Author name: Stephen Pinney

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Tips for Buying the Right Athletic Shoe

If you are starting a new athletic activity or recommitting to an old sport your choice of shoe wear is often critical. Choosing the right athletic shoe to optimize both comfort and performance is not easy. However, understanding the role of four components of an athletic shoe will help you make the right shoe choice. These shoe elements are: the size, the sole, the insert, and the uppers. 1. Shoe Size When thinking about getting an appropriate fitting shoe it is natural to think about shoe size. The listed shoe size is important, but there are other elements to having a well fitted shoe. There is a Chinese proverb that says: “if you want to forget, your troubles, wear tight shoes.“ Most people have experienced the discomfort associated with wearing shoes that are too small. However, shoes that are too large can also cause problems. Larger shoes may not be uncomfortable, but they often negatively impact performance, and the excess foot motion within a shoe that is too big can lead to blisters and other problems. Getting a good fitting shoe is so much more than just choosing the right “shoe size”. Shoe width is critical. The width of a shoe can vary widely between shoes that are the same “size”. For example, two size 11 shoes can be very different in their width, just as two individuals with “size 11 feet” may have very different widths to their respective feet. Making sure the length AND the width of the shoe fits your foot is essential. To do this often requires testing many brands, or in some cases seeking out specific shoe brands that make shoes in multiple widths. The “forefoot width to heel width” ratio is also important. Getting a shoe which is perfectly fitted for length and forefoot width can still create major issues if the heel is too loose, or too tight. It is fairly common for individuals to have a wide forefoot and a narrow heel. In this scenario, achieving a well fitted shoe may require some extra work. Sometimes adding heel cushioning can help. Alternatively, a snug fitting heel with a tight forefoot may be addressed by attempting to further stretching out the forefoot width. This can often be done professional via shoemaker or by purchasing a commercial shoe stretcher. 2. Optimizing the Sole Finding a well fitted shoe for your sport of choice is just the starting point. Ensuring that the sole functions optimum is the next step. When considering the sole of a shoe there are three elements to consider: stiffness, shock absorption, and heel height. A soul that is stiffer will generally be more comfortable. In some sports, such as running, a high-end stiff sole will absorb force and then return energy during the gait cycle helping to improve performance. However, in many sports there is a trade-off between having a stiff soled shoe that is more comfortable versus a shoe with a flexible sole that may improve performance and control. Sorting out this balance between comfort and performance is something that each individual will need to determine based on the sport they are performing, and their own personal preference. The shock absorbing capacity of a shoe’s sole can vary widely. Increased shock absorption provided by the sole of the shoe can improve comfort, but for some sports too much shock absorption in the sole can decrease performance. Additionally, consideration needs to be given to the longevity of the sole with respect to shock absorption. For sports that involve considerable walking or running the shock absorbing component of the shoe’s sole can be lost fairly quickly. It can be frustrating when you need to buy another pair of running shoes eight weeks after you made a purchase because the sole has lost its shock absorbing capacity. Finally, the heel height can be very important. The “heel rise“ is the difference between the height of the sole at the heel, and the height of the sole at the forefoot. For many sporting activities, a slight heel rise of 4–12 mm can help offload the Achilles and decrease the likelihood of developing Achilles tendinitis or other overuse injuries in this area. However, for other sports, there may be a loss of performance if the heel rise is too high. 3. Orthotic Insert The orthotic insert is another critical element when looking to purchase an athletic shoe. Inserts can be prefabricated or custom. A softer insert may be beneficial from a comfort point of view, especially if the sole of the shoe is fairly stiff. Many athletic shoes and hiking boots come with high-quality pre-fabricated orthotics. However, if the orthotic insert is flimsy consideration may be given to buying a shock absorbing over-the-counter orthotic. In some instances, individuals may benefit from a custom orthotic. Although it should be noted that many, if not most, custom orthotics are a high-priced version of a well-made over-the-counter orthotic. If the goal is dispersing force widely across the sole of the foot, a good over-the-counter orthotic will likely do the trick. Shoe Uppers The “upper” of a shoe is the part of the shoe above the sole that covers the foot. Choosing an athletic shoe with the right upper is often a matter of balancing comfort –versus protection and support. Many athletic shoes have flexible mesh-type shoe uppers which will provide considerable comfort. However, for some activities such as hiking, or sports such as tennis that require a sudden change of direction a more supportive, durable upper will be preferable. Additionally, it can take a while to “break in” a new shoe with a stiffer upper. Doing this in a graduated manner can make this process easier. Choosing the optimal shoe for your athletic or fitness endeavor can be a challenge. However, by thinking about the the four elements of 1) size, 2) sole, 3) orthotic, and 4) upper; you will be well on your way to getting an athletic shoe that is not only comfortable, but also

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Understanding Achilles Tendon Ruptures

There have been some high profile Achilles tendon ruptures recently, including NFL quarterbacks Aaron Rodgers and Kirk Cousins both suffering season ending Achilles tears. This has focused a spotlight on this fairly common injury. There are three important things to know about Achilles ruptures that will allow you to understand the injury –and why treatment of Achilles tendon ruptures can be challenging and prolonged: Role of the Achilles Tendon The calf muscle runs into the Achilles tendon (Figure 1). The tendon then attaches to the back of the heel bone. Effective functioning of this muscle-tendon unit is important for propelling the body forward, whether it be walking, running, or jumping to dunk basketball. When the calf muscle contracts it pulls through the Achilles tendon applying force on the heel bone which can move the foot downwards (plantar flexion). The calf muscle working through the Achilles tendon allows the foot to generate a strong push-off. However, “pushing off” is actually NOT the primary function of the calf muscle and the Achilles tendon. Its main function is to slow the upward movement of the foot immediately prior to pushing off (Figure 2). Think about suddenly changing direction like a running back might do in football. The calf muscle working through the Achilles tendon needs to generate a lot of force to limit, and then stop, the upward motion of the foot. This resistance to upward motion of the foot is essential so that the foot stops moving upwards and then begin the push-off motion -allowing the athlete to change direction. It is almost like a rubber band in that the Achilles lengthens with increased loading, and then recoils during push-off. This concept is critical to understand because it’s this phase when the calf muscle is contracting and the calf and Achilles are actually LENGTHENING when the most force goes through the Achilles tendon. This is known as an eccentric contraction. It’s during this phase just prior to push-off that the Achilles tendon ruptures. Requirements for optimal Achilles function To function optimally the Achilles tendon must be strong. Additionally, the calf muscle must not only be strong, but also contract in a coordinated manner. The forces generated by the previously mentioned eccentric contractions can be enormous –many times bodyweight in the case of certain athletic maneuvers. This is why the Achilles is the largest tendon in the body. It has to withstand the most force of any tendon. The need for the Achilles tendon and calf muscle to have optimal strength is problematic with respect to recovering from an Achilles tendon ruptures. Inherent challenges in recovery from an Achilles tendon rupture To function athletically we need a strong Achilles and a strong coordinated calf muscle. An Achilles tendon rupture affects both of these adversely for an extended period of time. A ruptured tendon will have no strength immediately after it has ruptured. It will remain weaker than needed for many months after the injury. This is because optimal tendon healing is a slow process. It takes time! Additionally, because the calf muscle is not used normally while the tendon is healing this muscle becomes considerably atrophied. This calf atrophy and loss of muscle coordination is exacerbated if the calf is not allowed to contract at all. So the inherent challenge of recovering from an Achilles rupture is that not only does the tendon need to heal to the point where it can withstand maximal force (many times bodyweight weight), but the associated calf muscle ALSO needs to be strengthened. It invariably loses considerable strength and coordination during the extend time when the Achilles tendon is healing. This is why modern rehabilitation strategies for Achilles tendon recovery focus on keeping the calf muscle firing while still allowing the tendon to heal without stretching out. It is an inherent challenge. Even with a strong surgical repair it is often six months before the Achilles tendon has regained enough strength to think about beginning intense athletic activity. Unfortunately, during this extended recovery period the calf muscle invariably loses a marked amount of strength and coordination –even with an optimal rehab program. In addition to subpar athletic performance re-rupture of the Achilles is a distinct possibility. Re-rupture of the tendon can occur if an athlete returns to sports prior to regaining BOTH Achilles tendon strength, and calf strength and function. Following an Achilles rupture the best outcomes occur when the patient and their medical team work diligently to balance allowing the Achilles tendon to heal strongly without lengthening, while still finding ways to fire the calf muscles so that calf atrophy is minimized -and then calf strength is ultimately regained. Good results can be achieved with both non-surgical and surgical repair. A strong surgical repair may allow patients to be using their calf muscle and Achilles a little earlier in the recovery process. However, this advantage needs to be balanced against the very real possibility of developing a devastating wound healing problem or infection. Working collaboratively with a skilled medical and rehabilitation team can greatly improve the chance of having a full recovery –although it won’t be quick! Published December 29th, 2023

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