Do you think our early ancestors wore half-length or full-length orthotic shoe inserts? Would their video-recorded gait assessments have revealed more under or over-pronators in the general population?

If we try to imagine how life was back in the day of the caveman we could safely assume that his ability to run both short sprints and long distances was necessary for surviving in a wild environment. Without the ability to track food or flee from dangerous predators the human evolution may not have been possible. What we can also be sure of is the caveman did not run in a pair of Asics trainers with rear-foot gel-cushioning outer soles structured for either a neutral or over-pronating gait . Nope, our early ancestors would have been running barefoot.

Many thousands of years later and despite our advances in footwear design and technology there is a ‘barefoot running’ revolution gaining traction in some circles. The idea is that we as a species have spent more time running barefoot than we have in our fancy high-tech shoes and therefore we are more physiologically suited to running barefoot.

As human beings we are ambulatory creatures, that is we walk upright and are very reliant on our legs to move us about. How the foot strikes the ground and the knock on effect this has up the lower limbs to the knee, hips, pelvis and low back in particular has become a subject of much debate and controversy in recent years.

Lower limb biomechanics refers to a complex interplay between the joints, muscles and nervous system which results in a certain patterning of movement, often referred to as ‘alignment’.

Much of the debate centres around what is considered ‘normal’ and what is considered ‘abnormal’ in biomechanical terms as well as the extent to which we should intervene should abnormal findings be found on assessment.

There are common causes of knee pain in children but it can be difficult to determine which aches and pains need medical attention and which they may “grow out of”.

Osgood Schlatters

A common cause of knee pain, particularly in boys, is Osgood Schlatters. Your child may complain of pain and tenderness below their knee cap and could recently have had a growth spurt. The pain is due to irritation of a ligament, called the patellar ligament, which connects the kneecap to the shin bone. This is sensitive to touch and your child may have pain with walking or jumping activities or on the stairs.

The initial treatment for Osgood Schlatters is “RICE” Rest Ice Compress Elevate which can help ease pain symptoms. Symptoms usually subside when the growth spurt ends…unfortunately this could take 1-2 years! Gentle stretching of the quadriceps muscle is also advised as it can reduce the tension on the patellar tendon. It is also important to consider lower limb biomechanics and gluteal/ hip muscle strength and intervene with Physiotherapy treatment where necessary to help accelerate the healing process.

In many cases, long term muscle imbalance exists already, an injury then occurs and an orthotic is prescribed to temporarily offload the injured structures to promote healing and recovery. 

In this situation, some biomechanics experts would argue that the orthotics, by placing the foot and ankle in a more ‘aligned' position, can actually help overcome and correct long term muscle imbalance, often with the help of corrective exercises and manual joint and soft tissue mobilisation techniques. This situation often occurs from the late teens onwards.

In a previous post "Should I Go Barefoot Or Stick With Trainers?" Simon explored some thoughts on the barefoot running technique that has become popular in minimalist circles.

Simon's objective review of the different fore foot strike patterns revealed he has himself adopted a slightly altered running position but clearly points out that barefoot running is not for everyone. In his own case, an over-pronator with a leg length discrepancy reliant on the use of orthotics, he makes a good point that barefoot running is probably not the best idea for him.

We all need to take such an honest and reflective view of our own biomechanics and medical history if considering the barefoot running style.

Here are two videos that will add insight and provoke thoughts well worth considering …

A client of mine has adult-acquired flat foot and presented with significant pain along the outside of the ankle and foot region when walking. She had been to see a surgeon who had suggested surgery but she was keen to see if there was anything Physiotherapy could do to assist with the view to possibly avoiding having to go down the surgical route.

Shoe insoles / foot orthotics have the power to positively transform your postural alignment - or ruin it.

If you are suffering any form of foot or ankle pain and if the thought of a shoe insole has crossed your mind, then please consider these few key points before taking any action.