If you’ve ever been injured, you may have been advised by your physician or therapist that your condition was in some part due to a physical imbalance or attribute. How important are some of these physical characteristics, such as foot arch height, regarding the actual injury? Most are completely irrelevant, though so many want to make some correlation between their presence and the complaint. Yet, although there is no science to back up the treatment or advice, many still buy into certain ideas behind injury correction and prevention based on assumptions.
Heavy patients are often told that their weight either caused an injury or is contributing to their inability to heal. This is very common for those with low-back, hip, and knee problems. Additionally, these overweight patients are told they need more shock absorption in their footwear.
For those with a foot or ankle injury, the physician will often make a strong correlation between the height, or lack thereof, of the arch and its relationship to the injury.
And for anyone who has ever been to a chiropractor, physical therapist, or other body specialist, they most likely were told that the length of their legs had something to do with their pain or injury.
Developing a treatment and rehabilitation program around such issues often works out unfavorably for the patient. Let’s learn why!
Arch Height: Overrated
Arch height, or the length of the foot arch, is rarely an issue when it comes to how well the foot functions and its susceptibility to injury. The foot’s base of support is much more important than whether the main arch of the foot (the longitudinal arch) is high or low. The support system is naturally built into the foot, with the heel at one end of the arch and the forefoot and toes at the other end. An injured athlete may have lost the natural strength of their foot and perhaps some, or all, of the arch. So they are prescribed support devices, such as arch supports and orthotics, which unfortunately, do nothing to strengthen the arch but rather “support” the middle of the arch, resulting in further weakening of the arch and other areas of the foot.
There are two types of flat feet: rigid flat feet (RFF) and flexible flat feet (FFF). An individual with RFF has no arch at any time, weight or non-weight bearing. RFF is usually caused by some underlying pathology, which I will not discuss here, as it’s not applicable to the content. (If you have RFF, then you should be investigating the pathological problem.) An individual with an arch non-weight bearing, which fatigues or collapses when they stand or the foot is stressed, is said to have FFF. FFF is most often due to ligament laxity (the ligaments connecting the bones together have weakened) or to muscle or tendon weakness. The tibialis posterior muscle has a major impact on the medial longitudinal arch, as it provides much of its support. Therefore, a problem with this muscle can result in FFF as well as other problems associated with tibialis posterior dysfunction: shin splints, plantar fasciitis, and injuries associated with overpronation.
FFF, or some loss of the arch of the foot, is common in athletes with foot and lower-leg injuries. However, if the complete or partial loss of the arch has been present for some time, the athlete may not be able to redevelop this arch. But that doesn’t mean the injury can’t be fully healed. Regardless of regaining the arch, full function can be achieved.
In 2009, Pediatrics published a study of 218 kids aged 11 to 15 and found “no disadvantages in sport performance originating from flat feet.” The kids with flat feet accomplished all 17 motor skills as well as the group with “normal” feet. Another study of 246 US Army recruits found that trainees with low or flat arches actually had a lower risk of injury than those with high arches during their 12-week infantry training. So again, you can’t make a correlation between arch height and function or even injury rates.
To strengthen your feet and lower legs to not just help prevent an injury but also naturally support your arches, follow the guidelines I describe in the article “Lose Your Shoes,” and also check out the Sock Doc video on foot strength and rehab.
Body Weight: Weigh More, Think Less
Physicians and therapists love to tell patients that the reason they became injured or are not healing properly is due to their body weight. That means you’re fat, and there’s supposedly “too much stress on your joints.” This is also common when a heavy person is advised on footwear; they’re told they need a heavily cushioned shoe to absorb their mighty impact. Both weight-related issues actually have no weight. (That pun is weak.)
Most people who are fat tend to carry around a lot of inflammation, as they are body fat. So there is a correlation between the two. An overly fat person is most likely to become injured and more likely to have trouble healing. And someone who is overly fat most likely will have poor joint function too, both from this inflammation and from a lack of proper muscle function. So yes, losing weight (fat) will help, but not because there is less stress on the joint. Simply consider someone who is heavy but very muscular: Isn’t there as much weight stress on their joints? Whether it’s fat above the torso or muscle above, they’re both going to contribute to the same weight “stress” to an injured knee or foot. And let’s not forget the relationship between body fat, estrogen, and ligament health—it’s a big deal when it comes to healing joints.
How about more cushin’ (in your shoe) when you’re pushin’ (the miles)?
The answer to this is not only definitely no, but actually less cushion. Yes, the Sock Doc may have a habit of saying the opposite of the conventional “wisdom,” but there is always a valid explanation as to why—at least, I think so.
Peak forces while running actually occur in midstance, not when the heel hits the ground, where the most shoe cushion is often added. Joint torque and stress are highest when the foot is fully planted, with or without shoes. Cushioned shoes cause joints to work harder in midstance, and this cushion response is out of sync with the natural increase and decrease of body weight through the gait cycle. It just doesn’t work.
So ideally, the heavier the runner, the better the gait needs to be to decrease their chances of injury. Often thick, high-heeled, and cushioned shoes disrupt gait. In addition to a good gait, there needs to be less impact through the joints, which will only occur if there is not a lot of cushion between the foot and the ground. So if you weigh too much, you might want to think too little.
Leg Length: Short Side or Long?
Leg length is commonly evaluated by doctors and therapists who focus on structure. Chiropractors often report to their patients that one leg may be longer than the other, and it is a cause of some of their hip, lower-back, or other areas of pain. Physical therapists often tell their patients that one side of their pelvis/hip is rotated anterior (forward), and this rotation is the root of their problem. The rotated pelvis will cause the leg to appear short, and often, the finding of a short leg has to do with a musculoskeletal imbalance of the pelvis.
Many of these therapists spend much, if not their entire treatment, trying to equal out the leg-length discrepancy, whether it’s a few millimeters or even several centimeters. They feel this is an abnormality that must be corrected—people should be symmetrical human beings.
Now, of course, you don’t want your pelvis shifted to the point where you’re off by a great amount and your leg appears “shortened” by a centimeter or two. But achieving a perfect balance of the legs alone often does not correlate with an improvement in symptoms or rate of injury.
These leg length (and pelvis) imbalances are due to muscle imbalances, and the muscle imbalances are due to anything and everything that can negatively affect the nervous system. I’m talking about the physical, chemical/nutritional, and emotional stress discussed throughout the Sock Doc site in relationship to poor health and injury. This is the cause of the problem, resulting in the symptom, in this case, the sign—the perceived short leg of the injured athlete. It’s a correlation.
There is no need for us to be perfectly symmetrical to function optimally and be 100% pain-free. But again, I don’t want you to think a great asymmetry is necessarily okay; far from it. But there is too much focus put on the leg length discrepancy, along with the high or anterior rotated pelvis. Plus, it’s a very objective finding and can vary based on how the patient is lying on the table or even differences in anatomical landmarks from left to right. Of course, if the patient’s shoes are left on, then that’s a factor too.
One last point on the leg-length assessment is the infamous “heel lift.” Many docs and therapists use this to equal out the leg or pelvis imbalance. Heel lifts make me cringe as much as orthotics. Now, if someone truly has an anatomical leg-length discrepancy due to an osseous (bone) disease during their growth years, or they suffered some accident resulting in the actual loss of bone length, I can understand the use of a lift—sometimes. It depends on the situation. But most people are prescribed a heel lift for musculoskeletal imbalances, and the heel lift is like putting a muzzle on a barking dog while you’re jumping on its tail.
Some therapists will put the lift under the “short” leg to make up the difference. The problem here is that the short leg is the side of the high pelvis, if you can picture that. If the lift is put under the longer leg, that would be the side of the lower pelvis, effectively raising the pelvis on that side to be more even, but also providing a longer contact with the ground. Either way, they do not correct the problem and often cause more imbalances and compensations.
So the lessons of this article are simple:
- Keep your body within a healthy weight to reduce inflammation in your joints and improve healing.
- Consider less shoe, especially if you’re packing on the pounds.
- Don’t worry about your arch height, but take note if it’s failing or falling.
- Don’t fret over a short leg or long leg being the cause of your injury, but rather why you may have an imbalance somewhere in your body.
