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 24 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.