Skier Stance

IS ‘SUBTALAR NEUTRAL’ SKIINGS’ HOUSE OF CARDS?

If you purchased custom footbeds for your ski boots or had your ski boots custom fit you may have been told that your foot was placed in subtalar neutral and that this created the strongest position of the bones of the foot and leg for skiing. Neutral in this context refers to a neutral configuration of the subtalar joint of the ankle/foot complex.

As best I can recall, the term subtalar neutral began to emerge in the ski industry about 1978. The authoritarian manner in which it was presented and promoted suggested that it was science-based and supported with evidence that conclusively demonstrated superior performance. But I never saw or heard any explanation as to how subtalar neutral could create the strongest position for skiing of the bones of the foot and leg and I have still not seen such an explanation.

Back in 1978, I didn’t even know what the subtalar joint was. I couldn’t envision how the bones of the foot and leg could be maintained in a specific configuration while foam was injected into a liner around the foot and leg or through some other custom fit system. But in spite of the lack of even a theory to support the premise of subtalar neutral as creating ideal biomechanical alignment of the bones of the foot and leg for skiing the premise seemed to be readily accepted as fact and quickly became mainstream. By the time The Shoe in Sport (which questioned the principles on which the plastic ski boot is based) was published in 1989 (1987 in German), neutral subtalar was firmly entrenched in the narrative of skiing.

In my US Patent 4,534,122 (filed on December 1, 2013) for a dorsal support system that I called the Dorthotic, I had unkowingly tried to fix the subtalar joint in a static position as evidenced by the excerpt below from the patent:

The system of the invention applies significant pressure to the dorsal (upper) surface of the foot over the instep, including the medial and lateral aspects thereof, and hence to the bones of the mid-foot to substantially prevent these bones from moving relative to each other.

Note: The prior art refers to the current paradigm in existence.

The objective of the dorsal support system was to immobilize the joints of the bones below the ankle in conjunction with the joints of the bones of the midfoot while allowing unrestricted dorsi-plantarflexion of the ankle joint within it’s normal range of motion. But the significant medial (inner) pressure applied by the  system to the bones of Podborski’s foot below his ankle made it difficult for him to stand and balance on one foot with the system in a ski boot shell even on the concrete floor of my workshop. Removing the offending structure from the dorsal support system quickly resolved the issue by allowing his foot to pronate. This made me aware that structures that impede supination did not appear to create issues. This insight raised the possibility of a fit system based on selective constraint applied to specific aspects of the foot and leg as opposed to what I termed indiscriminate (general) constraint.

Even though at the time that I wrote my US Patent No, 5,265,350 in February of 1992 I still did not comprehend the mechanism behind the claimed superior performance associated subtalar neutral, I knew enough to know that attempting to fix the subtalar joint in any configuration in a ski boot would interfere with, or even prevent, a skier from balancing on one foot.

Here is what I said in the patent:

The prior art refers to the importance of a “neutral sub-talar joint”. The sub-talar joint is a joint with rotational capability which underlies and supports the ankle joint.

………………….the prior art which teaches, in an indirect manner, that the ideal function for skiing will result from fixing the architecture of the foot in a position closely resembling that of bipedal function, thus preventing monopedal function (balance on one foot on the outside ski).

I later discovered that the above statement came close to the truth.

I also discussed the issue of subtalar neutral in my post NO NEUTRAL GROUND (2.) published on September 1, 2014. But I did not learn about the origins of subtatar neutral and especially the intense controversy surrounding it in professional circles until recently when I came across a discussion on Root and his subtalar neutral theory in an online podiatry forum.

The Origin of Subtalar Neutral

Merton’s Root’s subtalar joint neutral theory was first described in the textbooks, Biomechanical Examination of the Foot, Volume 1. – 1971 (Root, Orien, Weed and Hughes) and Normal and Abnormal Function of the Foot – 1977 (Root, Orien, Weed). The basic premise of Root’s subtalar neutral theory is that a neutral position of the subtalar joint (which Root defined as existing when the foot was neither supinated or pronated), is the ideal position of function in static (two-footed bipedal, erect) stance and in gait where the subtalar neutral theory posited that the foot was pronated in the first half of the stance phase then transitioned through neutral in mid stance to become supinated in the latter half of the stance phase.

Root’s paradigm proposes that the human foot functions ideally around the subtalar joint’s neutral position and that deviations from this ideal position are deformities.

What Root really said

Root and his associates never stated that the joints of the foot should be immobilized in subtalar neutral. The reference to static in subtalar neutral as the ideal position of function in static stance pertained to a subject standing in place in an erect bipedal stance on a flat, level, stable surface with the weight apportioned between the two feet. In this static stance the Root subtalar neutral theory posited that the subtalar joint should rest in neutral. Root and his associates never stated, implied or suggested that the joints of the foot should be configured and immobilized in subtalar neutral. Further, Root and his associates made no reference, of which I am aware, to the application of subtalar neutral to activities other than static stance and gait. Critrics have asserted that a subtalar neutral position in static stance is neither normal or ideal. In defining subtalar joint neutral as normal, Root’s theory implied the existence of abnormal pathologies in the feet of the majority of the world’s population.

The lack of evidence

Critics of Root and his associates “Eight Biophysical Criteria for Normalcy” claim the criteria was nothing more than hunches, that these conjectures were accepted as fact, when, in reality, there was no experimental data or research to support them and that the eight criteria were neither normal or ideal.

 The STJ neutral position problem

One of the early critics of Root and his associates was Kevin Kirby, DPM. He is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College in Oakland, Ca.

Kirby observed a large error range in determining STJ neutral position on the same foot from one examiner to another. In unpublished studies done during his Biomechanics Fellowship at the California College of Podiatric Medicine, Kirby found that the Biomechanics Professors were +/- 2 degrees (a 4 degree spread) and the podiatry students were +/- 5 degrees (a 10 degree spread)  in determining STJ neutral position.

Subtalar neutral appears to be what amounts to a knife edge between pronation and supination where neutral is the border or transition point between the two states. Unless the subtalar neutral position can be precisely and consistently identified, it is impossible to know whether the subtalar joint is pronated or supinated.

The future of subtalar neutral in skiing

Too many times theories of how the human foot functions and therefore how mechanically inducted foot problems are treated have been presented as if they were facts. The dogmatic adherence that sometimes ensues from such an approach has frequently stifled the evolution of foot mechanics. This has been particularly apparent in the field of podiatry which has been dominated by the Root paradigm. (4.)

The long standing controversy and growing challenges mounted against the credibily of Root’s subtalar neutral theory has significant implications for the continued promotion of subtalar neutral in skiing as providing the strongest position of the bones of the foot and leg.

It may eventually be shown to be unfortunate that Root’s influential textbooks were published at a time when the ski industry was attempting to come to terms with the skier/boot interface issues associated with the new paradigm created by the rigid shell plastic ski boot.

In my next post, I will discuss what a ski boot should do for the user or perhaps, more a case of what a ski boot shouldn’t do.


  1. Root ML, Orien WP, Weed JH, RJ Hughes: Biomechanical Examination of the Foot, Volume 1. Clinical Biomechanics Corporation, Los Angeles, 1971
  2. https://wp.me/p3vZhu-Bv
  3. Are Root Biomechanics Dying: Podiatry Today, March 27, 2009
  4. Foot biomechanics- emerging paradigms: Stephen F Albert, 4th Congress of the International Foot and Ankle Biomechanics (i-FAB) Community Busan, Korea. 8-11 April 2014

 

IS SHIFFRIN ON THE LEVEL?

By on the level, I am suggesting that Shiffrin may have a much lower zeppa-delta ramp angle than her competition.

Here are some screen shots from the March 18, 2018 Are Slalom where Shiffrin won by  1.58 seconds. She is on and off her edges in milliseconds as she just seems to pop from turn to turn – Total Domination From Shiffrin (1.)

Compare the angles of Shiffrin’s ankle, knee and hip in the photo below to those of her competition in the second and third photos below.

Notice how extended Shiffrin’s lower body is as she exits the rise line and enters the bottom of the turn in the photo below from a training session earlier in the year.

Extended in the Are Slalom.

Out of the start her knees and ankles are almost straight!

In my next post I will explain what I think is happening and why.


  1. https://youtu.be/gQu-LkyfsRQ?list=PLo6mlcgIm9mzWPBpeXnH2CpFOXrWhBiEB

ZEPPA-DELTA ANGLE EXTENDER

The problem associated with measuring boot board (zeppa) and/or binding (delta) ramp angle as individual components is that the resulting angle may not accurately reflect the actual angle between the plane of the base of the upper surface of the boot board and the base of the ski in the boot/binding/ski system. Boot boards of the same zeppa angle may not necessarily have the same zeppa angle with the base of the boot shell due to design and/or manufacturing variances.

A level inserted into a ski boot shell with the boot board in place can be difficult to read. With the liner in place, this is not a viable option. A better option is to extend the angle of the boot board up above the top of the shaft of the boot so it can be accurately and easily read.

A simple device for this purpose can be made for about $25 with basic hand tools and a few screws using 2 – 8 in (20 cm) x 12 in (30 cm) x 1/8 in (3 mm) thick steel carpenter’s squares.

Place the long arms of the squares over each other as shown in the photo below and clamp them securely together. Two-sided tape can be used to help secure the alignment. Then drill a hole  at one point on the vertical leg and screw the 2 squares together.

Check the parallelness of the 2 opposite arms on a level surface with a digital level. If good, secure the 2 levels together with a second screw. Then affix a section of 3/4 in (2 cm) x 3/4 in (2 cm) square or L-bar bar on the top of the extender to rest the level on.

To use the extender, place a boot shell on a hard, flat, level surface. If the surface is not level it should be leveled before the extender is used.

The photo below shows the extender being used to measure the zeppa angle of an old Salomon SX-90 shell. I didn’t have the electronic level for the photo. So I used a small torpedo level.

Insert the lower arm of the device into the shell as shown in the right hand image and place the lower arm firmly on the boot board. Place the level on the top arm and read the angle.

The photo below shows the same process as above. But in this example, the liner is in place. If an insole is in the liner, it should be flat with no arch form. I highlighted the square bar with pink to make it easily visible.

A check of the zeppa-delta angle of the boot-binding-ski system can be done by mounting the boot in the binding of the ski that is part of the system and clamping the ski to a flat surface with sufficient force to ensure the camber is removed and the running surface of the base is in full contact with the supporting surface. A strap wrapped over the front of the boot shell and under and around the supporting surface then tensioned will help ensure that the toe plate of the binding is loaded.

The Zeppa-Delta Angle Extender provides the user with a fast accurate way to know their total number. What’s yours?

 

WHY STANCE TRAINING IS ESSENTIAL

When readers click on my blog address at skimoves.me, analytics give me a hierarchy of the countries with the most views and the most popular posts in ascending order. This helps me identify which content resonates most strongly with viewers and which content draws a blank.

As I write this post, the top five countries are the US followed by Croatia, the United Kingdom, Slovakia and France.

The most viewed post today is THE SHOCKING TRUTH ABOUT POWER STRAPS; far and away the most popular post I have published to date. But the most important posts by far that I have ever written, A DEVICE TO DETERMINE OPTIMAL PERSONAL RAMP ANGLE and STANCE MUSCLE TENSIONING SEQUENCE EXERCISE barely sputtered in comparison. This strongly suggests that far from just some small gaps in the knowledge base skiing is founded on, massive craters exist.

Arguably the most important aspect of skiing is a strong stance. Any variance in the fore-aft angle of  the plane of support under the feet and the plane of the base of the ski has significant impact on stance. Yet these subjects are barely blips on the Doppler Radar of the ski industry.

Since I started the dynamic ramp angle assessment project a few weeks ago I have found that when asked to do so, it is rare for a skier of any ability to be able to assume a strong ski stance in an off the ski hill environment. Even when a skier  skis with a relatively strong stance, they seem to lack a sense of what a strong stance feels like. Because of this, they lack the ability to consciously replicate a strong stance. If asked to do so, they would be unable to coach a skier in the sequence of events that I described in my last post

In the dynamic ramp angle assessment project, I  have also observed that skiers with with a boot/binding ramp angle greater than 2.8 degrees appear to have become accustomed to the associated unstable, dysfunctional feeling and identify with it as ‘normal’. Before I can test them, I have to spend time coaching them into the correct stance because it feels unnatural to them.

When I go back and forth between a strong functional stance on a flat, hard level surface to a stance on the dynamic ramp angle device set to an angle of 4 degrees, I can get close to the same angles of ankle, knee and hip. But when I do, I feel strong tension, stiffness and even pain in my mid to lower back which is  common in some skiers and even racers.

Based on results to date with the dynamic ramp angle device, it appears as if strong skiers ski best with ramp angles close to zero. But depending on their sense of balance and athletic ability, they may have a wide range in which they sense little difference on the effect of ramp angle until they approach the upper limit of stability. While they may be able to ski well with a ramp angle close to the maximum limit of stability, ramp angles much above 1.2 to 1.5 degrees may not offer any benefits. This can only be tested on skis where balance is tested by dynamic forces which cannot be replicated in a static setting.

Issues affecting skier stance were discussed in detail in my post, THE SHOCKING TRUTH ABOUT POWER STRAPS. Here are the excerpts I posted from the chapter on The Ski Boot in the book, The Shoe in Sport (1989), published in German in 1987 as Der Schuh Im Sport– ISNB 0-8151-7814-X

“If flexion resistance stays the same over the entire range of flexion of the ski boot, the resulting flexion on the tibia will be decreased. With respect to the safety of the knee, however, this is a very poor solution. The increasing stiffness of the flexion joint of the boot decreases the ability of the ankle to compensate for the load and places the entire load on the knee”. – Biomechanical Considerations of the Ski Boot (Alpine) – Dr. E. Stussi,  Member of GOTS – Chief of Biomechanical Laboratory ETH, Zurich, Switzerland

“The shaft of the boot should provide the leg with good support, but not with great resistance for about two thirds of the possible arc, i.e., (14 degrees) 20 to 22 degrees. Up to that point, the normal, physiologic function of the ankle should not be impeded”.

“Previous misconceptions concerning its role in absorbing energy must be replaced by the realization that shaft pressure generates impulses affecting the motion patterns of the upper body, which in turn profoundly affect acceleration and balance.

“When the lateral stability of the shaft (the leg) is properly maintained, the forces acting in the sagittal direction should not be merely passive but should be the result of active muscle participation and tonic muscular tension. If muscular function is inhibited in the ankle area, greater loads will be placed on the knee”. – Kinematics of the Foot in the Ski Boot – Professor  Dr. M. Pfeiffer – Institute for the Athletic Science, University of Salzburg, Salzburg, Austria

It has been over 40 years since international authorities on sports science and safety raised red flags concerning the adverse effects of ski boots design and construction on skier stance, balance and the potential to cause or contribute to injury. It is time that their concerns were taken seriously and acted on. Research on stance and the effect of such things as zeppa and delta ramp angles is urgently needed.

 

STANCE MUSCLE TENSIONING SEQUENCE EXERCISE

Tensegrity

Tens(ion) + (Int)egrity 

The optimal ramp angle, as determined by the dynamic ramp device, is based on a stance predicated on the principles of tensegrity.

Fascial continuity suggests that the myofascia acts like an adjustable tensegrity around the skeleton – a continuous inward pulling tensional network like the elastics, with the bones acting like the struts in the tensegrity model, pushing out against the restricting ‘rubber bands: Tom Myers, Anatomy Trains (1.)

A ski stance based on the principles of tensegrity must be learned and rehearsed in a step-by-step process. It is neither natural or intuitive although elite skiers and racers such as Shiffrin and Hirscher appear to have acquired the elements of tensegrity. Assuming a group of racers of equal athletic ability, the odds will favour those whose stance is based on tensegrity.

In a ski stance base on tensegrity, tension in the arches of the feet will extend to the palms of the hands holding the poles.

  1. Start by standing barefoot on a hard flat floor or surface in a controlled environment such as your home. Where possible, use the same surface and place to rehearse the stance. If you have constructed a dynamic ramp assessment device, use this with the top plate set to level.
  2. Stand upright at attention. You should feel most of the weight under your  heels and less weight across the balls of your feet. This is normal. The fore-aft weight distribution is actually 50-50 heel to forefoot. But because the weight of the body is spread across the balls of the feet and along the outer aspect behind the small toes, more weight is sensed under the heels. Stand so your weight is distributed equally between both feet.
  3. Relax your hamstrings (in your thighs) and let your torso drop towards the floor.  Your knees move forward as they flex and your ankles will dorsiflex. Your ankles should stop dorsiflexing on their own when the front of your knee caps are aligned approximately over the balls of your feet. This is the point where the tension in your soleus (calf muscle) peaks with the tension in your arches. You should feel about the same pressure under the balls of your feet as you feel under your heels. But it should feel as if the circle of pressure under your heels has gotten bigger and your feet should feel more connected or integrated with the floor. I call this ‘rooted’ because it should feel as if your feet have sunk into the floor.
  4. While keeping your upper body erect, move slightly forward in the hips. You will quickly reach a point where you start to become unstable and feel as if you would fall forward onto your face if you move farther forward in the hips. When you get to this point your big toes should press down on the floor on their own to try stabilize you. This is the forward limit of stability.
  5. Now move rearward in the hips until you start to feel the same instability. This is the rearmost limit of stability.
  6. Now bend forward from the waist. Do not curl your back. Bend from the hip sockets for the thigh. The movement is actually thigh flexion. Lift your thigh to get the right feeling. As you bend forward from the waist, let your buttocks move rearward.  Your ankles and knees straighten. Allow your buttocks to drop towards the floor until you feel your body settling onto your feet. As this happens, reach forward with your arms as if you were going to hug a large barrel in front of you. Make sure the palms of your hands are facing each other with fingers curled and pointing towards each other. Find the place where your arms and head feel neutral to your spine. As your arms come into position you should feel your abdominal core and muscles in your back acquire tension.
  7. Experiment by increasing the amount of flexion at the waist while keeping solid pressure under your heels and balls of your feet as you straighten your knees slightly. As you increase the forward bend at the waist, pressure should increase under the balls of your feet. But you should not feel unstable. If anything, you should feel stronger and more stable. Make sure to keep solid pressure under your heels as you increase the pressure under the balls of your feet. You should feel as if the weight of your head and shoulders is pressing your feet down into the floor.
  8. Increase the bend at your waist while keeping the pressure on the balls of your feet and heels until the top of your head is down by your knees. You should still feel very strong and stable in the feet. The is the lowermost limit of waist flexion.

Once you have acquired a kinesthetic sense of the integrity of foot to hand tension, a sense of stability while pulsing the torso vertically up and down over the feet confirms a state of tensegrity.

The photo below is of simple model I designed and constructed in 1993 to illustrate the basic concept of bottom up tensegrity and how the degree of tension in the arches of the feet and the vertical biokinetic chain is driven by the weight of COM stacked over the foot.

The graphic below shows the continuum of tension from the balls of the feet to the opposite shoulders through the mechanism of the transverse posterior sling.

In my next post I will discuss what I term the NABOSO Effect.


  1. https://www.anatomytrains.com/fascia/tensegrity/

A FIVE STEP SKIER PERFORMANCE PROGRAM

Almost 40 years ago to the day, the head of the Whistler Pro Patrol, whose boots I had worked on, introduced me to Nancy Greene in the Roundhouse restaurant on top of Whistler Mountain. The rest is, as they say, history. Nancy asked me if I would work on her ski boots. She was so impressed by the results of my work that she approached the National Ski Team to make arrangements for me to work with some of Canada’s best racers.

Recently, while going through some archived files, I found copies of Nancy’s communication with the Program Director of the National Ski Team, Andrzej Kozbial. When Nancy approached me about working with our National Team, I stressed to her that I did not see any potential arrangement with the team as a job opportunity but instead as a vehicle where I could gain further experience and knowledge while providing a crucial service to the team and furthering the sport of skiing.

The graphic below is an excerpt copied from Nancy’s first letter of April 26, 1978 to the National Ski Team Program Director.

At the time that I wrote my US Patent 5,265,350 in early 1992, the intent and purpose of the detailed and lengthy specification was to provide a repository of the knowledge I had acquired to date to serve as a legacy for skiers and skiing to help advance the sport. While this information was in support of the inventions disclosed in the patent, the majority of the information was not subject to protection under the terms of the patent. The information was open access to the world. This was my intent.

In spring of 2000, I formed a company with 2 partners for the 2000-2001 ski season called Synergy Sports Performance Consultants Ltd. The objective of the venture was to gain further experience and knowledge and create a model that could be used as a template for future skier performance programs.

The following series of graphics are from Power Point presentations synergy made to ski schools.

The following graphic is the poster that described the synergy 5 Step Performance Program.

5 Step Performance Program description

The synergy Analysis Program looks at how your body interfaces with your ski equipment; primarily your footbeds and boots because this is the connection to your equipment and through it to the snow.

Synergy offers the program as a package made up of 5 components. They can either be taken as the complete package [recommended], several components or steps at once, or one component at time. Synergy recommends that you begin at step 1 and follow the sequence in numerical order. But the order can be arranged however you wish to suit your needs. The choice is yours.

1.Biomechanical Assessment

Good foot function is the key to control. That’s why the first thing we thing we assess is your biomechanical function. What that means is that we look at how well your foot and lower limb works. The examination is done by a podiatrist who looks at how your foot functions and how the lower limbs all connect.  Then we see how effectively your feet interface with the ground by putting you on insoles that read the pressures under your feet. We coach you through some balance movements while we watch how your foot functions while our computer records the results

2. Footbed Assessment

Footbeds can have a positive, neutral or negative effect on the function of your feet.

That’s why the next thing we check is how your foot interfaces with your footbed or orthotic.  We make sure that it allows your foot to function as well as it should without one.  And if your foot needs some assistance for optimal function we make sure the footbed is helping your foot do what it needs to do.

3. Ski Boot Assessment

Now that your foot is functioning optimally we make sure your ski boot lets it keep functioning. We conduct a thorough examination of your boot and provide you with a report that tells you how your boot is affecting your performance. Most important, we tell you what has to be done to fix the problem.

4. Kinesthetic Training

Skiing is about making the right moves. Kinesthetic Training is next. It teaches you how to tell when your body is making those moves. What is Kinesthetic Training? In simple terms it means to train your body to associate a feeling or sense with the right movements made at the right time. It is feeling and bringing about an awareness so you know when you are doing it right because we have taken you there and you have felt it. A picture may be worth a thousand words, but in skiing a feeling is worth a thousand pictures. We bring you to understand what you should feel in your foot at the start of the turn and then what it feels like to settle and balance onto the foot that drives the ski. By acquiring this sense you become more aware of how to allow your foot to transfer energy directly to the edge of the ski by using the body the way it was designed to be used. Remember, your body was not made to be a lever.

5. On-Hill Data Collection

This is where everything comes together. We move to the ski hill for this part of the package. We meet up top on Whistler or Blackcomb Mountain. We put our pressure insoles in your ski boots.  A pair of cables from the insoles goes up your ski pants where it connects to the data box [a kind of mini computer] we attached to your waistband.  Then we go out for a run on moderate, groomed terrain.  We record data in three takes in medium radius turns at a speed you are most comfortable with. While this is happening we videotape your skiing. Then we head into the lodge and synchronize the video with your foot pressure data. When this is done we watch your foot function in your boots on the computer screen on one side while we study your ski video on the other side of the screen. This way we confirm that your foot is functioning optimally as confirmed by analyzing your movement patterns and the timing of your skills.

My next post will be on the synergy Boot Assessment program.

 

BEYOND BIOMECHANICS BY DR. EMILY SPLICHAL

The following post appeared on the Evidence Based Fitness Academy (EBFA) fitness blog on February 6, 2018 under the title Beyond Biomechanics | Addressing Foot Pain with Sensory Stimulation (1.).

I have reproduced the post with the kind permission of Dr. Emily Splichal under the title Beyond Biomechanics by Dr. Emily Splichal because her emphasis on the role of sensory stimulation of the plantar foot on foot, lower limb and function of the entire body has both direct application to and implications for, skiing.

I have a theory on what I call The NABOSO Effect that explains how I think NABOSO insoles improve dynamic stability in the biokinetic chain that I will discuss in a future post. I have been testing NABOSO 1.0 and 1.5 for months.


Beyond Biomechanics | Addressing Foot Pain with Sensory Stimulation – by Dr. Emily Splichal

I want you to picture a human foot.   Now picture a person standing barefoot, and then walking barefoot.   Do you see the foot striking the ground and flexing under impact, only to re-stabilize and push off just a few milliseconds later?

Often times when we think of human movement we can’t help but to be drawn to the thought of joints moving and muscles contracting.   Or in the case of foot function we are quick to consider the mechanics of flat feet, high arches, pronation and supination.   However when we delve deeper into the science of human movement there is more than meets the eye.

The Two Sides of Foot Function

When I teach on behalf of EBFA Global or speak to my patients I always emphasize that there are two sides to foot function (and dysfunction) – biomechanical and neuromuscular.    Now both play an important role in foot function which means that both must be appreciated – however to solely treat foot pain with just one belief system in mind is inherently flawed.

In most Podiatric Medical Schools we are taught foot function and foot pathology solely from a biomechanical perspective.

This means that every patient is tested for foot mobility and told to stand statically to determine arch height and foot type.   Based on this foot-focused biomechanical assessment and foot classification system the patient’s cause of injury and treatment protocol is determined.   Some of the favorite treatment recommendations include motion-controlled footwear and custom-posted orthotic both of which are prescribed with the hopes of controlling foot-focused biomechanics and thereby reducing their foot pain.

Beyond Biomechanics

The other side of foot function is one that is driven from a neuromuscular perspective and integrates the science of sensory stimulation and fascial systems.   In the case of neuromuscular function every patient would be assessed for sensitivity of plantar mechanoceptors as well as co-activation patterns between the foot and the core.  The role of minimal footwear, myofascial releasing, breathing patterns and compensation patterns more proximal would all be considered.

So which is more appropriate?  Well it depends.   In certain cases there will be a stronger argument towards a more biomechanical influence and in others it is more sensory.  This means it really is a marriage between the two approaches that provides the greatest patient outcome.

Sensory Stimulation in Foot Pain

My practice and Podiatry career is built around bringing an awareness to the important role sensory stimulation has on foot function and foot pain.

With every step we take impact forces are entering the foot as vibration.  This vibrational noise stimulates unique mechanoceptors on the bottom of the foot and is used to coordinate the loading of impact forces through coordinated contractions of the intrinsic (small) muscles of the bottom of the foot.   This co-contraction leads to a stiffening or strengthening response of the foot.

Researchers such as Nigg et al. and Robbins et al. have demonstrated a direct relationship between sensory stimulation of the plantar foot and intrinsic muscle strength concluding that one is necessary for the other.   This means that if our footwear or orthotics disconnect us from sensory stimulation – as in the case of cushioned footwear – this can actually weaken our foot making us susceptible to plantar fasciitis, Achilles tendinitis and stress fractures.

Beyond Vibration Stimulation

Vibration stimulation is an extremely important sensory stimulation that enters our foot however it isn’t the only stimulation.   Another important stimulation is the ability for our foot to determine texture and if a surface is rough or smooth.   This information is used to help maintain dynamic balance (think walking on ice).

Enter the merkel disk mechanoceptors.   These superficial sensory nerves are used to determine what’s called 2 point discrimination which is translated to roughness or the texture of a surface.  Surface texture and insole texture is one of the most studied aspects of foot stimulation and posture or gait.  From decreased medial lateral sway in patients with Parkinson’s or MS to reduced prefrontal cortical activity in atheltes post-concusion the applications are promising!

One area that hasn’t been focused on for sensory stimulation and foot function is foot pain.  I am here to change the awareness around this concept and share the powerful application of sensory stimulation and foot pain.

As we mentioned earlier sensory stimulation of the foot leads to a contraction of the intrinsic muscles of the foot.   Intrinsic muscle contraction is not only a criticial step in the damping of impact forces but has also been shown to increase the medial arch and build co-activation contractions in the core.

 The Evolution of Textured Insoles

In October 2017 Naboso Technology launched the first-ever commercially available textured insole!   Naboso Technology essentially brought the science of touch and years of textured insole research to the market place giving new hope to people with foot pain.

Available in two strengths – Naboso 1.0 (1mm texture) and Naboso 1.5 (1.5mm texture) Naboso Insoles are designed to be worn without socks (or at the most very thin socks).  They fit into all footwear, are freely movable in all planes of motion and are only 3mm thick.

FROM THE GROUND UP

Are you barefoot strong?


Learn more about the power of texture! – http://www.nabosostechnology.com

  1. https://barefootstrongblog.com/2018/02/06/beyond-biomechanics-addressing-foot-pain-with-sensory-stimulation/