Arguments against orthotics?

Discussion in 'Health & Fitness' started by Frank Silbermann, Mar 18, 2012.

  1. Frank Silbermann

    Frank Silbermann Professional

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    There are a number of foot conditions for which orthotic shoe inserts are said to help. Potential bad fit aside, are there any arguments _against_ wearing orthotics?

    I am thinking along the lines of the "barefoot running" movement, who argue that it is safer and healthier to run barefoot than to wear padded protective running shoes. Are there any analogous arguments that stabilizing the foot can harm, say, balance or necessary foot flexibility?
     
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  2. Chas Tennis

    Chas Tennis Hall of Fame

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    heel lifts & toe-to-toe flexibility

    My uneducated opinion-

    Tight/short calves can lead to plantar faciitis and/or Achilles injuries. Some relieve this problem by putting lifting orthodics under the heel. These heel lifts allow the calves to function in a shortened state. A better fix is to stretch the calves to restore the proper range of motion. All stretching or exercises assume that your calves are not injured and that you are OK for stretching.

    After keeping my feet confined & flat in shoes for so many years my feet are not as flexible as they should be especially the toe-to-toe flexibility. http://www.tennisfitnesslove.com/2012/01/fit-and-healthy-feet-for-better-tennis-and-less-injuries/

    Are there any independent, scientific reports on the effectiveness of the 'barefoot shoes'?
     
    Last edited: Mar 18, 2012
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  3. LuckyR

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    Only two: cost and possible ineffectiveness.
     
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  4. Povl Carstensen

    Povl Carstensen Legend

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    The problem with arch support, as I see it, is that i disallows the arch to function by itself, which of course only makes it weaker. It replaces the arch muscles, and muscles that are not used disappear. So what came first, arch support or weak arches?
     
    Last edited: Mar 21, 2012
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  5. LeeD

    LeeD Bionic Poster

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    Weak arches, for sure! :):)
    I've had flat feet, and I mean a full footprint, since I was about 8. There were arch supports back then, most custom, and I had some, but didn't use them for serious play.
    No problems until I turned 59 and sprained my ankle really badly. Hasn't healed now in 4 years, and my other ankle got sprained, and it hasn't healed in 2 months. I know several older guys with flat feet who's feet were fine until they hit their mid 60's, now almost debilitated and NEEDING orthoditics of some kind just to make it around the house.
     
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  6. Povl Carstensen

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    I wouldn't say for sure, but sometimes. Sometimes people get "weak" or "bad" feet, because they are prohibited from strengthening and functioning by restrictive, supportive footwear for years, imo.
     
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  7. Ramon

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    I kind of see the benefit of minimalist shoes for running, just like I see the benefit of doing squats and deadlifts at normal levels without a weight belt. We've all seen Olympic runners who ran barefoot all their lives and win races that way. However, all of those Olympic runners are natural athletes with near perfect gaits, so I don't know if that applies to everyone.

    I don't see the movements in tennis as being "natural" like running. All the stops, turns, sudden movements, etc., don't seem like movements our bodies were designed to do at that frequency. Maybe people with strong feet can do that with no support, but people with weak feet will be more prone to turning an ankle or getting chronic knee and hip problems from over-pronation.

    To me, it's kind of like asking if playing football without a helmet and pads would be better for you because it will toughen you up. Well, it might make you tougher at first, but when you have to be taken to the hospital, it's over.
     
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  8. corners

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    There is very little evidence that orthotics do anything beneficial, but there is some. There is also very little evidence that custom orthotics are better than properly fitted over the counter orthotics. There is also rather intense debate about what exactly orthotics do that does provide reduction in symptoms in some people. The old "hyperpronation" model is somewhat discredited at this point and researchers are currently trying to figure out exactly what effect orthotics have and why they help some people and not others. Most of what has made it into the popular press about foot biomechanics and foot types is rubbish. For example, the US Army recently completed a huge study that concluded that the over-pronator, normal, under-pronator model of running shoe selection is useless. But I imagine that running shoe salepeople will still be putting "overpronators" in "motion-control" shoes for decades to come, despite this research.

    In terms of the barefoot movement and the theory that barefoot activity improves foot function...

    There is no evidence that wearing shoes or orthotics weakens feet.
    However, there is some evidence that not wearing shoes or wearing minimal shoes strengthens feet. Of course, absence of evidence can simply mean that nobody has studied it, or that no one has figured out the experiment that will provide the right kind of evidence. Feet are extremely complicated and at present technology is not advanced enough: 3d modeling of the foot's bone structure is very primitive, and it's not currently possible to directly study the contractions of individual foot muscles (we need better implantable electrodes).

    As Chas Tennis opines, tight achilles tendons and calves put a lot of stress on feet. Tight calves put more stress on barefeet because now the feet do not have a lift under the heel. Tight calves will loosen with barefoot activity but until they do one must be careful to not overload the feet.

    There is evidence from research done in the 80s that feet adapt to barefoot activity in a way that would make orthotics envious - the arches shorten and get a bit higher, and the instrinsic muscles in the feet get stronger. Many of these muscles perform the same function as the plantar fascia, so if they become stronger they can take over some of the plantar fascia's job and give it a break. Evidence from other studies in the past decade show that going barefoot somehow reduces the loads on knees and hips. This probably has to do with innate impact-modulating movement patterns that are guided by feedback from machanoreceptors in the soles of the feet. If this is the case, thin-soled shoes would be of very limited benefit.

    Personally, I don't see the point of minimal shoes, except for keeping the calves lengthened rather than shortened. But the skin on soles of our feet is much tougher than people tend to realize. I played an hour of tennis yesterday on a hardcourt without shoes. My feet are fine today. But it's not just the toughness of the skin that makes this possible. The mechanorecptors in the soles are extremely sensitive to indentation and shear forces and will force you to move in a way that reduces those forces. But just because I can play tennis barefoot doesn't necessarily mean it is better than playing in shoes. (Although my knees do not hurt after playing barefoot and sometimes do after playing in shoes.)

    In short, we need a lot more information. But the good news is that feet are beginning to be taken seriously by professions outside podiatry (which remains extremely orthotics-focused), especially by physical therapy and biomechanics researchers.
     
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  9. Ramon

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    Wow! Your feet are a lot tougher than mine. I could never do that. I have cousins who grew up walking around everyday in the hot sun in bare feet. They could probably do that, and their genetics are similar to mine. As for me, I grew up wearing shoes, and if I went barefoot for just one minute in the backyard to pick up something, I would always have the dumb luck of stepping on a sharp object, a piece of glass, or a bee that would sting me. For some reason that never seems to happen to people who walk outside every day in bare feet.

    Maybe I would have done better by walking around more in bare feet when I was younger, but it seems a bit late for that now.
     
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  10. spacediver

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  11. Povl Carstensen

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    This, is very interesting, and corresponds to my experiences (to the point of debillitating foot and knee problems). And thanks for the interesting post!
     
    Last edited: Mar 25, 2012
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  12. Povl Carstensen

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    Your feet could quickly catch up with a little progressional training, in my experience.
     
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  13. Sentinel

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    I used custom orthotics in the mid-eighties, made from a top podiatrist in NY recommended by Nike.

    Did not help at all. My injuries got worse. My take (only from my experience) is that supports of any kind only further weaken the legs. In any case, expensive running shoes with various kinds of supports had already started the process of shortening the calf muscles and the inside of the knees due to raised heels and knee support. Static stretching did not help.

    Ultimately, i reflected back on my first year of running (injury free), used to race barefoot and run in flat canvas shoes.

    So i slowly introduced barefoot and flat shoes into my running (keeping my Nikes for long road runs). Injuries vanished completely after this.

    Raised heels also make one run in an unnatural heel-ball-toe way which increases impact. Barefoot or flat shoe running encourages landing slightly ahead and this reduces impact.
     
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  14. sureshs

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    This is a hot topic in running now. "Naked" (barefoot) running and use of non-cushioned shoes. Lots of debate and allegations of big money being involved.
     
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  15. Povl Carstensen

    Povl Carstensen Legend

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    Totally true, in my experience.

    Of course there are big money involved from the point of shoe companies. Also from people who happen to make a living from treating peoples feet with inserts and so on. I believe the topic will spill into other sports than running more and more.
     
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  16. boramiNYC

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    Orthotics IMO are simply treating the symptoms. The original cause must be identified if real meaningful correction is desired. Like balance and posture training. It might take a while to do that but just treating immediate pain and continuing strenuous activities it might make the matters worse.
     
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  17. Povl Carstensen

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    Agreed, but heres a thought: Elevated shoes with shock dampening and raised heels might be the original cause, or a part of it. Which we then try to fix by putting more shoe into the shoe.
     
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  18. charliefedererer

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    Do tennis player's heels ever touch the court?


    Forehand sequences:
    [​IMG]

    Backhand sequence:
    [​IMG]

    Volley sequence:
    [​IMG]

    Serve Sequence:
    [​IMG]
     
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  19. Povl Carstensen

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    My heels do. But shoes without heels help me stay on my toes more.
     
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  20. SystemicAnomaly

    SystemicAnomaly G.O.A.T.

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    ^^ Good point. Elite players are on the balls of their feet, heels off the ground, quite a bit -- probably more than intermediate players. Quite a bit of footwork movement and hitting is executed on the balls of the feet. Amateur players would benefit by following the examples of the pros in this respect. However, the importance of the heels should not be overlooked.

    In looking at the footwork of Federer and other top movers, we do see some heel-to-toe actions of the front foot when executing shots. Also, when driving off the back foot, we can observe that the push initially often starts with the whole foot on the ground. The heel is also used for braking actions and, sometimes, for directional changes on the court. The heel may come into play when a lateral movement is translated to an upward movement or when pushing off to recover after hitting.

    Following is an account of "barefoot" tennis. The user appears to be an advocate of running with minimalist shoes. She also indicates some benefit from "barefoot" tennis. Note, however, she also talks about the down side of a minimalist shoe.

    http://barefootrunningshoes.org/2010/02/23/barefoot-tennis-shoes
     
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  21. SystemicAnomaly

    SystemicAnomaly G.O.A.T.

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    As an experiment, I recently took the insoles (DS CustomFit) out of my shoes for several days. After 3-4 days w/o the insoles, I developed a nasty case of shin splints. I then put the insoles back in my shoes and the shin splints started to diminish after a couple of days. Now, after 3 days, the shine splints are nearly gone. During the full week of the experiments I did a fair amount of walking and a moderate amount of tennis.

    Normally, I do most of my walking around the house barefoot.

    Going back to something I mentioned in my previous post... Recall that Sampras would start his serve motion with the toes of his front foot up off the ground. He used a heel-to-toe action as he transferred his weight forward. Following, is a link that talks about a heel-to-toe transfer when Federer hits a backhand.

    http://www.youtube.com/watch?v=vq3Pi1KIkT8
    .
     
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  22. corners

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    I don't know. I have gone barefoot a lot during my life, sometimes for long periods. But the hour of tennis I played the other day followed only two or three short barefoot walks over a period of a week or so, which was preceded by about six months of no barefoot activity at all (cities + winter). Maybe I acquired permanently thickened plantar skin from earlier barefoot bouts, but it doesn't look like it - my soles look like everyone else's.

    On the other hand, my wife can't stand to go barefoot outdoors. Her feet are very sensitive, but I don't know that her skin is any less robust than mine. I think most people would be surprised by how tough their feet really are. I studied biology in college so have an evolutionary perspective - it's hard for me to fathom how wearing shoes can be better than going barefoot. My experience is that shoes are only necessary when it is very cold, or slightly cold and wet, and when on sharp lava rocks. Every other condition seems just fine, except for the fashion part of things.
     
    Last edited: Mar 30, 2012
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  23. corners

    corners Legend

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    Nah, I'm just a compulsive researcher :)
     
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  24. corners

    corners Legend

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    Interesting. I also have got little benefit from a variety of custom and off-the-shelf orthotics over the years, although I have used them for short periods with success if I have an injury - posterior tibial tendonitis most recnetly.

    But, as a counterpoint, most top pros use them - Sampras, Fed, Nadal, Djoker...not that that means they are beneficial or anything.
     
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  25. corners

    corners Legend

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    Yeah, the do. Tennis involves a lot "breaking steps" that serve to "bounce" kinetic energy up the chain to express in a stroke. But most footwork patterns are very ball of foot focused.

    Here's a Tennis Magazine article from a couple months ago on the use of pressure sensors inside shoes being used to study footwork:

    http://blogs.tennis.com/the_pro_sho...-a-training-and-treatment-tool-for-feet-.html

    And a quote from that article:

    "Through scans we've found advanced players spend much more time on their toes than club players, and some of those players we've scanned have played in running shoes because running shoes are designed to help you push off your toes."

    Of course, if you are on your toes orthotics offer zero benefit. The heel has to be down for the arch to be in real contact with the orthotic shell.
     
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  26. corners

    corners Legend

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    If you are interested, you might want to try ditching the orthotics AND the shoes and going for walks on varied and generally rough surfaces. My experience is that I function best barefoot, worst in shoes, and in the middle with shoes + orthotics.
     
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  27. corners

    corners Legend

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    Yeah, there is the rub, for sure. That's the leap we take by ditching shoes - hoping that we are going to separate ourselves from a lifetime of shod movement patterns and somehow jump out of the shoe groove into some other hereditary pattern that we may have lost forever by wearing shoes all those years. But, the experiences of guys like us suggest that it may never be too late to benefit from kicking around like our ancestors.
     
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  28. corners

    corners Legend

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    My pleasure. I've been following your barefoot tennis progress for a while now. I wish you continued luck and success with it!
     
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  29. TTMR

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    While I agree it is probably the case that the demand for orthotics and foot pain relief is a side effect from cushioned shoes, note that for millions of years, humans would have walked barefoot on soil and sand, not on asphalt. That is the problem with the pro-paleolithic argument vis-a-vis reverting to bare feet outside. There has not been enough time for the human foot to 'evolve' or adapt to walking and running on pavement.

    I have very high arches and work on my feet all day. I wear non-custom orthotics and change my shoes 3-4 times a day, which mitigates but does not relieve the soreness. Going barefoot would probably strengthen the muscles in my feet and reduce the pain, but unfortunately it would be unsafe and unsanitary. Going barefoot around the house isn't enough to counter the effect.
     
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  30. LeeD

    LeeD Bionic Poster

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    and going barefoot is not going to help anyone with fallen arches.
    It's fallen, and won't rise without constant excersise and work.
    Worst, working contruction, not a great idea to go barefoot.
    Fallen archs ='s low ankle pain when hard moving is done. In tennis, I'm always moving hard. Take away my shoes, the bottoms of my feet would wear out.
     
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  31. Povl Carstensen

    Povl Carstensen Legend

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    But here is were the middle ground comes in: Try shoes like Vivo Barefoot, that are basically just a thin, flexible membrane between you and the surface, protecting you from dirt, temperatures and sharp objects, while allowing your foot to function like barefoot. This is what I use for everyday use.

    Thank you!
     
    Last edited: Mar 31, 2012
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  32. Povl Carstensen

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    The diagnosis put foreward by the surgical orthopedician to me was "fallen/sunken forefoot" (directly translated from danish). I do not know how that complies to you. But in my case, it showed up that I did not need the inserts. And walking barefoot and/or in minimalist shoes gives your feet constant exercise and work. Perhaps it is beneficial to aid the process in the beginning by specific exercises, I have done that. But I must admit I have never heard about minimalist safety shoes, that might be a niché to consider...
     
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  33. Povl Carstensen

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    If you want to be sure about the experiment, you should try it with shoes that are not worn, preferably new. I was pretty happy with using traditional shoes without inserts (and insoles) for a time, but always got trouble as they got worn. Inserts can to a point compensate for the worn shoes lack of support.
    In fact worn shoes give you anti-support, because they tilt to the inside (if you pronate as most people do, for supinators its the other way around).
     
    Last edited: Apr 1, 2012
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  34. dak95_00

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    Interesting reading from the group here. I've suffered from PF since 2005 and in various stages. I was a runner and aggravated it through running, overuse, and a lack of knowledge or just improper stretching. It is currently on the side of getting better but was the worst it has ever been around Thanksgiving.

    I wear orthotics. They help my foot heel by allowing the overuse symptoms to stop while I am still currently on my feet a bunch. I have a small heel spur due to the overuse and my body's natural healing process of sending blood to the affected area which then calcifies, creates bone, a spur, etc.

    While the orthotic to me was once hopefully a temporary fix, it is now permanent. It is an adjustment by the body to get used to the feeling and at first causes more pain while wearing, it eventually gets better.

    I have not tried minimalist shoes.

    I do notice that when I am doing P90X that the combination of the workouts named PlyoX, YogaX, and KenpoX all improve my flexibility and relieve my pain more. The pain was reduced so much so last year that I quit wearing orthotics for a time and considered myself pain free for the first time in 6 years. That was a mistake. Once you start wearing orthotics, you should never stop.

    In summary, I agree with the flexibility assessments. However, our jobs and lives will keep us either flexible or make us more and more inflexible as we age. I do everything I can but at 40, I am just not flexible in certain areas. I'm still more flexible than most. I can touch my toes and even put my palms on the ground. I just think genetics has something to do with it too.
     
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  35. Povl Carstensen

    Povl Carstensen Legend

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    That may be your experience, but certainly not mine.
     
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  36. Povl Carstensen

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    I thought I would post the exercises I find helpfull to activate and strength my feet, ankles, arches. All done in socks or bare feet.
    1. Foot circles: Just as it says, both ways around in outer position. Can be done lying down, with one leg on top of the other knee.
    2. Foot pointing: Point the foot back and foreward, to extreme position, like above.
    3. Short foot exercise: "Shorten" the foot by bending the arch (not the toes) repeatedly. Can be done lying down or standing up (perhaps best). One foot at a time or both. Perhaps one for better focus. Notice it involves muscles in your calves.
    4. Foot rocking: Standing up, start on your heels, rock via flat foot up on your toes (as far as you can) and back again. Can be done on one foot at a time for more resistance, start with both.
    5. Foot tilting: Stand on both feet flat (relaxed). Tilt out to the outside of your feet, lifting the inside of the foot/arch (as far as you can), and back again. This involves bending your arch.
    6. Jumping on toes: Jump up and down on your toes (heels not touching the ground). Hard for the calves, good for the feet. Can also be done on one foot for more resistance. Or two-three jumps on each foot at a time, like skipping rope. Easier when holding on to a door opening or something.
    Dont be put off by if you are not able to do all the exercises at once. And do not feel that you must do the harder exercises on one foot.
     
    Last edited: Apr 3, 2012
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  37. Frank Silbermann

    Frank Silbermann Professional

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    You certainly shouldn't stop suddenly. That would be as though a completely sedentary 50 year-old having grown soft for decades suddenly tried to act like Tarzan.

    If you've become pain-free with Orthotics, then I would say try walking barefoot for five minutes a day. If you can do that for a month without pain, then try walking barefoot for ten minutes a day. Over the course of a year, you can build up to an hour a day barefoot.

    Then you can try going without your orthotics for two hours a day, and gradually build up so that, after three years you're going half a day without them. Pretty soon, you can just keep them on hand for recuperation after days that are unusually stressful on your feet.
     
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  38. LeeD

    LeeD Bionic Poster

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    Just wondering....
    Since my feet are completely flat, how can walking without shoes possibly help my feet to get some semblance of an arch? MY FEET ARE FLAT.
    And pain in the lower ankles started when I turned 60, now ongoing for 3 years. Pain in the upper arch area was around since I can remember, like maybe 10 years old.
    Insoles raise my heels an inch, and turn my foot outward, to counter it's pronation. It helps, but only a very limited amount.
     
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  39. WildVolley

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    The goal of walking barefoot isn't to develop an arch; it is to strengthen the foot. Even if you don't have an arch, you do have muscles all through your feet.

    There are credible cases of people having arches become bigger by walking barefoot. I don't know of a case of this happening for someone who has had flat feet since childhood.

    I have completely normal arches, but I definitely increased the strength of my feet by walking and exercising barefoot. I'm convinced that shoes weakened my feet.
     
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  40. LeeD

    LeeD Bionic Poster

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    Thanks for the answer.
    I was a surfer for 23 odd years, and mostly walked barefoot on the beach. I had flat feet way before that, and walking barefoot was never a problem, except for the occasional glass shards and pointy buried sticks...:):)
    Walking was always a problem, since memory. Did a short stint in USArmy walking 23 miles with a 40 lb. pack, sheer determination made it.
     
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  41. WildVolley

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    That's too bad. It wouldn't be fun to have trouble walking since childhood.

    You've really beaten up your body. However, I don't it is impossible for you to heal up somewhat. In the video of you serving, you were sort of hobbling around like a cripple. At your age, recovery takes a much longer time, and you really have to have more discipline to do your exercises, get enough rest, and proper nutrition. I've seen guys in their 70s recover from ankle sprains, but it does take a long time compared to teenagers.
     
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  42. NLBwell

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    I believe that one of the reasons for so many people having achilles injuries and plantar faciatis is because today's shoes are so good in supporting the feet. This protects the feet, but doesn't allow them to move through the range of motion and support themselves. Therefore, they become weak.
    Wearing the barefoot shoes are really good in preventing injury in the long run. If you already have an injury, wait for it to heal before using them. However, don't use them for tennis. Your feet were not designed for jumping, landing, and cutting on cement courts.

    I did know a guy in college who went barefoot all the time, even in the snow. The only time he wore shoes (other than when absolutely required) was playing tennis.
     
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  43. Povl Carstensen

    Povl Carstensen Legend

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    Am I reading this right: walking barefoot was never a problem, but walking in shoes was always a problem?
     
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  44. LeeD

    LeeD Bionic Poster

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    Distance made all the difference.
    Short walks from clothes to water, easy.
    Medium walks, from house to water, 4 blocks, possible.
    Long walks, like a mile on a dirt road to 4mile, needed sandals for rock protection, but never easy.
    Hikes, like 2+ miles into walkin spots, either way on the beach, but some were broken rock walks, needing shoes or sandals.
    4 mile runs for training, basically impossible either with shoes or without.
    Longer, no chance. However, give me an M-16 and the goal to stay in top of the class, possible. Just can't walk the next day.
     
    #44
  45. Bobby Jr

    Bobby Jr Legend

    Joined:
    Jul 5, 2010
    Messages:
    7,489
    Just a quick note on this. The pros may be a tiny bit misleading in this respect - Federer and Nadal in particular, who both strap their feet for every match.

    I had my feet strapped a couple of times to prevent injury back in my early 20s and the way they do them in relation to the heel/Achilles can be like kinesio tape x 10. You can strap in a manner which makes your feet try to 'point' more than normal, adding tons of extra effective strength (and therefore injury prevention) in that area. I suspect Federer does this to some level.
     
    #45
  46. Ronaldo

    Ronaldo G.O.A.T.

    Joined:
    Feb 18, 2004
    Messages:
    14,306
    Never had as much relief from patella tendonitis as with a good taping. Now can and do walk barefoot on hard ceramic tile daily pain-free. Orthotics are great. No longer need them.
     
    #46
  47. Povl Carstensen

    Povl Carstensen Legend

    Joined:
    Jun 14, 2004
    Messages:
    5,757
    Enjoying my barefoot clay court tennis here. And finished Copenhagen Marathon barefooted in 4.59.28 (I know it is not fast).
     
    #47

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