The Aptowian

Toe Shoes: Is it wrong to be weird?

2012-02-22T09:57:00.000-08:00

You’ve probably seen them and wondered, “why man, why?” as your fellow gym-goer steps on the treadmill looking like he’s ready to wade in a tide pool. They are probably the ugliest running shoes on the market, and the most controversial. We’re talking about toe shoes, otherwise known as minimalist running shoes. They are revolutionary in starting the “toe pocket” shoe trend, and they’ve got everyone from podiatrists to Navy Seals atwitter.

Here at Aptow, we like to be open-minded. Does a Nintendo Wii work for rehab? We bought one and tried it out. Do people like to do yoga at 6am? We hosted a session to see for ourselves (no one showed up). So when these ugly, weird, outrageous shoes walked into our clinic, we vowed to get to the sole of it.

Let’s start with the appeal of minimalist shoes. The web site birthdayshoes.com says:

We evolved without shoes: our feet function optimally barefoot (as they were "designed" to function). Traditional shoes get in the way of natural foot function.
FiveFingers (and other minimally soled shoes) support a barefoot feel by providing a great deal of sensation of the ground with a minimal amount of cushioning. Being able to feel the ground educates your form when walking or running — forcing you to reduce the impact on your feet (Pain avoidance).
Toe shoes and shoes with wide toe boxes allow your toes to splay (spread out); they accommodate wider feet/don't constrain your foot like traditional shoes.
Healthy shoes don't lift the heel and put the feet in a neutral, flat position. Elevated heels negatively affect gait (heel-striking being the primary result) and posture.

The site also goes on to say,

“Should we be surprised that 100% of shoes fail to maintain full functionality of the foot? The gross majority of shoes end up being almost parodies of function, clunky monstrosities that impair our posture, increase impact on our joints, and cause all sorts of maladies to our bodies.”

Now, to dial it back a notch, it’s obvious that a site called “birthday shoes” is going to be wildly in favor of the feet-freeing trend. Back in the Aptow clinic, Krista Clarke, DPT, had a different experience.

“I had a patient who came in with an ankle sprain. He was overweight and started the shoes cold-turkey, meaning he didn’t ease into them. I told him he’d be better off using the Vibram Five Fingers as water shoes.”

The issue, Krista says, is that people don’t have the patience for a gradual transition from regular shoes to minimalist shoes, and they end up getting hurt.

She recommends a transitional running shoe first. The brand Karhu featured a transitional shoe at the Miami Runner’s Expo called Forward Ride. Krista bought a pair. “The idea is to force you into being a toe-runner, while still providing some cushioning.” The shoes have slender cushioning under the ball of the foot which serve the purpose of forcing the runner forward. “This is what I would recommend to someone who wants to try the minimalist shoe,” Krista says.

So what about our neighbors at Ft Drum? They’re the ones supplying us with the majority of our foot and ankle patients, so where do they fall on the issue? Well surprisingly, even the Army is open to the idea of free-range toes. As mentioned in this article of the Army Times: “VFFs are the best thing out there for rehabilitating lower extremity injuries,” -Doctor and physical therapist Lt. Cmdr. John Mahoney at Kandahar.

Ultimately, though, the Army is leaving the toe-shoe debate in the hands of local commanders. Some commanders think the shoes give an unfair advantage to users during the pt test, while others simply don’t care. Army podiatrists don’t have enough data to take a stance one way or the other.

Our owner, Chantal Wilton, aligns herself with the research. Which is to say, “there is no right or wrong when it comes to toe shoes.” The advantage of minimalist shoes or barefoot running is that it engages the muscles around the foot and ankle. It also improves balance. For instance, if you step in a hole while running, you’re going to feel that with your bare foot fast enough to correct your alignment. In cushioned shoes, you might roll your ankle or twist your knee. This is called proprioception, and it relates to the body’s ability to self-correct. For trail runners, the minimalist shoes might be worth looking into.

“There is not enough conclusive evidence pointing one way or the other,” Chantal says, “just like there is no conclusive research proving that high-impact exercises are bad for the knees. This is a fad, and it was popular in the 50s, popular in the 70s, and is once again seeing a rise. If it feels good, then continue wearing minimalist running shoes or even go barefoot.”

We haven’t tried the shoes ourselves yet. We did have a patient who came in wearing Vibram Five Fingers a little while ago, and she found them comfortable. Then again, she was here for physical therapy!

Sugar can harm like alcohol and tobacco, regulate it: article says

2012-02-02T07:08:00.000-08:00

So when the waiter brings us the dessert menu, he might as well bring a box of cigars and shots of Brandy for the table.

Sugar can harm like alcohol and tobacco, regulate it: article says

Aptow on Vacation

2012-02-01T07:53:00.000-08:00

One of the perks of working at Aptow? An awesome boss who flew the whole staff down to Ft Lauderdale for a 4 day, beach resort vacation. We left Syracuse airport on Wednesday morning, 6am, 31 degrees, and touched down in Ft Lauderdale Wednesday afternoon, 78 degrees. We arrived at the Beachcomber Resort and promptly hit up the tiki bar beside the hotel pool. Drinks, volleyball, a fitness expo, more drinks, lying by the pool, dinner, club, more drinks, lying on the beach--and before we knew it, we were back in Watertown.

You know you're jealous.

Medicare Shakin' it Up

2012-01-24T08:43:00.000-08:00

We’re seeing a shift in the way Medicare is operating this year. For the first time since Aptow opened its doors, Medicare is requiring payment of the $140 deductible up front. Usually patients will see their doctor before coming to see us, in which case that deductible will land on the doc. However, we’ve had a couple patients who have carried over from last year, so that $140 lands on us, and Medicare won't pay for any office visits until that deductible has been met.

According to the 2012 Medicare handbook:

Under Original Medicare, if the Part B deductible applies you must pay all costs until you meet the yearly Part B deductible ($140 in 2012) before Medicare begins to pay its share. Then, after your deductible is met, you typically pay 20% of the Medicare-approved amount of the service, if the doctor or other health care provider accepts assignment. There is no yearly limit for what you pay out-of-pocket. Visit http://www.medicare.gov/ or call 1‑800‑MEDICARE to get specific cost information.

Patients with a secondary are in decent shape, but should still be aware of the $140, in case a portion doesn't get covered and needs to be billed to the patient.

Icy Parking Lot = Genius Business Model

2012-01-23T07:49:00.000-08:00

Ice rinks require large water filtration systems, heated concrete slabs, insulation and refrigerated concrete slabs to create the smooth skating surfaces sustainable indoors. The Aptow parking lot has a much simpler approach: flat lot, no drainage, and freezing rain. The result is a picturesque outdoor skating rink complete with patients on crutches, canes, walkers and wheelchairs gliding to our front door. Some even spin and shake while flapping their arms in an attempt to stay upright. The older the patient, the better the show. On occasion, a dog locked in a parked car will bark in beat to provide the skater with some tempo, while our staff watches from the window, clutching our mugs of hot tea.

Now, some patients have suggested that we use this ice rink as means of encouraging injury, thus insuring repeat customers and sustainable business. Some think we ice the lot down for our own entertainment. While there are great ideas and we are flattered to be credit with such genius, the rink is an act of nature, not man. When it comes to man, there is a man who put a stop to all this extra-curricular activity. His name is Roger, and he is our parking lot surveyor, the holder of the salt. Drop him a line: Roger@GoodMorningReality.com. I’m sure he’d be happy to speak to you (instead of us!).