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Be a Pro at Proprioception

By Sanatan Golden

	Lower Leg (Gastroc / Plantar Fascia) Put one foot on a wedge (slanted at about 30º) with heel resting on floor. Keep toes straight, and support with hands on wall. With leg straight, press entire body forward. Hold 30 seconds. Repeat with other leg. Repeat 1-2 times. Do 2-4 sessions per day.
	Lower Leg (Achilles / Soleus) With back foot flat and toes turned slightly inward, lower hips and bend knees until stretch is felt. Hold 30 seconds. Repeat with other leg. Repeat 1-2 times. Do 2-4 sessions per day.

There is a recent, growing discussion about the benefits of walking and running barefoot, and even the potential hazards of wearing traditional athletic shoes. In fact, multiple related articles have appeared in this publication over the last few years. Whether you have read about it or just noticed more people on the road and trail with toe-shoes or other thin-soled footwear, the following questions may arise. Should I change to a more “barefoot shoe”? What are the advantages? Would it be safe for me?

First, “barefoot shoe” is clearly an oxymoron. “Minimalist shoes” is the most commonly accepted term for footwear that tries to diminish impact on natural gait. Of course the most minimalist footwear of all is simply being barefoot. Characteristics of minimalist footwear include a thin, flat sole with no elevation of the heel or toes; plenty of width throughout the foot bed to allow toes and balls of the feet to spread fully; little to no “corrective measures” in the shoe, such as heel cupping and arch support; and a very flexible sole. Further information about minimalist footwear can be found in the prior Walk About article, “Minimal Footwear for Walking — Putting Your Best Foot Forward,” by Dr. Ray McClanahan (www.walkaboutmag.com/38minimalfootwear.html).

Advantages of walking with minimalist footwear include a more natural gait pattern that decreases impact forces and increases efficiency by taking shorter and faster strides; a transition from a “heel strike” to a “heel stroke”; and improved strength and mobility in the muscles and joints of the foot. You can also expect to have fewer long-term health problems seen primarily in traditional shoe-wearing cultures, such as bunions, hammer toes, hallux rigidus, and collapsed arches. Many people also report increased enjoyment of their walks due to a better communion with their surroundings.

When my patients ask me if they should consider switching, I first ask how they are feeling with their current footwear. If they are able to walk the distance and frequency that they desire, have no pain or injuries, and enjoy their outings, I cannot recommend a change in footwear. If their walking program is not where they want it to be, or they are have recurring pain or injury, then I often suggest a transition to more minimalist footwear along with the medical treatment they are receiving.

In cases of significant injury or pain, I regularly prescribe more support for the foot via footwear, specific taping, or even orthotics. However, I usually view this as a temporary measure to allow the injured tissues to rest and heal and then work to restore a more natural movement pattern. You might compare this to a patient who needs to wear a neck brace after an accident. Extra support may be needed while the tissues heal, but we never expect the patient to wear the brace permanently. We expect a transition back to normal motion. Yet we will brace our feet with heavily supportive shoes and orthotics because we were told to or they made us feel better, and then feel that we are dependent of them for the rest of our lives. Why do we traditionally treat feet so differently? In my experience there are very few people who could not safely transition to a more minimalist shoe.

For some the transition is as simple as kicking off their old shoes and building up mileage in their new minimalist footwear. For others with feet more habituated to their traditional shoes, the change is slower and requires more attention to safety. Determining where you fall on this spectrum will not be covered in this article, but if you are interested, the best way is to give it a try. Just start slowly, perhaps one or two blocks on the first day, before switching back to your regular shoes. Remember to carry your old shoes as “hand weights.” If you feel good, continue to add a block or two each day. If you begin to feel pain, slow the progression down and give yourself more time to adapt. Regardless of where you are in the process, good ankle mobility is very helpful with natural gait. The stretches included here are a great first step.

For those who want more specific guidance, Dr. McClanahan and I have developed Minimalist Mondays, a free weekly clinic for those interested in making a safe transition to a more natural gait. We meet each week in downtown Portland, OR to discuss exercises and techniques to help this process. You can find the details on the Internet at (www.therapeuticassociates.com/locations/oregon/portlandvancouver/downtown-portland/minimalist-mondays/). For those in Portland, I welcome you to come down and give it a try. For those who can’t make it, you can access the Minimalist Mondays weekly archives for helpful information. Be sure to check out the videos on how to assess your own ankle mobility and my favorite ankle stretches at the Minimalist Mondays Week #5 recap. Happy Walking!

Sanatan Golden, PT, DPT, (pronounced sah-NAH-tahn) is a certified strength and conditioning specialist at the Downtown Portland Therapeutic Associate location. Visit www.therapeuticassociates.com for more information.