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August, 2012

Natural Solutions for Your Patients' Foot and Ankle Ailments

By Robyn Hughes

The need for natural and conservative alternatives to conventional foot and ankle problems has never been greater. According to the American Academy of Orthopedic Surgeons, approximately 43.1 million Americans have foot problems and the cost of foot surgery to correct problems associated with improper footwear — bunions, hammertoes, corns and calluses, among others — is about $2 billion per year. The cost rises to $3.5 billion when you factor in lost work time for surgery and recovery.1 Many of these surgeries could be avoided if patients better understood what constitutes normal, healthy foot anatomy and the actions required to preserve foot form and function.

Natural foot care is a new approach to treating foot and lower extremity ailments that draws on the accumulated wisdom of podiatric visionaries, observations of unshod cultures and a growing body of evidence-based resources. At the core of the natural foot care approach is the belief that your foot is inherently strong, stable and adaptive, and that by restoring proper foot anatomy, you can realize lifelong foot health. Natural solutions for your patients' foot and ankle ailments are safe, elegantly simple and, in many cases, address the underlying cause of common foot and lower limb problems.

Chiropractic physicians are in an excellent position to share preventive or corrective natural foot health strategies with their patients, as many chiropractic patients already are interested in conservative techniques that encourage and support the body's own natural healing mechanisms. Chiropractors and chiropractic patients understand the importance of a stable and healthy support platform on spine health and how the feet affect posture, gait and joint health throughout the body. Many patients who have been treated using conventional foot care therapies are still in pain and they are looking to chiropractors and other complementary alternative providers for a more natural and effective treatment approach.

Philosophical and Historical Underpinnings

The principle philosophical approach underlying natural foot care is that you were born with perfect feet and that your feet require no additional support, augmentation or embellishment to improve their function. You can maintain the same foot shape as an infant throughout your lifespan with the proper care and attention, which in turn may protect you from some of the most common foot and ankle ailments. Foot and toe deformations are common among shod, or shoe-wearing, people, and many of these deformations — and the disorders associated with them — are caused by unhealthy footwear use.2

Studies conducted decades ago on the feet of unshod populations reveal marked differences in the structure, appearance and health of these feet compared to shod populations.3,4,5 One such study, published in the Journal of the National Association of Chiropodists in 1949, examined the feet of people in India and China who had never worn shoes. The authors of this study report that the incidence of foot problems in unshod populations, including hallux valgus, hallux rigidus, arthritis and fungal infection, is significantly lower than in shoe-wearing populations.6 Examples of normal, healthy foot anatomy can still be seen today in certain regions of the world, such as parts of Africa, Asia and South and Central America, in which no or little conventional footwear is used.

Things to Look For in Feet and Footwear

To gain a better understanding of the most common signs and symptoms of foot and ankle problems that may benefit from a more natural treatment approach, it is important to first review the characteristics of normal, healthy foot anatomy. A human foot in its most natural state is widest at the ends of the toes (not at the ball of the foot), possesses significant natural toe splay and shows no evidence of bent or crooked toes. A healthy human foot also possesses strong, sturdy arches (arches can be low, medium, or high and still be healthy), excellent manual dexterity and active range of motion, and smooth, pink toenails.

Many non-traumatic foot problems may effectively be treated by restoring proper foot anatomy and function and selecting footwear that accommodates natural toe splay. Foot pain or problems that may respond to this conservative treatment approach include bunions, hallux limitus and rigidus, hammertoes, clawtoes, neuromas, ingrown toenails and plantar fasciosis. Other conditions that may be treated or prevented using natural methods, such as shoe therapy and toe realignment, include shin splints, runner's knee and knee osteoarthritis. A 2006 study published in the Journal Arthritis and Rheumatism states that shoes (at least conventional shoes) may unfavorably boost loads on the lower extremity joints, including the knees, which in turn may contribute to increased prevalence and progression of osteoarthritis in our society.7

Most conventional shoes, according to sports podiatrist Dr. Ray McClanahan, possess at least four design features that may contribute to foot and toe deformation and problems over time, including tapering toe boxes, heel elevation, toe spring, and rigid, inflexible soles.8 Other problematic design features often built into conventional footwear include arch support, pronation control and faulty last design. Taken together, these design features place your foot in an unnatural position and immobilize it for prolonged periods. A healthy shoe should allow your foot to function like a bare foot inside your shoe and allow your toes to splay the way nature intended. A healthy shoe should respect the natural design of your foot instead of supporting the idea that your foot is inherently flawed and worthy of remodeling.

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