Shoe Research Project Gävle
Compiled in cooperation with The Department of Family Medicine,
University of Uppsala, Sweden.
Goal: to show that a method for shoe and foot analysis developed with the help of two swedish athletic stores, including foot and shoe classification, video-filming of walking or running on a treadmill, and individually fitted shoes,
1) decreases pain/problems with ordinary exercisers and
2) indicates that the current practice of prescribing orthotics to many joggers/exercisers is often quite unnecessary.
Method: Testing of the participants of this study was performed by two shoe salesmen, who had no previous medical education, and an orthopedic engineer. Patients/subjects were randomly distributed among their regular customers. The salesmen received a two day course in shoe and foot analysis prior to this study. This education was given by the orthopedic engineer and a physician, both with several years of experience in this method and of shoe classification.
The treatment group (T) consisted of 86 randomly selected patients complaining of problems/pain during jogging or walking. Group (T) received individually fitted shoes from the onset, while a control group (C) received individually fitted shoes after a 3 month period. Follow-up studies were made after 3, 6 and 36 months.
Only shoes from the standard assortment of the athletic stores were used. (No specially-designed shoes were included.) The subjects of this study were aged 12 - 78 years, with middle-aged individuals predominating. Although not included in this research, earlier experience with the above method revealed that even younger children can benefit from these same techniques.
History of ailments: 55% of the patients in this study had experienced problems for 5 years or more. 35% had experienced problems for more than 10 years. Only 10% had experienced problems for less than one year. The problems treated originated in the feet, the Achilles tendon, the lower leg, knees and hips, but improvements were even noted in patients complaining of problems in the lower back.
Results - after 6 months: In group (T), more than 50% of all participants were completely free of discomfort. One person was problem-free after having experienced walking pains since the 2nd World War! Out of the 40-50% remaining who were not completely freed of discomfort, their problems decreased by appox. 60%. Only 4 patients reported the same amount of pain following the 6-month period.
Group(C)’s problems remained unchanged during the first 3 months when properly fitted shoes were introduced.following 3 months, resulting in an immediate reduction in discomfort.
Results – after 3 years: After 3 years 41% of all participants experienced no pain/problems during exercise, walking or jogging. 56% were free of pain when not exercising. Apprx 75% of all problems in the feet, lower legs and lumbar region were cured. 86% of all subjects with knee -pain experienced no pain at rest, 60% were cured of all knee pain even during jogging. Only two patients received individually-fitted orthotics after other fundamental corrections failed to reduce pain or whatever discomfort they experienced.
The results of this study show that exact measurement of the foot angles during VCR filming is unnecessary except in special cases. The most important procedure during the video analysis is to see to that the foot is somewhat straight and to avoid overcorrection, in particular the so-called pronation/eversion angles, which is the most usual position of the foot during the weight-bearing midphase of the step.
When choosing new walking or jogging shoes we recommend first and foremost that the stability of the shoes are checked followed by matching the foot-type to the type of shoe selected. The shock-absorbing abilities of modern medium and high priced jogging shoes are most often satisfactory. The regular customer need not worry about shock-absorption unless he/she is extremcly over- or underweight ,or, if running under extreme conditions is planned.
The results of this study show that a professional cooperation between shoe salesmen, an orthopedic engineer and a physician interested in foot and shoe analysis, will produce excellent results for many patients/customers who have suffered for years or even decades from discomfort during exercise. The study also shows that patients with problems of the lower leg, when provided with an adequate choice of shoes, no longer need rest indicated. Indeed, it is highly probable that many discomforts exercisers complain of are actually caused by an inadequate choice of shoes. The study shows that shoe and foot analysis followed by individually -fitted shoes prevents and results in less pain/problems for ordinary exercisers.
Shoe Research Project Gävle
Compiled in cooperation with The Department of Family Medicine,
University of Uppsala, Sweden.
To test the efficacy of a regimen consisting of shoe and foot analysis including a simple classification of the feet and running style, followed by correctly fitting shoes in accordance with the principles of shoe classification as developed at two different athletics stores in the cities of Gävle and Sandviken, Sweden. This study is meant as a quality assurance of the already indoctrinated work and analysis routines that have been in use in these stores for the past several years, a method that continues to be developed in cooperation with an orthopedic engineer and a physician.
Following an advertisement in the local paper during the spring of 1995, where we stated that we were looking for ordinary exercisers (not professional atheletes) with problems while running or walking, 86 subjects were enlisted, 39 men and 47 women, randomly divided into two groups.
Treatment Group (T), 46 participants, received newly-fitted shoes from the onset, while Control Group (C), numbering 40 participants, received shoes after approx. 3 months.
Follow-ups on both groups were performed after 1, 3 and 6 months as well as a 4 month follow-up for Group (C), one month after they had been issued fitted-shoes.
The final follow-up was performed after 3 years, during the fall of 1998.
The subjects in the Group (C) were free to use or exercise in their old shoes (or any shoes they preferred) for the 3 months prior to being analysed and fitted, to assure that their problems did not disappear by themselves. ”Exercise” in this study was defined as either walking or runnning for the sake of exercise, to increase or maintain one’s physical stamina.
The testing of the shoes and video filming the walking and running steps, was performed by two shoe salesmen (who had no medical education), together with an orthopedic engineer. Prior to the study the shoe salesmen received a 2-3 day course in shoe-analysis, running-analysis and video technology, conducted by the orthopedic engineer and the physician. Both shoe salesmen had long experience in shoe-analysis and both had been active in the shoe-analysis program which had laid the groundwork for the shoe-classification system used in this study in the above-mentioned stores. Both salesmen were thoroughly acquinted with the shoe assortment and their characteristics.
The 6-month follow-up was performed in the fall of 1995 by a independant physician who had not previously participated in the selection of any shoes nor in any of the subject’s previous follow-ups. A medical examination was not performed at this time, because the aim of the study was to show that the shoe and foot analysis and the shoe-classification system together with the analytical process currently in use in the participating stores succeeds in reducing pain for exercisers.
A record of the each of the subjects’ problems was based on questionnaires and pain-drawings which the subjects were asked to fill-in at all follow-ups.
The shoes used in this study were of different brands and had been chosen from the standard athletic store assortment. None of the shoes were valued at more than 120 USD; most were valued at 50-100 USD. During shoe selection the subjects were asked for a 50 USD deposit, refundable after the 6 month period.
Age spread, duration of problems, and estimated levels of pain were quite similar in both groups. Distribution of gender was randomly uneven, 59% males in the Group (T) and 70% females in the Group (C), for totally 39 males and 47 females. Gender did not appear to have any effect on the study’s final results. All 86 subjects completed the study through to the 6th month follow-up. A total of 11 out of the 86 subjects did not participate in the 3 year follow-up:
6 refused to attend due to unrelated medical problems or change of address (two developed cancer, one was post-surgery / disease unrelated to this study, and 3 had moved away),
an additional 5 subjects we were unable to be contacted.
Not included among the 86 participants in this study were:
one subject dismissed from the study due to a general illness which prevented exercise / usage of the shoes he was issued, and one subject disqualified from the study due to severe arthritis of the foot joints.
Most of the participants of the project were middle-aged with 38% between 40-49 years.
Age-spread of the 86 subjects was 12 - 78 years .
Duration of problems
Participants selected had long-standing complaints / pain, averaging approx. 8 years.
Only 10% had suffered for less than one year, while 55% had a history of discomfort spanning 5 years or more. Approx 35% had experienced problems for more than 10 years. All were equally divided between Groups (C) and (T).
6 month results
The problems continued unchanged with Control Group(C)’s subjects (who had been free to exercise in their old shoes or shoes of their own choice), until after the 3-month period. Upon receiving their new fitted-shoes, their problems reduced dramatically in the same manner as for Treatment Group(T) (who had received fitted-shoes at the onset of the study).
82 of the 86 participants felt an improvement of their problems. 61% of Group(T) and 45% of Group(C) were totally cured (no remaining problems). The discrepancy is explained by Group(C)’s 3 month shorter use of the shoes vs Group (T).Our expectations of a further decrease in Group(C) levels of discomfort to a level equivalent with Group(T) was vindicated by the results of the 3-year follow-up.
On a pain scale (VAS 0-100) the average value decreased from 48-55 to a median of approx. 19-20.
Only 4 subjects did not decrease their pain score. Following a doser analysis it was noted that 3 of these had partially improved in some of their symptoms, while some symptoms still remained, resulting in an equally high pain score totally, according to the VAS-method. Only one subject continued to have the same level of pain score following the 6 month period as he had experienced at the onset of the study, but he maintained the same level and intensity of exercise (several full rounds of golf per week).
3 year results
The problems that were treated originated from the feet, Achilles tendons, lower legs, knees and hips, but problems in the lower back were also relieved.
Only two subjects received individually-made orthotics, but only after other fundamental corrections failed to reduce pain or whatever problems they experienced.
After 3 years 41% of all subjects reported no pain/problems during exercise, walking, or jogging (no pain in any part of the body) and 56% were free of pain when not exercising.
Approx 75% of all discomforts in the feet, lower legs and lumbar region were cured after the first 6 months.
86% of all subjects with knee pain experienced no pain at rest, while 60% were free from all knee pain even during jogging or walking. The lowest score in the study occurred with hip discomforts, where only 40% were relieved.
A slight tendency toward increased pain was noted at the 3 year follow-up vs the 6-month results. This tendency was not statistically significant in several of the parameters tested. Those experiencing an increase in foot discomfort were limited to the Group(T), who had received individually fitted-shoes directly upon entering the study. Some hip problems also increased, but these occurred mainly at rest, strangely enough not while exercising. Those experiencing diminished pain in the knees or lumbar region after 6 months reported no increase at the 3 year follow-up.
Neck problems were reduced from 12% to 7% and thoracic pain was reduced from 8% to 3%: no significant conclusions could be drawn from this, as these problems were in the minority at the onset of the study.
Especially notable were that knee discomforts cured faster than foot problems after individually fitted-shoes were worn.
Early on, 2-3 months after the fitted-shoes were issued, significant relief from knee discomfort took place. This decrease in knee pain continued through both the 6-month and the 3 year follow-up..
Foot and lower leg pain took somewhat longer to relieve: useful information when discussing recovery-time with a patient.
The slight tendancy to experience more discomfort after 3 years, compared to after 6 months, is statistically and significantly correlated to the collapse of the material in the shoes: a collapse evidenced conclusively with slow-motion video. The results of the study clearly indicate that it is quite difficult for even experienced staff to visually assertain if shoes are worn out. Only when the shoes displayed severe wear/damage, was this statistically correlated to increased pain. A perusal of the outward appearance of the shoes often gave no indication as to their true condition! Collapse usually occurred long before the shoes began to appear worn.
Conclusion: significant collapse of the material could only be detected using slow motion video.
Intensity and frequency of exercise activities
With decreased pain both the intensity and frequency of exercise increased: test subjects reported being able to exercise both longer and more often. Activities increased to the 6 month follow-up, decreasing somewhat by the 3 year follow-up. Both subjects who performed no exercise whatsoever, and those who normally exercised a good deal, were able to increase their activities substantially by the 6 month follow-up and maintained this level to the 3 year follow-up. Those subjects falling in between also enjoyed increased activity by the 6 month follow-up, albeit somewhat less. This activity level decreased by the 3 year follow-up for unknown reasons.
ln Group(C) no increased level of activity was noted until after the 3 month control.
The majority of the subjects in this study were either unable to exercise, or severely hindered in their activities at the onset of the study and had been so for long periods of time. The change to fitted-shoes clearly made it possible for the participants to increase their activities due to diminished pain. Group(C) did not increase their activities, experiencing undiminished discomfort, until the time when they received fitted-shoes.
This project has proven that the measures taken in this study have not only a short term, but also a long term effect.
It is important to note that no special shoes were used for this study, and that only two subjects were given orthotics (individually molded and fitted inserts). Cheap wedges, anterior arch supports and simple prefabricated insoles have been complemented where needed.
-Slow-motion video analysis and freeze-frame techniques together with the treadmill are considered to be important tools and methods. Of equal, if not greater import, are the following parameters where the foot-type decide the choice of shoes:
-Correct width of the shoe. The shoe must allow space for the foot to widen approx. 1/3 inch when pressure is put on the anterior arch of the foot in the weight-bearing phase of the step.
-Correct length of the shoe. The shoe must allow space for the foot to elongate approx. 1/3 inch when pressure is put on the longitudinal arch of the foot in the weight-bearing phase of the step.
-Sufficient anti-torsion characteristics in the sole
-The sole should bend where the toes bend (approx. 1/3 to 1/4 of the length of the sole from the front end of the shoe along the "metatarsal break" = the axis of movement)
-Insoles should be washable and exchangeable, to give place for wedges, inserts and orthotics if necessary.
-Sufficient stability of heel cap to hold the foot correctly in place and to prevent malpositioning of the feet.
-Rounded heel (or other construction with similar effect) for smoother heel-strike.
-Adjusted toe box (front of the shoe) suited to the anatomy of the toes and fore foot
-Correct last for the foot type. In general, a flat foot will need a straight (medial) inner margin of the sole and a high arch will need a curved sole. Exceptions to this may occur, for example: there is at times a difficulty in finding wide enough shoe for people with high arches who normally should be given shoes with a curved sole. In order to fit the foot into a shoe we sometimes have had to supply customers or patients (also some participants in this study) with the ideally "wrong" last in order to initially find a shoe for them with other acceptable characteristics. The choice available when fitting shoes will at times not be ideal when limited to the standard assortment of commercially available shoes. Notwithstanding, the results of this study prove that the simple testing procedures used in this project work extremely well.
-Finally: Vital are educated personell with an understanding of what is to be analyzed. A treadmill and a VCR placed in a store is no guarantee of good results.
Even when orthotics are placed in the shoes, a video analysis on a treadmill should be performed to check the results: most orthopedic departments currently lack this essential routine.
Video analysis on a treadmill should be performed at the same speed normally used walking or running, since weight-bearing and the angles of the foot will vary with different running or walking speeds.
Measurment of angle between heel and center of lower leg and the misuse of the terms ”pronation” and ”supination”
In the past we were all taught to use exact measurements of the so-called "pronation” and "supination" angles, filmed from behind, to determine the angle between the Achilles tendon and the longitudinal length axis in the middle of the lower leg. The practice is still currently in use, but in our opinion, information obtained by measuring this angle gives not only incomplete, but also both flawed and conflicting information.
Measurments of this angle will vary with differing running speeds. They also vary depending on how familiar the tested person is with running on a treadmill and the length of time this person runs during the test. The angle will also vary with the differing measuring techniques between one shoe salesmen and another.
Of vital importance: this angle also reflects the degree of bow-leggedness a person has. The foot can be corrected to a completely straight position but the angle measured will still show "pronation" due simply to bow-leggedness. It is our experience that trying to correct this "pronation", although the foot is straight, will create overcompensation and most surely increased problems for the customer. For these reasons we have abandoned this technique years ago.
From a medical biomechanical standpoint, the movements of pronation and supination occur in the forefoot only, and around a completely different axis than the heel movements, which occur in the subtalar joints - termed inversion and eversion. Besides these movements, there is considerable instability within the ankle (foot joint) itself, which enhances the impression of in- and eversion of the ankle or heel. This instability increases with more plantar flexion of the foot. Furthermore, the movements of both the forefoot and the heel are different in different stages of the step. Therefore the step should be also analyzed during the other weight-bearing phases rather than just during the midphase of the step. Focusing on the heel angle thus becomes less important.
The foot’s outward movements (pronation/eversion = pes valgus) are more important to study during the mid- and endphases of the step. The foot's inward movements (supination/inversion = pes varus) are more important to observe during the heel-strike and mid-phase. Pronation of the forefoot is more common (approx. 75%) than supination (less than 5% ) and is part of the body’s own shock-absorbing mechanism. A jogger with supination/inversion will experience his legs as considerably less shock-absorbing; they will feel stiff while running and he will frequently have problems in the feet or hips, according our previous experience. On the whole, our experience shows that supinators have more problems than pronators. Supination is more difficult to detect and therefore not as easy to treat and correct as is pronation.
We recommend that in the future a more precise and correct terminology be used, our essential argument being that these different movements during a running analysis need to be strictly differentiated.
We would like to be rid of such terms as "pronation", "underpronation" and "supination" regarding the movements of the heel. The term "forefoot pronation" is unnecessary since pronation only takes place in the forefoot and not in the heel. The term "(anti)pronation wedge” should be used only for wedges that correct movements of the forefoot.
Principles of video analysis
Our goal in this study was to find out if the following simple principles of correcting the foot during video analysis were enough to cure pain or eliminate experienced problems.
a) In correcting the heel-strike phase at a moderate running speed it has been our goal to avoid extreme outer positions of the heel in inversion, to avoid problems of the hip region and the pelvis.
b) During the mid phase of the step both movements of the heel and forefoot have been corrected, so that the foot stands seemingly straight without having to correct too much or to care too much about the exact positioning the foot. In our earlier experience a more exact correction than this, will in most cases, be unnecessary.
Only if this correction did not produce satisfactory results, were finer adjustments performed
In this study we never measured heel angles exactly.
During the mid-phase of the step we took pains to avoid overcorrecting someone with pronation/eversion.
c) We corrected subjects with supination/inversion more carefully. If supination/inversion was evident during the midphase, the subjects were corrected to a strictly neutral position
The use of orthotics
In this study we have shown that several problems of the lower extremities can be cured or reduced solely by the use of individually fitted-shoes. Many people in this study who had experienced problems for several years and who previously had been examined and treated without much success by healthcare specialists (doctors, physiotherapists, orthopedic engineers, acupuncture etc), experienced a radical improvement or were completely cured.
Often specially fitted orthotics are not needed. Orthotics have become a livelihood amongst orthopedic engineers and orthopedic technicians at running-clinics and orthopedic workshops. We consider that orthotics are an important supplement, but only when one fails to choose an adequate shoe design.. According to our extensive experience, orthotics are needed in less than 5% of all shoe store customers. In our study we needed to supply only 2 out of 86 subjects with them. Others claim that up to 53% need orthotics (Graversen-Simmons: Previa-Löplabbet, Study on mailmen in Borås and Gothenburg, Sweden).
Our advice is to always begin with a well-fitted choice of shoes. To put orthotics into shoes that have not been analyzed or into shoes that are not fitted to the individual, is by our standards deficient methodology. We have met several patients who have had problems for years, who were prescribed specially fitted orthotics and who still were not rid of their problems. Yet when these shoes and supplements were discarded for properly fitted-shoes using the simple methods tested and proven effective in this scientific project, they were freed of discomfort..
Less stable shoes can be fine to walk or stand in, although they might prove less useful for running or walking longer distances. Lighter shoes are often preferred, feeling more comfortable to run in than heavier ones (ie. for a marathon). For the average exerciser/jogger we recommend that he regard stability as a first priority, which at times may mean a slightly heavier shoe.
A lighter, perhaps less stable shoe might possibly prove faster in a competition, particularly for those who do not weigh very much, but for basic training we recommend a more stable shoe to prevent injuries.
Shoe producers often make advertising claims that shock-absorption is an essential reason to choose a certain shoe. In our opinion, other than in extreme cases, shock-absorption is no longer an important argument when selecting shoes. No matter how they are constructed, most shoes on the market have good shock absorption, with the exception of some very cheap models.
No shoe brand can be said to be best. No specific shoe can be said to be the best.
In this study we have used different shoes of different brands, many well-known world wide and available in most countries of the world. In this report we chose not to mention what brands we have used because we consider this of less importance. No funds or other means have been accepted for the cost of this study from any shoe manufacturer. This study used mostly 7 to 9 different shoe models from the standard assortment of shoes in an athletics store, with complementary characteristics of our choice. In addition to these more widely-used shoe models we have used 3 to 4 other models which we considered necessary to hold in stock for special customers/patients, but although these shoes are not often sold, they are nevertheless important to have access to. If for some reason these 7-9 plus 3-4 models were not available, we would most likely be able to choose equivalent shoes from other brands complementing each others’ characteristics and thus obtain the same results.
The individual walking or running style, as well as the foot’s appearance (width, length, foot -type) will be effected by the last and therefore the choice of shoes will always be very individual.
A shoe that is considered to be perfect for one person might be a poor choice for someone else and vice versa.
One specific shoe model might have different characteristics different years, a rather common occurrence. Shoes of the same model and brand can even vary in their characteristics during the same season even though their appearance remains unchanged !
Expensive shoes are not always better than cheaper ones!
Famous or well-known brands do not guarantee good quality or even that the shoe will fit you!
It is important to make sure that the shoe is functional, ie. fits your foot-type and your running or walking style and that it suits the activity you will be using the shoe for.
Shoe salesmen should be educated to master the methods that we used in this project.
The results that are shown in the study indicate that more resources and measures must be taken for exercisers and atheletes before they have to turn to the healthcare system. These methods can also be used with success for healthcare patients.
The community encourages people to exercise. It should be just as important that this wide spread athletic movement should result in as few injuries as possible, something that this study shows can be attained by simple means combined with knowledge.
The spread of this knowledge would probably spare a lot of patients/customers/exercisers considerable suffering and save the community/healthcare system a great deal of tax money.
Logically the spread of this information is not only the responsibility of, but also in the interest of everyone in the shoe and athletics industry, in healthcare and insurance, as well as the medical industry and the media.
Fitted shoes can give positive results on certain lower back, thoracic, and as well as neck problems: an effect we noted in our daily work - and in this study. The number of patients in this project with these kinds of problems were too few to be able to make statistically significant conclusions, but an obvious tendency for good results was evident.
The fitted-shoes must be used to achieve any alleviation of those problems present.
We noticed that some of the participants at the onset of the study did not use the fitted shoes very often. Following recommendations to use the shoes, i.e. to participate in the study, their problems were most often drastically reduced.
This has practical implications.
Although many in this study improved in a short period of time, it sometimes took about 1-2 months before the problems disappeared, and at times even longer. For a realistic approach to rehabilitation, it is important to inform patients/customers about the expected time for recovery and future levels / intensity of physical exercise.
Recommendations when shoe analysis fails to reduce pain (not shown in this study)
If the results following fitted-shoes and foot analysis are inadequate, the patient/customer should be examined by medical personnel (physician, physiotherapist, orthopedic engineer, orthopedic technician etc). It is essential that non-medically trained shoe salesmen do not develop a belief that they can cure everything by using the methods we have developed. It is also important that shoestores maintain good relationships with healthcare personnel, especially in regard to those customers who are not relieved by shoe corrections.
ln this study we have tested jogging and exercise shoes from the standard assortment common to most athletics stores. In our experience, these shoes are also acceptible for walking, for work, and are often excellent for diabetics and for quite a number of those with foot deformities. In our opinion these shoes are often better than expensive specially constructed shoes from orthopedic departments. Indoor shoes and special shoes for different sporting events have not been tested in this study.
Our recommendations to health care personnel regarding their patients are: initially, the patient should look in the athletics / regular shoe stores in town for shoes that will properly fit him, before being prescribed expensive handmade shoes from the orthopedic departments.
If shoes from the orthopedic department do not solve the patient’s problem, the patient should return once again to search the regular shoestores for shoes that conform to the recommendations we have outlined in this study.
-By this prospective, randomized study including a control group, we have shown that joggers and exercisers, most with a history of leg problems spanning several years (foot, lower leg, knee and hip), achieved a total improvement in approx. 80% of their problems (shown in pain evaluation scales) only after being issued fitted-shoes.
-More than half of all of the participants at the 6 month follow-up and more than 40% after the 3 year results were pain-free. Those who were not completely cured by this simple method of shoe-fitting, experienced 60% average reduction in pain. About 75% of the problems in the foot, lower leg and lumbar region were cured and 60% of all knee problems disappeared: the result of following a basic analysis and classification method of foot and shoe-type combined with a simple and fast video analysis of stability with the help of a treadmill.
-We have shown that shoe salesmen without medical training can be taught this specific method and analysis to the benefit of the customer/patient
-We have shown that recommending / prescribing orthotics should not be the first step in finding a solution to walking or jogging problems.
-The store owner in this study found that selling shoes using this method saved his staff both time and energy. The stores also experienced considerably fewer complaints / product returns and a notable increase in the quantities of shoes sold after the introduction of this method.
During this study and the development of these methods we have also learned which characteristics are required for good shoes. Shoe designs to meet the customers’ needs are often held as a manufacturer’s secret. This project revealed that many manufacturers are, in effect, unaware that some of their products on the market actually cause problems.
Fashion aspects have not at all been considered in this project, though in our opinion it is perfectly possible to produce fashionable shoes with good functional characteristics that will prevent pain, overstraining and other, related problems.
This study was performed by:
Bemt Ersson M.D. Gävle, Sweden
Lasse Höglund, Orthopedic engineer, Gävle
Eje Bergström, Store owner with additional staff, Intersport Gävle
Kurt Svärdsudd, Professor, Dept. Family Medicine, University of Uppsala, Sweden
If you have any questions please feel free to contact:
Dr Bernt Ersson Strömsbrov. 56 S-806 45 GÄVLE - SWEDEN
Web site: www.shoedoc.se email: firstname.lastname@example.org
fax: + 46(0)26510914 (from abroad) fax: 026-510914 (from Sweden)
office telephone: +46(0)26127600 fr abroad work telephone: 026-127600 from Sweden
Special comments on Achilles tendon problems
ln the Control Group that received the fitted-shoes and wedges following approx. 3 months, we discovered 10 subjects with Achilles tendon problems.
6 of these were completely cured with corrections, 2 reported major improvement, while 2 felt no improvement in their Achilles tendons, in spite of feeling improvements re other problems they suffered from.
Another 4 subjects in the Control Group marked calfpain but Achilles tendons pain on their pain drawings. 2 of these were cured, the other 2 considerably improved.
Everyone in the Control Group had more than a 1-year history of Achilles tendon or calf problems (excepting 3 who had experienced problems for only 3-6 months prior). 7 had more than a 12 year history of problems.
The entire Control Group reported no change in discomfort during the 3 months before they were issued fitted-shoes. All improvement occurred within 2 months of being fitted shoes.
In this group there were 13 persons with Achilles tendon problems and l person with calf problems. 10 were completely cured and another 4 noticed marked improvement.
The improvement occurred relatively soon after receiving the fitted shoes, mostly within 1-3 months.
7 subjects had experienced problems for more than 3 years and 4 of them for more than 7 years.
2 subjects had experienced pain for less than l year (2 months and 6 months resp)
Method of correction
It is important to point out in this situation that after several years of treating athletic injuries and via research projects, we have noted that problems of the Achilles tendons should not only be treated by elevating the heel in the shoe with traditional wedges.
It is important to make sure that the foot during the running or walking step does not have an improper angle, both in the forefoot (pronation/supination) but also in the rear portion of the foot (inversion/eversion). Shock absorption of the heel, especially if too soft, stability of the heel cap and its’ formation, along with the stiffness of the sole in the front portion of the shoe can be part of the problem.
Although the number of experimental persons with problems of the Achilles tendon and calf seems low (28 people), our study indicates a certain strong tendency: Achilles tendon and calf problems can most definitely be improved with well-fitted shoes, and, if necessary, cheap supplements of different kinds like wedges and inserts.
If one also considers that most of the participants of this study had experienced their problems for a long time (years), and that 26 out of 28 participants were cured or experienced a major improvement of their problems following correctional adjustments of their shoes only. This fact, and the fact that the subjects in this study could continue with their exercising can only lead us to conclude that rest as a treatment for Achilles tendon problems may not be the only valid method to prescribe.
Contrary to common practice, we consider it important to give the patient a well-adjusted choice of shoes along with a rehabilitation plan including individual instruction on how to train, including walking, stretching and so-called excentric exercise(recommended) as opposed to concentric (not recommended).
Inflammation of the Achilles tendon is considered to be an overstrain injury.
For several reasons it is both debatable and even questionable to prescribe only rest as a cure for overstrain injuries.
Bernt Ersson M.D.
Ideal characteristics of the golf shoe
The ideal golf shoe will be a compromise between the best characteristics of a walking or jogging shoe and those necessary for a stable golf swing. Common construction faults of golf shoes are poor shoe adjustments to the anatomy of the foot (wrong last, width, length, toe box etc) as well as insufficient stability, poor anti-torsion characteristics, unstable heel cup and failure to correct foot position while walking and well in the swing. The heels of golf shoes are often too hard and thin, the soles too thin and they often bend incorrectly.
-If walking is the option on the golf course, golf shoes should have most characteristies of good walking shoes as described in "Shoe Project Gävle". Priorities should be comfort, stability, anti-torsion characteristics and a sole with a good grip to prevent sliding of the shoe. The sole should bend where the toes bend.
Water repellent and "breathing" characteristies will depending on climate. Since the swing makes a golf shoe wear upfront, protection against wear and water should also be built into the front portion of a golf shoe.
-For increased stability in the swing a slightly concave and relatively wide sole, as well as a stable heel cup is recommended. The sole and heel of the shoe may preferably be made in one straight piece with continous contact with the ground for better grip instead of the traditional
2-piece construction. Elevation of the heel: about 1/2 inch.
-The grip pattern of the sole should in the front portion prevent sliding sideways and make a good contact with the ground in the front swing, especially that of the right foot. In the back portion of the shoe the grip pattern should prevent sideways and forward sliding for stability of the swing and to prevent falling when walking downhill.
Metal spikes today undoubtedly give the best grip in the swing. Soft spikes do not give as good a grip, but we have probably not seen the end of research on better soft spikes and sole grip- patterns. Metal spikes, on the other hand, often give other comfort problems.
-For the swing it is important that pronation is not overcorrected when analysing the walking pattern.
-Specially made orthotics are needed only if the characteristics of the shoes prove unsatisfactory and if a shoe and foot analysis show that it is impossible to choose another better fitted-shoe.
Summary of a presentation at the 'Sports Achievements & Health Conference" held by the Swedish Golf Federation