Injury Prevention Begins at Your Foot



Over the past couple of weeks, I talked about What is Posture – the fundamental need for stabilization to provide healthy movement; and You Cannot Control Your Posture – postural control does not come from conscious thought. This brings up an obvious question. How do you train postural control? The answer is by integrating a full body, holistic approach to health and fitness. The program I use with my clients involves deep tissue massage therapy with a focus on the fascial system, self-massage using a foam roller, flexibility training, corrective exercise, functional strength training, and barefoot or minimalist walking and running. In today’s post, I will take you through the first steps (pun intended) of this process.

It Starts With the Feet

The feet are your connection to the Earth.  They are the foundation of your posture and the platform from which you move. In Architecture, the foundation of a building provides a base of stabilization that supports the entire structure. A weak foundation leads to collapse. The same is true for your feet, with a very significant difference… you move! Your feet have the challenging responsibility of providing strength and stability while maintaining flexibility and mobility to aid in the movement of the entire body structure. Not a simple task!

The Feet are your Foundation

With a strong healthy posture, the body aligns over the feet.  This is what provides the incredible stability from which healthy movement is derived. Just like the foundation of a building must be stable to support walls and a roof, the feet must be stable to support the legs, torso, spine and head. If your feet are weak, they are unstable. This is equivalent to building a house upon a bed of sand. The feet become misaligned and the ankles, knees, hips, back, and shoulders follow. Misalignment creates dysfunctional movement which causes pain and injury. A healthy foot is fundamental to good posture.

How Do We Get There?

What should you do if your goal is healthy feet and good posture? Focus on developing strength, stability and mobility while staying grounded and connected to the Earth. A great way to do this is to take your shoes off. You can read more on why I am an advocate of making the transition to barefoot or minimalist footwear in Free Your Feet, and how shoes affect running and walking gait patterns. But before you toss your shoes and fully convert to a barefoot lifestyle there is an important step you must take. It is vital that you rebuild the strength and stabilization of the muscles of your lower leg and feet – they are likely weak from decades of neglect.

Remember: the feet you walk on are the very foundation of your posture. The healthier your foot care is the better your body will move and feel. Below are exercises to build strength, balance and stability in your feet and lower legs.

The following exercises will help strengthen the intrinsic muscles of your foot and leg, challenge postural muscles, and train your foot and lower leg to stabilize providing healthy movement for your entire body. I recommend doing these exercises two to three times a week for eight to twelve weeks. As your foot gets stronger you can continue to perform these exercises for maintenance on a weekly basis.

Self-Myofascial Release using Foam Roller Therapy

By performing self-myofascial release techniques using a foam roller or ball, you can reduce trigger points, decrease tissue tension, and break down scar tissue adhesions in injured myofascial tissue (muscle and fascia) formed by a combination of acute trauma, poor posture, repetitive movement, over-training, or inadequate sleep. The goal of self-myofascial release is to speed up the healing and recovery process, reduce pain, improve joint range of motion, balance the body, and prevent injury.

Stand on each foot for one minute. Try to keep the inside ball, outside ball, and heel of the foot in contact with the ground for the entire minute. Do not stabilize with your opposite leg.
Stand on a stability disc with each foot for one minute. Do not stabilize with your opposite leg.
From a seated or standing position, lay a towel on the floor beneath your foot. Using your toes, grab the towel and hold it for a few seconds and release. Repeat 20 times on each foot.

Standing with your forefoot on a platform, press through the ball of your foot lifting your heel as high as you can
Drop our heel. Make sure as you press, you don’t roll to the outside of the foot. Do 2-3 sets of 12-15.


From a seated or standing position, clench your toes and do 30 circles in each direction.


Balancing on one leg, lift opposite heel towards the ceiling. Try to keep the inside ball, outside ball, and heel of the foot in contact with the ground. Keep your hips and shoulders parallel to the ground, don’t let your hip rotate up towards the ceiling. Do 12 on each leg.


Walk using each foot position making a 10 foot circle in each direction. Example, walk on the outside of your forefoot to your left, making a 10 foot circle, then turn around and make the same 10 foot circle to your right before switching to the inside ball of your foot. There are six foot positions walked in each direction making The Twelve Walks.


You Cannot Control Your Posture

Last week I defined posture, not as an ideal position, but as the necessary stabilty from which all healthy movement is derived. Today I am talking about the first step in re-engaging postural control.How did we get here?
The human body is awe-inspiring. It is capable of moving with speed, power, agility, stamina, and grace — in an amazingly wide range of motions. It is also capable of adapting to the demands that are placed upon it. Unfortunately, most of us no longer move the way our body was designed to move.  We weren’t trained to.  The training grounds that once shaped The Human Body no longer exist. What we have instead are cars, couches, computers and ergonomic chairs. These are the new “training grounds” and our body has adapted to them well.  For many, it has adapted too well.
In this training we sit for long hours each day. We do not utilize movement that engages our postural system the way it was designed to be engaged. Over time, these muscles become weak. They atrophy. They fall asleep and quit functioning. They no longer provide the essential stabilization that is so important to movement. In time, our body adapts to this new environment and develops bad habits.  The most prominent example is the recruitment of mobile muscles to provide stability. Let’s revisit the analogy of driving your car with the brakes and the gas pedals pressed down at the same time. How well would your car move? Not well at all.  Driving like this is extremely damaging to the car.  The same is true for your body.  The pain you feel in your body is the indicator light telling you “stop driving and visit a mechanic.” A mechanic in this sense would be a “body” mechanic, a deep tissue massage therapist, postural movement coach, or physical therapist. I recommend somebody with advanced knowledge and experience with the fascial system and how it relates to pain.

What is next?
Before you can sit up straight or intentionally hold your body “in good posture,” you must re-teach your body to stabilize, but how is this accomplished?

You have heard the phrase, “stand up straight and pull your shoulders back.” For most of us this is our cue to establish “good” posture. There is something inherently wrong with this method and it lies in a concept that we have conscious control over our posture, when in fact we do not.

Postural Control
You do not have conscious control over your postural muscles. Your postural muscles are controlled by a part of your sub-conscious system. If you had conscious control over your posture you would be unable to do anything else. For example, while you are reading this, you probably aren’t consciously thinking about holding your head off your chest, or keeping your body from collapsing to the ground.  The reason is… you don’t have to. Your nervous system does the job of maintaining your posture naturally – without you even thinking about it.Regardless of this natural ability, we are taught to think or be mindful about our posture. We are told to hold our heads up, have our shoulders pulled down and back, and our abs pulled in tight. But since we do not have conscious control over our postural muscles, the act of consciously engaging our muscles to provide postural support activates the mobile muscles that we do have conscious control over. Over time, these movement muscles become neurologically trained to function as stabilizing postural muscles. This is not what they were designed to do. As our movement muscles are re-programed to provide postural stability, they become less efficient at providing movement. All this happens and our postural muscles remain inept. The result is the significant loss of range of motion which will lead to dysfunction, pain and injury…

Compared to five or ten years ago, how well can you fully open up your hips and chest; reach your hand behind your back as if to scratch an itch between your shoulder blades with both hands; or bend over at the waist to touch your toes?

Change in the ability to perform prior movement patterns is another indicator light signalling… Visit mechanic.

If you are currently suffering from acute or chronic pain, the first step is to treat the pain. Pain prevents or changes movement. There is no such thing as healthy movement with pain. Pain is the signal that something is wrong and you need to see that mechanic.What does this mean?
It means you have to stop thinking and move. Your body needs to be retrained to move healthy. It means, on a regular basis, moving your body the way it is designed to move, every muscle, every joint, with full range of motion, in every direction, at all speeds, performed with agility, power and grace. You don’t want movement where you have to think about your posture. You must challenge and train your body to once again think for itself.

With my clients, I create a program of deep tissue massage therapy to re-establish healthy fascia, show them how to do self-myofascial release using a foam roller, teach them full body flexibility and corrective exercises, and create a training protocol which incorporates barefoot walking and running combined with functional exercise. This has proven successful in breaking down pain patterns and establishing pain-free healthy movement.


What is Posture and How to Improve Your Posture

Anatomy chart side view of good posture.When I think about posture, the first thing that comes to mind are the words I’ve heard, and still hear, in childhood and adulthood: “stand up straight and pull your shoulders back.”  Or I get an image of the skeletal and muscular anatomy posters in a doctor’s office with a plumb line that goes directly through the center of the head, shoulder, hip, knees, and through arches of the feet. This is what many of us are taught is “good” or “perfect” posture. There is a problem with these pictures and instructions: they do not represent the entire story of what posture truly is, nor do they effectively teach you how to maintain it.


What is posture?

Posture is not a concept. Neither is it an “ideal or static position.” Posture IS position.  It is the stable position of your body as it moves in gravity right now. Posture is the shape of YOU – moment by moment, movement by movement. What provides that shape is a highly complex system of bones, muscles, tendons, ligaments, and fascia that provides stability, strength and coordination to the body.

Postural muscles [or core muscles] stabilize the joints within the skeletal system through movement, against gravity. In terms of posture, stabilization means to slow down joint movement.  In essence, postural muscles are a high-tech braking system. When it comes to movement and injury prevention, stability is king. It is more important – for long term joint and movement health – to be capable of slowing or stopping joint movement than it is to speed it up, and your body inherently knows this.

It is from stability that all healthy movement is derived.

Movement Muscles
Movement muscles [called phasic muscles] are the muscles that provide mobility. These muscles are primarily responsible for movement. Your phasic muscles are what make you go. They are the gas pedal.
What causes poor posture and pain?
X-ray picture of person sitting in front of the computer in a very poor posture position.When postural muscles are not engaged, such as from sitting for long hours every day, or lack of functional exercise, they go to sleep.  If you do not use them, your postural muscles literally lose the ability to stabilize the joints of the body. Since stability is so important to movement, when your postural muscles lose their ability to function, your body MUST do something about it.
What does this look like? A great example of this is the lower core. It is primarily responsible for stabilizing the hip and the lower back. Sitting shuts off the lower core muscles. If you sit for long hours every day, over time you lose the ability to turn your lower core on. You can no longer fully engage them. Do this long enough and you will lose the functional ability to stabilize the hip and lower back with your core muscles. The muscles are there, but they are no longer doing their job.What happens…
You have your postural muscles, the brakes. You have your movement muscles, the gas pedal. When the postural muscles shut down, the movement muscles are left with the responsibility of providing stability as well as mobility. This is the equivalent of having your foot on the gas pedal and on the brake at the exact same time.What does this look like?
Picture of someone with hip pain due to poor posture habits. Let’s think again about your lower core. Once the lower core muscles have shut down, the pelvis is left unstable. Remember, stability is king! Your body will recruit stability from somewhere else when needed. In this instance the stability will come from the hip flexors and gluteals – both mobile muscles. The hip flexors and gluteals take over stability control of the pelvis. In doing so, they lose some functional ability as mobile muscles placing greater stress on the hamstrings and low back, leading to significant reductions in the range of motion of the hips and secondarily to the shoulders, knees, and feet. Reduced range of motion causes imbalances throughout the body, which ultimately lead to dysfunction, pain, and injury.
What is the lesson here?
For your body it is posture, aka stability, that trumps movement.  If your postural muscles have lost their ability to function, your body will automatically trade in movement to achieve stability.  There is no movement that does not begin without stability.To improve posture, you must improve your body’s ability to stabilize itself within every range of motion available. This means creating a fundamental shift in how you move and how you train movement. The program I recommend to my clients includes self-myofascial release using a foam roller, deep tissue massage therapy, full body flexibility, corrective exercise, functional strength training, and being barefoot.


Warning About Transitioning Towards Minimalism By Jesse James Retherford














“The heel cushions and arch supports within modern shoes have made our feet weaker, the foot has so much support in these shoes that the muscles don’t need to work as much as they would otherwise and have grown weaker … If you transition to barefoot running slowly and run correctly, so you build up to it, you could decrease the risk of injury over the long term.” Science News


I want to return to the discussion of minimalist or barefoot walking and running to stress a point that I may not have made strongly enough about the transition to minimalist or barefoot shoes and the process of changing one’s walking and/or running form.

Please be aware that changing your walking/running mechanics will place new demands upon muscles, joints, and tendons that are weak and unstable due to under use. If you are a habitual barefoot runner or walker, then your body is more prepared to make this transition. For everyone else, plan for the transition away from shod running/walking into minimalist or barefoot running/walking to be very slow.

I definitely do not recommend that you throw your shoes away and go run the same way you have been up until now. Until you develop strength and stabilization in the foot and leg, even half a mile of barefoot running can cause a serious injury which can take months of recovery.

My suggestion is to plan to take between six months up to three years to fully transition into barefoot/minimalist running/walking safely. A very small few can make the transition quicker, but they are taking a very big risk. Far too many people who attempt a quick transition end up injured. Spend the extra time now; it will pay off the rest of your life.

Good indicators that you are doing too much too fast: extreme soreness in the calves, achilles tendon(s), and/or arches; pain on top or beneath the foot; and/or knee and hip pain after you run.

No Pain = Your Gain

My number one goal with my clients is pain-free movement. The feeling of pain is an indicator of a problem; it is the body’s way of communicating that something is wrong. It is important to listen to this 911 call. Stop what you are doing and utilize the appropriate treatment for the issue before returning to the activity in which you were participating.

By not doing this, you are placing yourself at an increased risk of significant pain and injury. I cannot stress this enough; I consistently see it each week with new clients. Ignoring pain leads to even greater pain.


Flexible Spending Accounts: A great way to finance massage By Greg Haggard, LCMT

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Natick Massage | Wayland Massage | Turtle Dance Bodywork

In these difficult financial times, when stress levels are high and every dollar counts, massage is more necessary than ever. I am frequently asked if I can bill insurance for the services I provide. Many people don’t understand why it is not covered in most instances, considering other treatments like acupuncture and chiropractic often are. My best answer is to suggest they look into flexible spending accounts, or FSA’s, as a reasonable alternative.

FSA’s are available through many health plans, most large employers, and any company that offers benefits under a “cafeteria plan”. Once the account is set up, the employee determines a set amount to be set aside pre-tax from their regular paycheck. These accounts are typically used to cover qualified medical related costs not covered by insurance. The primary advantage of a FSA is that the money goes in before payroll taxes, which means roughly 30% more value on every dollar.

Because expenses covered have to be “qualified”, it means your doctor has to prescribe massage for a specific health issue. The commonly accepted definition of what is qualified is as follows:
Section 213(d) of the Federal tax code stipulates that a qualified expense must be “to alleviate or prevent a physical or mental defect or illness.”
Since therapeutic massage is frequently used for stress related issues, like high blood pressure and anxiety, as well as chronic pain and musculo-skeletal issues, a physician would most likely write a prescription for these types of conditions.

A recent study, published July 5, 2011 (article) has shown that massage is clearly effective in reducing low back pain. This is a huge step forward in establishing the therapeutic value of massage in a resistant medical culture. Citing studies of this nature can be helpful in persuading a doctor who might be hesitant to prescribe.

The two common methods of using the FSA account are with a debit card and with reimbursement. Many companies are using the debit card option, as it cuts down on processing and paperwork. Otherwise, the client pays for the session, gets a receipt from the therapist, and submits that receipt for reimbursement. Receipts need to include the medical reason for the visit in order for the FSA to process it. Not all therapists are able to accept debit cards, so the reimbursement method may be the only option.

One thing to be aware of with the Flexible Spending Account is that it is “use it or lose it”. These plans are annually renewed, typically at the beginning of the year, which means the full benefit is available January 1. However, anything left in the account after December 31 gets absorbed, leaving the employee with a loss.

Many therapists offer bulk purchase discounts, allowing additional savings. When purchasing these bulk plans early in the year, the employee can potentially get a discounted rate for the package prior to actually paying for it, on top of the 30% pre-tax savings! A little advance planning is a worthwhile thing.

While most people believe in the therapeutic benefit of massage, the financial concern is the most often sited reason for visiting less frequently. With the Flexible Spending Account, you can think of your massage visit as being automatically discounted 30%. A conversation with your HR person or health insurance provider is strongly recommended to find out the specifics about the plan you have access to.

I hope this information is helpful to those who are hesitant to visit their massage therapist because of the expense. I’d love to hear feedback from people who have used, or are currently using a FSA for massage. Have your experiences been positive, negative or neutral?


Ask the Experts: How Much “Time” Do I Need to Safely Transition to Minimalist Footwear? By Jay Dicharry

Q: In the transition to minimalist footwear, am I going to get hurt? And how long does this transition take?

Jay Dicharry responds:

There has been a lot of interest lately in the transition to minimal footwear. Am I going to get hurt? How long does this transition take? Is this really better for me? Will my old shoes take it personally? Last year at this time, there were 6 minimalists shoes on the market. This year there are 64. It’s a hot market, and folks are taking notice. While shoes are nice to talk about, let’s not forget that it’s the runner in the shoe that plays an active role in this equation. Shoes don’t run by themselves.

The recent article by Giuliani et. al. ( Giuliani J, Masini B, Alitz C, Owens BD. “Barefoot-simulating Footwear Associated With Metatarsal Stress Injury in 2 Runners,” Orthopedics. 2011 July) has raised some concerns.They highlight two cases of stress fractures in two different runners who transition to minimal footwear. The switch to minimal footwear can be dramatic. You get more “feel” since the squishy midsole is reduced or gone. You get a lower differential from your rear foot to your forefoot. These two factors change: a) the position of the foot (heel isn’t higher than the forefoot in full contact) and; b) the demand of the runner to stabilize the foot inside the shoe. In short, with less “stuff” in between you and the ground, you need your body to do a bit more, and will be forced to accommodate to a bit more as well.

Ever hear about the experiment with pre-school kids with the marshmallow? Researchers put a kid in a room with one marshmallow on the table and tell him/her that they can eat it and they’ll get another one.  But, if they don’t eat it, they’ll get two marshmallows later. The tester walks out of the room and the kids go into panic mode when sitting in front of this stellar, delicious marshmallow. Most eat the single marshmallow for instant gratification.  They fail to see the merits of waiting patiently for a better result.

What in the world do toddlers and marshmallows have to do with running shoes? A lot. The switch to minimal footwear can pay off in the long run, but you need ensure you’ve got what it takes for a successful transition. Obviously any time you make a change to your body, there is an adaptation period that needs to occur.  A lot of “experts” say that it will take six months to a year to fully transition to a minimal shoe. I’d like to think that this is overly cautious, and like to discuss why using the anatomy.  Here at our Lab, we’ve found great success using the following three criteria for runners looking to run with “less”.

1. Mobility: Traditional running shoes have about a 10-13mm drop from the heel to the forefoot. This creates a “rocker” effect in the shoe. Take a look at a shoe from the side and you’ll see that the curve from the ball of the foot to the tip of the toe rises up. Since your foot is flat, you need to ensure that you have enough mobility (called dorsiflexion) of the big toe to allow the foot to roll over. Additionally, since the heel is higher in a traditional running shoe (think a small high heel) the heel chords are used to operating in a shortened position. You need to ensure that you’ve got the mobility needed to allow the heel chords to operate form their slightly lengthened position. So what to you test?
◦    Ankle mobility (heel chords) – you need to be able to dorsiflex (cock the foot up towards the shin) about 25 degrees. Lack of mobility here means you’ll need to stretch the calf and Achilles.
◦    Plantar facsia mobility – with the ankle in about 5 degrees of dorsiflexion, you need to have 30 degrees of dorsiflexion at the big toe. If you don’t have this, you can’t roll over the toes, and will be forced to spin off of the forefoot.

2. Single-leg Standing Balance: normal balance has been identified as standing on single leg for 30 seconds with a still upper body and full foot contact. Since the midstance phase of running is essentially a single leg squat, it is essential that the runner is able to maintain the foot in contact. A triangle between the inside ball of the foot (1st MTP), end of the big toe (distal phalanx of the 1st ray), and outside ball of the foot (5th MTP) should be seen. When in single leg stance, the muscles in the foot need to be “pro-active” not “re-active”. If you are wobbling your foot back and forth when standing on one foot, you’ve got some room to improve your “proprioception” – or sense of where and what you’re your foot is doing during contact. The most successful way to improve single leg balance is to perform it frequently (15-20 times a day) for small doses (30 seconds each).

3. Ability to Isolate the Flexor Hallucis Brevis: a key factor that distinguishes humans from primates is our medial longitudinal arch. This arch is actively stabilized by the flexor hallicus brevius (FHB). While standing, try to drive the big toe (1st MTP) into the ground (plantar flexion) while slightly elevating (dorsiflexing) the lesser toes. Make sure not to roll the ankle in or out. This test enables screening of muscles inside the foot that stabilize the arch. The FHB can be easily distinguished from the longus (FHL), as the FHL crosses another joint in your big toe (1st IP joint), resulting in your big toe curling. Spend some time getting to know your foot. Aim to drive the big toe down while lifting the little toes (without curling the big toe!), and lift the big toe up while driving the little toes down. It’s the best way to work on coordination of muscles that actively stabilize the foot in stance. It’s your foot – control it! If you can do this, it’s a sign that you can keep the rear foot stable on the forefoot when the body sees the greatest amount of pronation (which is just slightly after midstance and AFTER the heel is off of the ground by the way.)1 Midstance is when forces are highest throughout the body- about 2.5 times your body weight. You need the internal strength to be able to respond to these forces to keep things in alignment.


When your foot “works” it can actively stabilize the transfer of forces through the foot. If you don’t pass these three tests, no worry  -simply get to work on improving your limitations. Pay a visit to your local PT if you need help with specific exercises and stretches to improve.

If you lack mobility, research shows it takes 10 to 12 weeks to gain significant improvements. So stretching for two weeks likely won’t be enough for most folks. Improving tissue length can take some time. If your limitations are in the balance aspect, you’ll be amazed how quickly this improves if you simply “practice practice practice. “Typically, about two weeks yields a significant improvement. Finally, strength gains take about 6-8 weeks to achieve. So if you really have trouble isolating your foot muscles, this could take a bit to get them stronger – but you can always improve the strength of your muscles!

Passing these three tests doesn’t mean that you should go run a marathon in your new minimal shoes on day one, but we’ve seen that folks who master these have little to no problem making the transition. I’ll note here that these tests are not new in my mind. I’d like all runners  – even those who run in traditional shoes – to pass these tests. Its that when the “stuff” under your foot is less, these traits are that much more important.

So invest some time to improve your foot. Because it’s always better to be able to eat two marshmallows instead of one!  Shoes make a difference, but it’s the runner in the shoe that you’ve got control over.

This essay originally appeared on Jay’s blog. Go here.


Free Your Feet

Feet are the foundation of posture.  A strong foot creates the base support structure for a strong healthy body. A weak foot creates an unstable foundation affecting the posture from head to toe. You cannot build a strong stable structure over an unstable foundation. It would be like attempting to build a house on top of sand. Sooner than later the entire structure will collapse.

As a movement therapist, one of the things I specialize in is helping clients heal from chronic pain and injury. In the majority of clients that I treat, I have seen a connection between their chronic pain and the health of their feet, including the shoes they wear.  Painful conditions of the knees, hips, low back, shoulders, and neck can all be traced down to the feet. I believe that foot health is one of, if not the biggest, determining factor of pain, injury, disease, overall health, wellness, and vitality. To have healthy feet, you must free your feet.

Happy Feet - Free your feet.Your feet are your connection to the Earth.

The sole of your foot is one of the most sensory nerve-rich parts of your body, comparable with the palms of your hands, mouth, and genitals. Sensory nerves receive stimuli from the environment, such as texture, temperature, and traction. Let that sink in a bit. Imagine spending 10-12 hours a day with thick padding on your hands. How well would you be able to interact with the environment?

“Sensory information from the foot is used to protect the foot itself from injury, but it’s also used by the brain to make subtle adjustments in your gait to protect bones and joints all the way up your body and to maximize the efficiency of your movements.”Dr. Daniel Howell, the barefoot professor

Imagine that, from the moment you start to crawl and explore the world, thick cushioned gloves were placed on your hands for eight to 16 hours each day. How would the world look and feel now? You would lose finger dexterity and the ability to grip.  Without grip strength, your body would look much different. The muscles of your chest, back, shoulders, and arms would be dysfunctional, weak and atrophied, affecting functional movement of your entire body.  Your life also would look considerably different. More than likely you would feel a physical, emotional, and spiritual disconnect from friends, family, and environment. This is what has already happened with your feet. Instead of saying “free your feet”, I’d be promoting “free your hands.”

Feet in high heels. These are not happy feet. Free your feet.
They may look happy
X-Ray of foot in high heels. Free your feet.
But they really are not happy
Hokka Running shoes make not happy feet. Free your feet.
Great marketing, but definitely not happy feet

Free Your Feet!

For most of us, shoes are on our feet from the time we take our first baby steps — shoes with hard, thick rubber soles. These shoes lift your foot an inch or more off the ground and block the sensory nerves from receiving external stimuli. This weakens the intrinsic muscles that make up the arch of the foot, changing the way you walk and run and undermining the development of the core muscles that make up your posture. After decades of wearing shoes, many peoples’ arches have partially or fully collapsed, creating muscular and postural dysfunction, wreaking havoc, and causing considerable pain throughout the body.

So where does foot health begin? It begins with your next step and the shoes you choose to wear.I am an advocate of minimalist shoes. The least amount of shoe on your foot that you can manage pain-free, the stronger your body will be.Here is the best definition of minimalism and minimalist shoes I have found. It is borrowed from Dr. Mark Cucuzzelas.Barefoot in grass. Free your feet.

What is minimalism?
• free your feet to develop naturally
• looks for the least amount of shoe you can safely wear now
• works toward reducing the amount of shoe necessary through strengthening the foot and improving your stride
• practices running as a natural movement of the body, rather than an unnatural act requiring artificial support to perform safely
• embraces the notion that the beefier the shoe, the more a runner’s natural stride is inhibitedWhat is a minimalist shoe?
• complements natural foot function
• has very low heel-to-toe drop
• is constructed with thin material under the foot, allowing maximum ground feel
• has a soft and flexible upper
• is light and flexible

Nike Shox. They look cool and all, but they are not happy feet. Free your feet.
Not minimalist shoes and very unhappy feet

The most common question I hear about minimalist shoes and my response

Don’t I need arch support?
You have the most advanced arch support design system in the history of bipedal locomotion, and it is already built into your foot. There is nothing that man can create that will be superior to God.

The structure of an arch is a phenomenal piece of engineering. The Romans perfected the use of arches in their architecture. Why? The arch is the strongest shape in natural architecture and becomes more structurally stable with more weight pushing down.  Your arches actually get stronger with weight on them. If you were to apply upward pressure from underneath, you would collapse the arch, which is exactly what arch supports in your shoes do, whether they are built into the shoe or insertable orthotics.

Arch supports are designed to immobilize or limit the motion of your arches. While immobilizing may be appropriate to aid the healing process of a broken bone or a torn ligament, permanently immobilizing any part of the body will lead to loss of function.

Barefoot skiing. Free your feet.
Yeah happy feet!

The foot is not only the foundation of your postural body, it is your connection to the planet. Every step you make in life begins with the foot. If you utilize the natural engineering and design of your foot, you will build a solid support structure that will be more capable to carry you pain and injury free throughout life. The more contact between the earth and your foot, the better you will feel physically, emotionally, and spiritually. It is time to Free Your Feet!


Carpal Tunnel Syndrome Pain Is Not Just Physical BY ROBERT_VIGNOLI

The Emotional Effects Of Carpal Tunnel Syndrome Can Be More Harmful!

Carpal Tunnel Syndrom

Carpal Tunnel Syndrome is a condition caused by compression of a key nerve in the wrist. It is an especially painful condition that affects approximately three percent of all adults in the United States.

People who work with their hands are the most at risk of developing Carpal Tunnel Syndrome. This includes artists, musicians, some construction workers, and those who use a computer for extended periods of time.

How does Carpal Tunnel Syndrome Affect Someone Emotionally?

Though not part of a normal description of Carpal Tunnel Syndrome, this crippling disorder has many emotional effects as well. Because of this disorder, many strong emotions may come up that one is not prepared to deal with. It is important to familiarize yourself with the common emotional upheavals so you can be prepared to deal with them.

Emotions associated with Carpal Tunnel Syndrome may include:

  1. Feelings of uselessness. Carpal Tunnel Syndrome can make it too painful to do anything, including cooking and normal household chores. This leads to feelings of uselessness, and the belief that one cannot make it on their own with Carpal Tunnel Syndrome, especially if they live alone. To overcome this feeling, focus on the many things you still can do and learn to make adaptations to complete normal tasks that are painful.
  2. Anxiety and fear of the future. Similar to feelings of uselessness, anxiety stems from not being able to perform everyday tasks. People with Carpal Tunnel Syndrome are worried about the future, and what is going to happen to them if they are unable to take care of themselves. To get over these fears, it is important to stay in the present moment. The anxiety will pass, but it will also never come up if you are not projecting.
  3. Loss of enjoyment in fun activities. When you have Carpal Tunnel Syndrome, you may no longer enjoy activities that are fun to you because of your pain. Your future may seem bleak. It is important to concentrate on the fact that you can still have fun and look for activities that will not make your Carpal Tunnel Syndrome worse.
  4. Serious depression. Carpal Tunnel Syndrome can be so debilitating that one loses interest in life entirely. It is important to focus on the good things in life. If you are severely depressed, contact a psychiatrist for help.

What are the Symptoms of Carpal Tunnel Syndrome?

Symptoms of Carpal Tunnel Syndrome are varied. They can be felt not only when the hand is in use, but also when it is resting. The pain associated with Carpal Tunnel Syndrome increases gradually over time, and usually must occur for a minimum of 10 weeks. Common symptoms include:

  • Pain in the wrist and hand
  • Numbness in the fingers
  • Tingling of the fingers
  • A sense of weakness
  • The tendency to drop things
  • Loss of feeling coolness or heat in the hand or wrist
  • Feeling of swollen hands even though there is no visible swelling

So, as you can see, there are several emotional side effects to this disease. Don’t let it get you down. Get help, and don’t forget that Carpal Tunnel Syndrome doesn’t always last forever. Early recognition and proper treatment is important to treating Carpal Tunnel Syndrome.

Dr. Mark Cucuzzella’s Reply to Jeff Galloway’s Views on Minimalist Running Shoes and Injuries: Thoughts From a Minimalist Shoe Store Owner

With all his books, coaching experience, training methods, racing achievements, and Ironman-like durability with just over a half-century of miles on his legs, Jeff Galloway is a respected fixture in the running community. And along with many other runners, I’m a subscriber to his email newsletter.

But his take on minimalist running shoes in his most recent newsletter is not one that I share. Here’s what he wrote:

“Many runners who own one of the minimal and exotic shoes that have popped up on today’s market will tell you that these shoes have solved their running problems. I hear the other side of this issue, about every day, from those who have been injured (often severely) by using these products or by running barefooted. Many have to stop running for 4 to 6 months. Thousands have reported significant problems.

I’ve seen this fad come and go 5 times during my 52 years of running. Something will come out in the media about minimal support/barefooted running, and thousands will try it. About a third of those who try it run for short distances and like the tingle of the feet so they run more. Without support, the distance or the surface of the run will often cause an injury–including a number of serious ones such as stress fractures. Each fad cycle ends when those injured tell other runners about their experience–so that very few want to put themselves at risk.

Minimal shoe/barefooted running has its place if the foot can handle it: Short runs when running on a safe surface can give the foot a bit more strength and develop a lighter touch. Unfortunately, there are lots of risks on most running surfaces: pieces of glass, medal or rock–hidden below even the most groomed grass surfaces. There are also lots of surface irregularities that can produce serious trauma injuries in one step.

Today’s shoes have decades of orthopedic research behind them and can protect the foot from most of the problems due to running surface. Go to a store with trained and experienced staff members, like my Phidippides stores in Atlanta, and get the best advice.”

Here’s my reply to Jeff:

I am curious about the runners who are showing up everyday claiming to have been injured as a result of minimalist shoes. Over a year ago in Shepherdstown, West Virginia, I opened the first footwear store in the nation purely devoted to minimalism and sold no shoes with traditional elevated heels. Two Rivers Treadswas only the first store of its kind. There are now six new stores in the country who have embraced minimalism – and all are partners with the Natural Running Center (, where I am also its executive director. All of these stores are completely aligned with the education message of teaching good form, prescribing more functional footwear, and the progressive adaptation to more natural running.

At Two Rivers Treads, we just don’t sell shoes; we have a discussion with each and every customer regarding their running, injuries, goals, and some simple and clear instruction on how to reduce impact loads on their joints. We have sold over 3,000 pairs of shoes in a year and only five customers at most have returned with an injury and blamed the shoe. This is far less than Galloway’s daily experience. Are the injured runners just going to the doctor instead of back to us? I doubt it as we would be the first place they would return to if they felt it were the shoes. Do I have scientific data for all this….no, we are a small business.

Maybe we are doing something different when we sell minimal shoes. So just what are we doing? The following educational information is included on our store walls and handouts.

Let’s first define how we interpret minimalisma minimalist shoe, the risks, and the gradual progress.

What is Minimalism?

— Free the foot to develop naturally

— Look for the least amount of shoe you can safely wear now

— Work toward reducing the amount of shoe necessary through strengthening the foot and improving your stride

— Running is a natural movement of the body, rather than an unnatural act that requires artificial support to perform safely

— Embraces the notion that the beefier the shoe, the more a runner’s natural stride is inhibited

What is a Minimalist Shoe?

— Complements natural foot function

— Heel to toe drop is very low

— Material under the foot is thin….allowing maximum ground feel

— Upper is Soft and Flexible

— Light Weight and Flexible

Effects of a Modern Running Shoe?

— Impairs your natural bounce

— Promotes heel striking

— Alters your natural lever (heel lift)

— Creates unstable base

— Causes loss of sensory input

— Causes skin atrophy

— Creates unhelpful movement memory

What are the Risks of Minimalism?

— Foot is NOT guided into running stride

— Feet need to do some of the work and need to get strong

— If form is incorrect and you are not strong in the right places you may develop soreness….so listen to your body and progress gradually

How to go Minimal?

— Take it slow at first

— Add distance gradually

— The more minimal the shoe the more adaptation it will take

— Progress through the stages of Shoes from Neutral/Transition to Minimalist to Barefoot Style

— Do some barefoot running and walking

For early adapters who are weak in their foot and hip stabilizers a minimal shoe may be what we call a “neutral –transition shoe”, such as a Newton Isaac or Altra Intuition.

Now how do we define shoes? This too is on our store walls, and the shoes are displayed this way in the Natural Running Center Shoe review section

Barefoot-Style Shoe

— Your feet “feel” the ground

— Thinnest layer of protection between foot and ground

— Heel and toes are level

— Land on the midfoot/forefoot

— Lightweight

Minimalist Running

— Some cushiony comfort

— Little to no heel-to-toe drop

— Enhanced ground feel

— Soft, flexible shoe moves with feet

— Ideal for all surfaces– road, trail, track


— Similar protection to most running shoes but without elevated heel

— Little to no heel-to-toe area drop

— Foot is in natural position

— Encourages midfoot/forefoot landing

— Ideal “starter” shoe for transitioning runners to minimalist/barefoot-style

The real folks making this happen in a small community such as Shepherdstown are my lead employees, aka the Shoe Guys, Tom Shantz and James Munnis. Tom and James lend some practical and philosophical advice on the topic.

Here’s Tom: “We give verbal warnings to all minimalist shoe buyers. I have been adapting for a little over a year now. It’s a slow process. What I have found that works best is to have two pair of shoes. One that is ‘flat’, zero drop, and one that has a drop of 5mm. One should transition into the 5mm shoe first. It should take approximately 2 weeks. The zero-drop shoe should take you approximately three months to transition into. Once you have transitioned into both shoes you should continue to slowly increase your distance in the zero-drop shoe. The 10% week rule is out the window. Try 1% increase in the zero-drop shoe. For a younger runner who has been in racing flats the transition is much shorter.”

Now here’s James: “It’s still funny to me how three million years of evolution is still considered a fad by some folks. Nobody who has ever followed our advice on gradual transition has ever been injured from the act of running completely barefoot, or in minimalist shoes. Many do have the usual fatigue and discomfort over a period of up to a year or so trying to undo the weakness and atrophy of the most excellent foot that has been caused by horrible traditional footwear for everyday wear and for running. Mother Nature has given us a foot that is very endurable and survivable, despite our very recent efforts to screw it up with the many ridiculous features of a traditional running shoe. Would anyone please tell me one single reason to elevate a human heel above the forefoot for anything, or to interfere with our natural suspension system with arch support, and especially for running?”

So there you have it: Two Rivers Treads’ Shoe Guys have spoken. And as their informal comments reflect, it is not about the shoe, but the education. An example of one of the fun educational sessions hosted by our store is the recentNatural Running Roundup with Chris McDougall on the home page of the Natural Running Center.

Here’s to healthier running,

Dr. Mark Cucuzzella


Plantar Fasciitis By Dr. Mark Cucuzzella

Barefoot running, plantar fasciitis, pain managementPlantar Fasciitis
By Dr. Mark Cucuzzella

Plantar Fasciitis is the common term for what should be more accurately termed Plantar Fasciosis. itits is an acute inflammation caused by a trauma or infection. osis is chronic degenerative condition.

No evidence exists for an ideal treatment of this condition without identifying and treating the causes, which can be many. Since we have no literature to guide us, this advice comes from seeing hundreds of runners and guiding them in self corrections.

Plantar Fascia

What is the Plantar Fascia?

The plantar fascia (PF) is a strong ligament that runs from the heel to the metatarsal heads in the front of your foot. This ligament helps absorb the shock that occurs when your foot contacts the ground. It has function in the windlass mechanism recreating the arch on takeoff.

What is the Cause of Plantar Fasciitis?

The PF is designed to manage a relatively small amount of stress. The intrinsic and extrinsic muscles of the foot are designed to receive signals from the fascia and in turn manage the majority of the load. When those muscles are dysfunctional the load gets transferred to the PF which is unable to handle it hence causing tears or plantar fasciitis. You can repair these tears by using palliative methods but as soon as you hit it again you will have to go through the same process. The only way that you can actually fix plantar fasciitis is to address the root cause… weak foot muscles. (Thank you Lance from Barefoot Science for the insight).

Several Structural Causes can Contribute to the Problem

  • Weak intrinsic muscles of the foot
  • A misaligned and weak first toe
  • Tight shortened calf muscles
  • Tight plantar fascia

Other Important Contributors

  • Increased mechanical stress from the amount of running or activity
  • Obesity
  • Adapting too fast from supportive footwear which inhibits intrinsic muscles to flat shoes or barefoot (i.e. summer if going quickly into flip flops or barefoot)
  • Poor walking and running mechanics
  • Overly supportive footwear leading to instability. This is a paradox as shoes that over support will weaken the foot which in turn leads to the foot’s instability.

What Can You Do to Correct Plantar Fasciitis?

There are a few basic principles but they will vary depending on the cause:

  • Any support from an orthotic, arch support, or taping should be a temporary modality while you strengthen and lengthen the tissues. Using one of these forever is akin to breaking your arm and leaving the cast on forever (in one week muscles begin to atrophy from disuse).
  • Doing eccentric drop down exercises from a stair can help. Place your foot on stair and drop your heels down. It is OK to have a little pain doing this as long as it is getting progressively better.
  • Dorsiflex the big toe to lengthen PF if it is tight
  • Get out of heels – gradually – in ALL activities
  • Work on foot intrinsics… pick things up with your foot. Walk barefoot.
  • Practice a technique of running encouraging more natural form, ligher ground contact and loading rates, and more proprioceptive cueing. For more info, check out Chi Running by Danny Dreyer, Natural Running by Danny Abshire, Evolution Running by Ken Mierke, and the excellent teaching of Lee Saxby of Terra Plana VIVOBAREFOOT (see video).
  • Strengthen your big toe by pushing it into the ground as often as you can whenever you are standing throughout the day. This will wake up the foot muscles and help recreate the arch.
  • If you first toe is bent in consider a product to straighten it like Correct toes from Dr. Ray McClanahan.
  • Use the principle of gradual progression and body sensing when making any changes
  • Avoid NSAIDS (Motrin, Ibuprofen, etc). These drugs interfere with natural healthy healing processes.
  • See a good health provider who understands natural running and walking

Photo: Markusram

What About Orthotics?

Read this excerpt from Barefoot Science Canada (I am completely aligned with their opinion):


Custom orthotics and similar products attempt to stabilize the subtalar joint by supporting the arch, claiming to correct the poor biomechanics of the foot. This claim of correction is quite misleading. Orthotics only mask the symptoms by artificially supporting a dysfunctional structure along with its inherent muscle imbalances, while introducing a new angle of ground interface to the foot.

The artificial support provided by orthotics has little or no effect on the alignment or structural integrity of the interlocking bones that are still loose and unstable. The foot remains functionally unstable and will become increasingly weaker and dependent on the support. These bracing and supporting characteristics can actually prevent proper alignment in the foot and ankle as they manage multi-directional activities, contributing to increased stresses at the ankle and knee. And the chance of injury increases when misalignment and increased stress combines with an unlocked structure.

From a biomechanical perspective, by introducing a new angle of ground interface, orthotics cause a shift in the dynamics of the repetitive movement. The symptoms resulting from the old dynamic disappear and the problem seems to be corrected. Unfortunately, over time or with increased activity levels at the new ground interface angle, the repetitive movement often results in new symptoms at different locations. This creates a recurring cycle where new orthotics are prescribed to compensate for the ever-migrating symptoms and pathologies. The current practice is to recommend new orthotics at least every couple of years.

Heel-that-pain has some great exercises and videos including a nice demo on taping. The heel seat can also be a useful non supportive tool to give some short term relief while you strengthen the foot.

And finally do not wear shoes that shorten your PF or place your foot in all-day-dysfunctionwear minimalist footwear!

About the Author

Mark Cucuzella is a Family Physician at Harpers Ferry Family Medicine and Associate Professor at West Virginia University School of Medicine. As a Lieutenant Colonel in the Air Force Reserves, he is coach and captain of their marathon team and designing programs to reduce running injuries in military personnel. His passion for health extends beyond the walls of the clinic into the medical home’s “backyard”- the trails and open space that create the arena for optimum wellness.

You can read more about Mark on his website:


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