, like, not that I've done surgical repairs of the Achilles, but you know, the surgeon is talking about, it's like, kind of, you know, so a mob, you know, the ends of a mob together sometimes and trying to find ways to augment the repair. So So I guess it depends on how he did it. And but I don't know that there's one. Like for a lot of stuff, as you guys know, there isn't one agreed upon rehab program, but But yeah, sometimes keeping the small things strong and active while you're working on the ability to start loading the big repaired structure can can help with the progress. Not sure.

Dr. Spencer Baron: 25:57

In the same stride in that conversation. You know, there have been quite a few ankle, excuse me, Achilles tendon tears, because of the think it's because of the turf, that there you instead of, you know, real grass in the NFL? Have you heard anything about that? I

Unknown: 26:18

haven't. And I haven't seen the I know, there's a few different papers on it. And in fact, I've actually had downloaded a couple and I haven't even read. I mean, I've got a couple of my computer but but yeah, I know it's controversial, but what it does, I thought I saw something that that showed there wasn't a significantly higher rate of rupture on turf and grass. But then I saw another paper that was so I think it might be a little bit mixed. And

Dr. Terry Weyman: 26:42

we'll give you five minutes to go read those papers and come back and give us your paper but

Unknown: 26:49

maybe another topic down the line. But but but yeah, but certainly with this last season, it was it was in the

Dr. Terry Weyman: 26:55

totally but why do you think it is because Trump's been around for a while and and so why do you see this this all sudden, this increasing ruptures? Is it? Is it the shoes? Is it lack of blood strength? Is it lack of anterior tibialis? What's your opinion?

Unknown: 27:15

Yeah, I could only speculate. I don't. I don't think I could pinpoint because even though like you said the tour's been around for a while and and the shoes haven't really changed that much in that time either. Jerry so yeah, so I really I really couldn't speculate. I

Dr. Terry Weyman: 27:28

don't what's your guess?

Unknown: 27:32

I honestly, I don't even have a guess that. I couldn't tell you it could it be? I think it'd be a reach to say, oh, maybe their foot intrinsic strength needs to be better and they wouldn't rupture. Oh, yeah, I couldn't tell you. I mean, you could certainly say that you know, the size of these guys and the speed they play at I mean, the performance levels are higher and higher is that it has ever reached the maximum capacity of the kilise tendon when when the huge guys are playing at that kind of speed? I don't know.

Dr. Spencer Baron: 28:01

Actually, Paul, I have a question that I've been wanting to ask someone for the longest time and that is have you seen cleats lately? Like I mean, especially standard issue cleats that the NFL or or you know soccer provide? I mean, yeah, they don't seem very bomb mechanically sound cleat I hear so many comments and complaints about about standard issue cleats that maybe come from Nike or Adidas any thoughts or now

Unknown: 28:36

I'm with you Spencer. I'm like, I will even see some of the athletes that we treat, have just a nightmare of a time trying to find shoes that fit them all right, especially the cleats. And it's you know, some of the guys are wearing like, like cleats that are three sizes too long, because they can't they don't have anything that's wide enough, right. And it's shocking, these high level athletes don't have access to cleated footwear that actually is shaped like their foot. I mean, that's one of the things that that like I like about the minimalist shoes is they're kind of shaped like our feet a little bit more right but but you can see even especially the position players their their cleats are super narrow super pointy in the toe. And I guess if you think about sports performance and and hopefully this will be there'll be some good research that can highlight this in the near future but but I mean, I can't imagine that squeezing your toes together and trying to perform well is better for you the letting your feet spread out and in natural shape and be able to utilize your toes better right so I think there's a startup company in somewhere in the Pacific Northwest that's developing custom soccer cleats that are made from a scan of your foot so then the Queen's are shapely foot, and they're I believe they're trying to come to market kind of as we speak but I mean that concept to me would really is really overdue and necessary for these athletes. And it is shocking that Nike and Adidas and others aren't really kind of saying, Okay, at this point, we need to make sure that we fit the foot well, because there's evidence even just on comfort of footwear, that if you were, if you have comfort options and you select the most comfortable shoe, you're less likely to get injured, you fatigue less quickly, your sports performance improves. There's even evidence that your prefrontal cortex brainwave activity is smoother in shoes that are comfortable, and the most important part of comfort is fit. It's the first and most important things. So So yeah, that's that's that's definitely Spencer. It's shocking. You know, you see these athletes that look like could afford a custom shoe that fit them well. And it's not available to choose the moment

Dr. Spencer Baron: 30:52

what what you would have fallen over, if you would have seen how some of these guys they get these brand new shoes that because Nikes is a sponsor, let's say, and you'll see the brand new shoe has a little X cut into where the bunion is where the metatarsal the where the bunion would get squashed in there. Yeah, yeah, yeah.

Unknown: 31:17

Yeah, that's one thing too, about, you know, all these colleges and teams, you know, have their footwear contracts. And so, you know, saying that every athlete on the soccer team has to be a Nike or every athlete on the track and field team has to be a Nike. It's like, okay, that's, that's really not the way to stay healthy and optimize performance. But that's the way it is in this world.

Dr. Spencer Baron: 31:38

You would, you would think that would be the most important piece of equipment. Yeah. Gary, with that said, you know, I the dilemma that I've always tended to experience and a lot of my patients do is choosing the right footwear. Could you share some thoughts on how you would approach or you tell a patient to select their footwear?

Unknown: 32:02

Yeah, so most of the research on prescribing footwear has been done on running shoes, because there's such a high incidence of overuse injury in runners. And the basically, the research shows that the traditional method that's done in a shoe store and full disclosure, I actually have an ownership interest in a running shoe store in Minneapolis. And so I help educate the staff. But what if you go into most shoe stores in the US, they're gonna look at your foot, maybe who wants you walk and say, Oh, your arch does this, therefore, we're going to put you in this shoe, are you overpronate, therefore you need this shoe, there's been at least eight or 10 different studies that tried to validate that method to show that it does reduce pain or injury and runners and none of them showed that it works. So so we know that that method of fitting shoes is not scientifically valid. So but if you look at the research on okay, what is a valid method for reducing pain or injuries in runners, all the research shows that it comes down to the person trying shoes on running in the shoes, because comfort decreases from standing to walk into running. So you do have to run as a shoe or perform the sports movement in that shoe that you're going to be using it for to assess comfort. And then if you select the most comfortable option, and you have to try on at least three or four minimum, then that would reduce your risk of injury and improve increased sports performance. So so that's why I tell patients do not buy your shoes online. And make sure you go to a store where you can try them on. Don't let anyone tell you what shoe to get. I'm not going to tell them what to get their therapist and tell them what to get their coach their their. Their athletic trainers should not tell them what to get because all the research shows we have to be our own expert at what's comfortable to us. And we all prioritize things differently like some people like a really cushy running shoes some people like a shoe with more road feel. And here's here's a really cool study that I cite very often done by bento. Nagin colleagues up at University of Calgary they took a group of runners small group it was only like five or 10 people in the study but they had them come to the lab and they fit them for five different shoes each. And then they sent those subjects away for a week they said Go spend a week running in the shoes getting familiar with them and then come back for some testing. When they came back into the lab. They had them rate the shoes from most comfortable to least comfortable. So if subjects had five shoes to rate and then they they put them on a treadmill they tested their vo two Max and each of the shoes and they found that the shoes that they were most comfortable in were the shoe that they were most metabolically efficient in and Flipside the shoes that were least comfortable, they released efficiently. And so that study is pretty cool. That shows part of the way we perceive comfort has to do with whether that shoe works with our body's preferred movement pattern or against it and that was MiGs theory that preferred movement patterns that, that we can't necessarily measure or quantify how the shoe is going to affect our movement. But if you use comfort as sort of a proxy that tells you the one that's working the best, and when you're most efficient, and you're going to proceed, that's cool. So that's what I tell my patients just trust instinct that that study right there. We're not testing vo two Max in the running shoe store. So you just got to go buy comfort.

Dr. Spencer Baron: 35:24

So some one of the running shoe stores that I always send my patients that has a treadmill in there, which I think is super cool. And they actually have our local podiatrists go in and educate the salespeople. And it's yeah, it's fascinating. Because it used to be you go to Sports Authority, or Dick's and you pick out your favorite color.

Unknown: 35:44

Right? Exactly. Yeah. And so yeah, and you have to run in the shoe to get a sense of it. Like when I'm because I'll go to the store and fit people, my patients will come in and meet me or I'll just be there myself. But But when some people just stand up and shoot like guy like, and I'm like, No, you gotta run.

Dr. Terry Weyman: 36:00

And I'm so glad you mentioned to go to a store and run because I have a friend of mine owns a running store. And he's he's extremely knowledgeable when it comes to shoes and his businesses going under because everybody's going to Amazon and buying shoes. And then they won't bring the shoes back to him because they don't work. And he's like, Well, you didn't buy him here. And they but they want they Hey, where you are at, and his business is going under because everybody's doing especially since the shutdown. Everybody went online and trying to get those patients back in the store is killing them. And so I'm so glad you mentioned that, because it's so you're so right, you've got to walk move. Do that. And so thank you for that for all those shoe owners out there, or shoe stores owners out there.

Unknown: 36:47

Yeah, well, I just feel like you know, if you treat foot and ankle, you have to have good relationships with retailers in your area, because you need them to take care of your patients. And you need them to be kind of intellectually honest when they're fitting shoes, too, right? So yeah, I pretty much on a daily basis. That's one of my first questions, especially when I'm treating an injured router is where did you get your shoe? And did you compare it to a few others before you got it? Or did someone tell you to get it? And I think right now, like 20, some percent of all shoes are bought online. And you know, if you're going for fashion, that's fine. But if you're going for performance or trying to reduce your risk of injury, that's not, it's not fine. It's not going to serve you in the end. And obviously, you know, we're seeing people that are already injured. That's why they came into our clinics. So to them especially like, you got to go try not you got to go to a place that

Dr. Spencer Baron: 37:41

has you hear about the barefoot runners from Ethiopia that are breaking records in our, you know, marathons here in the United States? And, you know, they're just, you know, they're, they're bred to be barefoot runners. How did shoo this shoe evolve into such an? Well, now now it's a fashion statement. But now it's evolved and keeps evolving, like it does? Well, it

Unknown: 38:11

was like in, you know, in the 70s is when they started getting more cushion. And then they just kind of kept getting thicker and thicker as the cushioning, you know, became more and more prominent. And then I think to a point where, you know, injury rates when you look at, you know, running before the whole cushioning phenomenon hit, running injury rates didn't really go down, we just changed like, I had read some stuff that showed during the first running boom and early 70s, the most common running injury was was Achilles tendon and calf strains. But then as shoes got more cushioned than knee pain, patellofemoral pain became the most common injury. And the thought was that the higher cushioning changes shock loading rates, but it also encourages a longer stride which increases the load on the knee. And then that, you know, if you if you land with two and a half times your body weight on an elevated platform of foam, there's more torsional forces tissues can compress on evenly. And so so so the the injury rates didn't go down, but they just changed to different places. And it's and it's a good friend of mine, Craig Payne is an Australian podiatrist and he's brilliant, but he always says different shoes load different, different tissues differently for different runners. And his point is that, that that there's always stress and load with running and whether you're talking to minimalist or maximalist or old shoes versus new shoes, there's a stress and load with running the shoes influenced differently for different people in different ways. So, so the kind of can't get away from the injury rate and runners and part of that is that running is highly repetitious. You know, we run in straight lines on flat surfaces relatively constant paces. So there's a lack of variability in that movement pattern. And so that's one of the thoughts why overuse injuries are So high end runners. And so one thing that I tell my patients is you want to introduce variability by either changing up the terrain, so getting off road going to the beach, you know, having trail run versus asphalt, and concrete. But there was a paper that showed that having more than one pair of running shoes reduces your risk of injury. And that again, would be because you're introducing variability. And I usually tell my patients make sure those shoes are as different from each other as you find comfortable, because I am seeing and maybe you guys are seeing this in clinic to like some people that only run in shoes with big rockers, like hokas are the maximalist type of shoes. I've starting to see people getting like to be sent to your tendinitis. I never used to see that in runners, but now you see it, and I always ask them, Is this your only running shoe? And very often they're like, yep. Or they're like, No, I have another pair of focus, too. It's like, okay, well, you know, if you have a conventional shoe good are you like your home, because I'm not telling you not to run in it. But you need to find another shoe to rotate into the mix. And just like with the other stuff, there isn't like a hard and fast rule. Like one shoe should be for your long runs. Once you shoes should be for your speed workouts. Some people like it that way. But others are like, Yep, I got a trail shoe. I got a minimalist shoe, I got a Hoka shoe, I got whatever. So but but having at least to introduce that variability is a way in strategy to reduce your risk of injury.

Dr. Spencer Baron: 41:21

Absolutely fascinating. I love I love it, and you cite references. That is great. Thanks, Paul. I appreciate that. Now, I have another age old questions I've been so curious about for so long is the routine ankle bracing and taping that you typically see in football basketball now? No, I understand that. And for the listening audience, I love athletic trainers. I mean, they we get along always so well. And yet, what I see is the the the constant need to tape an ankle, even in the absence of injury. Your thoughts on what that does to the biomechanics of the foot? Yeah,

Unknown: 42:11

well, and I'd say I haven't, like dove into literature on that recently. But But yeah, you do. Anytime you restrict motion in one joint, the joints nearest it, then have an altered stress and load to right. So so yeah, so what is the right amount to safely, you know, limit motion of the ankle joint without increasing the stress and load on the knee or the joints of the foot and ankle. And, but I certainly see a lot of that too. Although, I guess in my area. I don't think I see it overuse. We work with some of the local universities and colleges and some of the professional teams and I would say that I don't necessarily see a lot of like what we'd call prophylactic taping or people or taping just to prevent an injury. But I did have recently a high level volleyball player her her mother was a college volleyball player in the 90s. And she came in with foot pain. And as we were kind of talking about things, I think it might have taken even the second visit before I understood that she always plays an ankle braces. And once once she told me that I was like, Okay, well, so because you have ankle sprains. She's like, No, my mom had ankle sprains when she played college volleyball, so, so she always had to wear ankle braces. So now I wear ankle braces. And so I had, I had to talk to the mom. And she was kind of reluctant at first, but I said, Hey, look, you know, the research has changed that, that prophylactic taping or bracing, if she, if your daughter doesn't have an ankle injury or history of ankle injuries, we wouldn't want a brace, we'd want to strengthen her. And the problem was she had, she was getting pain to her tail on a vehicular joint, which is, as you guys know, not a common area to get beat up. But that's kind of right where the brace was causing her to probably overload that part of her foot. So I was like, we gotta get her out of the brace because of her foot pain. And the good news is that that she doesn't need to be in a brace because she doesn't have yesterday, ankles injuries anyway. And like I said, the mom was reluctant and and they actually became really good patients because they have other athletic kids. So I see him regularly but but the mom having played college sports in the 90s was like, okay, that's just what we did. And it's like, I know that is what you did. And it was done more commonly than right, is that what you guys see feel? Yeah, I'm

Dr. Terry Weyman: 44:22

still seeing high school and colleges tape profile prophylactically and spat and doing all this stuff. It seems like it hasn't caught up yet.

Unknown: 44:32

Yeah, and as you know, it can be different school to school or region to region to right. Some of the the philosophies of the athletic training team and the medical team kind of vary on that.

Dr. Spencer Baron: 44:44

It's such an integral integral part of preparation before a game or practice that I wonder if some of the athletic trainers would think that that they would, their utility would decrease if they stopped doing like what else would they do? I'm sure there's other things but I mean, it just it It's so it's so pervasive. I mean, it's everything. And actually, a few really sharp NFL guys would would would say, No, I don't want any taping. I've never had an ankle sprain or had an ankle sprain. But I really want to depend on my own biomechanics. And I'm impressed that they go against the grain of what?

Dr. Terry Weyman: 45:22

Well, I got a quick question, because I read somewhere down the road that, especially with like a xodus tape, it only really is good for about 20 minutes. Is that true? Because maybe part of the taping, they get taped an hour before the actual game. And by the time they actually start the game, the tape isn't really doing anything anyway. And maybe it's more of a mental thing. What's your thought on that?

Unknown: 45:49

Yeah, no, I saw that to theory. I think I saw something that after about 20 minutes, that tape has kind of stretched a bit. And, and I guess, I guess the maybe I remember the paper, like, it didn't mean that it wasn't doing anything anymore. But it wasn't given as much support as what was first applied, of course. So yeah, I don't know. But there was another paper I downloaded but didn't read yet. That even just showed foot intrinsic strengthening is a great part of rehab after any sprain, so. So you'd also think that because obviously with sprains, we're always talking about preventing the reoccurrence. Right, so so maybe that's an area it's like maybe again, coming back a little bit to where we started, instead of taping a lot, should we just be making sure that they're really strong and activated and those intrinsic muscles of their fluid in addition to the same strength, balance proprioception training that we're doing post ankle sprain.

Dr. Spencer Baron: 46:40

So, Paul, we are entering the phase of one of my favorite parts of the, of our show, and that is the rapid fire questions. Some of it has nothing to do with what we talked about. And some of the questions have something to do we talk about, but it's more personal. And there's five questions. And as I said, the rapid fire. Are you prior bring them on? Alright, man. Ready? Question number one. Where's your favorite place to go? Barefoot beach forest desert or park or somewhere else?

Unknown: 47:14

Yeah, I guess I'd have to say beach. Yeah, it's just safer. And the sound of the ocean is just something therapeutic. Perfect.

Dr. Spencer Baron: 47:23

Yeah. Great. Great question number two favorite foot health tip that you'd like to share? Or you feel as unique?

Unknown: 47:31

I would say kick off your shoes. Just kick them off. Go barefoot, let your foot spread out. It's so good.

Dr. Spencer Baron: 47:39

Yeah. Question number three is, you know, I've seen I've seen YouTube we've all seen these videos of people that have no arms that can do such things. There's with such dexterity with their feet. Is there something that that you would suggest a skill that everyone should learn? That does have arms but yet should do their feet?

Unknown: 48:11

You know, actually, this might sound funny, but so I'm not much of a golfer. I don't know if you guys are. I'm actually pretty terrible at golf. But yeah, my wife and I did like a nine hole read a few years ago just to have something to get out of the house. I would encourage I think what people worry about, like as you get older is that you need to be to have more protection. But as a part of the aging processes, you know, I think there should be like a minimalist culture, I think there should be minimal issues for way in the yard. Like, like, wherever you feel safe. Just letting your feet on a natural surface move. Well, I would say that would be like maybe a tip for like, like, like health and longevity is keeping your feet mobile, keeping your feet strong and utilizing opportunities at a natural surface. So let your feet do a beer design. Hey, since golfing is such a common thing for older kids, Hey

Dr. Terry Weyman: 49:02

Paul, and especially I'm gonna give you a little tip I've been having every patient take up to shoot and I go within six weeks I want you to be able to write your name by holding a pen in your foot and be able to write your name on a piece of paper with your foot because now they have to control their toes strength and hold the pen and add the dexterity of writing their name. And it's pretty cool because at first people came in hold the pen so I go and then once they can write it with their dominant foot they have to build right with their opposite foot

Unknown: 49:34

and that's not a bad idea like we need those little challenges

Dr. Terry Weyman: 49:43

the athletes hate it because they can't lift their big toe up and they get so competitive and they get so pissed off and and then I'll sometimes my favorite ones I'm like if you can't write your name you have to be will grant the legend six weeks and if you can't sign the check with your feet you bye All right.

Dr. Spencer Baron: 50:12

Great. All right, question number four. If you could go back in time and meet one person, who would it be and why?

Unknown: 50:21

Well, this is probably super personal, but it would be my grandfather, my, my mom's father died in World War Two. And he was he was a pilot. He was I was kind of a hero to me and to her. So it's too personal for people to see in context, historical figures.

Dr. Terry Weyman: 50:38

But that, that's cool.

Dr. Spencer Baron: 50:42

That's good. That's good. Oh, yeah. Yeah. And question number five. Last one is what is one thing you would like to be remembered for? Oh,

Unknown: 50:51

that's a good question. I know more than I think I would just want to be remembered for as a compassionate caregiver, just someone you know, I don't do life and death medicine. But if I can do little things that help people kind of live their life and enjoy their life and, and have a better quality of life, especially as their age. That's that was cool.

Dr. Spencer Baron: 51:10

That's great. That's great. Hey, I really, this has been a fantastic, very informative program, and you're really sharp. And I can see that you're quite the caregiver to, you know, being able to cite references, as well as you know, make statements that really will help shift people's consciousness about foot health. I want to thank Ted for confer you have introduced us to you. That is one brilliant

Dr. Terry Weyman: 51:39

guy. Right? Do you have to say that he's had to sit on air? We can't tell him that he's brilliant on air. Bob, Ted, Ted's fantastic. Yeah. Now

Unknown: 51:53

he's a good guy. And I'm thankful for the introduction to

Dr. Spencer Baron: 51:58

it was great. Well, thank you.

Dr. Terry Weyman: 52:00

Thank you very much, Dr. Paul. And I do want before we end, I do want to ask one question, where do you see the future of footwear innovations on the horizon? I want you that you go look into the future. And tell me where you think all this is going? I know, we've alluded to it. But where do you see the future of health? footcare? Yeah.

Unknown: 52:20

No, that's a good question, Terry. So there, there are some industry footwear industry experts that think that in the next five to 10 years, we will all have access to customized footwear, basically. And the technology is all out there now, like I do 3d printing with with custom orthotics and clinic when I need it. We also have a 3d scanner in our running shoe store. So we can make really precise, accurate measurements and 3d models of people's feet. Even with our phone, I scan for orthotics with my phone and clinic. So the access to customization is increasing. So in the not too distant future, you could scan your own foot at home, upload a 3d model of your foot to a website, a company's website, and then you could design the shoe, they can design the shoe for you. They can use algorithms to determine you know, what might be the right amount of cushioning or support. That part's still has a lot can be worked out. But certainly artificial intelligence, data mining, and machine learning will go into helping customize footwear.

Dr. Terry Weyman: 53:19

All right, I'll end on that. That was fantastic. Doc, thank you so much for your expertise. And it's so nice to talk to a podiatrist with this forward thinking of exercising your feet is so important. So thank you, and I would concur with Spencer. Thank you, Teddy for making this introduction. But I appreciate your time, man.

Unknown: 53:42

Thanks, guys. I enjoyed it.

Dr. Spencer Baron: 53:43

Thanks. Thank you for listening to today's episode of The cracking backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at cracking backs podcast. catch new episodes every Monday. See you next time.