Sunday, January 1, 2012
Musings from a Footstool: Why Arch Height Really does not Mean Much.
Happy New Year 2012
I want to start this year's blogging about feet getting back to my roots. In podiatry school I learned the basics of how someone should walk or run, how to measure their bone structure, how to predict what structural or movement abnormalities would cause what type of problem, and how to design inserts to help these findings. I loved it so much, I took an extra year studying biomechanics in fellowship, and earned my Masters in Science in Education since I could now teach it. 30 years later I am now trying to teach you my readers the truths I learned in school, the truths I learned in my podiatry practice, and the truths that have been dispelled over the years. Some generalizations I was taught as gospel truth was only accurate 50% of the time (but these general rules are hard to get rid of).
So, as I sit on my foot stool on January 1, 2012, and I ponder these things, I must laugh a little, cry a little, and stay motivated to keep on trying to educate. Let us tackle one thought for the next few minutes.
Many professions dealing with feet make a big deal about arch height. Think of your conservations at a shoe store. You were told if you had a high arch foot you need a neutral shoe for shock absorption since all high arch feet pound too much. You were told if you have a low arch foot you need a motion control shoe. If you have a normal arch you can use a stability shoe, or perhaps a neutral shoe as well. But all this is based on low arch feet always pronating, high arch feet always pounding too hard, normal arches never doing anything worth mentioning. This is so wrong.
4 days ago I had a patient with a high arch. She always knew she had a high arch. She would tell friends she had a high arch. She asked me and I told her she had a high arch. Why am I saying all this, because the Spenco In Store Computer meant to help pick out an Arch Support for her told her she had a normal arch.
In my 4 years of podiatry school, 2 years of residency and fellowship in biomechanics, I never focused too much on whether the patient had a high or low or normal arch. It really did not matter. What mattered was how they moved. Did they pronate? Did they supinate? Was their shock absorption poor? Did they function asymmetrically possibly indicating a functional or structural short leg syndrome? It was these things that lead to treatments to help them? A normal arched foot can do a lot of bad things? A high or low arch can function perfectly normal.
So, I say from my foot stool we should abandon shoe selection or Over The Counter Arch Support criteria based on arch height, and doctors/physical therapists should focus patients on what their individual biomechanics dictate. Stealing a line from Sue Sylvester from Glee---And This Is How I C it. Dr Rich Blake