Shoes: The greatest fall risk?

Footwear has been used since 1600-1200 BC as a way to protect, support and even dress up the feet. From a protection perspective, shoes keep the feet warm and dry, and create a barrier between rough terrain and the skin. As we age, many people start to wear increasingly more supportive shoes in an attempt to maintain balance. Rather than using the muscles and structural tissues of the feet and lower limbs, as well as the sensory receptors of the peripheral nervous system, we inhibit these natural supports to the extent that it has a negative effect on our ability to balance. Isn’t that the exact opposite of what we are trying to accomplish?

Have you ever experienced a fall? Often times the ‘Faller’ will later recount “I don’t know what happened. The next thing I knew I was on the ground”. Why didn’t this person have a sense that they were falling, and then auto-correct to avoid the impact? In my opinion, the answer is clear: shoes may just be the greatest fall risk.

Stand on both feet, bare feet if you please. The surface that you are standing on isn’t important, it can be carpet, hardwood, concrete or even gravel. Regardless, feel your feet on whatever surface you choose to stand upon. Feel the texture of the surface and the points of contact between your feet and the ground. Now, start to shift your body forward and back then side to side on your feet. Notice that as you shift, you can feel some parts of your feet leaving the ground. Notice that the more you lean, your body will intuitively begin to right itself to stay over the center of balance and avoid falling. How much do your feet leave the ground before this adjustment happens? If you keep leaning in one direction to the point of no return, notice that immediately you step a foot out to the front, back or side to catch yourself from falling. Again, notice how much your feet leave the ground before this adjustment happens.

Now repeat the same exercise with shoes on. Can you feel the ground under your feet, the texture, the firmness? Not really. What points of your feet are connected to the ground? None, they are connected to your shoe. You have the same points of connection as you would if your feet were up on a table with shoes on, just perhaps with less weight. So, now that we’ve removed all sensory awareness of your feet touching the ground, let’s start to shift forward and back and side to side.

As you sway, when do you start to correct to maintain your center of balance, sooner, later? Now notice when you lean farther, when do you step out to catch yourself, sooner, later? In most cases, the answer will be later to both questions. Why?

When you are wearing shoes, your foot is always touching a surface. Your sensory perception of leaving the surface you are standing on is minimized because your shoe moves with you as you shift, therefore keeping some connection between your foot and your sensed surface. So you must not be falling, right? By the time your brain senses that you are falling by using the inner ear as a guide to sense a balance change, you may already be beyond the point of being able to catch yourself by stepping out or grabbing something, or even worse, you may already be on the ground.

Furthermore, the soft edges of our feet and the many bones and joints within allow us to articulate and roll around all sides while maintaining that necessary sensory connection to the ground. In shoes, the soles are flat with a sharp-angled edge that we must maneuver around to move to the sides of our feet. This edge creates an obstacle that often eliminates our foot’s ability to articulate which further challenges our balance and creates more instability.

One last question, if you have experienced a fall, and most people have in their lives, were you wearing shoes at the time? I would hazard a guess that most of you answered ‘yes’.

By some proponents of the minimal footwear movement, shoes have even been referred to as foot coffins and sensory-deprivation chambers. 

Have you noticed that most activities that require agility, balance and control of movement are done barefoot or with very thin footwear, like ballet, gymnastics, Pilates, yoga, martial arts, track and field sports, etc. Bare feet are needed for agility and dexterity in movement. Imagine monkeys wore shoes while climbing from tree to tree.

You have hundreds of sensory receptors in your feet. These need to be stimulated to continue to work optimally for sensation, balance and proprioception. The only way to stimulate these effectively is to move around life with as much connection directly between your skin and the ground, and when you can’t be barefoot, to wear shoes that provide some sensory input from the ground. An example is lightweight, flexible shoes that allow your toes to move, your feet to articulate, and the soles of your feet to feel the texture of the ground.

There are a number of tools and movements that can also help maintain the integrity of your foot and the activity of the sensory receptors. Some of these include spikey pods and balls, tennis and lacrosse balls, and various types of rollers. Here are a few ways to give your feet some much needed love to encourage their natural articulation, rejuvenate circulation and increase sensory reception…plus just make them feel really good!

8 Point Massage or Press: 
Note: Whether you press or roll, please do so gently. Some tenderness can be expected in certain areas but please do not put excess pressure into sensitive areas especially if you are using a firm ball. 

  • Stand near a stable surface to hold on to, and place your ball of choice (spikey, smooth, large or small) on the floor a few inches in front of your foot
  • Place the ball of your big toe (the large bulbous bony joint that connects your toe to your foot) on the ball, keeping your heel on the ground like standing on a gas pedal.
  • Gently press into the ball and hold for the count of 5. Repeat 3 times. You may also roll the ball forward and back one inch along this joint if your prefer.
  • Move the foot over until the ball of your second toe is on the ball, and repeat as above, either pressing or rolling.
  • Continue this same process until you have moved to your third, fourth and fifth toe balls, then the middle of your inside arch, middle of your outside arch, and finally under your heel bone.

Once you have pressed or rolled under all 8 points, return that foot to the ground and feel its connection to the ground compared to the other foot.

Wringing out your Feet:

  • Cross your right lower leg over your left thigh so that your foot is dangling
  • Place the palm of your right hand over top of all joints of your toes, wrapping your thumb around the ball of your big toe, and the rest of your fingers around the pinky toe side of your foot
  • Now place your left hand around your heel like a cup with your thumb holding the inside of your heel and the other fingers holding the outside of your heel.
  • Gently begin to turn your hands in opposition to rotate the forefoot upwards as you rotate the heel down, and vice versa like you are wringing out a wet towel.
  • Repeat on the other foot

Once you have wrung out both feet, stand and walk to feel the articulation of your feet and connection to the ground.

As you start to change your footwear routine, it is important to remember that you have likely worn shoes for most of your life. Depending on your footwear choices, your feet may be very accustomed to having maximal support most of the day, or having your heel elevated as in heels. This new routine will take time to adjust to, and small steps (no pun intended) should be taken to reduce your footwear gradually. Try switching your shoes to something more flexible to start, and start being barefoot when at home. In time, you will feel the benefits of freeing your feet, and you can expect to feel more stable and sure-footed as you move throughout your life. Enjoy!

Written by
Holly Wallis, Certified Movement & Rehabilitation Specialist, PMA®-CPT
Director of US Operations, Body Harmonics Pilates & Movement Institute

Studio Director, ReActive Movement, 6200 LaSalle Ave, Oakland, CA 94611

© 2017. All rights reserved.

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