Rethinking the toebox

I always have great intentions to put myself a calendar reminder when it's time to replace my work shoes, and inevitably the reminder flashes and goes in the midst of a busy storm and is forgotten. Until my footsies starts barking up about new shoes, a reminder that is harder to ignore.

This most recent swapping of the footwear was an opportunity to think a little more intentionally about optimal footwear that is truly designed for the human foot. It's the subject of millions of blogs and discussion posts, and quite a bit of research too. But in the end, there is still not a great consensus and still several opposing camps when it comes to supportive versus minimalist shoes for example. The purpose of this discussion is not to weigh in on this debate, which I think needs to be nuanced and little more individualized based on the terrain you walk on,existing foot stability and injuries However one area that is pretty universally agreed upon is the fact that the shape of the toebox needs to be matching the shape of the forefoot, which in most people is going to be quite a bit wider than the heel.

During 1 of my recent tango dancing trip out of state, I was surprised to see how many female dancers had switched from the traditionally extremely aesthetically pleasing high heel ritzy shoes to very plain looking flats with an anatomically correct wide toebox. It was a little odd to see the combination of the elegant silk dresses with the type of shoe you more traditionally associate with a long dog walk on a trail, but in the end, that new trend is here to stay and none of the dancers I talked to are ever going back. Nor should they. From a biomechanical and functional standpoint, the ability of the front of your foot to have adequate space for every joint of your metatarsals and toes to properly articulate during the gait cycle is a total no-brainer. It allows normal kinetic chain muscular activation in the lower extremity all the way to the trunk, something that should be remembered in cases of chronic lower back and hip discomfort during walking. There is even evidence based on pediatric studies that wide toebox shoes result in better concentration and cognitive processing in children. Probably the reason why many children with no divergence tend to instinctively go barefoot the majority of the time.

The photo attached shows on one side more traditional shoe and a wide toebox with my barefoot in between (. I should have remembered to get a pedicure before the photo..). My foot is not much different than the average foot and you can clearly say how much wider my toes are than the shape of the shoe on the right side, almost identically matching the shape of the shoe on the left. Going forward, I am slowly replacing all of the shoes in which I spend any meaningful amount of time with something that looks more anatomic correct at the front, and I invite you to do the same. The number of shoe vendors who are starting to redesign the shoes accordingly is increasing, with a greater variety of styles available. It is taking all of us a little bit to get used to the new look of our shoes, but about 100 years ago, the world suddenly got used to seeing women with normal size waists after most of them exited their corsets, and the world has been a better place for all of us as a result. So let your toes shed their "corset" and enjoy some much deserved freedom.

FINALLY ! REVAMPED SENSIBLE NUTRITIONAL GUIDELINES

After many years of often biased and poorly data driven debate on the animal versus non animal product composition of the optimal human diet I welcome this latest piece of research consensus out of the Brussels University. The data they used to come to their recommendation is really quite solid.

The take away message is that after many years of being vilified, animal products are now recognized for their value in the human diet because of the nutrient density of certain hard to get nutrients. This would include things like certain essential amino acids, certain minerals like iron zinc, certain essential fatty acids and many more. While some non animal products may contain many of these nutrients, they are often not bioavailable to humans because our digestive tract is different from animals who can easily extract them (Think of a cow’s ability to extract essential fatty acids from grass that goes right through a human digestive tract).

The recommendation is for approximately one third of human calories to come from animal sources in order to ensure adequate essential nutrient intake. It does not discount the fact that plants and non-animal products still have a very important role in the human diet obviously, but they need to be eaten in combination with animal products for optimal results. Interesting piece of information buried within the long consensus paper was that the risk of obesity with strict vegan diet may increase, since the body will continue to upregulate the eating reflex until the minimum intake of certain key nutrients, especially essential amino acids, has been met. This would mean that someone’s hunger reflex would continue to drive food seeking behaviors until they have eaten 3000 calories on a vegan diet to obtain the same amount of amino acids that would be obtained after 1800 calories of a mixed animal vegan diet.

As always, the quality of the animal product needs to be emphasized in the context of an omnivore diet. Thankfully we live in an area where properly raised animal products are relatively easy to come by.

https://sustainablefoodtrust.org/news-views/a-new-perspective-on-healthy-eating/?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%27s%20Friday%20Favorites%20%28LINKS%20FIXED%29&utm_term=new%20dietary%20framework&utm_content=new%20dietary%20framework&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

Cervical core strength

When discussing core strength and stability training, we often focus exclusively on the trunk and lumbar spine, while forgetting the cervical spine. This does not do us justice since cervical core strength is equally important, possibly more so since our modern sedentary lifestyle tend to deactivate a lot of our stabilizing postural muscles from the shoulder girdle up to the head. It should be noted that cervical strength and stability also depends a lot on the overall strength and stability of the trunk and upper extremity especially, so any attempt to stabilize the cervical spine from chronic reinjury does need to involve some shoulder strength training for sure. However this relatively simple exercise done in the supine position can be very powerful in engaging the deep cervical core muscle group, which is the equivalent of the deep abdominal group in the lumbar spine. Most patients are surprised to find out how really weak this muscle group is when we test them in the office. It will often require patients to start with relatively short interval of times in order to practice the exercise and stable form. It's also important for patients to have a slight chin tucked, imagining holding a tennis ball or an orange between their chin and the chest, in order to gauge the deep cervical muscles and other superficial muscles like the SCM.

https://www.youtube.com/shorts/VR8uic1-0N4

Chiropractic, posture and risk of falling

https://www.researchgate.net/publication/378090792_Risk_of_Fall_Cognition_and_Static_Posture_in_Aging

I came across this very interesting article while listening to one of my chiropractic research podcasts. It reminded me of a conversation I had with a patient and her adult daughter who drove her to her appointment last year. The mother, in her early 80s, had moved closer to her daughter’s family and was trying to reestablish chiropractic care on a more consistent basis. She was a lifelong chiropractic patient, for episodic neck injuries and later on decided to stay on a preventive checkup schedule because she felt overall better and more balanced when she did so. During the history, her daughter chimed in on her mother’s comment that “ she has a tendency to be more clumsy and trip “ when she has not had a chiropractic check and adjustment in a while. The daughter was unfamiliar with chiropractic and simply curious about the correlation between the two. At the time, I share my 30 years of clinical experience in observing that correlation and the biological mechanisms connecting the chiropractic treatment on the neurological adjustment of proprioception and reflex time. I wish I had had that piece of research to add to the conversation.

The research led by a lesser known Brazilian colleague showed a correlation between two key measures of sagittal posture and the risk of fall: the degree of anterior neck shifting in relationship to the trunk, and the anterior angle of the ankle. Both indicating that the body is off its center of gravity and thus has less time to respond to stay upright before hitting the ground. Both posture indicators are exam findings that we observe and report, and both are factors that we aim to improve/correct with manual therapy and guidance on home activities and corrective exercises. One little golden nugget for me to take away from this research is that I can use it in conversation with patients when they question why I work on their lower extremities, especially their ankles and feet, when their primary problem seems to lie elsewhere. I almost often look at the lower extremity alignment when doing my initial evaluation and I will adjust them if needed, something that makes some folks a little testy when I ask them to take off their shoes and poke at one more body area. Now I can remind them that when I take on that additional endeavor at 5 pm, when their footsies are a little more “ aromatic”, it is indeed solely for their own benefit and backed by solid scientific research

(photo courtesy Freepik)

LEG LIFT EXERCISES WITHOUT LOW BACK INJURY

https://www.youtube.com/watch?v=Q2m3qCbinzA

After 30 years of practice there are some injuries that you know like the back of your hand. One such common injury is the lumbosacral hyperextension strain from leg lifts. It mostly happens to patients who have not been doing any form of core workout for while and decide to take on this rather challenging workout practice without the appropriate gradual ramp-up, but I've seen it happen even in seasoned gym rats. The problem is the amount of hyperextension loading when someone tries to do bilateral leg lift starting in a supine position with flat legs on the table. It's an extremely high leverage for the lumbosacral spine if the abdominals are not optimally efficient at immediate initiation and stabilization of the low back. Leg lifts can be a great addition to a core workout and can be safely done with 2 small modifications: starting with the legs in the up position, only lowering them in a range that allows the lowback to stay in contact with the exercise mat; during the exercise one leg at a time to build up strength and endurance and stability rather than both legs at the time, which may be achieved over time.

Aspartame and atherosclerosis

I've come across a lot of really good nutrition research recently that is worth sharing because of its direct application to what we put in our mouth every day.

I'm still baffled by the number of people who continue to ingest artificial sweeteners on a daily basis, considering that the research has been loud and clear on the adverse health impact for so many years. I know we all have bad habits to kick as some foods are our comfort or survival go to, but I still run into a lot of people who are fully convinced that there is no scientific evidence for the harm of some of these food additives, and they see the benefit from the decreased caloric intake. (Although data has also found to be false over time as artificial sugars keep increasing our brain's desire for more sweetness across the board).

This piece of research pertains in particular to the sweetener aspartame, which is found in a lot of diet sodas. Aspartame is an excitotoxins that can easily cross the blood brain barrier and have widespread repercussions in the central nervous system. It also is known to have adverse effect on lymphoid tissue with some correlation noted over time with blood cancers. This particular piece of research more clearly establishes the direct biochemical link between aspartame and the insulin cascade leading to vascular lining inflammation and increased risk of plaquing. This is especially important when you consider that a lot of people are trying to manage the complications of metabolic syndrome, including diabetes and atherosclerosis, by switching from regular sugar to artificial sweeteners. As always, best to cut out those chemicals, and whenever possible stick to the least amount of naturally occurring sugars in your diet.

https://www.cell.com/cell-metabolism/pdfExtended/S1550-4131(25)00006-3?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%27s%20Friday%20Favorites&utm_term=disturbing%20new%20study&utm_content=disturbing%20new%20study&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

How to dodge the "senior slug": free exercise resources from Silver Sneakers

After today's 12 inch dumping of wet snow, spring much the summer feel a little bit elusive. I've had several conversations in the last 2 weeks with patients who find themselves in the same predicament: recently retired (within the last 2 years), previously physically active informally through their job, currently dealing with increased neuromusculoskeletal issues that stem from deconditioning. I found after 30 years of practice that transitioning into retirement can be fraught with loss of normal physical stamina if a retiree is not intentional about structuring a bulletproof routine that makes up the inherent physical activity that was built in the previous occupation. I think it's a phenomenon that often is below people's radar, who have the false impression that their life is busy enough to meet those needs, but in reality, when testing their strength, cardiovascular endurance, those patients often fall short and have actually rapidly deteriorated over 12 months. This being compounded by the fact that the Minnesota winter is not always conducive to normal outdoors activities when it's cold dark and slippery.

At any rate. There are a lot of opportunities out there but some patients who never formally exercised in their earlier working life are little bit at a loss of where to start. 1st, you need to try to determine what is it you'd enjoy doing enough to do it consistently. It's going to be different for different people and you need to best isolate that, since it is a lot easier to stick with something you don't hate.

1 underutilized resource for our seniors eligible for Medicare is the silver sneakers program. It's often a benefit of most Medicare C and Medicare supplemental policies. Silver sneakers is basically a free program of senior focused fitness routines that comes in a variety of formats: in person group classes for seniors only at local participating gyms, lifestream classes schedule multiple times a day, and a collection of video resources. All of them are excellent, carefully designed with senior needs in mind, and covering a variety of options from home cardiovascular walking, balance exercises, chair yoga, gentle strength training etc.

Below is the link to the silver sneakers website. To see if your particular Medicare policy offers those benefits, you can do a quick eligibility check. If eligible you just have to create your login credentials and you're all set to go. I will happily assist you in selecting a couple of good starting classes based on what I know of your health.

https://tools.silversneakers.com/Eligibility/CheckEligibility

CHIROPRACTIC, DIZZINESS AND NECK PROBLEMS

I have had a little bit of time recently to look through some research articles that were backlogged in my reading list. I found a couple real gems in the process.

The prevalence of dizziness in patients presenting for chiropractic care with neck and shoulder pain is remarkably high. It's not usually the primary complaint,but is mentioned when we are asking about additional associated symptoms such as headaches visual changes dizziness tingling and hearing changes. Dizziness is surprisingly common with neck pain. There is a good physiological reason for that: the balance centers in the brain receive information from a variety of structures including the inner ear, the feet and ankle, and the cervical facet joints, which are highly affected by the irritation of mechanical disturbances to the cervical spine.

When the balance centers try to integrate information from the various peripheral sensors, if one part of the system sends faulty sensory information that  conflicts with what the inner ear, the visual system and the feet are reporting, It's going to be manifest as confusion in the balance centers and can be expressed as a sensation of dizziness. This is the primary mechanism by which cervical mechanical problems can manifest as a sensation of dizziness. Conversely, the resolution of that faulty sensory information from the cervical facets by manual adjustments can reset the sensory input and make it fully integrate with the rest of the peripheral sensors , thus resolving the symptoms of dizziness.

This research article reflects that reality, with a surprisingly high number of patients reporting resolution of the dizziness from chiropractic intervention while traditional medical evaluation and pharmacological approach does not. It's good news for the chiropractic patient.  Not so much for those of us who have been working in the chiropractic field for a few decades, but it was somewhat of a surprise to the researchers who ran the study.

https://pubmed.ncbi.nlm.nih.gov/26362851/