Uneven wear on the sole of my shoe; What does this mean?

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Hi everybody, todays blog has two points.  One is to highlight a little about the process of gait analysis and the second is to show you something really useful, that anyone can do, without the need for specific gait analysis skills.

It’s also a little driven by the fact we have a gait analysis CPD course coming up soon and in a way the question in the title underpins the philosophy that underpins the course.

Whenever we teach or indeed carry out a gait analysis I take care to highlight the difference between analysis and observation. Of course, that sounds simple on the surface, but actually the two can become a little blurred.

To note that a runner overpronates through one foot and  shows a hip drop on one side; or runs with a forefoot strike, is simply gait observation and that bit takes place on the track, treadmill or road. To ascertain, why this occurs and indeed whether it is even an issue, is the analysis and that takes place, in your head, at your desk, treatment couch or gym mat. This is where things can get blurred, let me demonstrate how, with an oversimplified example:

We may observe that our client displays a prominent forefoot strike when they run. Well, this is actually quite a common trait in footballers and ex footballers and when we establish their past activities history, it turns out they are just that.

So:

  1. We may conclude:
    That our client forefoot strikes because they are a footballer and that’s simply the way they learned to run. So is that an analysis? Well, yes and no! Really it’s more of an observation.
  2. So let’s try adding another layer of thought:
    The demands of football require fast acceleration from an almost standing start, slowing down, re-accelerating along with quick directional changes. The mechanics of the foot and lower leg mean that to achieve this we need to utilise the forefoot. Without going into deep mechanics, this is to get the bodies centre of gravity away from the base of support quickly but also with stability and to allow the calf to fully engage to generate the power required for a standing start. So, are we
    analysing yet? Well…….yes and no! It’s getting a little blurred now, are we observing that a footballer finds it helpful to favour the forefoot, or are we analysing why they may favour the forefoot? It’s a bit of both really.

So, here’s the real trick. Let’s use that information to HELP the client in front of us by asking a couple of simple questions:

  1. Is the client experiencing pain or injury, or showing signs of impending injury, that would be associated with the nature of forefoot striking?
  2. Is a forefoot strike useful for the kind of running, they are now doing?

We can, of course, apply that same question to all running styles. Is their gait creating, or showing signs of creating injury and does their gait work for their chosen discipline? From this, we can unravel most presentations.

Well, I have a real-world example for us here: Having carried out my ‘observation’ (in this case on film) and having worked through the imbalances and issues this could be causing, I can come to the bit that ties it all up.

My ex-professional footballer is trying, rather unsuccessfully, to get into 50-mile ultra runs and they are struggling with shin splints. So, in a nutshell, their habitual forefoot strike is not overly useful when they don’t need all that acceleration and is leading to overuse of the calves due to the sustained nature of their new running, versus their old stop-start requirement.

In turn that’s leading to the shin splints. So massaging and stretching will only have a temporary effect and in this case, strengthening the calfs will only add to the issues. Therefore, I need to either change their gait or suggest a different type of running event!

I also needed to bear in mind they are not able to simply change to a different running style at this point, due to the differing muscle firing patterns and strength requirements for different running styles. This all needs some careful and lengthy retraining and managing expectations for them to achieve their goals.

That’s been useful to my client though because we have taken care not only to carry out an actual mechanical analysis but we have added a layer of clinical reasoning that works even with just an observation.

So, the second point of this blog is, rather than go into great detail about various shoe wear patterns and what they may mean, I want to offer you a single thought and simple but powerful observation that can tell you many things.

Question: Is the amount and pattern of wear on the sole of your shoe even left and right?

This is an incredibly important but easily observable wear pattern that’s so useful not only to/ health or fitness professionals but to everyone. This really does take precedence over whether you under pronate, over pronate, heel, mid-foot or forefoot strike, but why?

Do you have a different wear pattern on each shoe?

If the pattern or degree of wear is different left or right it quite simply indicates that you are most likely favouring one leg! Which means you are overusing one leg, overloading one leg, etc.

If that’s the case, sooner or later you are likely to end up with an overuse injury anywhere from the foot to the shoulder and that doesn’t just occur in runners, it occurs in anyone who enjoys being active.

We are naturally left or right handed and for fine skills tend to favour either our left or right. But we are NOT left or right legged when it comes to gait. Whilst we favour a particular leg for specific occasional movements such as jumping, or kicking a ball but we are simply not designed to favour one leg in gait. If we were, we would ultimately walk in a circle.

So what might cause favouring one side?

Favouring one leg can occur from a variety of sources. Here are just a few:

  1. A weak foot.
  2. An over pronating foot (?)
  3. An under pronating foot (?)
  4. A weak glute muscle.
  5. A tight glute
  6. A pelvic tilt or rotation.
  7. A non fully healed past injury on the opposite leg.
  8. Running on a camber for several miles.
  9. Incorrect shoes.
  10. Shoes that are losing their integrity with increasing mileage.
  11. Carrying a water bottle in one hand.
  12. Wearing a smart phone or I pod on an arm band.
  13. Restriction in trunk rotation.
  14. A protracted shoulder on one side.

So have a look have a look at the bottom of your shoes, your client’s shoes, your friend’s shoes. Don’t worry about the meanings of specific wear if that’s not your thing, we can can all see general wear and if that wear is uneven it may be wise to seek /advise help before something potentially goes wrong.

Maybe your profession has given you the tools to tackle some of the above issues yourself, maybe you need to refer, which is why it’s great to build a network around you. It doesn’t matter if you have no knowledge in this field or can read tread or analyse a shoe. It’s a simple but massive observation that a client could be thanking you for for years to come.

Want to use this for CPD?

Heres a couple of tasks depending on what angle you want to come in at:

  1. Pick one, several or all of the 14 points above and work through why each would create a favouring of one leg.
    Some are more straightforward than others.
  2. Put hands on therapy techniques to one side for a moment and using training and exercise techniques how many of these can you solve. Think about interventions such corrective exercise, targeted strengthening, Rock Tape techniques, stretching replacing massage and how concepts such as reciprocal inhibition and the stretch reflex may be useful.

Then write it all up in your CPD logbook. For your FREE Reinge Education logbook, click here.

Reinge Education provide CPD courses for therapists and trainers across the country, these are in both an online format and in face to face workshops. Our unique combination of knowledge allows us to provide a fresh approach, looking at how anatomy affects function within the body, merging therapy and sports science to give a unique perspective.

#runninggait #runninganalysis #runninginjury #runningpain #running

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