How an Epidemic of Equinus Created a Successful Retail Pedorthic Business
on the balls of his feet. The textbooks say to
dispense full contact orthoses and elevate the
heels to address the tight Achilles. I made the
orthotics and put them in a pair of Altra zero
drop shoes. The patient returned for a follow-up a
couple of weeks later and told me I had changed
his life. Now, this may seem a little dramatic until
you understand that during the evaluation he had
neglected to tell me he didn’t sleep at night due
to muscle spasms and cramping in the back of
his legs. Now that he is getting the stretch from
having his heels on the ground, he no longer has
nighttime cramping. His callouses are gone, too.
Patient #2 had acute Achilles tendonitis. The
conventional wisdom is to elevate the heels and
refer to physical therapy (stretching). I asked her
if she was comfortable barefoot at home. She said
that other than the discomfort from a lack of fat
pad on the balls of her feet she was fine and was
most comfortable in her Birkenstocks. She told me
“it only hurts when I wear my shoes”. I put her in
a pair of zero drop shoes and she had instant relief.
I have sold over 4,000 pairs of zero drop shoes over
the past 5 years. I repeatedly have positive results.
While zero drop shoes may not be the solution in
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Pedorthic Footcare Association www.pedorthics.org
all cases, the efficacy of this approach to treatment
of foot pain has been more than amazing.
A recent edition of Podiatry Today features an
article titled “Understanding the Biomechanics of
Equinus.” The article, written by Craig Clifford
DPM, claims that Equinus is the root cause of
most foot pathologies including plantar fasciitis,
neuromas, bunions, flat-footedness and Achilles
tendonitis. He goes on to say that the common
treatments include intense physical therapy,
taping, Botox injections, surgical elongation of the
tendons and…heel lifts?²
Although this is based on anecdotal evidence, I
think that many of the conventional approaches for
treating common foot problems are fundamentally
incorrect. Consider adding 6mm of heel lift to a
shoe that already has 12mm of drop. This puts the
foot at 18mm of plantar flexion. This patient is
then sent home to do their stretches. We should
be recommending footwear that encourages the
same stretching of the posterior compartment that
we would get in our natural condition. Elevating
the heels in shoes even 6mm promotes poor foot
health and function.