Separating the Buzz from the Biomechanics:A Guide to Athletic

Shoes & Podiatry

SeparatingSeparating thethe BuzzBuzz fromfrom thethe Biomechanics:Biomechanics: AA GuideGuide toto AthleticAthletic ShoeShoe TTrendsrends && InnovationsInnovations

Here’s a look at the latest in athletic footwear and how to separate fact from fiction.

By Stephen Pribut, D.P.M and Douglas ment of injuries to the lower ex- podiatric medicine, even though Richie, Jr., D.P.M. tremity. this category of shoes will be the Recommending or prescribing most common one prescribed by recent survey of members of footwear can be an intimidating any podiatrist in private practice. the American Academy of process for the podiatric physician. The American Academy of Podi- APodiatric Sports Medicine Over the past 30 years, the subject atric Sports Medicine has undertak- showed that the typical sports podi- of footwear has been almost non- en a number of efforts to educate atrist refers a patient for the pur- existent in the curriculum of podi- students and practitioners on vari- chase of a new pair of athletic shoes atric medical schools. Recently ous aspects of athletic shoe evalua- between 10 and 50 times per week. there has been a promising effort to tion and prescription. Each year, America’s podiatrists may be pre- include lectures and even complete several workshops on athletic scribing somewhere between 6 and courses in pedorthics at the col- footwear are offered at schools of 31 million pairs of athletic shoes leges. This has been in response to podiatric medicine and at the annually of the 448 million pairs of an increasing trend for podiatric APMA Annual Scientific Meeting. athletic shoes sold each year (2003 physicians to prescribe therapeutic The AAPSM website maintains an figures). Clearly, podiatric physi- footwear for diabetic patients over updated list of recommended shoes cians who treat athletes have recog- the past 10 years. In-depth lectures at www.aapsm.org. nized the critical role of footwear in on athletic footwear, however, are Virtually every patient who

Image Source the cause, prevention and treat- still a rare occurrence at schools of Continued on page 86

www.podiatrym.com OCTOBER 2004 • PODIATRY MANAGEMENT 85 Biomechanics... cross training shoe. is worth visit- Many patients will seek advice ing the stores wears shoes owns a pair of athletic from their podiatric physicians in your area to shoes. These shoes may not be used about some new shoe innovation determine for sport, but are the favorite choice advertised on television or in a which stores for weekend wear, shopping and magazine. More often than not, the have knowl- travel. In the current $14.4 billion practitioner is caught off guard, edgeable per- athletic shoe industry, most experts having never heard of the gimmick sonnel, and to agree that many of the shoes pur- let alone understanding whether it discuss both chased are not actually used for the has true value to the patient. Of your patients’ sport intended. Fashion often more importance to the podiatric needs and your Dr. Romansky counts as much as function in the physician recommending athletic personal phi- choice of an athletic shoe. How shoes to patients is general knowl- losophy towards athletic shoes. many times does a patient tell you edge about shoe construction tech- Another positive trend in ath- they have chosen their shoe based niques which have direct implica- letic shoes has been the offering of on color or some other stylistic at- tion on function. Memorizing trade widths in many brands and models. tribute? names of patented cushioning sys- In the past, New Balance was Notwithstanding, whether for tems is of little benefit to the clini- known to be the only athletic shoe casual use or for a high perfor- company offering a wide range of mance sport, the choice of footwear widths. They have been joined by can be critical for the comfort, safe- many other athletic shoe compa- ty and enjoyment of the activity. nies that now offer at least three The general public has a perception width options (narrow, medium, that the podiatric physician can Recommending or wide) for many of their popular provide all the necessary informa- prescribing footwear can models. A list of companies and tion for the selection of the perfect be an intimidating models with multiple width offer- shoe for any given patient. Yet, in ings is provid- reality, it is almost impossible for process for the podiatric ed in the ac- the average practitioner to stay physician. companying abreast of new technologies and table of run- changes in the athletic shoe mar- ning shoes ketplace. Many of these new tech- evaluated by nologies are merely marketing gim- the AAPSM. micks while others have great value (insert sidebar for the user. cian. Understanding what features of running It is difficult to tell fact from fic- to look for in a shoe for a particular shoes) tion in reading foot type or treatment of an injury Dr. Sharnoff the marketing is invaluable. Who Has the pieces provided This article is designed to give Ultimate Cushioning Systems? by most athlet- an update in trends and innova- We believe that cushioning sys- ic shoe manu- tions in athletic footwear as it per- tems are far over-rated as the pri- facturers. tains to the podiatric physician mary shoe feature to help most of Clearly, these who recommends these products. our patients. In many categories of companies are We will focus on those characteris- athletic shoes, the primary differen- trying to push tics having the most relevance to tiating feature between brands is the hot button foot health and injury prevention the cushioning system. Here, a of the average and review new technologies re- plethora of patented and trade- Shawn Fenty consumer seek- cently made available. marked technologies provide a ing something new in shoes. Some mind-boggling number of choices years back, the cross-training shoe In Search of the Perfect Fit for the consumer. Whether it is the was created more to fulfill a mar- Whether evaluating your pa- Nike Air®, the Asics Gel® or the keting need than an equipment re- tient’s footgear or referring for pur- Brooks Hydroflow® the consumer quirement. This shoe, said to be a chase of new footwear, proper fit appeal of a high-tech cushioning jack-of-all-trades, is certainly a mas- should supercede all other con- system is enormous. Thus, the pri- ter of none. The AAPSM supports cerns. Yet, the majority of athletic mary advertising focus in the ath- the policy of sports-specific shoes shoes are sold today in high vol- letic shoe marketplace seems to be and advises against the use of cross ume chain retail outlets with no the cushioning system. This em- training shoes for most uses, espe- trained or committed sales staff to phasis results from the fact that the cially for running. It is clear that assure proper shoe fitting. It is to average consumer equates cushion- one would not want to run in a bi- your advantage to locate a quality ing with comfort and prevention of cycle shoe or a golf shoe. One running shoe store with knowl- injury. The reality of the situation should also not undertake distance edgeable personnel that are well today, however, is that we really do running using a court shoe or a qualified to fit your patients’ feet. It Continued on page 87

86 PODIATRY MANAGEMENT • OCTOBER 2004 www.podiatrym.com Biomechanics... cushioning characteristics within their not fully understand how cushion- own product line, ing of shoes affects the athlete and but are not able to what cushioning characteristics are make good cross- suited for different foot types. brand comparisons. Early research on athletic shoes Baffling to re- showed surprising results when searchers has been testing impact forces on shoes of the inability to pre- varying hardness or cushioning. dict which foot type When running across force plat- requires which forms, runners did not strike the amount of cushion- ground with greater impact when ing to perform opti- running on shoes with harder mid- mally. While many Brooks Ariel soles. While extreme examples of still cling to the no- hard and soft shoes gave the ex- tion that cavus feet need more Palm® and a Furby®. This shoe is pected results, the broad range of cushion than planus feet, there are scheduled to be introduced late fall cushioning commonly found in many exceptions which make sys- of 2004. athletic shoes did not change the tematic prediction of the perfect net impact in runners’ feet. Ath- shoe for a particular patient almost Biomechanical Research vs. letes were found to adapt and mod- impossible. Adidas has developed Marketing Research ify foot strike depending on hard- their version of a solution to this A good question to keep in ness of the surface or shoe so that dilemma using a new technology in mind is how much research affects the net impact was the same, re- the shoe, simply called “1.” The the production of athletic shoes. gardless of shoe cushioning. Fur- Adidas 1 uses a microprocessor con- While pondering this question you thermore, shoes with greater cush- trolled system to adjust the shock might also wonder if the research ioning caused increased rearfoot absorption in the shoe. It has been that is most heavily relied upon is pronation compared to firmer, described as effectively having biomechanical research or market- more rigid shoes. Many researchers brainpower somewhere between a Continued on page 88 have concluded that propriocep- tion and muscle response play a major role in attenuating impact shock. During the late 80’s and through the 90’s, there was a general trend in the running and basketball industry to increase the firm- ness of the midsoles of shoes. In contrast to this, marketers por- trayed to the consumer that ad- vanced “cushioning” systems had been developed. Ever since, manufacturers have been on a quest to find the perfect balance between cush- Dr. Losito ioning and support. Today, cushioning systems in athletic shoes are as confusing as ever. Whether one company’s system is superior to another is largely speculative. What is important is the fact that companies offer models of shoes in various categories of cushioning, i.e., cushioned trainer vs. motion control which can be very helpful to the prescribing doc- tor. Companies thus can compare www.podiatrym.com OCTOBER 2004 • PODIATRY MANAGEMENT 87 Biomechanics... Accel, Asics I.G.S. (impact guidance system) and the ing research. Consumer surveys are Adidas torsion control sys- more likely to predict sales and are tem. Besides the technology often used to determine what fea- used by Adidas to determine tures consumers are most interested optimal cushioning, the pos- in and will pay most attention to. sibility exists that future Consumer profiles are used to de- technology could determine termine consumer attitudes toward bending moments within athletic shoes, brand and price pref- the sole. Modifiable longitu- erences, and future expectations of dinal bands responding to the industry and consumers. sensor input could be used Marketing is often created with to increase the stability of a lifestyles in mind. Lee Applebaum, shoe. VP of Marketing for Footaction USA Recent research has been was quoted in Brandweek (June 4, emerging from the biome- 2001) saying in reference to the chanics community regard- marketing of basketball shoes, “a ing how shoes and orthotics lot of these ads are not about perfo- affect lower extremity func- mance basketball. It’s about the en- tion. Research has shown ergy of the street and the passion that shoes can affect muscle behind basketball, with links to function in a positive or a hip-hop, urban culture.” Branding, negative fashion, depending name recognition, and celebrity en- on the cushioning character- Adidas F50 Soccer dorsements and use of the product istics. Much recent work has generate buzz and energy for the been conducted at the University of of the Nike Free shoe. This shoe is product. Why do the Rolling Stones Calgary Human Performance Labo- designed to mimic barefoot running wear Reebok shoes in concert? Is it ratory under the direction of Dr. as much as possible. One surprising just for that little Union Jack or is Benno Nigg, who has proposed the statement made by their head re- there some money changing concept that the foot follows a searcher was that they were sur- hands? “preferred movement pathway” prised to find that the limb followed which is optimal. A shoe or a foot the foot and that the toes moved How Much Motion Should We orthotic can enhance or can com- more out of the shoe than in a shoe. Control? promise this preferred movement Apparently they had not spent In addition to the hype and the pattern. In other words, foot or- much time watching unshod feet thotics may either walk and run, nor had they read Dr. over-control or George Sheehan in the early 70’s hamper lower ex- declaring that the key to treating tremity function or runner’s knee was though the foot they may enhance since the knee follows the foot. function. Not every trend has improved ASICS has incor- the control of the severely over- porated this con- pronated foot. Straight last running cept in their new shoes are being made less often. Gel-Evolution™ This may also reflect a trend to- shoe. This shoe is wards not “over-controlling” the actually a motion foot. Several companies offer a vari- control shoe which ety of last shapes designed to en- is designed to allow hance natural foot function and fit a certain amount of of shoes. These lasts are similar but Mizumo Waver 3 “natural foot mo- are often given fancier sounding tion.” This shoe is names by the manufacturer. An ex- science of shock absorption, run- designed to allow contact phase ample is Brooks naming their lasts: ning and walking shoes over the pronation rather than inhibit it. universal, curved, and linear for past 15 years have improved con- Flexibility is enhanced in this shoe semi-curved, curved, and straight. struction features which limit foot to theoretically improve propriocep- The trend away from control must pronation. These features include tion. Both of these features are not be tempered by the applicability of dual-density midsoles which pro- found in typical motion control this concept to our patients. Is the vide a medial “posting” type effect shoes, but ASICS believes that in the patient you are treating a lean under the foot. In addition, there is end, these features will enhance world class athlete? Does your pa- a wide array of trademarked tech- performance and lessen injury. tient over pronate? Would your pa- nologies such as the Brooks Pro- Nike has gone to an extreme tient benefit from limiting excess gressive Diagonal Roll Bar and DRB with this concept in the production Continued on page 90

88 PODIATRY MANAGEMENT • OCTOBER 2004 www.podiatrym.com Biomechanics... ing and stability. Flexibility has evolved to be found in the proper pronation? If so, then you will be biomechanical location in many in- looking for more motion control stances. This is accomplished by a for your patient, but perhaps not combination of careful placement the significant control provided by of materials and flexion grooves. the Brooks Beast. The Brooks Beast ASICS has changed their shoes is arguably the best motion control in a variety of ways. The IDS (im- shoe available, pact design sys- having a straight tem), with last and many grooves and anti-pronation notches, allows a features needed better flow of by some of our Understanding what force and a more patients. features to look for in a natural flexion and gait pattern. Shoes and shoe for a particular foot They have tried Orthotic type or treatment of an to use the biome- Compatibility injury is invaluable. chanics and Over the past anatomy to shape two years some their conceptual- manufacturers ization of how to have increased design a shoe. the prominence This design has of anti-pronation control devices in extended even to their socks, which their shoes. This may sometimes are now specialized to right and left make it difficult to fit an orthotic feet and even for a specific shoe. device into a shoe. The contour of Adidas began some of the midfoot the arch design of the shoe, an ex- “force flow/flexion” concepts with tended counter and a prominent their Torsion Control System, external counter can, in combina- which has evolved significantly tion, get in the way of the orthotic over the past 12 years since it was you are trying to add to the athletic first introduced. shoe. It is easiest to fit an orthotic Shawn Fenty, manager of Fleet into a shoe that has a flat foot bed. Feet, Washington, DC, feels that 10 While in the past many practition- years ago most manufacturers did ers would often completely remove not feel that motion control was an insole from the shoe, we recom- important in the women’s running mend that when not using a full- shoe marketplace. Their shoe de- length orthotic, you should cut the sign seemed to be based on the idea insole so that it is flat (by removing that all running women weighed the arch and heel cup of the sock 125 pounds and did not need mo- liner) and place it below the orthot- tion control. This change was driv- ic. This will lift the orthotic up en by the rise in charity events. above the bulk of the shoe compo- There are now many more over- nents that interfere with proper weight women (and men) partici- seating of the orthotic. pating in running who have not Having discussed all of the chal- previously been runners. These for- lenges of evaluating fit, cushion merly non-running women are able and motion control, we proceed to participate because the shoes with caution to describe the new have changed and can now provide trends in footwear in running, ten- them with the support and stability nis, basketball and cleated sports. they require. ASICS previously had the MC+ Running Ahead: Advances in and Gel Koji as their motion con- Running Shoes trol shoes. These have been elimi- Over the past 5 to 10 years mid- nated from their product line in sole compounds have improved sig- keeping with the trend of changing nificantly. We have moved forward from the strong support they his- from merely using dual-durometer torically offered in a straight last heels to complex combinations of shoe. The ASICS torsion control de- materials now lighter in weight and vice, however, has had many modi- offering a blend of durable cushion- Continued on page 91

90 PODIATRY MANAGEMENT • OCTOBER 2004 www.podiatrym.com Biomechanics... A Look at Shoe Upper Design Shoe manufacturers have exper- fications that allow it to meet the imented for years with a variety of needs of a variety of foot types materials for the shoe upper. For from those that need more rigidity runners, a breathable upper that al- to those that do well with flexibili- lows for evaporation and a mois- ty. With few exceptions the feeling ture gradient is important. Manu- seems to be there is no straight foot facturers are now looking to make to fit into the straight last shoe so their breathable fibers somewhat they are building support into a softer. Nike in 2003 briefly brought semi-curved last shoe. This is a very a stifling synthetic leather upper to recent change occurring in the past the Air Max. This short-lived exper- 2 years. These shoes are well de- iment in failure ended after Run- signed for a flexible cavus foot, or ning Times declared the shoe to be in other words, a high-arched foot both dead and reminiscent of a that “collapses” or over-pronates. bowling shoe. Nike revived it by This is an important conceptual using an open, breathable mesh de- change that many manufacturers sign in the Nike Air Max 2004. have reached. All podiatric practi- Saucony appears to have begun tioners should recognize this foot using a new soft and breathable type. For the traditional severe upper in some of their 2004 shoe over-pronator, Asics has the newly models. The new material appears developed Evolution which has a to be very comfortable and func- straight last. tionally breathable. Likewise, the Nike Air Skylon has changed upper materials over the past two years. Now in its third generation, the Skylon has a soft breathable upper, after using a much stiffer and less soft upper in 2003. Brooks also improved its uppers and has begun using a softer ma- Asics Nimbus 3 terial with a more Mr. Fenty, pointing out the im- open, highly ventilated mesh. The portance of fit in addition to func- new more breathable upper is tion, says it is “important not to called “element air mesh” and is put a square peg into a round found in several of their lines in- hole.” The straight foot should not cluding the Adrenaline GTS and go into a semi-curved last. After fit- Trance NXG. ting tens of thousands of feet Mr. Fenty observes, “When people get Lacing Systems hurt they look to cushioning, but Lacing systems come and go. foot mechanics is more likely the Some of the lock systems, such as cause of their problem.” He wisely that used in the Mizuno Wave Leg- states, “it would be better if people end 2, have been eliminated or re- could buy a left and right shoe sep- modeled for the better. The lock arately; then they would more like- systems make it harder to use lac- ly get the proper fit and size for ing modifications such as “skip lac- each foot.” After treating tens of ing” patterns. thousands of feet, we’d have to agree. Fenty also points out that Bouncing Forward With “when purchasing running shoes, Basketball Shoes buyers are attracted to particular We are all aware of the Michael shoe colors and shiny objects or Jordan line of basketball shoes. gadgets on the shoe.” Continued on page 92 www.podiatrym.com OCTOBER 2004 • PODIATRY MANAGEMENT 91 Biomechanics... and refine- ment of the Much biomechanical thought has acrylic fiber TABLE 1 gone into the shoe line and they with im- have significantly influenced the proved construction of other basketball wicking po- Example Sock Selections and athletic shoes. James Losito, tential and DPM, podiatrist for the Miami reduced Thick Socks: Heat, says: “I think that without a friction as doubt, the most significant devel- the most Adidas Performance Running Sock: Extra cush- opment (improvement) in basket- significant ball shoes is the carbon fiber shank innovation. ioning under ball and heel reinforcement. This has allowed for As with Brooks Adrenaline GTS Sock: Anatomical Fit— improved shank stability and re- other sports, right and left duced the weight and bulk of the it is difficult shoe.” Dr. Losito gives this ad- to find liter- vancement the primary credit for ature con- Thin Socks: reducing shoe-related injuries such firming that as plantar fasciitis in both the recre- the im- ASICS Nimbus Low-Cut: Minimalist sock. Multi- ational and professional athlete. He provements ple densities. goes on to say that “advancement in basketball Nike Dry Fit Anti-Blister Low Cut of cushioning methods such as the shoes im- air-sole and Shox technology is prove per- Pearl Isumi Keirin: Ultra-thin fabric. probably the second most impor- formance. tant advancement.” Dr. Losito Dr. Losito feels that many other observes that the athlete feels these bility, which is even incorporated developments over the last 10 years changes do help. We do know that into the lace cover. The sockliner is are gimmicky and market-driven. these improvements definitely re- designed to be both moldable and The features he considers gimmicks duce the incidence of injury and in- of dual density. The usual carbon include: mid-foot midsole cut-outs, crease comfort. Both Dr. Losito and fiber mid-foot shank plate is pre- flexible shanks and uppers, super- Dr. Michael Lowe, podiatrist for the sent and the sole has been re- light shoes, Achilles tendon notch- Utah Jazz, have mentioned that designed for improved court con- es, and fashion-driven features such both teams have many players that tact and traction. as “wild color schemes” and materi- use custom foot orthotics in addi- als such as suede and snake-skin. In tion to sophisticated shoes to reduce Soccer Shoe Advances basketball, as with other sports, the incidence of injury. Soccer is quite a different sport there have been significant ad- The latest Jordan shoe, the Jor- than road racing. Accordingly the vancements in hosiery. Dr. Losito dan XIX has a number of key fea- most significant advances in soccer specifically cited the development tures, including improved breatha- Continued on page 94

TABLE 2 Problem Solving With Shoes Problem Cause Correction

Achilles tendonitis Excess cushioning Firmer heel. Heel lift, orthotic.

Plantar fasciitis Excessive “natural motion” Flexion Anti-pronation devices. instability Flexion stability

Peroneal tendonitis/ Excess anti-pronation features Less “motion control” ankle sprains

Subungual hematoma Toe-box too narrow Deeper toe-box

Painful first met-cuneiform joint Lacing design Skip lacing

Anterior ankle pain Lacing over ankle Eliminate top lace

92 PODIATRY MANAGEMENT • OCTOBER 2004 www.podiatrym.com Biomechanics...

shoes have been in the upper and TABLE 3 in the sole, rather than in the midsole, as is the case with running Evaluation of a Running or Court Shoe shoes. Soccer shoes are also now made of stronger and lighter mate- 1. Flexion Stability rials. According to Nick Romansky, 2. Torsion Stability DPM, podiatrist for the U.S. nation- 3. Heel counter al soccer team, “the new uppers are 4. Additional motion control devices now better mirroring the anatomi- 5. Fit cal contour of the foot. Even the 6. Upper stability heel counter is contoured for a bet- 7. Upper wear ter fit and the overall new shape 8. Sole wear helps provide comfort, stability, and better ball handling.” Dr. Romansky also indicated tion, speed, and acceleration.” A ments, the overall shoes are often that the newly designed asymmetri- recent advancement in turf shoe made with a “low-to-ground” style cal design of the lacing system has cleat design is the development of which brings the foot closer to the decreased the bulk of the lacing sys- the “blade” cleat. The choice of a court. Socks made for tennis have proper shoe for additional padding in the forefoot the terrain has re- and rearfoot and are now made of sulted in im- materials that enhance wicking of proved perfor- moisture. David Sharnoff, DPM mance and lower points out that shoes designed to injuries. sit close to the ground and made Dr. Romanksy lighter appear to have reduced fa- mentioned two tigue. These shoes also give the additional devel- player a feeling of being faster and opments that are more responsive on the court. Dr. not positive in all Sharnoff feels that there is no need cases. He noted for what seems to be the market- that there has driven technology of Shox technol- been a removal of ogy or air pumps in tennis shoes. much midsole ma- Tennis shoes are carrying over

Getty Images for Adidas terial in an at- many elements of technology that Adidas F50 tempt to make the were originally designed for running shoe lighter. This shoes. Compression-molded midsole tem and assists in improving fit has appeared to cause more cases of EVA, motion control systems such as which provides better feel and plantar fasciitis to occur in high- the Adidas torsion system, and graphite touch for the ball. There are, how- level soccer play- rollbars all began ever, certain problems associated ers. He also noted with running shoes with lacing systems that are placed that some manu- and are now being medially or laterally, rather than facturers have Research has shown that modified for use in centrally. There may be a decrease made shoes that tennis shoes, which in the stability of the upper of the sit in varus. shoes can affect muscle require lateral sta- shoe which may shift to the side of While this may function in a positive bility. Sole con- the lacing system. Furthermore, a make the player or a negative fashion, struction has taken lacing system placed in such a “feel faster,” it traction into prime manner may interfere with a play- may also make depending on the consideration. A va- er’s ability to properly put spin on the individual cushioning riety of sole materi- the ball. more prone to als are now used, Other features that have im- ankle sprains. Be- characteristics. which were first proved recently include injected ware of shoes that employed for other midsoles and improved cleat de- artificially are athletic shoes. PU sign and placement. Cleats are de- canted into varus (polyurethane) signed for turf, soft ground and or valgus. soles are useful for tacky court surfaces. hard ground. Dr. Romansky has Manufacturers, including Nike and found that recent revision of cleat Tennis Shoe Advances Adidas, are trying to heighten interest placement has resulted in a de- As in running shoes, there has in their soles by offering six-month crease in turf toe injury and fifth been a recent improvement in heat guarantees in certain cases. Many of metatarsal base injuries. “The new and moisture regulation in tennis these shoes employ a variety of sole cleat designs have maximized trac- shoes. Besides the upper improve- Continued on page 96

94 PODIATRY MANAGEMENT • OCTOBER 2004 www.podiatrym.com Biomechanics... suggested to your patients. Anyone The ASICS Kayano sock is made for left performing walking or running for 30 and right feet. We often emphasize configurations with a “speed” herring- minutes or more should be wearing that it is important that the foot and bone pattern rapidly becoming a fa- Coolmax® socks and not cotton socks. the shoe (and orthotics if needed) vorite. New knitting machines in Italy should act as an integral unit. ASICS has carried this one step further and Changing Socks includes the sock in the “unit” con- Over the last decade there have cept. Our patients can now choose been a number of notable advances in Over the past two years from natural and synthetic fibers, se- sock construction. Not that long ago some manufacturers lect various lengths, and varied thick- cotton athletic socks were considered ness socks. the ultimate in sports socks. Many pa- have increased the tients and some doctors still believe prominence of Out in the Open: Sport Sandals this to be so. Cotton socks hold mois- Not that many years ago the pri- ture against the foot and compress anti-pronation control mary use for sandals in sports was to when wet. This leads to a loss of cush- devices in their shoes. use waterproof sandals in gym show- ioning by the sock and an increased ers. Teva was one of the first compa- likelihood of the development of nies to make well-designed sandals moisture-related maladies such as blis- that could play a role in sports. Re- ters and athlete’s foot. Coolmax and allow the manufacturing of virtually cently, Teva has begun making a va- similar fibers that are hydrophobic and seamless socks. ASICS has made good riety of unsound, poorly designed, wick moisture away from the foot are use of this technology and leads in de- flimsy and cheap products including now readily available and should be signing anatomically correct socks. Continued on page 97

AAPSM Running Shoe List

Running Shoes—Moderate Motion Control Key widths readily available in widths (partial listing ASICS Nandi (M/W) Trail Shoe and subject to change) ASICS Gel Kayano X (M/W) widths si si readily available in large sizes (partial listing ASICS Gel-Foundation Plus (M/W) widths si and subject to change) ASICS Gel Evolution (M/W)(replaces Koji Plus) widths si Brooks Addiction 6 (M/W) widths si Running Shoes—Mild Motion Control Mizuno Wave Legend 3 si Reebok Supreme Control DMX (M/W) Adidas Cairo III (M/W) Puma Complete Premise Adidas Calibrate (M/W) widths si Saucony: 3D Grid Regulate (M/W) si Asics 2080 (M/W) widths si Saucony: Grid Stabil MC (M/W) widths Asics 2090 (M/W) widths si Asics Gel Empire (M/W) si Brooks Adrenaline GTS 5 (M/W) widths si Running Shoes—Maximum Motion Control Brooks Trance NXS (M/W) si ASICS Gel MC+ V (M/W) si Mizuno Wave Alchemy ‘03 widths si Brooks Beast ‘02 (M/W) widths si New Balance 856 (M/W) widths si Brooks Ariel ‘02 (W) (* note somewhat less control then New Balance 765 (M/W) widths si the Beast) widths si New Balance 991 (M/W) widths si Mizuno Wave Renegade si New Balance 1220/1221/1300 (M/W) widths si New Balance 1122 (M/W) widths Nike Air Structure Triax 8 (M/W) widths si Nike Air Max Moto II (M/W) si Running Shoes—Cushioning Nike Shox TL si Nike Air Stasis widths si ASICS Gel-Cumulus VI widths si Nike Air Kantara ‘03 (M/W) si ASICS Gel Landreth si Saucony GRID Omni 4 Brooks Glycerin 3 Saucony Shadow 6000 (Classic) Mizuno Wave Rider ‘04 widths Saucony Grid Hurricane 6 Running Shoes Mizuno Wave Creation ‘04 si

96 PODIATRY MANAGEMENT • OCTOBER 2004 www.podiatrym.com Biomechanics...

Teva flip-flops. Taking up where Teva TABLE 4 has left off is the new-comer Bite, which makes well-designed sandals for running, hiking and playing golf. Background information http://www.sgma.com/press/2004/press1080244356-26089.html Sandals that are suitable for use in sports have soles that flex at the ball Sales figures 2003 athletic shoes (in billions) of the foot and are rigid proximal to Mens’ $9 that point and have straps that keep Womens’ $4.4 the heels firmly attached to the san- Children $2.8 dal itself. When recommending a total $16.354 sandal, you can no longer do so merely by mentioning brand. You Pairs purchased in millions will have to review with your patient Mens’ 197 the characteristics of the sandal or Women’ 126.5 Children 124.7 recommend a specific model. Total 448.276 A Good Walk With New Spikes Market style (by percent) In addition to the traditional form of golf spikes, golf shoes now Running 28% come with softer spikes. These Basketball 23.3 spikes often use a quick screw in Cross training 9.6 and locking mechanism. Some golf Low performance 6.9 shoes are spikeless and incorporate Walking 5.4% the traction qualities into the sole Tennis 5.3% of the shoe. The Nike Q-LOK sys- Hiking 4.1% tem accomplishes a secure lock Sports sandals 1.9% within 1/4 turn and promises that the spike will not damage the grass. Consumers reported that they purchased 448,276,000 pairs of athletic Advancement Results: Freedom shoes in 2003, compared to 428,623,000 the year before. Spending for of Choice men’s shoes rose 2.2% in 2003 to $9.015 billion from $8.816 billion in Choice is one of the hallmarks 2002. of athletic shoe selection. From cushioning to varying degrees of promotional control, from straight of low back muscles when jogging.” Int lasts to curved lasts, from wide to Dr. Pribut is vice- J Sports Med 22(6): 414-9. president of the narrow and from the latest and McKay, G. D., P. A. Goldie, et al. American Acade- greatest shoes to classic models, we (2001). “Ankle injuries in basketball: in- my of Podiatric have the largest amount of choices jury rate and risk factors.” Br J Sports Sports Medicine ever available. With so many choic- Med 35(2): 103-8. and host of the es available, steer your patients to- Kurz, M. J. and N. Stergiou (2004). popular sports wards shoes that will fit their foot “Does footwear affect ankle coordina- medicine web- type and shoes that mesh with tion strategies?” J Am Podiatr Med Assoc site www.dr- their biomechanical structure. 94(1): 53-8. pribut.com. He is There is no longer an excuse for O’Connor, K. M. and J. Hamill a clinical assistant professor at George (2004). “The role of selected extrinsic recommending a generic sport shoe Washington School of Health Sciences foot muscles during running.” Clin and practices in Washington, DC. rather than a sport-specific shoe. ■ Biomech (Bristol, Avon) 19(1): 71-7. Dr. Richie is Mundermann, A., B. M. Nigg, et al. an Adjunct Clini- References (2003). “Orthotic comfort is related to cal Professor at Llana, S., G. Brizuela, et al. (2002). “A kinematics, kinetics, and EMG in recre- the California study of the discomfort associated with ten- ational runners.” Med Sci Sports Exerc School of Podi- nis shoes.” J Sports Sci 20(9): 671-9. 35(10): 1710-9. atric Medicine Milgrom, C., A. Finestone, et al. Nigg, B. M., D. Stefanyshyn, et al. at Samuel Mer- (2001). “The effect of shoe sole compo- (2003). “The effect of material charac- ritt College. He sition on in vivo tibial strains during teristics of shoe soles on muscle activa- is currently Pres- walking.” Foot Ankle Int 22(7): 598-602. tion and energy aspects during run- ident-Elect of Wakeling, J. M., V. Von Tscharner, ning.” J Biomech 36(4): 569-75. the American et al. (2001). “Muscle activity in the leg Nigg, B. M., P. Stergiou, et al. Academy of Podiatric Sports Medicine is tuned in response to ground reaction (2003). “Effect of shoe inserts on kine- and holds four patents for technolo- forces.” J Appl Physiol 91(3): 1307-17. matics, center of pressure, and leg joint gies in footwear, shoe construction Ogon, M., A. R. Aleksiev, et al. moments during running.” Med Sci and ankle-foot-orthosis design. He (2001). “Footwear affects the behavior Sports Exerc 35(2): 314-9. practices in Seal Beach, CA. www.podiatrym.com OCTOBER 2004 • PODIATRY MANAGEMENT 97