Our Podiatrist , Malia , was featured giving her comments on the various brands of ‘shape you up’ shoes. We even did a simple gait analysis to see if these shoes really worked.

Check out the clips on razortv!

Part 1: http://www.razor.tv/site/servlet/segment/main/lifestyle/65492.html

Part 2:http://www.razor.tv/site/servlet/segment/main/lifestyle/65490.html

 http://www.asiaone.com/Just%2BWoman/About%2BMe/Well%2BBeing/Story/A1Story20081103-98099.html

What is the maximum safe height of heels before there is a risk of damage such as bunions, hammer toes, neuromas, metatarsalgia, Achilles tendonitis, ingrown toenails, and corn and calluses?

Heels should not be more than 1 inch in height. Our feet are made to walk on flat relatively flat surfaces. Wearing high heels shifts the weight of the body to the forefoot. E.g. 70% of our body weight is on the forefoot  when wearing 3 inch heels as compared to 20% when wearing 1 inch heels. This leads to a variety of foot problems e.g. bunions, metatarsalgia ( forefoot pain ) , heel and arch pain, Achilles tendonitis.

What treatments do you offer for such damage cause by high heels?

For bunions, hammer toes, neuromas, metatarsalgia, Achilles tendonitis, ingrown toenails, switch to lower heels with wider toe boxes ( Mary Jane type shoes ) until the foot injury recovers.

To prevent calluses, use footwear with  lower heels, broader toe boxes, insoles prescribed by our podiatrist to redistribute the pressures under your foot effectively

To prevent cracked heels, use a pumice stone to remove dead skin cells alternate days. Moisturise immediately after. Wear stockings to retain moisture if you are always in an air-conditioned environment.

To prevent blisters, never wear new shoes for more than 1 hour in the beginning as shoes are not yet worn in and may cause blisters.

What do high heels do to our feet, posture and biomechanics of the human body?

Wearing heels also shifts the centre of gravity forwards – the pelvis is tilted forwards, and the shoulders have to be held back to prevent the lady from falling forwards. This gives a lady a very straight sexy posture but in the long run, will cause knee and lower back pain.

What are the most important steps to take when buying, looking for, considering, wearing high heels? (you can give as many important steps as possible)

Toe box should be wide enough to accommodate the widest part of the foot comfortably.

Avoid heels with only a strap across the forefoot. Choose one with at least straps around the ankles too. Slim kitty heels usually provide little stability. Go for broader heels or wedges.

What are the dangers for women in the 25-35 year-old age range? Are this group especially vulnerable or resistant to the negatives of high heels?

4 inch stilettos are bad for your feet regardless of how old you are. The best thing to do is to minimise the time you spend in these shoes. One good practice, if your working lifestyle permits, is to have a good comfortable pair of shoes to wear while commuting to and from work, and while in office. Leave your heels in the office and use them only when you need to meet clients or for formal meetings.

Is there a difference for office high heels and party/club high heels?

What statistics do you have in terms of damage done, diseases caused, cost of medical bills caused by high heels.

Some problems are not purely from high heels alone but could be also stemmed from a pre-disposing problem such as flat feet. As such, it is hard to isolate damage, disease etc to be only caused by the use of high heels. Most injuries recover once the wearer changes footwear.

What styles/types/designs of high heels are best and which are worst?

Better

1 inch heel closed leather court shoe, Mary Jane design

Bad

High heeled slippers with only a strap across the forefoot. Kitty heels

What treatments can you do to repair the damage from high heels?

Quick fix

Have a spare pair of comfortable shoes in the car or office to change into. Have plasters in your handbag in case blister breaks, insoles and paddings are also available at most pharmacies

Long term

If foot pain persists, a visit to the podiatrist will enable you to understand your foot type and walking pattern. Your podiatrist will then discuss with you the type of footwear and/ or insoles that are  suitable for you and what are not. He/ she may also prescribe for you some simple foot exercises and stretches that you can do at home to help alleviate the foot pain.

What case studies do you have of people affected by high heels?

Do you have drastic studies such as not being able to walk, surgery etc and ones that turn out better such as good ending stories? From your own personal experiences/patients?

It is hard to say that a certain injury is caused only by high heels as most injuries are multi-factorial.

The most common injury that requires surgery would be a bunionectomy, may be better to speak to an orthopaedic doctor about this regarding to costs, recovery time etc.

What footwear should someone going to the gym wear? Would running shoes or cross-trainers be better? Or should it be something else? Why?

The person should be wearing a shoe that reflects the activities that the person is doing. Each type of sports shoe is designed specifically for that sport and if used for other sports may 1) not work as effectively 2) not last as long 3) increase potential for injury. Having said that, if the sport you are doing has similar movements to the sport your shoe was designed for (i.e. squash, tennis, badminton), it may well be adequate.

For example a shoe specifically designed for running would not be a good choice for a tennis shoe. This is because running is largely a straight forward-directional sport, with (hopefully!) very little lateral movement, so all of the engineering gone into the shoe would be designed to deal with the forces associated with running in a straight line. Tennis is a very lateral sport and involves much sidestepping and very fast changes of direction. This movement will place lots of force into the shoe for which it is not designed and therefore the shoe may not last as long as it should.

Another consideration is the height of the heel in the shoe. Running trainers tend to have a higher heel than tennis, basketball or cross trainers. This means that the participants foot is higher from the floor, therefore the centre of gravity is higher and requires less force to turn the ankle, placing the participant at potentially increased risk of ankle injuries.

If you look at the sole of a running trainer the grip tends to be one of ridges which run across the sole from side to side. This gives a good traction when running in a straight line but if you need to turn/pivot on the foot the tread will not be aiding this. With trainers designed for court based games and lots of stopping, starting and turning the sole will have a mixture of ridges and areas designed for a body to pivot on. Infact recently there was a football boot that was marketed with a pivoting stud under the ball of the foot to aid the sportspersons movement. In this instance however I am unsure how much difference this makes though and may just be a marketing gimmick. Also, shoes that are designed for sports with a lot of lateral movement tend to have a much stronger side panel, and in the cases of things like basket ball boots, the shoe/boot will come up higher to protect the ankle.

With regards to wearing a cross trainer for running, it really depends on how much running you will be doing. If you are doing 5 minutes as a warm up at the gym a couple of times a week then you will likely get away with cross trainer. A basket ball shoe is not neccessarily designed to cope with the forces associated with running, so may well lead to injury.

An important thing to remember about injury, especially chronic injuries sustained by populations such as runners, is that everyone is individual. As an example I am sure everyone hears of stories of a poeple who ran a marathon last year in 2hr 30 min in a pair of 1984 Hitec squash shoes. This sort of person has been blessed with very good biomechanics and may well be able to continue doing this their whole life. This doesn’t mean that everyone is able to do this. What I am getting at is that everyone is individual, and they are put together in a unique way, so what might work for one person may not work for another. Don’t buy a shoe because your friend swears by it. Go get assessed and find the shoe suitable for you.

If someone takes part in several sports, should he then have one pair for tennis, one for jogging, one for walking etc? Or would one pair of cross-trainer be good enough?

If you are playing several sports I think it is wise to have a shoe for each type of activity. Running and walking you can use the same shoes, unless the walking is on particularly rugged terrain, where you would benefit from a more rigid walking shoe. Tennis, badminton, squash it is best to find another pair appropriate to that activity. As I previously mentioned, think about the movements you will make during that activity and think about the sport the shoe is designed for. If they are similar then the shoe is possibly ok.

How does one pick a shoe that is suitable for them?

If you plan to do any sport consistently, lets use running as an example, then it is best to have a pair of shoes fitted by someone who knows what they are doing. There are a few specialist running shops in Singapore who’s staff have an understanding of correctly fitting footwear.

Correctly fitting means that the length, width, depth, weight, shape of the toe box, shape of the last, height of the heel counter, most appropriate lacing technique, appropriateness for activity, rigidity/composition of the sole and whether the shoe is a support or cushioning shoe (and where the various support and cushioning is placed in the sole) are all factors influencing picking the right shoe for you. If you are in any real doubt it is best to see an appropriately trained sports medicine practition, such as a Sports Podiatrist, who can provide a full biomechanical and gait examination and then discuss with you the options and pros and cons of various footwear.

When buying your shoe spend a bit of time with them on in the shop. 10-15min or more if you have to. If the shop has a treadmil (as some do) have a run in them. Always try an alternative shoe to compare the first choice with. If it isn’t comfortable now it is unlikely to get much more comfortable once you have done 10k in the shoe. If you are unsure, try another or don’t buy.

Are branded or high-end shoes necessarily better? Or are less expensive brands be equally as good? What’re the differences to look out for?

High-end branded footwear and expensive shoes do not neccessarily make the shoe better than a cheaper or lesser well known brand shoe. Often slightly lesser well known brands such as Mizuno, brooks and saucony have some excellent running shoes.

There was a research paper released recently that showed in the lab that the really expensive shock absorption shoes didn’t actually provide any more shock absorption than the entry level model for that brand. There is also a school of thought that believe too much shock absorption is a bad thing, because it can decrease the response of the in-built shock attenuation system the body has.

The main thing to look for in a shoe is fit, comfort and it is designed to support your body type and lower limb mechanics for the activity you are planning to do.

Please like our facebook page to keep up to date with articles, talks and informed opinion on all things foot health and sports injury related (with a podiatry focus).

http://www.facebook.com/pages/The-Foot-Practice-Podiatrist/187088421309243

Regards,

Sam Randall

Bad footwear beget bad feet

an article published on Asiaone.com.

Malia Ho, Podiatrist
The Foot Practice @ Singapore Sports Medicine Centre

Your child is ready for shoes when he starts to walk. It is vital for them to be able to walk barefoot steadily before they start wearing shoes. This age varies from child to child but should be between 11 – 18 months old.

When they first start walking indoors, you could start them off on socks with a non-slip base or soft leather shoes. This is because toddlers depend on the sensation and feedback from their feet in order to position their feet on the ground. You will also notice that toddlers will claw their toes more in order to get a better grip of the ground. This phenomenon decreases as the toddler grows and his gross motor ability improves.

When your child starts to be more steady and is ready to walk outdoors, they can start to wear shoes. Although it is best to wear shoes if your child is walking on hard surfaces, he should be encouraged to walk barefoot on soft ground such as sand or grass to encourage the development of the foot muscles.

Depending on how active your child is, you may want to have 1-2 pairs of shoes for sports and running around ( to be rotated on alternate days ) and 1 pair of sport sandals.

A good shoe should have the following features: –

1. Heel counter should be firm
2. Toe box should be high (the child should be able to wriggle their toes when wearing them)
3. Foot should be well strapped into the shoe either by a Velcro strap or buckles
4. Internally, there shouldn’t be any rough seams or edges which could cause calluses and blisters
5. Soles should be flat and anti-slip (no high heels!!!!!)
6. The upper of the shoe should be made of a breathable material such as leather

To ensure that you have the right size, always buy shoes in the evening or late afternoon. At home, get your child to step on a piece of paper and draw round the foot. This is the shape of the weight bearing foot. Cut this out and use it as a template. At the shoe shop, place this template into the shoe. If the edges crumple up, then the shoes are too small.

It is always best to go shoe shopping with the child to ensure that the fit is right.

After your child has put on the shoe, ensure that there is about 0.5 cm between end of shoe and longest toe. The width must be as wide as the broadest part of the forefoot.As your child is walking, the heel should not be slipping out of the heel counter.

Wearing shoes too big may cause your child to walk clumsily and trip often. Conversely, shoes that are too tight will cause blisters, calluses, in-grown toe nails and inhibit growth if worn for long hours.

At about 18 months, you may need to buy bigger shoes every 3 months. The rate of growth slows down as the child gets older and you may find that you will only need to buy bigger shoes every 5-6 months when the child reaches the age of 3 years. Rate of development differs between boys and girls ( boys tend to develop physically at a slower rate. )

It is not good to wear hand-me-down shoes as the shoe will mould itself into the shape of the first wearer’s feet. This would be different from the 2^nd wearer and may cause blisters/ calluses in the 2^nd wearer.

You may want to bring your child to a Podiatrist for a foot assessment if he is excessively clumsy, trips often, has feet that are pointing inwards, or if he is unwilling to walk and wants to be carried all the time ( a child may not be able to verbalise foot pain and may show this by simply refusing to walk! )

As a podiatrist, one of the most common things I hear from concerned parents is “I think my child has flat feet, do they need insoles?”.

Unfortunately there is no straight forward answer to this question. However, there are a few facts and a little guidance that I think it is very important for everyone to be aware of, which may make your decision on whether to seek professional advice and/or intervention a little easier.

Firstly, during normal development and growth of a childs skeleton all children up until around the age of 6 years old will appear to have flat feet. This is partially due to the angles of the bones in the leg and foot and how they move, and it is also due to the fact that children tend to have a little fat pad in the arch of their foot giving the appearance of a flat foot. The child should grow out of this and the foot start to appear more normal and adult after age 6.

Secondly, there is actually no strong scientific evidence that a flat feet will cause problems in later life. Most of the african elite marathon runners have what would be classed as flat feet. So flat feet are of very poor predictive value for future injury.

This said, if your childs feet are so flat that the outside edge is off the floor, or they are complaining of pain, discomfort or aching in the feet or legs, or their toes point too far out (duck feet), or too far in (pigeon toes) then they may need someone to have a look at them. Symptoms do not just include pain, any thing that impairs your childs activity to run, jump, play and enjoy life as a child can be counted as a symptom. Also, family history is very important. If you or your spouse had problems as a child or young adult, there is a chance that your child could inherit the anatomy responsible for this injury and be themselves at increased risk of similar injury.

Lastly, there are certain unscrupulous types offering insoles from stalls in malls in various places around Singapore. These companies offer a 18 or 24 month “flat foot correction plan”. They claim that their insoles will improve your childs foot structure and at the end of this timely and costly procedue your child will have a “normal” foot. This is not true and is most definitely NOT supported by any scientific evidence whatsoever. Furthermore, if we look back to earlier in this article, you will remember that up until the age of 6 years old nost children have a flat footed appearance. If you were to give a child an insole at the age of 5, 18 months later I would expect that child to have developed a more normal looking arch. This would be as part of their normal development though, and it had nothing to do with the insole.

The best thing to do if you are worried is to ask yourself these questions:
- Does my child complain of any pain in the lower limb?
- Does my child have difficulty keeping up with their peers?
- Does my childs foot position look abnormal?
- Is there any history of foot injury or problems in the immediate family?

If the answer to any of these question is yes, then it is probably worth getting your child assessed by a podiatrist.

I more than happy to answer and questions, comments and queries you may have, on all aspects of foot injury (children and adults) and podiatry in genereal. Please feel free to contact me on sam@thefootpractice.com.

Lets Take a Walk Training Clinic, The Green Room, Body With Soul, Rochester Park – 4th December 2010

“Let’s Take A Walk is organised by a small group of volunteers, all in the name of doing something good and meaningful for our society. Some are first-timers, some are “old-guards” who have been quietly contributing their time and effort to this endurance walkathon.

“The power of internet has helped spread the word about Let’s Take A Walk, far and wide. As organisers, we are elated to have over 680 registered walkers despite the many numerous walkathons and marathons in town. During the planning journey of Let’s Take A Walk, we met familiar faces and made new friends. And to our pleasant surprise, newfound sponsors came knocking on our doors. It’s heartening to receive mails or contacts from people and advertisers whom we have never met to offer their professional services for our charity event.

“The Let’s Take A Walk 2010 Walking Clinic is somewhat a convergence of good deeds and kind souls. Through Sam Randall, Podiatrist at Foot Practice and his contacts with Vanessa Mc Namara, Senior Dietian at Food Clinic and Onaka Cafe, we successfully held the Walking Clinic at the gorgeous black & white colonial house, home of Body with Soul.

“4 December was the day of the Let’s Take A Walk 2010 Walking Clinic, Understanding Foot Health & Gearing Yourself For the Let’s Take A Walk . Despite the drizzle, the Green House was packed with our 40 participants.

Yousi , Chairman of the Let’s Take A Walk Organising Committee gave a quick introduction of the committee members and our guest speakers, Sam and Vanessa.

“Sam gave a comprehensive and interesting presentation on how to best prepare for the upcoming Let’s Take A Walk. At lightning speed, the candid foot expert shared useful tips on how to prevent blisters, suitable kinds of shoes to wear for the walk and varied foot-related matters.

“Vanessa gave the participants an insightful presentation from her professional perspective as a Senior Dietitian. From food diets, ways to “carbo-load”, ideal snacks and drinks to checking your pee with the pee-chart, Vanessa set many minds thinking about their existing diets and how to get themselves to tip-top condition for the real walk.

“Chiew Boon and Chan Peng, our “old guards” of Let’s Take A Walk and 100km PowerWalk survivors shared their personal experiences of how they survived their 100km endurance journeys. The participants were also treated to minty lemonade and yummy hummus dip with crackers vegetable crudités await, thanks to the reception sponsor, Onaka, Healing Café.

“Our act of paying it forward by organising this charity marathon does have some magnetism to attract like-minded walkers, sponsors and partners. Our walking clinic would not have been possible without our sponsors. We are grateful to each and everyone who have been in one way or other spread the word about this charity walkathon.Special thanks to his boss, for alerting Sam about the Let’s Take A Walk and our guest speakers, Sam and Vanessa for choosing to wake up early on a Saturday morning and sharing their knowledge with our walkers. And Rommel, for facilitating the technical set-up and Body with Soul for the complimentary use of their Green Room and the thoughtful signages to direct our walkers.

“As The Let’s Take A Walk event dates (18 to 19 December) draw near, we hope that you would garner with friends’ support to be your “ra-ra” team during the actual walk, and encourage friends to pledge donations for your endurance walk.

“To all walkers, thanks for being a good sport and taking part in this Let’s Take A Walk 2010. See you next week 11 December at the final briefing at Boys’ Town. Come 18 to 19 December, at the Let’s Take A Walk event, we would have a mega-gathering of all the kind souls – our walkers who have pledged donations (registration fees) as they embark on their personal walk challenges.”